Thomas Subin, Pawar Devanand Bhimrao, Ruparel Dipakkumar Hiralal, Sedani Shweta
Department of Anaesthesia, Government Medical College, Nagpur, Maharashtra, India.
Department of Anaesthesia, SRTR Government Medical College, Ambajogai, Maharashtra, India.
Anesth Essays Res. 2022 Jan-Mar;16(1):12-16. doi: 10.4103/aer.aer_20_22. Epub 2022 Jun 14.
Ambulatory surgeries are increasing all over. While searching for an ideal anesthetic, the use of lidocaine was linked to a greater rate of transitory neurological symptoms and bupivacaine delays discharge due to a longer duration of motor blockade. 2-chloroprocaine (2CP) with a shorter duration of action is gaining popularity. We aimed to compare intrathecal bupivacaine and 2CP for the subarachnoid block for elective ambulatory gynecological surgeries.
A single-blind study was conducted on 90 patients comparing 40 mg 2CP and 10 mg 0.5% bupivacaine heavy measuring pinprick sensation, motor block, time to ambulation, and voiding of urine so as to get ready for discharge.
In both groups, the beginning of sensory blockage occurred at a similar time, while motor blockade achieved was faster in the 2CP group. The resolution of motor blockade was 1.7 times faster in the 2CP group than in the bupivacaine group. Time taken for ambulation was delayed significantly in the bupivacaine group, i.e., 263.04 ± 29.08 min compared to the 2CP group, i.e., 225.44 ± 29.48 min which was a delay of almost 38 min. Voiding of urine was also delayed in the bupivacaine group by 60 min compared to the 2CP group and was significant finding leading to delay of discharge of patients. Adverse effects were comparable in both groups.
Intrathecal preservative-free 2CP provides satisfactory surgical block, and has a considerably faster rate of block regression, resulting in earlier ambulation and voiding, allowing the patient to be discharged from the hospital sooner as compared to intrathecal bupivacaine.
门诊手术在全球范围内日益增多。在寻找理想麻醉剂的过程中，利多卡因的使用与更高的短暂性神经症状发生率相关，而布比卡因则因运动阻滞持续时间较长导致出院延迟。作用时间较短的2-氯普鲁卡因（2CP）越来越受欢迎。我们旨在比较鞘内注射布比卡因和2CP用于择期门诊妇科手术蛛网膜下腔阻滞的效果。
对90例患者进行单盲研究，比较40mg 2CP和10mg 0.5%重比重布比卡因，测量针刺感觉、运动阻滞、下床活动时间和排尿情况，以便为出院做好准备。
两组感觉阻滞开始时间相似，但2CP组运动阻滞起效更快。2CP组运动阻滞消退速度比布比卡因组快1.7倍。布比卡因组下床活动时间明显延迟，即263.04±29.08分钟，而2CP组为225.44±29.48分钟，延迟近38分钟。布比卡因组排尿时间也比2CP组延迟60分钟，这是导致患者出院延迟的显著发现。两组不良反应相当。
鞘内注射无防腐剂的2CP可提供满意的手术阻滞，且阻滞消退速度明显更快，导致更早下床活动和排尿，与鞘内注射布比卡因相比，患者可更早出院。
