title: Spinal 2-chloroprocaine: a comparison with small-dose bupivacaine in volunteers.
abstract: Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. Preservative-free 2-chloroprocaine (2-CP) has reemerged as an alternative for outpatient spinal anesthesia. We designed this double-blind, randomized, crossover, volunteer study to compare 40 mg of 2-CP with small-dose (7.5 mg) bupivacaine with measures of pinprick anesthesia, motor strength, tolerance to tourniquet and electrical stimulation, and simulated discharge criteria. Peak block height (2-CP average T7 [range T3-10]; bupivacaine average T9 [range T4-L1]), regression to L1 (2-CP 64 +/- 10 versus bupivacaine 87 +/- 41 min), and tourniquet tolerance (2-CP 52 +/- 11 versus bupivacaine 60 +/- 27 min) did not differ between drugs (P = 0.15, 0.12, and 0.40, respectively). However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 +/- 14, bupivacaine 191 +/- 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine.
authors.affiliation: Department of Anesthesiology, Virginia Mason Clinic, Seattle, Washington.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Yoos
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Kopacz
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007537:Isometric Contraction / Q000187:drug effects; D008297:Male; D009046:Motor Neurons / Q000187:drug effects; D018482:Muscle, Skeletal / Q000187:drug effects; D009407:Nerve Block; D010147:Pain Measurement / Q000187:drug effects; D010812:Physical Stimulation; D011343:Procaine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D002045:Bupivacaine