title: 0.5% versus 1.0% 2-chloroprocaine for intravenous regional anesthesia: a prospective, randomized, double-blind trial.
abstract: In this randomized prospective double-blind study we tested the hypothesis that compared with 40 mL chloroprocaine 0.5%, 40 mL chloroprocaine 1% results in an earlier onset to analgesia duration and improves distal tourniquet tolerance in 150 patients undergoing forearm surgery under IV regional anesthesia using a double-cuff technique, switching from the proximal to the distal cuff was performed if pain scores increased above 4 of 10. Switching to the distal cuff resulted in pain scores below 4 in 69% of patients in the 0.5% group and in 88% of patients in the 1% group (P = 0.047). In addition, both groups differed in the sustained effect on distal tourniquet pain (P = 0.020). Time between injection and onset to analgesia duration was 13 +/- 1 min in the 0.5% group and 11 +/- 1 min in the 1% group (P = 0.0006). On release of the tourniquet, signs of systemic local anesthetic toxicity occurred in 6 patients of the 0.5% group and 28 of the 1% group (P < 0.0001). We conclude that chloroprocaine 1% resulted in an earlier onset of analgesia and improved distal tourniquet tolerance. However, these beneficial effects must be weighed against a fourfold increase in side effects.
  
  
  CONCLUSIONS
  Compared to a standard dose of 40 mL 0.5% chloroprocaine, 40 mL 1% chloroprocaine resulted in an earlier onset of analgesia duration and improved distal tourniquet tolerance during IV regional anesthesia. These beneficial effects must be weighed against a fourfold increase in signs of systemic local anesthetic toxicity.
authors.affiliation: From the Departments of *Anesthesia and †Surgery, Krankenhaus Thusis, Thusis, Switzerland.
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Marsch
authors.forename: Mathias
authors.initials: M
authors.lastname: Sluga
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Studer
authors.forename: Jonas
authors.initials: J
authors.lastname: Barandun
authors.forename: Domenic
authors.initials: D
authors.lastname: Scharplatz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ummenhofer
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D016001:Confidence Intervals; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011343:Procaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine