Gilreath Noah, Liu Jonathan, Thomson Cameron, Daher Mohammad, Caus Sandi, Dunn Harrison, Antoci Valentin, Barrett Thomas, Cohen Eric
University Orthopedics, Inc, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
UMass Chan Medical School, Worcester, MA, USA.
Knee Surg Relat Res. 2025 Aug 7;37(1):33. doi: 10.1186/s43019-025-00283-4.
Chloroprocaine is a rapid, short-acting spinal anesthetic that may facilitate quicker postoperative recovery in total knee arthroplasty (TKA). However, limited literature exists regarding its use in patients undergoing same-day discharge (SDD) TKA. This study evaluated the clinical outcomes and safety of chloroprocaine compared with those of mepivacaine.
This retrospective study of 178 patients who underwent primary TKA at a single ambulatory surgery center from March 2022 to June 2023 compared chloroprocaine (n = 114) and mepivacaine (n = 64) spinal anesthesia. Surgical outcomes, including estimated blood loss (EBL), operative time, discharge time, 90-day emergency department visits, and 90-day readmissions, were evaluated. In addition, anesthesia-related complications such as hypotension, bradycardia, urinary retention, and postanesthesia care unit (PACU) outcomes were recorded. Continuous variables between the chloroprocaine and mepivacaine groups were compared via independent sample t-tests, whereas categorical variables were analyzed via chi-squared tests. A p-value of less than 0.05 was considered statistically significant.
There were no differences in the baseline characteristics between the two groups. The chloroprocaine group had a significantly shorter operative time (73.1 versus 84.9 min, p < 0.001) and faster discharge (3.7 versus 4.2 h, p < 0.001), with no difference in EBL. Patients in the chloroprocaine group had a lower incidence of urinary retention (2.5 versus 15.6%, p = 0.004), a lower proportion of patients who needed a urinary catheter (2.6 versus 14.1%, p = 0.004), and fewer postoperative complaints of numbness (19.3 versus 39.1%, p = 0.004). There were no differences in surgical complications.
Compared with mepivacaine, chloroprocaine spinal anesthesia for SDD TKA was associated with lower rates of urinary retention, a reduced need for urinary catheterization, fewer neurological complaints in the PACU, and faster discharge times. No differences were observed in surgical outcomes between the groups, and there were no instances of unplanned direct admissions. These results suggest that chloroprocaine can be safely used as a reliable alternative to mepivacaine in outpatient TKA.
氯普鲁卡因是一种起效迅速、作用时间短的脊髓麻醉剂，可能有助于全膝关节置换术（TKA）患者术后更快恢复。然而，关于其在当日出院（SDD）TKA患者中的应用的文献有限。本研究评估了氯普鲁卡因与甲哌卡因相比的临床疗效和安全性。
本回顾性研究对2022年3月至2023年6月在单一门诊手术中心接受初次TKA的178例患者进行了比较，其中氯普鲁卡因组（n = 114）和甲哌卡因组（n = 64）采用脊髓麻醉。评估了手术结果，包括估计失血量（EBL）、手术时间、出院时间、90天急诊就诊次数和90天再入院情况。此外，记录了麻醉相关并发症，如低血压、心动过缓、尿潴留和麻醉后护理单元（PACU）的结果。氯普鲁卡因组和甲哌卡因组之间的连续变量通过独立样本t检验进行比较，分类变量通过卡方检验进行分析。p值小于0.05被认为具有统计学意义。
两组的基线特征无差异。氯普鲁卡因组的手术时间明显更短（73.1对84.9分钟，p < 0.001），出院更快（3.7对4.2小时，p < 0.001），EBL无差异。氯普鲁卡因组的尿潴留发生率较低（2.5%对15.6%，p = 0.004），需要导尿的患者比例较低（2.6%对14.1%，p = 0.004），术后麻木主诉较少（19.3%对39.1%，p = 0.004）。手术并发症无差异。
与甲哌卡因相比，SDD TKA采用氯普鲁卡因脊髓麻醉与尿潴留发生率较低、导尿需求减少、PACU中神经学主诉较少以及出院时间更快相关。两组之间的手术结果未观察到差异，也没有计划外直接入院的情况。这些结果表明，在门诊TKA中，氯普鲁卡因可作为甲哌卡因的可靠替代药物安全使用。
