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Dan J Kopacz - One of the best experts on this subject based on the ideXlab platform.
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Spinal 2-Chloroprocaine: a comparison with lidocaine in volunteers.
Anesthesia & Analgesia, 2004Co-Authors: Mary E Kouri, Dan J KopaczAbstract:Subarachnoid lidocaine has been the anesthetic of choice for outpatient spinal anesthesia. However, its use is associated with transient neurologic symptoms (TNS). Preservative-free formulations of 2-Chloroprocaine are now available and may compare favorably with lidocaine for spinal anesthesia. In this double-blinded, randomized, crossover study, we compared spinal Chloroprocaine and lidocaine in 8 volunteers, each receiving 2 spinal anesthetics: 1 with 40 mg 2% lidocaine and the other with 40 mg 2% preservative-free 2-Chloroprocaine. Pinprick anesthesia, tolerance to transcutaneous electrical stimulation and thigh tourniquet, motor strength, and a simulated discharge pathway were assessed. Chloroprocaine produced anesthetic efficacy similar to lidocaine, including peak block height (T8 [T5-11] versus T8 [T6-12], P = 0.8183) and tourniquet tolerance (46 +/- 6 min versus 38 +/- 24 min, P = 0.4897). Chloroprocaine anesthesia resulted in faster resolution of sensory (103 +/- 13 min versus 126 +/- 16 min, P = 0.0045) and more rapid attainment of simulated discharge criteria (104 +/- 12 min versus 134 +/- 14 min, P = 0.0007). Lidocaine was associated with mild to moderate TNS in 7 of 8 subjects; no subject complained of TNS with Chloroprocaine (P = 0.0004). We conclude that the anesthetic profile of Chloroprocaine compares favorably with lidocaine. Reliable sensory and motor blockade with predictable duration and minimal side effects make Chloroprocaine an attractive choice for outpatient spinal anesthesia. The spinal anesthetic profile of Chloroprocaine (40 mg) compares favorably with the same dose of spinal lidocaine. Reliable sensory and motor blockade with predictable duration and minimal side effects and without signs of transient neurological symptoms make Chloroprocaine an attractive choice for outpatient spinal anesthesia.
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spinal Chloroprocaine solutions density at 37 c and ph titration
Anesthesia & Analgesia, 2004Co-Authors: Dan J KopaczAbstract:UNLABELLED The density and pH of a local anesthetic are important characteristics in its use as an intrathecal drug. Preservative- and antioxidant-free formulations of Chloroprocaine are available and are being investigated for short-duration spinal anesthesia. In this study, we evaluated the pH and density (to 5 significant digits in g/mL, at 37.0 degrees C) of these new Chloroprocaine formulations. In addition to plain 2% and 3% Chloroprocaine and 2% lidocaine, mixed solutions of 2% Chloroprocaine with epinephrine or with bicarbonate were evaluated. Density was also measured after water dilution and after increasing amounts of added dextrose. Chloroprocaine, 2% or 3%, is hyperbaric relative to cerebrospinal fluid (CSF) before any addition of dextrose (density 1.00123 g/mL and 1.00257 g/mL, respectively). When diluted with water, all the solutions are hypobaric relative to CSF (density <1.00028 g/mL). Plain 2% lidocaine is the only dextrose-free solution measured to be hypobaric (density 1.00004 g/mL). Bisulfite-free 2-Chloroprocaine remains very acidic (pH <4.0), but the pH can be increased to more than 7.0 with a small amount of bicarbonate (0.25-0.33 mL/10 mL). The increased density of plain Chloroprocaine makes it a useful hyperbaric spinal drug without the addition of dextrose. IMPLICATIONS Dextrose-free 2-Chloroprocaine is hyperbaric relative to cerebrospinal fluid at 37 degrees C, and therefore can be used for spinal anesthesia without dextrose. Bisulfite-free 2-Chloroprocaine remains very acidic (pH <4.0). The pH can be increased to more than 7.0 with a small amount of bicarbonate (0.25-0.33 mL/10 mL).
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Spinal Chloroprocaine Solutions: Density at 37?? C and pH Titration
Anesthesia & Analgesia, 2004Co-Authors: Dan J KopaczAbstract:UNLABELLED The density and pH of a local anesthetic are important characteristics in its use as an intrathecal drug. Preservative- and antioxidant-free formulations of Chloroprocaine are available and are being investigated for short-duration spinal anesthesia. In this study, we evaluated the pH and density (to 5 significant digits in g/mL, at 37.0 degrees C) of these new Chloroprocaine formulations. In addition to plain 2% and 3% Chloroprocaine and 2% lidocaine, mixed solutions of 2% Chloroprocaine with epinephrine or with bicarbonate were evaluated. Density was also measured after water dilution and after increasing amounts of added dextrose. Chloroprocaine, 2% or 3%, is hyperbaric relative to cerebrospinal fluid (CSF) before any addition of dextrose (density 1.00123 g/mL and 1.00257 g/mL, respectively). When diluted with water, all the solutions are hypobaric relative to CSF (density
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Spinal 2-Chloroprocaine: the effect of added dextrose.
Anesthesia & Analgesia, 2004Co-Authors: Daniel T. Warren, Dan J KopaczAbstract:Spinal 2-Chloroprocaine is being investigated as an alternative short-acting spinal anesthetic to replace lidocaine for outpatient surgery. Adding dextrose increases the baricity of solutions and alters the characteristics of spinal anesthesia. In this study, we compared 2-Chloroprocaine spinal anes
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Spinal 2-Chloroprocaine: the effect of added fentanyl.
Anesthesia & Analgesia, 2004Co-Authors: Julie S. Vath, Dan J KopaczAbstract:Chloroprocaine is being investigated as a possible replacement for spinal lidocaine. Adding fentanyl to lidocaine increases the quality of spinal anesthesia without prolongation of block. We report the characteristics of 2-Chloroprocaine (2-CP) spinal anesthesia with or without fentanyl in 8 volunte
Jacques T. Yadeau - One of the best experts on this subject based on the ideXlab platform.
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Chloroprocaine Provides Safe, Effective, Short-Acting Spinal Anesthesia Ideal for Ambulatory Surgeries: A Retrospective Review
HSS Journal ®, 2019Co-Authors: David H. Kim, Richard L. Kahn, Andrew G. Lee, Phuong Dinh Mac, Yu-fen Chiu, Jacques T. Yadeau, Jiabin LiuAbstract:The ideal local anesthetic for use in ambulatory spinal anesthesia is safe, with minimal adverse effects, and of a duration that does not impede post-anesthesia care unit (PACU) discharge. Since its approval for use in spinal anesthesia in Europe in 2012, Chloroprocaine has seen a resurgence. Recent studies have investigated the safety and efficacy of preservative-free Chloroprocaine for use in spinal anesthesia, but few provide the incidence of adverse events such as urinary retention and transient neurologic symptoms. We sought to assess the safety of Chloroprocaine for spinal anesthesia, including the incidence of adverse events and the duration and quality of its use, in the initial 6 months of its use at our institution. We hypothesized that Chloroprocaine would provide effective spinal anesthesia for orthopedic cases of short duration, with a low rate of complications. We conducted a retrospective chart review of all patients from June to December 2016 at our institution who had ambulatory knee arthroscopy or foot procedures in which Chloroprocaine spinal anesthesia was used. For all 445 charts analyzed, data were collected on anesthesia characteristics, office visits, nursing PACU assessment, and nursing post-operative day 1 follow-up phone calls. The median Chloroprocaine dosage was 44 mg (interquartile range [IQR], 40 to 50). The median duration of sensory block was 156 min (IQR, 128 to 189) and of motor block was 148 min (IQR, 123 to 181). Time to ambulation was 186 min (IQR, 158 to 218) and time to meeting of discharge criteria was 218 min (IQR, 189 to 250). The most common adverse events in the PACU were bradycardia and hypotension. No patients had urinary retention or transient neurologic symptoms. In 6 months of use at our institution, Chloroprocaine provided safe and effective spinal anesthesia for short orthopedic procedures, with no incidence of transient neurologic symptoms, neuropraxia, or urinary retention.
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Chloroprocaine Provides Safe, Effective, Short-Acting Spinal Anesthesia Ideal for Ambulatory Surgeries: A Retrospective Review
HSS Journal ®, 2019Co-Authors: Richard Kahn, Yu-fen Chiu, Jacques T. YadeauAbstract:Background The ideal local anesthetic for use in ambulatory spinal anesthesia is safe, with minimal adverse effects, and of a duration that does not impede post-anesthesia care unit (PACU) discharge. Since its approval for use in spinal anesthesia in Europe in 2012, Chloroprocaine has seen a resurgence. Recent studies have investigated the safety and efficacy of preservative-free Chloroprocaine for use in spinal anesthesia, but few provide the incidence of adverse events such as urinary retention and transient neurologic symptoms. Questions/Purposes We sought to assess the safety of Chloroprocaine for spinal anesthesia, including the incidence of adverse events and the duration and quality of its use, in the initial 6 months of its use at our institution. We hypothesized that Chloroprocaine would provide effective spinal anesthesia for orthopedic cases of short duration, with a low rate of complications. Methods We conducted a retrospective chart review of all patients from June to December 2016 at our institution who had ambulatory knee arthroscopy or foot procedures in which Chloroprocaine spinal anesthesia was used. For all 445 charts analyzed, data were collected on anesthesia characteristics, office visits, nursing PACU assessment, and nursing post-operative day 1 follow-up phone calls. Results The median Chloroprocaine dosage was 44 mg (interquartile range [IQR], 40 to 50). The median duration of sensory block was 156 min (IQR, 128 to 189) and of motor block was 148 min (IQR, 123 to 181). Time to ambulation was 186 min (IQR, 158 to 218) and time to meeting of discharge criteria was 218 min (IQR, 189 to 250). The most common adverse events in the PACU were bradycardia and hypotension. No patients had urinary retention or transient neurologic symptoms. Conclusions In 6 months of use at our institution, Chloroprocaine provided safe and effective spinal anesthesia for short orthopedic procedures, with no incidence of transient neurologic symptoms, neuropraxia, or urinary retention.
Himat Vaghadia - One of the best experts on this subject based on the ideXlab platform.
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Selective spinal anesthesia for outpatient transurethral prostatectomy (TURP): randomized controlled comparison of Chloroprocaine with lidocaine.
Acta Anaesthesiologica Scandinavica, 2012Co-Authors: Himat Vaghadia, G. Neilson, Pamela H. LennoxAbstract:Background This is a study comparing two short-acting local anesthetics lidocaine and 2-Chloroprocaine in combination with fentanyl, to provide selective spinal anesthesia for outpatient transurethral resection of the prostate (TURP). Methods In this prospective, randomized double-blind study, selective spinal anesthesia was performed in 40 American Society of Anesthesiologists I-III outpatients undergoing TURP using either 40 mg of Chloroprocaine mixed with 12.5 μg of fentanyl (n = 20) or 35 mg of lidocaine mixed with 12.5 μg of fentanyl (n = 20). The primary outcome was duration of spinal block. Secondary outcomes were time to reach T10 (onset), time to maximal level, duration above T10 and lidocaine 3, maximal level of block, and adverse effects. Results The median (minimum, maximum) onset time was 4 (1, 16) and 3 (2, 10) min for Chloroprocaine and lidocaine, respectively. Time to maximal level was 20 (17, 29) and 22 (16, 26) min for Chloroprocaine and lidocaine, respectively. Mean maximal level was T7-T8 for both agents. Duration of block above T10 was 54 (28, 88) and 63 (31, 87) min for Chloroprocaine and lidocaine, respectively. Duration of block above lidocaine 3 was 93 (56, 218) and 98 (58, 151) min for Chloroprocaine and lidocaine, respectively. There was no statistical difference between the two groups with respect to these clinical end points. Four patients in the lidocaine group developed transient neurological symptoms. One patient in the Chloroprocaine group developed a cauda equina-like syndrome but recovered fully after several weeks. Conclusions Selective spinal anesthesia with Chloroprocaine and lidocaine for TURP yielded comparable results for clinical characteristics. Further research on transient neurological symptom and cauda equina risk with Chloroprocaine is warranted.
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non alkalinized and alkalinized 2 Chloroprocainevs lidocaine for intravenous regional anesthesia during outpatient hand surgery
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1999Co-Authors: Patrick A Lavin, Cynthia Henderson, Himat VaghadiaAbstract:Purpose Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-Chloroprocaine 0.5% with lidocaine for IVRA.
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Non-alkalinized and alkalinized 2-Chloroprocainevs lidocaine for intravenous regional anesthesia during outpatient hand surgery
Canadian Journal of Anaesthesia, 1999Co-Authors: Patrick A Lavin, Cynthia L. Henderson, Himat VaghadiaAbstract:Purpose Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-Chloroprocaine 0.5% with lidocaine for IVRA. Methods In two separate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-Chloroprocaine 0.5%, alkalinized 2-Chloroprocaine 0.5% or lidocaine 0.5% for IVRA. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared. Results There was no difference in time to sensory or motor block in either group. Patients who received plain Chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine ( P < 0.05). Comparing alkalinized Chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives. Conclusion In conclusion, alkalinized Chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain Chloroprocaine for IVRA produced more minor side effects than lidocaine. Objectif La Chloroprocaine est un agent idéal pour l’anesthésie régionale intraveineuse (ARIV) étant donné sa rapidité d’action et l’hydrolyse des esters. En élevant le pH des anesthésiques locaux, on peut accélérer le début de l’action et augmenter l’intensité des blocages nerveux. Nous avons comparé la 2-chloroprocaïne simple 0,5 % et alcalinisée avec la lidocaïne pour une ARIV. Méthode Il y a eu deux études séparées , à double insu, auprès de 78 patients dont l’opération d’une main avait été prévue en chirurgie d’un jour et qui ont été répartis au hasard afin de recevoir 40 mL de 2-chloroprocaïne simple 0,5%, ou alcalinisée, ou de la lidocaïne 0,5% pour une ARIV. Le temps nécessaire pour atteindre le blocage sensitif et moteur, les besoins d’analgésie supplémentaire et les effets secondaires ont été comparés. Résultats Il n’y a pas eu de différence intergroupe quant au temps nécessaire au blocage sensitif et moteur. Les patients qui ont reçu la chloroprocaïne simple ont demandé plus d’opioïdes supplémentaires et ont présenté une plus forte incidence de goût métallique et d’urticaire que les patients qui ont reçu la lidocaïne ( P < 0,05). Par contre, il n’y a pas eu de différence intergroupe entre les patients qui ont reçu la chloroprocaïne alcalinisée et ceux qui ont reçu la lidocaïne. Conclusion La chloroprocaïne alcalinisée a été jugée efficace comme agent d’ARIV, mais n’a pas présenté d’avantage par rapport à la lidocaïne. La chloroprocaïne simple a produit plus d’effets secondaires mineurs que la lidocaïne.
M A De Leeuw - One of the best experts on this subject based on the ideXlab platform.
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esra19 0571 Chloroprocaine versus prilocaine for spinal anaesthesia in ambulatory knee arthroscopy a double blind randomised trial
Regional Anesthesia and Pain Medicine, 2019Co-Authors: Elsbeth J Wesselink, G Van Den Hurk, R Van Der Vegt, Cornelis Slagt, J Van Der Aa, Christa Boer, M A De Leeuw, P Van De VenAbstract:Background and aims In ambulatory lower limb surgery, spinal anaesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-Chloroprocaine would be associated with a faster full recovery from motor block compared to prilocaine. a difference of 15 minutes was considered as clinically relevant. Methods 150 patients were randomly allocated to receive either spinal 40 mg 2-Chloroprocaine or 40 mg prilocaine. Primary outcome was the time to complete recovery from motor blockade. Secondary outcome parameters included time to full regression of sensory block, peak sensory block level, urine retention needing catheterisation, time until hospital discharge, TNS and patient satisfaction. Results Time to complete recovery from motor blockade was 15 minutes shorter for 2-Chloroprocaine (median: 60 min; interquartile range (IQR) 60–82.5) than for prilocaine (median: 75 min; IQR 60–90; p = 0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared to 165 min; IQR: 135–190, p Conclusions In knee arthroscopy, spinal anaesthesia with 2-Chloroprocaine results in sufficient anaesthesia with a faster recovery of motor and sensory block, leading to quicker hospital discharge compared to prilocaine.
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Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy a double blind randomized trial
Regional Anesthesia and Pain Medicine, 2019Co-Authors: Elsbeth J Wesselink, R Van Der Vegt, Cornelis Slagt, J Van Der Aa, Christa Boer, P Van De Ven, Godelief Janssenvan Den Hurk, Eric Franssen, Noortje Swart, M A De LeeuwAbstract:Background In ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-Chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant. Methods 150 patients were randomly allocated to receive intrathecally either 40 mg of 2-Chloroprocaine or 40 mg of prilocaine. The primary outcome was the time to complete recovery from motor blockade. Secondary outcomes included time to full regression of sensory block, peak sensory block level, urine retention needing catheterization, time until hospital discharge, incidence of transient neurologic symptoms and patient satisfaction. Results Time to complete recovery from motor blockade was 15 min shorter for 2-Chloroprocaine (median: 60 min; IQR: 60–82.5) than for prilocaine (median: 75 min; IQR: 60–90; p=0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared with median: 165 min; IQR: 135–190, p Conclusions In knee arthroscopy, spinal anesthesia with 2-Chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine. Trial registration number NTR6796.
P Van De Ven - One of the best experts on this subject based on the ideXlab platform.
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esra19 0571 Chloroprocaine versus prilocaine for spinal anaesthesia in ambulatory knee arthroscopy a double blind randomised trial
Regional Anesthesia and Pain Medicine, 2019Co-Authors: Elsbeth J Wesselink, G Van Den Hurk, R Van Der Vegt, Cornelis Slagt, J Van Der Aa, Christa Boer, M A De Leeuw, P Van De VenAbstract:Background and aims In ambulatory lower limb surgery, spinal anaesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-Chloroprocaine would be associated with a faster full recovery from motor block compared to prilocaine. a difference of 15 minutes was considered as clinically relevant. Methods 150 patients were randomly allocated to receive either spinal 40 mg 2-Chloroprocaine or 40 mg prilocaine. Primary outcome was the time to complete recovery from motor blockade. Secondary outcome parameters included time to full regression of sensory block, peak sensory block level, urine retention needing catheterisation, time until hospital discharge, TNS and patient satisfaction. Results Time to complete recovery from motor blockade was 15 minutes shorter for 2-Chloroprocaine (median: 60 min; interquartile range (IQR) 60–82.5) than for prilocaine (median: 75 min; IQR 60–90; p = 0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared to 165 min; IQR: 135–190, p Conclusions In knee arthroscopy, spinal anaesthesia with 2-Chloroprocaine results in sufficient anaesthesia with a faster recovery of motor and sensory block, leading to quicker hospital discharge compared to prilocaine.
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Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy a double blind randomized trial
Regional Anesthesia and Pain Medicine, 2019Co-Authors: Elsbeth J Wesselink, R Van Der Vegt, Cornelis Slagt, J Van Der Aa, Christa Boer, P Van De Ven, Godelief Janssenvan Den Hurk, Eric Franssen, Noortje Swart, M A De LeeuwAbstract:Background In ambulatory lower limb surgery, spinal anesthesia with rapid onset and a short duration of block is preferable. We hypothesized that the use of 2-Chloroprocaine would be associated with a faster motor block recovery compared with prilocaine in knee arthroscopy. A difference of 15 min was considered clinically relevant. Methods 150 patients were randomly allocated to receive intrathecally either 40 mg of 2-Chloroprocaine or 40 mg of prilocaine. The primary outcome was the time to complete recovery from motor blockade. Secondary outcomes included time to full regression of sensory block, peak sensory block level, urine retention needing catheterization, time until hospital discharge, incidence of transient neurologic symptoms and patient satisfaction. Results Time to complete recovery from motor blockade was 15 min shorter for 2-Chloroprocaine (median: 60 min; IQR: 60–82.5) than for prilocaine (median: 75 min; IQR: 60–90; p=0.004). 2-Chloroprocaine also resulted in faster full regression of sensory block (median: 120 min; IQR: 90–135 compared with median: 165 min; IQR: 135–190, p Conclusions In knee arthroscopy, spinal anesthesia with 2-Chloroprocaine results in a faster recovery of motor and sensory block, leading to quicker hospital discharge compared with prilocaine. Trial registration number NTR6796.