Mims S C, Zanolli N C, Fuller M, Habib A S
Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States of America.
Department of Anesthesiology, Duke University School of Medicine, Durham, NC, United States of America.
Int J Obstet Anesth. 2022 May;50:103276. doi: 10.1016/j.ijoa.2022.103276. Epub 2022 Mar 4.
Bupivacaine is commonly used in spinal anesthesia for cervical cerclage placement, but its long duration of action can delay hospital discharge. Chloroprocaine has a short duration of action and has re-emerged as an agent for ambulatory neuraxial anesthesia. There are limited data comparing intrathecal bupivacaine and chloroprocaine when used for cerclage placement. This retrospective study compares the time to hospital discharge between these drugs when used in spinal anesthesia for cervical cerclage placement.
A retrospective analysis of patients who underwent transvaginal cerclage placement under neuraxial anesthesia with intrathecal hyperbaric bupivacaine or plain chloroprocaine between January 1, 2015 and October 31, 2020. The primary outcome was the time to hospital discharge. Secondary outcomes included the incidence of inadequate anesthesia, postoperative pain scores and postoperative neurologic symptoms.
Three hundred and sixty patients were included in the final analysis (bupivacaine n=236, chloroprocaine n=124). The median (IQR) intrathecal dose was 7.5 (7.5, 9) mg and 45 (45, 50) mg in the bupivacaine and chloroprocaine groups respectively. The time (median [IQR]) from spinal anesthesia to hospital discharge was significantly shorter in the chloroprocaine group compared with the bupivacaine group (218 [180, 253] vs. 370 [309, 424] min, P<0.001). There were no significant differences between the groups for secondary outcomes and neither group had a patient report neurologic symptoms.
When utilized in spinal anesthesia for transvaginal cervical cerclage placement, chloroprocaine may reduce the time to discharge while providing comparable anesthesia to that provided by bupivacaine.
布比卡因常用于宫颈环扎术的脊髓麻醉，但其作用时间长会延迟出院。氯普鲁卡因作用时间短，已重新成为门诊神经轴麻醉的药物。用于环扎术时，比较鞘内注射布比卡因和氯普鲁卡因的资料有限。这项回顾性研究比较了这两种药物用于宫颈环扎术脊髓麻醉时的出院时间。
回顾性分析2015年1月1日至2020年10月31日期间在神经轴麻醉下接受经阴道宫颈环扎术的患者，术中鞘内注射重比重布比卡因或普通氯普鲁卡因。主要结局是出院时间。次要结局包括麻醉不足的发生率、术后疼痛评分和术后神经症状。
360例患者纳入最终分析（布比卡因组236例，氯普鲁卡因组124例）。布比卡因组和氯普鲁卡因组鞘内注射剂量的中位数（IQR）分别为7.5（7.5，9）mg和45（45，50）mg。与布比卡因组相比，氯普鲁卡因组从脊髓麻醉到出院的时间（中位数[IQR]）显著缩短（218[180，253]分钟对370[309，424]分钟，P<0.001）。两组次要结局无显著差异，两组均无患者报告神经症状。
在经阴道宫颈环扎术的脊髓麻醉中使用时，氯普鲁卡因可能会缩短出院时间，同时提供与布比卡因相当的麻醉效果。
