Background and aims Short gynaecological surgeries are routinely performed on day care basis. Neuraxial anaesthesia in comparison to general anaesthesia offers better patient comfort, early ambulation and discharge with excellent postoperative pain relief. Intrathecal lignocaine is associated with transient neurological symptoms and small dose bupivacaine produces prolonged motor and sensory blockade. Recently chloroprocaine, a short acting local anaesthetic agent became available for intrathecal use. Our study aimed to compare intrathecal chloroprocaine with bupivacaine in short gynaecological procedures.
Methods Forty-three patients undergoing short duration gynaecological procedures were enrolled in this prospective, double blind, randomised controlled study. Patients were randomly allocated to receive either 40mg 1%chloroprocaine (n=22) or 10mg 0.25%plain bupivacaine (n=21) intrathecally. the primary outcome criteria were time to ambulation and discharge readiness. the secondary outcome criteria were onset, duration and intensity of sensory and motor blockade, time to voiding and any adverse effect.
Results Patients receiving chloroprocaine had significantly (p<0.001) faster time (158 ± 31 min) to ambulation compared to bupivacaine (241 ± 23 min). the regression of sensory blockade was significantly faster(p<0.001) with chloroprocaine (60 ± 13 minutes) than bupivacaine (94±24 minutes). Mean time to motor onset was significantly (<0.05) faster in chloroprocaine (8± 3 min) than bupivacaine (12 ± 3 min) group. Significantly faster (p<0.001) recovery of motor blockade was observed with chloroprocaine (130±32 min) than bupivacaine (211± 22 min). the time to first voiding was also significantly earlier with stable haemodynamics and no adverse effects in chloroprocaine group.
Conclusions Intrathecal chloroprocaine may prove as an attractive alternative and is superior to isobaric bupivacaine as it provides early ambulation and discharge readiness, for day care anaesthesia in short gynaecological procedures.
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