Does spinal chloroprocaine pharmacokinetic profile actually translate into a clinical advantage in terms of clinical outcomes when compared to low-dose spinal bupivacaine? A systematic review and meta-analysis

Andrea Saporito, Marcello Ceppi, Andreas Perren, Davide La Regina, Stefano Cafarotti, Alain Borgeat, José Aguirre, Marc Van De Velde, An Teunkens

Research output: Contribution to journalReview article

Abstract

Study objective: Spinal anesthesia is well suited for day-care surgery, however a persisting motor block after surgery can delay discharge. Among the new drugs available, chloroprocaine has been associated with a short onset time, and motor block duration and a quicker discharge. However, it is not clear if those outcomes are clinically significantly superior compared to those associated with the use of low-dose hyperbaric bupivacaine. Design: Aim of the study was to determine if spinal 2-chloroprocaine was superior to low-dose spinal bupivacaine regarding the following outcomes: onset time, block duration, time to ambulation and time to discharge. Patients/interventions: We performed a systematic literature search of the last 30 years using PubMed Embase and the Cochrane Controlled Trials Register. We included only blinded, prospective trials comparing chloroprocaine with a low dose of bupivacaine for spinal anesthesia. Low dose bupivacaine was defined as a dose of 10 mg or less. Outcomes of interest were time to motor block regression (primary outcome), time to ambulation and time to discharge (secondary outcomes), as indirect indicators of a complete recovery after spinal anesthesia. Main results: Compared to a low dose bupivacaine, spinal 2-chloroprocaine was associated with significantly faster motor and sensory block regression (pMD = −57 min–140.3 min; P = 0.015 and <0.001 respectively), a significantly shorter time to ambulation and an earlier discharge (pMD = −84.6 min; P < 0.001 and pMD = −88.6 min and <0.001 respectively). Onset time did not differ between the two drugs (pMD = −1.1 min; P = 0.118). Conclusions: Spinal 2-chloroprocaine has a shorter motor block duration, a significantly quicker time to ambulation and time to discharge compared to low dose hyperbaric bupivacaine and may be advantageous when spinal anesthesia is performed for day case surgery.

Original languageEnglish
Pages (from-to)99-104
Number of pages6
JournalJournal of Clinical Anesthesia
Volume52
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Ambulatory surgery
  • Chloroprocaine
  • Fast-track surgery
  • Spinal anesthesia

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Fingerprint Dive into the research topics of 'Does spinal chloroprocaine pharmacokinetic profile actually translate into a clinical advantage in terms of clinical outcomes when compared to low-dose spinal bupivacaine? A systematic review and meta-analysis'. Together they form a unique fingerprint.

  • Cite this