Singh Narinder P, Siddiqui Naveed T, Makkar Jeetinder K, Guffey Ryan, Singh Preet M
Department of Anesthesia and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
Department of Anesthesia and Pain Management, Sinai Health, Mount Sinai Hospital, Toronto, ON, Canada.
Can J Anaesth. 2025 Apr;72(4):550-566. doi: 10.1007/s12630-025-02924-4. Epub 2025 Apr 8.
Dosing and types of local anesthetic agents for spinal anesthesia in ambulatory settings vary significantly. We sought to conduct a network meta-analysis to evaluate the effect of the type and dose of local anesthetic on outcomes in patients undergoing ambulatory surgery.
After PROSPERO registration (CRD42023399356), we searched various databases for randomized controlled trials (RCTs) evaluating adult patients undergoing daycare surgery under spinal anesthesia. Most included trials focused on patients undergoing knee arthroscopy, while other covered procedures were perineal, lower abdominal, and limb surgeries. Unfortunately, we could not include trials on arthroplasty surgery owing to the lack of RCTs in this area. We used Confidence in Network Meta-Analysis (CINeMA) to assess the confidence in the estimates, and we used surface under the cumulative ranking curve (SUCRA) to determine the probability rank order. The primary outcome was the time to discharge. Intraoperative effectiveness of anesthetic, sensory, and motor blockade duration; time to first micturition; time to ambulation; and adverse effects such as urinary retention and transient neurologic symptoms (TNS) were the secondary outcomes.
Overall, this study included 44 trials comprising 3,299 patients, each comprising 11 distinct agents (2-chloroprocaine, articaine, high-dose bupivacaine, low-dose bupivacaine, lidocaine, high-dose levobupivacaine, low-dose levobupivacaine, mepivacaine, prilocaine, high-dose ropivacaine, and low-dose ropivacaine). Low- to moderate-certainty evidence showed that 2-chloroprocaine, lidocaine, and mepivacaine were superior for discharge readiness, while 2-chloroprocaine ranked highest for other outcomes (sensory and motor block duration, time to first ambulation, and spontaneous voiding).
Evidence supports 2-chloroprocaine for short-duration spinal anesthesia in the ambulatory setting.
PROSPERO ( CRD42023399356 ); first submitted 13 February 2023.
门诊环境下脊髓麻醉的局部麻醉药剂量和类型差异很大。我们试图进行一项网状Meta分析，以评估局部麻醉药的类型和剂量对接受门诊手术患者结局的影响。
在PROSPERO注册（CRD42023399356）后，我们在多个数据库中检索了评估成年患者在脊髓麻醉下接受日间手术的随机对照试验（RCT）。大多数纳入试验聚焦于接受膝关节镜检查的患者，而其他涵盖的手术包括会阴、下腹部和肢体手术。遗憾的是，由于该领域缺乏RCT，我们未能纳入关节置换手术的试验。我们使用网状Meta分析置信度（CINeMA）来评估估计值的置信度，并使用累积排名曲线下面积（SUCRA）来确定概率排名顺序。主要结局是出院时间。麻醉、感觉和运动阻滞持续时间的术中有效性；首次排尿时间；行走时间；以及诸如尿潴留和短暂性神经症状（TNS）等不良反应为次要结局。
总体而言，本研究纳入了44项试验，共3299例患者，每项试验包含11种不同药物（2-氯普鲁卡因、阿替卡因、高剂量布比卡因、低剂量布比卡因、利多卡因、高剂量左旋布比卡因、低剂量左旋布比卡因、甲哌卡因、丙胺卡因、高剂量罗哌卡因和低剂量罗哌卡因）。低至中等确定性证据表明，2-氯普鲁卡因、利多卡因和甲哌卡因在出院准备方面更具优势，而2-氯普鲁卡因在其他结局（感觉和运动阻滞持续时间、首次行走时间和自主排尿）方面排名最高。
有证据支持在门诊环境中使用2-氯普鲁卡因进行短效脊髓麻醉。
PROSPERO（CRD42023399356）；首次提交于2023年2月13日。
