A Comparative Study of Isobaric 1% Chloroprocaine With 0.5% Isobaric Bupivacaine for Ureteroscopic Lithotripsy Under Spinal Anaesthesia: A Prospective Randomised Study.

Introduction Day-care surgery has become an immensely popular modality of treatment throughout the globe. Ureteroscopic lithotripsy (URSL) surgery is commonly performed on a day-care basis, and the duration of surgery ranges from 15 minutes to 45 minutes. URSL is routinely done under spinal anaesthesia. Spinal anaesthesia with conventional drugs has its problems like delayed regression and urinary retention, necessitating a longer hospital stay, thereby increasing the time and resources needed. For day-care surgery, short-acting local anaesthetics have a quicker onset with fewer side effects, and drugs that ensure quicker hospital discharge are more often preferred over long-acting anaesthetics. For spinal anaesthesia, we planned to perform a randomised prospective study to compare the effectiveness of 40 mg of preservative-free 1% chloroprocaine over 10 mg of plain 0.5% isobaric bupivacaine. Materials and method After obtaining clearance from the institute's ethical committee and written informed consent from the patients, 64 patients between the ages of 18 and 50 years of either sex belonging to American Society of Anesthesiologists (ASA) 1 and 2 scheduled for URSL surgery were included in our study. They were randomised using a computer-generated sealed envelope technique into two groups. Group C received 4 ml of 1% isobaric chloroprocaine, and group B received 2 ml of 0.5% isobaric bupivacaine in the intrathecal space. The primary outcome was to compare the in-hospital time among both groups. Our secondary outcomes were the onset time of motor and sensory blocks, the duration of the blocks, time to unaided ambulation and voiding, the need for an overnight stay, and the side effects like postoperative nausea and vomiting (PONV), and urinary retention. The data were analysed using the unpaired t-test and chi-square test and calculated by SPSS 20.0 software version (IBM Corp., Armonk, NY). Results Final analyses were done among 60 patients. In-hospital time was significantly lower in group C as compared to group B (p<0.05). The onset time of sensory and motor blockade was significantly lower in group C as compared to group B (p<0.005). The duration of sensory and motor blockade was significantly less in group C as compared to group B (p<0.005). The time for unaided voiding and ambulation was less in group C as compared to group B. The need for an overnight stay was only needed in group B. The incidence of PONV and urinary retention was higher in group B. Conclusion In URSL surgery, the use of intrathecal 1% isobaric chloroprocaine 40 mg resulted in a reduced hospital stay time as compared to the use of intrathecal 10 mg of 0.5% isobaric bupivacaine. Also, it resulted in a significantly faster onset and faster regression of the block, less duration of the blockade, shorter time to ambulation and micturition, and a requirement for an overnight stay when compared with isobaric spinal bupivacaine.