Ambulatory surgery with chloroprocaine spinal anesthesia: a review

Figures & data

Table 1 Main results of randomized controlled trials published about chloroprocaine between 2004 and 2015

Author, year of publication	Setting	Drug	Sensory block				Motor block		Discharge time		Complications
			Peak height	Tourniquet tolerance	Time until 2-dermatome regression	Resolution of sensory block	Time until recovery at abdomen	Time until recovery - Bromage Scale	Ambulation	Micturition	Complications
Kouri and Kopacz, 2004^Citation27	8 healthy volunteers Age 35±6 years (clinical endpoints^v and simulated discharge pathway)	40 mg plain chloroprocaine vs 40 mg 2% lidocaine	T8 (T5—11) vs T8 (T6-I2)	46±6 min vs 38±24 min	57±14 min^* vs 73±23 min	103± 13 min^* 126± 16 min (at S2)	71 ± 18 min vs 60±53 min	79±15 min vs 90± 14 min	104± 12 min^* vs 134± 14 min	104± 12 min^* vs 134± 14 min	TNS in 7 out of 8 patients with lidocaine No TNS with chloroprocaine
Smith et al, 2004^Citation23	18 healthy volunteers Age 35±9 years (clinical endpoints^v and simulated discharge pathway)	30, 45, and 60 mg hyperbaric chloroprocaine ± epinephrine	T8 (T10-T6), T4 (T11–C6), T1 (T8–C5)^* T7 (L3-T2), T5 (T10-T1), T2 (T6-C5) (T6-C5)^a	40±15 min, 72±21 min, 71±12 min^* 37±11 min, 42±II min, 62± I0 min^a	47±3 min, 52±17 min, 57±3 min 47±8 min, 45±3 min, 43±5 min^a	153±25 min, 162±33 min, 148±29 min^* 98±20 min, 116± 15 min, 132±23 min^a	60±65 min, 88±43 min, 80±26 min^* 43±26 min, 56±9 min, 78±16 min^a	90±30 min, 131 ±46 min, 120±30 min^* 72± 12 min, 88±15 min, 100± 13 min^a	158±33 min, 162±33 min, 151 ±33 min^* 100±20 min, 119± 15 min, 133±20 min^a	167±47 min, 161 ±33 min, 164±24 min^* 100±21 min, 132± 19 min, 141 ±21 min^a	Nonspecific flu-like symptoms, radiating back pain (2 pt), non-radiating low back ache (4 pt) after 2-CP and epinephrine non-radiating low back pain (1 pt) after 2-CP
Vath and Kopacz, 2004^Citation24	8 healthy volunteers Age 37±13 years (clinical endpoints^v and simulated discharge pathway)	40 mg chloroprocaine ±20 μg fentanyl	T5 (T7-T3)^* vs T8 (L1-T4)	51±8 min^* vs 34± 14 min	48±8 min vs 45±16 min	104±7 min^* vs 95±9 min	61 ± 11 min vs 49±10 min	81±16 min^* vs 67± 13 min	104±7 min^* vs 95±9 min	104±7 min^* vs 95±9 min	Itching (no treatment required) when fentanyl was used
Warren and Kopacz, 2004^Citation25	8 healthy volunteers Age 21–48 years (clinical endpoints^v and simulated discharge pathway)	40 mg chloroprocaine with 0.25 mL 10% dextrose or 0.25 mL saline	T3 (T7-C6) vs T4 (T7-C7)	45±7 min vs 42± 11 min	40±10 min vs 47±8 min	95±8 min vs 96±9 min	64± 12 min vs 60±19 min	80± 14 min vs 81 ± 15 min	96±7 min vs 96±9 min	101 ±7 min vs 96±9 min	Greater residual bladder volumes in the dextrose group
Kopacz, 20 05^Citation38	8 healthy volunteers Age 40±11 years (clinical endpoints^v and simulated discharge pathway)	10 mg vs 20 mg chloroprocaine	LI (T8-L4) vs T9 (T4-L1)	7±6 min vs 22±9 min	40±18 min vs 37± 12 min	49±10 min^* vs 72± 11 min	NA	16± 15 min^* vs 48±7 min	44± 19 min^* vs 73 ±9 min	50± 10 min^* vs 73±9 min	No TNS
Davis and Kopacz, 2005^Citation26	8 healthy volunteers Age 27-60 years (clinical endpoints^v and simulated discharge pathway)	30 mg chloroprocaine ±15 μg clonidine	T8 (T4-T11) vs T8 (T6-L2)	46±11 min vs 33± I2 min	50±9 min vs 50±22 min	131±15 min^* vs 99±18 min	NA	79± 19 min^* vs 65± 13 min	131 ± 15 min^* vs 99± 18 min	131 ± 15 min^* vs 99± 18 min	No TNS
Yoos and Kopacz, 2005^Citation29	122 patients Age 55±16 years variety of surgical procedures	Chloroprocaine 20-60 mg ± 10-20 μg fentanyl (rarely dextrose or water)	Peak T6-T8. More than T10 in all patients	NA	NA	NA	NA	NA	155±35 min	207.9±69.4 min (discharge)	11 patients complained of nausea in the PACU No TNS
Yoos and Kopacz, 2005^Citation29	8 healthy volunteers Age 38±7 years (clinical endpoints^v and simulated discharge pathway)	Chloroprocaine 40 mg vs bupivacaine 7.5 mg	T7 (T3-T10) vs T9 (T4-L1)	NA	45±20 min^* vs 74±20 min	113±14 min^* vs 191 ±30 min	NA	81 ± 15 min^* vs 138±24 min^¶	113± 14 min^* vs 191 ±30 min	113± 14 min^* vs 191 ±32 min	No TNS
Gonter and Kopacz, 2005^Citation28	Healthy volunteers Age 42±11 years (clinical endpoints^v and simulated discharge pathway)	Chloroprocaine 30 mg vs procaine 80 mg	T9 (T6-T12) vs T6 (T4-T8)	37±16 min vs 49±17 min	51 ±17 min vs 53±10 min	103±12 min^* vs 151 ±26 min	NA	54±23 min vs 55±44 min	103± 12 min^* vs 151 ±26 min	103± 12 min^* vs 156±23 min	Pruritus in 1 patient and dysphoria in 1 patient (both in the procaine group)
Casati et al, 2006^Citation39	45 ASA I-II outpatients Age 59±13, 56± 14, 48±16 years^b Lower limb surgery	Chloroprocaine 30, 40, and 50 mg	NA	NA	NA	60 (41-98) min,^* 85 (46-141) min, 97 (60-I69) min^b	NA	NA	85 (45-198) min,^* 180 (72-281) min, 185 (90-355) min^b	182 (120-267) min, 198 (123-271) min, 203 (102-394) min^b	No TNS
Casati et al, 2007^Citation40	30 ASA patients Age 18-70 years Knee arthroscopy	Chloroprocaine 50 mg vs lidocaine 50 mg	NA	NA	NA	120 (80-175) min^* vs 95 (68-170) min	NA	100 (60-140) min^* vs 60 (45-120) min	152 (100-185) min^* vs 103 (70-191) min	190 (148-340) min vs 180 (100-354) min	TNS in 33% of patients in the lidocaine group. No TNS with chloroprocaine
Sell et al, 2008^Citation37	64 ASA I-III patients Age 18-80 years Lower limb surgery	Chloroprocaine 35, 40, 45, and 50 mg	T9 in all groups	NA	NA	111 (96-126) min,^* 108 (95-121) min,^* 128 (116-138) min, 134 (123-145) min^c	NA	106 (91-121) min, 100 (99-123) min, 111 (99-123) min, 119 (I02-I37) min^c	117 (103-131) min,^* 116 (103-130) min,^* 127 (106-148) min, 144 (128-161) min^c	123 (108-138) min,^* 122 (109-135) min,^* 137 (124-149) min, 165 (141-189) min^c	No TNS
Lacasse et al, 2011^Citation44	106 ASA I-III patients Age > 18 years Short ambulatory procedures	Chloroprocaine 40 mg vs bupivacaine 7.5 mg	T7 (T1-T10) vs T7 (T1-T11)	NA	50±18 min^* vs 75±37 min	146±38 min^* vs 329±82 min	NA	76±25 min^* vs 119±93 min	225±56 min^* vs 265±65 min	271±96 min^* vs 338±99 min	1 post-dural puncture headache per group, 1 TNS per group, 45% back ache after 2-CP and 38% after bupivacaine
Forster et al, 2011^Citation13	70 ASA I-II patients Age ≤65 years Day-case knee arthroscopy	Chloroprocaine 40 mg vs articaine 60 mg	T10 (T12-T6) vs T10 (T11-T5)	NA	60 (45-75) min vs 60 (45-75) min	105 (105-135) min^* vs 165 (135-180) min	NA	75 (60/90) min^* vs 135 (105/150) min	318±74.2 min vs 392±93.2 min^^	204±61.8 min vs 219±71.6 min^^	No TNS
Vaghadia et al, 2012^Citation41	40 ASA I-III patients Age 59-78 years TURP	Chloroprocaine 40 mg + 12.5 μg fentanyl vs 35 mg lidocaine + 12.5 μg fentanyl	T8 in both groups	NA	NA	155±55 min vs 163±37 min	81±41 min 71±41 min	117±36 min 120±35 min	NA	NA	4 patients developed TNS with lidocaine 1 patient developed cauda equina syndrome after chloroprocaine fully recovered after some weeks
Forster et al, 2013^Citation43	36 ASA I-III patients Age 18-70 years Day-case knee surgery	Chloroprocaine 40 mg vs articaine 40 mg	T8 (T10-T7) vs T8 (T12-T6)	NA	60 (45-60) min^* vs 75 (49-75) min	105 (90-124) min^* vs 135 (109-176) min	NA	75 (71/90) min^* vs 105 (94/120) min	NA	171 (163/197) min vs 236 (152/279) min	5 patients had PONV in both groups on first POD 1 patient had PONV after articaine vs 4 patients after chloroprocaine on POD 7 2 patients after articaine vs 3 after chloroprocaine had non-PDPH on POD 1 3 patients after articaine vs I patient after chloroprocaine had non-PDPH on POD 7 1 patient showed TNS after articaine on POD 1
Breebart et al, 2014^Citation42	100 ASA I-II patients Age, mean (SD): 44 (12); 46 (14); 43 (12); 51 (12) years^d Knee arthroscopy	Lidocaine 60 mg ±500 mL iv preload (lidocaine+; lidocaine–)Chloroprocaine 40 mg ±500 mL iv preload (CP+; CP-)	T5, T5, T7, T7^d	NA	NA	I40 (46) min,^Table Footnote# 129 (37) min,^Table Footnote# 92 (25) min,^Table Footnote#Table Footnote* 86 (21) min,^Table Footnote#,Table Footnote*Table Footnoted	NA	95 (26) min,^Table Footnote# 94 (10) min,^Table Footnote# 65 (20) min,^Table Footnote#·Table Footnote* 62 (20) min,^Table Footnote#,Table Footnote*,d	NA	210 (55) min, 205 (58) min, 161 (36) min,^* 175 (51) min^d	1 patient complained of TNS after lidocaine
Camponovo et al, 2014^Citation45	130 ASA I-II patients Age 18-80 years Lower abdominal or lower limb procedures (T10 level required)	Chloroprocaine 50 mg vs bupivacaine 10 mg	T10 (T10-T3) vs T10 (T10-T2)	NA	NA	105 (60-194) min^* vs 225 (130—442) min	NA	100 (40-194) min^* vs 210 (120-415) min	142.5 (86-454) min^* vs 290.5 (190-490) min	NA	1 patient experienced foot cramps after bupivacaine 1 patient reported non-PDPH after bupivacaine 1 patient reported injection site pain after bupivacaine No TNS was reported

Notes: Data are shown as mean ± standard deviation or median (25th–75th percentiles), unless stated otherwise.

* Significant versus other treatment/group.

# Regression to L2.

¶ Gastrocnemius dynamometry (90% of baseline) (minutes).

^ Time to hospital discharge.

a The first three rows of data are results for hyperbaric chloroprocaine 30, 45 and 60 mg with epinephrine, and the next three rows of data are results for 30, 45 and 60 mg without epinephrine.

b The three rows or items of data are the results for chloroprocaine 30, 40, and 50 mg, respectively.

c The four rows of data are the results for chloroprocaine 35, 40, 45, and 50 mg, respectively.

d The four rows or items of data are the results for lidocaine+, lidocaine−, CP+, and CP−, respectively.

Abbreviations: 2-CP, 2-chloroprocaine; ASA, American Society of Anesthesiologists; CP, chloroprocaine; CP+, chloroprocaine with iv preload; CP−, chloroprocaine without iv preload; iv, intravenous; min, minutes; lidocaine+, lidocaine with iv preload; lidocaine–, lidocaine without iv preload; NA, not available; PACU, post-anesthesia care unit; PDPH, post-dural puncture headache; POD, postoperative day; PONV, postoperative nausea and vomiting; pt, patient(s); TNS, transient neurological symptoms; TURP, transurethral resection of the prostate.

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