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Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial
  1. Elsbeth Wesselink1,
  2. Godelief Janssen-van den Hurk2,
  3. Rien van der Vegt3,
  4. Cornelis Slagt4,
  5. Jan van der Aa5,
  6. Eric Franssen6,
  7. Peter van de Ven7,
  8. Noortje Swart8,
  9. Christa Boer9 and
  10. Marcel de Leeuw10
  1. 1Clinical Pharmacy, Zaans Medisch Centrum, Zaandam, Noord-Holland, The Netherlands
  2. 2Clinical Pharmacy, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
  3. 3Anesthesiology, Zaans Medisch Centrum, Zaandam, Noord-Holland, The Netherlands
  4. 4Anesthesia, Pain and Palliative Medicine, Radboudumc, Nijmegen, Gelderland, The Netherlands
  5. 5Orthopedic Surgery, Zaans Medisch Centrum, Zaandam, Noord-Holland, The Netherlands
  6. 6Clinical Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, Noord-Holland, The Netherlands
  7. 7Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
  8. 8Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
  9. 9Faculty of Medicine, VU University, Amsterdam, Noord-Holland, The Netherlands
  10. 10Anesthesiology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
  1. Correspondence to Mrs Elsbeth Wesselink, Clinical Pharmacy, Zaans Medisch Centrum, Zaandam 1502 DV, The Netherlands; e.wesselink{at}vumc.nl

Abstract

Background In ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant.

Methods 150 patients were randomly allocated to receive intrathecally either 40 mg of 2-chloroprocaine or 40 mg of prilocaine. The primary outcome was the time to complete recovery from motor blockade. Secondary outcomes included time to full regression of sensory block, peak sensory block level, urine retention needing catheterization, time until hospital discharge, incidence of transient neurologic symptoms and patient satisfaction.

Results Time to complete recovery from motor blockade was 15 min shorter for 2-chloroprocaine (median: 60 min; IQR: 60–82.5) than for prilocaine (median: 75 min; IQR: 60–90; p=0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared with median: 165 min; IQR: 135–190, p<0.001) and faster time to hospital discharge (mean difference: 57 min; 95% CI 38 to 77, p<0.001). Peak sensory block was higher in the 2-chloroprocaine group (median: T9; IQR: T6–T12 compared with median: T10; IQR: T8–T12, p<0.008). Patient satisfaction and urine retention needing catheterization were equal in both groups.

Conclusions In knee arthroscopy, spinal anesthesia with 2-chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine.

Trial registration number NTR6796.

  • arthroscopy
  • 2-chloroprocaine hydrochloride
  • knee
  • prilocaine
  • spinal anesthesia
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Footnotes

  • Presented at Data from this work were presented at the 44th Annual Regional Anesthesiology and Acute Pain Medicine meeting, 11–14 April 2019, Las Vegas, Nevada. The abstract received a Best of Meeting Award for this meeting.

  • Contributors EW participated in the design of the study, coordinated the study, performed the database validation and wrote the manuscript. GJvdH coordinated the patient recruitment, assessments and follow-up, performed the data entry, and participated in writing the manuscript. RvdV participated in the design of the study, enrolled patients, administered anesthesia and participated in writing the manuscript. CS and MdL participated in the design of the study and in writing the manuscript. JvdA performed surgical procedures and participated in writing the manuscript. EF participated in writing the manuscript. PvdV performed statistical analyses and participated in writing the manuscript. NS and CB participated in writing the manuscript and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study received approval from the Ethical Committee of VUmc (Ref: NL53492.029.15).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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