Kim David H, Kahn Richard, Lee Andrew, Mac Phuong Dinh, Chiu Yu-Fen, Yadeau Jacques, Liu Jiabin
Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Department of Anesthesiology, Weill Cornell Medicine, New York, NY USA.
HSS J. 2020 Dec;16(Suppl 2):280-284. doi: 10.1007/s11420-019-09713-y. Epub 2019 Aug 26.
The ideal local anesthetic for use in ambulatory spinal anesthesia is safe, with minimal adverse effects, and of a duration that does not impede post-anesthesia care unit (PACU) discharge. Since its approval 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.
QUESTIONS/PURPOSES: 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 6 months 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 44 mg (interquartile range [IQR], 40 to 50). The median duration of sensory block was 156 min (IQR, 128 to 189) and of motor block was 148 min (IQR, 123 to 181). Time to ambulation was 186 min (IQR, 158 to 218) and time to meeting of discharge criteria was 218 min (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 6 months 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.
用于门诊脊柱麻醉的理想局部麻醉药应安全，副作用最小，且其作用持续时间不会妨碍麻醉后护理单元（PACU）的出院。自2012年在欧洲获批用于脊柱麻醉以来，氯普鲁卡因再度受到关注。近期研究调查了不含防腐剂的氯普鲁卡因用于脊柱麻醉的安全性和有效性，但很少有研究提供诸如尿潴留和短暂性神经症状等不良事件的发生率。
问题/目的：我们试图评估氯普鲁卡因在我院使用的最初6个月用于脊柱麻醉的安全性，包括不良事件的发生率及其使用的持续时间和质量。我们假设氯普鲁卡因可为短期骨科手术提供有效的脊柱麻醉，并发症发生率低。
我们对2016年6月至12月在我院接受门诊膝关节镜检查或足部手术并使用氯普鲁卡因脊柱麻醉的所有患者进行了回顾性病历审查。对于分析的所有445份病历，收集了麻醉特征、门诊就诊、护理PACU评估以及术后第1天护理随访电话的数据。
氯普鲁卡因的中位剂量为44mg（四分位间距[IQR]，40至50）。感觉阻滞的中位持续时间为156分钟（IQR，128至189），运动阻滞的中位持续时间为148分钟（IQR，123至181）。下床活动时间为186分钟（IQR，158至218），达到出院标准的时间为218分钟（IQR，189至250）。PACU中最常见的不良事件是心动过缓和低血压。没有患者出现尿潴留或短暂性神经症状。
在我院使用的6个月中，氯普鲁卡因为短期骨科手术提供了安全有效的脊柱麻醉，未发生短暂性神经症状、神经失用或尿潴留。
