Breebaart Margaretha B, Saerens Lies, Branders Jordi, Casaer Sari, Sermeus Luc, Van Houwe Patrick
Department of Medicine and Healthcare Sciences, University of Antwerp, Wilrijk, Belgium.
Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium.
Local Reg Anesth. 2021 Nov 20;14:153-160. doi: 10.2147/LRA.S324876. eCollection 2021.
Chloroprocaine provides spinal anesthesia for day-case surgery lasting up to 40 minutes. Intravenous and spinal dexmedetomidine can prolong spinal anesthesia, but no data are available for the combination with chloroprocaine. This double-blind randomized controlled trial compares chloroprocaine with spinal or intravenous dexmedetomidine regarding block characteristics, micturition, and discharge times.
After ethical approval and informed consent, 135 patients scheduled for knee arthroscopy were randomized to receive either 40mg spinal chloroprocaine (Chloro-group), 40mg chloroprocaine with 5 mcg spinal dexmedetomidine (Spinal Dex-group) or 40mg chloroprocaine with 0.5 mcg/kg IV dexmedetomidine (IV DEXgroup). Block characteristics, hemodynamic variables and the use of analgesics were registered. Voiding and discharge times were noted. A scoring system was used for micturition problems and sedation. Transient neurological symptoms (TNS) and other late side effects were evaluated after one week.
Demographic data were similar between groups. Block onset times and intensity of motor block were comparable between groups. The time to L2 and Bromage 1 regression was prolonged in the SpinalDEx-group by approximately 30 minutes compared to the other groups (p < 0.01). First voiding as well as discharge from the hospital was prolonged in the Spinal Dex-group by approximately 40 minutes p < 0.01. There was no significant difference between groups regarding treatment of hypotension, sedation, micturition problems or the use of postoperative analgesics (P > 0.8). One patient experienced TNS.
Intrathecal but not intravenous (0.5 mcg/kg) dexmedetomidine can prolong chloroprocaine (40mg) spinal anesthesia when surgery is expected to last over 40 minutes. Despite a similar incidence of adverse effects, this also led to a postponed hospital discharge time.
氯普鲁卡因可用于持续时间长达40分钟的日间手术的脊髓麻醉。静脉注射和脊髓注射右美托咪定可延长脊髓麻醉时间，但尚无氯普鲁卡因与之联合应用的数据。这项双盲随机对照试验比较了氯普鲁卡因与脊髓或静脉注射右美托咪定在阻滞特征、排尿及出院时间方面的差异。
经伦理批准并获得知情同意后，将135例计划行膝关节镜检查的患者随机分为三组，分别接受40mg脊髓注射氯普鲁卡因（氯普鲁卡因组）、40mg氯普鲁卡因联合5μg脊髓注射右美托咪定（脊髓右美托咪定组）或40mg氯普鲁卡因联合0.5μg/kg静脉注射右美托咪定（静脉右美托咪定组）。记录阻滞特征、血流动力学变量及镇痛药的使用情况。记录排尿及出院时间。采用评分系统评估排尿问题及镇静情况。一周后评估短暂性神经症状（TNS）及其他晚期副作用。
各组间人口统计学数据相似。各组间阻滞起效时间及运动阻滞强度相当。与其他组相比，脊髓右美托咪定组L2及布罗玛分级1级恢复时间延长约30分钟（p<0.01）。脊髓右美托咪定组首次排尿及出院时间延长约40分钟（p<0.01）。各组间在低血压治疗、镇静、排尿问题或术后镇痛药使用方面无显著差异（P>0.8）。1例患者出现TNS。
当预计手术持续时间超过40分钟时，鞘内注射而非静脉注射（0.5μg/kg）右美托咪定可延长氯普鲁卡因（40mg）脊髓麻醉时间。尽管不良反应发生率相似，但这也导致出院时间推迟。
