Chloroprocaine Provides Safe, Effective, Short-Acting Spinal Anesthesia Ideal for Ambulatory Surgeries: A RetrospectiveReview.

Abstract

The ideal local anesthetic for use in ambulatory spinal anesthesia is safe, with minimal adverse effects, and of aduration that does not impede post-anesthesia care unit (PACU) discharge. Since itsapproval for use in spinal anesthesia in Europe in 2012, chloroprocaine has seen a resurgence. Recent studies have investigated the safety and efficacy of preservative-free chloroprocaine for use in spinal anesthesia, but few provide the incidence of adverse events such as urinary retention and transient neurologic symptoms. We sought to assess the safety of chloroprocaine for spinal anesthesia, including the incidence of adverse events and the duration and quality of its use, in the initial 6months of its use at our institution. We hypothesized that chloroprocaine would provide effective spinal anesthesia for orthopedic cases of short duration, with a low rate of complications. We conducted a retrospective chart review of all patients from June to December 2016 at our institution who had ambulatory knee arthroscopy or foot procedures in which chloroprocaine spinal anesthesia was used. For all 445 charts analyzed, data were collected on anesthesia characteristics, office visits, nursing PACU assessment, and nursing post-operative day 1 follow-up phone calls. The median chloroprocaine dosage was 44mg (interquartile range [IQR], 40 to 50). The median duration of sensory block was 156min (IQR, 128 to 189) and of motor block was 148min (IQR, 123 to 181). Time to ambulation was 186min (IQR, 158 to 218) and time to meeting of discharge criteria was 218min (IQR, 189 to 250). The most common adverse events in the PACU were bradycardia and hypotension. No patients had urinary retention or transient neurologic symptoms. In 6months of use at our institution, chloroprocaine provided safe and effective spinal anesthesia for short orthopedic procedures, with no incidence of transient neurologic symptoms, neuropraxia, or urinary retention.