Intrathecal 2-Chloroprocaine 3% Versus Hyperbaric Bupivacaine 0.75% for Cervical Cerclage: A Double-Blind Randomized Controlled Trial
Intrathecal 2-Chloroprocaine 3% Versus Hyperbaric Bupivacaine 0.75% for Cervical Cerclage: A Double-Blind Randomized Controlled Trial
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DOI：
10.1213/ane.0000000000005653
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发表时间：
2022-03-01
影响因子：
5.7
通讯作者：
Smiley, Richard
中科院分区：
文献类型：
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作者：
Lee, Allison;Shatil, Ben;Smiley, Richard
背景：宫颈环扎术是一种短期的门诊手术。对于脊髓麻醉，需要术后快速消退的局部麻醉剂。我们假设，与芬太尼联合使用，鞘内注射 2-氯普鲁卡因会更早解决运动阻滞，从而比高压布比卡因更短地达到恢复室出院标准。 方法：在脊髓麻醉下接受宫颈环扎术的女性被随机接受鞘内注射 2-氯普鲁卡因 3% 50 mg 或高压布比卡因 0.75% 9 mg，两者均联合芬太尼15亩克。剂量是凭经验选择的。监测感觉和运动阻滞的发生和缓解以及达到恢复室出院标准的时间。术后第一天，患者评价对麻醉的满意度，并报告短暂的神经系统症状 (TNS)、背痛或头痛。主要结果是从脊髓注射到运动阻滞缓解的时间。主要次要结局包括从脊柱注射到 (i) T12 皮节水平、(ii) 感觉阻滞消退和 (iii) 行走和排尿能力的时间。 结果：43 名女性被纳入并随机分为氯普鲁卡因组 (N = 23) 或布比卡因组 (N = 20)。手术的平均（标准差 [SD]）持续时间为 35.3（11.4）分钟。各组之间运动阻滞缓解时间没有差异 - 布比卡因组 (N = 17) 的中位[四分位距]时间为 112 [97-143] 分钟，而氯普鲁卡因组 (N = 22) 为 109 [88-148] 分钟，P = .66，但感觉阻滞缓解的中位时间存在显着差异：143 [116-162] 分钟氯普鲁卡因组与布比卡因组 198 [152-263] 分钟相比，P = .002。氯普鲁卡因组提前 76 分钟（95% CI，33-145）达到恢复室出院标准，其中包括能够独立行走和排尿，P < 0.0005。高压布比卡因发生 1 例完全阻滞失败，每组 2 名受试者因术中不适而接受治疗。没有患者报告 TNS。结论：鞘内注射 3% 2-氯普卡因为环扎术提供同样有效的手术麻醉。尽管组间运动阻滞缓解时间没有差异，但接受氯普鲁卡因治疗的患者的感觉阻滞缓解时间和达到康复室出院标准的时间均显着短于接受布比卡因治疗的患者。未来的研究需要确定和比较氯普鲁卡因和布比卡因的等效剂量，以确认氯普鲁卡因在这种门诊产科手术中的优越性。
BACKGROUND: Cervical cerclage is a short ambulatory procedure. For spinal anesthesia, local anesthetic agents with rapid postoperative resolution are desired. We hypothesized that in combination with fentanyl, intrathecal 2-chloroprocaine would produce earlier resolution of motor block, resulting in shorter time to meet recovery room discharge criteria than hyperbaric bupivacaine.METHODS: Women undergoing cervical cerclage with spinal anesthesia were randomized to receive intrathecal 2-chloroprocaine 3% 50 mg or hyperbaric bupivacaine 0.75% 9 mg, both with fentanyl 15 mu g. Doses were empirically selected. The onset and resolution of sensory and motor blockade and time to achieve recovery room discharge criteria were monitored. On postoperative day 1, patients rated their satisfaction with the anesthetic and reported on transient neurologic symptoms (TNS), back pain, or headache. The primary outcome was time from spinal injection to motor block resolution. The main secondary outcomes included times from spinal injection to (i) T12 dermatomal level, (ii) sensory block resolution, and (iii) ability to ambulate and void.RESULTS: Forty-three women were enrolled and randomized to either the chloroprocaine (N = 23) or bupivacaine group (N = 20). The mean (standard deviation [SD]) duration of surgery was 35.3 (11.4) minutes. There was no difference between groups for time to motor block resolution-the median [interquartile range] time for the bupivacaine group (N = 17) was 112 [97-143] minutes versus 109 [88-148] minutes in the chloroprocaine group (N = 22), P = .66, but there was a significant difference in median time to sensory block resolution: 143 [116-162] minutes in the chloroprocaine group versus 198 [152-263] minutes in the bupivacaine group, P = .002. The recovery room discharge criteria, which at our institution include the ability to ambulate unassisted and void urine, were met 76 (95% CI, 33-145) minutes earlier in the chloroprocaine group, P < .0005. One complete block failure occurred with hyperbaric bupivacaine and 2 subjects in each group received treatment for intraoperative discomfort. No patients reported TNS.CONCLUSIONS: Intrathecal 2-chloropocaine 3% provided similarly effective surgical anesthesia for cerclage placement. Although no difference in time to motor block resolution between groups was observed, the time to sensory block resolution and time to meet recovery room discharge criteria were both significantly shorter among patients who received chloroprocaine than patients who received bupivacaine. Future studies are needed to identify and compare equipotent doses of chloroprocaine and bupivacaine to confirm the superiority of chloroprocaine for this ambulatory obstetric procedure.