Khurana Bisman Jeet Kaur, Choudhary Sujata, Singhal Meghna, Rautela Rajesh S, Salhotra Rashmi, Singh Alpana, Meena Seema
Anesthesiology and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, IND.
Anesthesiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2023 Aug 27;15(8):e44187. doi: 10.7759/cureus.44187. eCollection 2023 Aug.
Background Neuraxial anesthesia, compared to general anesthesia, offers better patient comfort, early ambulation, and discharge with excellent post-operative pain relief for short gynecological procedures. Recently chloroprocaine, a short-acting local anesthetic agent became available for intrathecal use. This study aimed to compare intrathecal chloroprocaine with bupivacaine in short gynecological procedures. Methodology Consecutive patients undergoing short gynecological procedures, patients belonging to the American Society of Anesthesiology (ASA) I and II, between 18 and 60 years of age, and patients with a height between 150 cm and 180 cm were included in the study. Randomization was done using a computer-generated random number table. Patients were allocated to one of the two study groups. Group B received 4 mL of isobaric bupivacaine (0.25%) 10 mg intrathecal, and Group C received 4 mL of isobaric chloroprocaine (1%) 40 mg intrathecal. The primary outcome criteria were time to ambulation and discharge readiness. The secondary outcome criteria were onset, duration, and intensity of sensory and motor blockade, time to voiding, and any adverse effects. Results Patients receiving chloroprocaine had a significantly (p=0.001) faster time (158±31 min) to ambulation compared to bupivacaine (241±23 min). The regression of sensory blockade was substantially faster (p=0.001) with chloroprocaine (60±13 min) than with bupivacaine (94±24 min). Mean time to motor onset was significantly (p=0.05) faster in chloroprocaine (8±3 min) than bupivacaine (12±3 min) group. Significantly faster (p=0.001) recovery of motor blockade was observed with chloroprocaine (130±32 min) than bupivacaine (211±22 min). The time to first voiding was also significantly earlier with stable hemodynamics and no adverse effects in chloroprocaine group. Conclusion Intrathecal chloroprocaine may be an attractive alternative and is superior to isobaric bupivacaine as it provides early ambulation and discharge readiness for daycare anesthesia in short gynecological procedures.
与全身麻醉相比,神经轴索麻醉能为患者带来更好的舒适度,使其能更早活动和出院,且对短时间妇科手术术后疼痛有良好的缓解效果。最近,短效局部麻醉药氯普鲁卡因可用于鞘内注射。本研究旨在比较鞘内注射氯普鲁卡因与布比卡因用于短时间妇科手术的效果。
本研究纳入了接受短时间妇科手术的连续患者,这些患者年龄在18至60岁之间,属于美国麻醉医师协会(ASA)I级和II级,身高在150厘米至180厘米之间。使用计算机生成的随机数字表进行随机分组。患者被分配到两个研究组之一。B组鞘内注射4毫升等比重布比卡因(0.25%)10毫克,C组鞘内注射4毫升等比重氯普鲁卡因(1%)40毫克。主要观察指标为活动时间和出院准备时间。次要观察指标为感觉和运动阻滞的起效时间、持续时间和强度、排尿时间以及任何不良反应。
与布比卡因组(241±23分钟)相比,接受氯普鲁卡因的患者活动时间显著更快(p = 0.001)(158±31分钟)。氯普鲁卡因组(60±13分钟)感觉阻滞的消退明显比布比卡因组(94±24分钟)更快(p = 0.001)。氯普鲁卡因组运动起效的平均时间(8±3分钟)显著比布比卡因组(12±3分钟)更快(p = 0.05)。观察到氯普鲁卡因组(130±32分钟)运动阻滞的恢复明显比布比卡因组(211±22分钟)更快(p = 0.001)。氯普鲁卡因组首次排尿时间也显著更早,血流动力学稳定且无不良反应。
鞘内注射氯普鲁卡因可能是一种有吸引力的替代方法,并且优于等比重布比卡因,因为它能使患者在短时间妇科手术的日间麻醉中更早活动和做好出院准备。