Recovery of motor function in ambulatory hand trauma using chloroprocaine 2%

Abstract

Chloroprocaine 2% is an ester local anaesthetic offering a shorter onset, duration of action, and offset than other commonly used agents, making it particularly suitable for ambulatory surgery.1 Although established for short-acting spinal anaesthesia, it has only recently launched on the UK market for peripheral nerve block.2 We evaluated recovery of motor function in patients undergoing awake surgery using chloroprocaine 2% for ambulatory hand trauma procedures. Thirteen patients received an ultrasound-guided axillary brachial plexus block with 30 ml chloroprocaine 2%, of which 5 ml (100 mg) were specifically deposited around the musculocutaneous nerve. We established baseline biceps muscle strength (peak force over a 3-s period) with a handheld dynamometer (Lafayette). Patients also received supplemental distal blocks of the median, ulnar and superficial radial nerves as appropriate with levobupivacaine for postoperative analgesia. Biceps strength was assessed at fixed time points after block until >75% return of baseline function. Mean block performance time was 11 min (7–14 min). Surgery started 5–22 min (mean 12 min) thereafter with an operative time between 13 and 50 min (mean, 34 min). Median peak force immediately after block was 0% (0–25%) of pre-block strength. Six of 13 patients had >50% recovery of biceps strength by 70 min after block (Fig. 3). All had ≥75% recovery by 120 min (Table 1). Surgical conditions were excellent for all patients, and none received supplemental analgesia or reported tourniquet discomfort. Chloroprocaine 2% provided rapid onset block, good surgical conditions, and rapid recovery of motor function. In terms of offset and readiness for discharge, chloroprocaine 2% was a marked improvement on our previous awake surgery local anaesthetic mixture of lidocaine 1.5% with epinephrine. This has benefits for theatre efficiency, and patient safety and satisfaction. Of note patients were able to dress themselves in the PACU without aid. Five patients recorded higher peak force postoperatively compared with baseline, which may have been attributable to pain inhibition. We plan to recommend wider use of chloroprocaine 2% for procedures where operative duration is anticipated to be ≤1 h. Supplemental distal blocks can limit any concerns about postoperative analgesia.Table 1Biceps muscle strength post block.Duration since block finish (min)Median biceps muscle strength (% of baseline)00%7057%8085%12098% Open table in a new tab 1.Saporito A, Anselmi L, Borgeat A, Aguirre J. J Clinical Anesth 2016; 32: 119–262.Jafari S, Kalstein A, Nasrullah H, et al. Anesth Analg 2008; 107: 1746–50