Spinal anesthesia with lidocaine or preservative-free 2-chlorprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison.
BACKGROUND
In this prospective, randomized, double-blind study we tested the hypothesis that 50 mg of 1% preservative-free 2-chloroprocaine would provide a faster resolution of spinal block than the same dose of 1% plain lidocaine.


METHODS
After IV midazolam premedication (0.03 mg/kg), 30 ASA physical status I-II outpatients undergoing knee arthroscopy were randomly allocated to receive 50 mg of either 1% plain lidocaine (n = 15) or 1% preservative-free plain chloroprocaine (n = 15). A blinded observer recorded the evolution of sensory (loss of pinprick sensation) and motor (modified Bromage scale) block until complete regression, as well as times to unassisted ambulation and voiding. A telephone call follow-up was performed 24 h and 7 days after surgery.


RESULTS
Two chloroprocaine patients (13%) and one lidocaine patient (7%) required fentanyl supplementation (100 microg IV) (P = 0.99) intraoperatively, but no patient required general anesthesia to complete surgery. Median (range) times for recovery of sensory and motor function, and unassisted ambulation were faster with 2-chloroprocaine [95 (68-170) min; 60 (45-120) min; and 103 (70-191) min] than lidocaine [120 (80-175) min; 100 (60-140) min; and 152 (100-185) min] (P = 0.019, P = 0.0005, and P = 0.003, respectively). No differences in first voiding were reported between chloroprocaine [180 (100-354) min] and lidocaine patients [190 (148-340) min] (P = 0.191). Transient neurological symptoms were reported in five lidocaine patients (33%) but no chloroprocaine patients (0%) (P = 0.042).


CONCLUSIONS
Intrathecal injection of 50 mg of preservative-free 2-chloroprocaine 1% resulted in quicker recovery of sensory/motor function, and unassisted ambulation, and fewer incidences of transient neurologic symptoms than the same dose of 1% lidocaine.
Casati
Andrea
A
University of Parma, Department of Anesthesiology and Pain Therapy, Ospedale Maggiore di Parma, Via Gramsci 14, 43100 Parma, Italy. andrea.casati@unipr.it
Fanelli
Guido
G
Danelli
Giorgio
G
Berti
Marco
M
Ghisi
Daniela
D
Brivio
Matteo
M
Putzu
Marta
M
Barbagallo
Alessia
A
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000009:adverse effects; D001182:Arthroscopy; D004311:Double-Blind Method; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D053208:Kaplan-Meier Estimate; D007717:Knee / Q000601:surgery*; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000187:drug effects; D009475:Neurons, Afferent / Q000187:drug effects; D011343:Procaine / Q000009:adverse effects / Q000031:analogs & derivatives*; D011446:Prospective Studies; D013997:Time Factors
D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine