title: Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blind randomized trial.
abstract: BACKGROUND
  We have always been searching for the ideal local anesthetic for outpatient spinal anesthesia. Lidocaine has been associated with a high incidence of transient neurological symptoms, and bupivacaine produces sensory and motor blocks of long duration. Preservative-free 2-chloroprocaine (2-CP) seems to be a promising alternative, being a short-acting agent of increasing popularity in recent years. This study was designed to compare 2-CP with bupivacaine for spinal anesthesia in an elective ambulatory setting.
  
  
  METHODS
  A total of 106 patients were enrolled in this randomized double-blind study. Spinal anesthesia was achieved with 0.75% hyperbaric bupivacaine 7.5 mg (n = 53) or 2% preservative-free 2-CP 40 mg (n = 53). The primary endpoint for the study was the time until reaching eligibility for discharge. Secondary outcomes included the duration of the sensory and motor blocks, the length of stay in the postanesthesia care unit, the time until ambulation, and the time until micturition.
  
  
  RESULTS
  The average time to discharge readiness was 277 min in the 2-CP group and 353 min in the bupivacaine group, a difference of 76 min (95% confidence interval [CI]: 40 to 112 min; P < 0.001). The average time for complete regression of the sensory block was 146 min in the 2-CP group and 329 min in the bupivacaine group, a difference of 185 min (95% CI: 159 to 212 min; P < 0.001). Times to ambulation and micturition were also significantly lower in the 2-CP group.
  
  
  CONCLUSIONS
  Spinal 2-chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with the advantages of faster block resolution and earlier hospital discharge compared with spinal bupivacaine. (ClinicalTrials.gov number, NCT00845962).
authors.affiliation: Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital St-Luc, 1058 Saint-Denis, Montreal, QC, H2X 3J4, Canada.
authors.forename: Marie-Andrée
authors.initials: MA
authors.lastname: Lacasse
authors.forename: Jean-Denis
authors.initials: JD
authors.lastname: Roy
authors.forename: Josée
authors.initials: J
authors.lastname: Forget
authors.forename: Franck
authors.initials: F
authors.lastname: Vandenbroucke
authors.forename: Robert F
authors.initials: RF
authors.lastname: Seal
authors.forename: Danielle
authors.initials: D
authors.lastname: Beaulieu
authors.forename: Michael
authors.initials: M
authors.lastname: McCormack
authors.forename: Luc
authors.initials: L
authors.lastname: Massicotte
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000009:adverse effects / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011343:Procaine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D013997:Time Factors
chemical_list: D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D002045:Bupivacaine