Chloroprocaine vz. prilocaine for spinal anaesthesia in day-case surgery: a double-blind randomized trial

Background

Starting date: 15/05/2016

In day case lower limb surgery, spinal anaesthesia with both rapid onset and a short duration of block is preferable. A short acting spinal anaesthetic facilitates a smooth patient flow: quick recovery of motor function will facilitate unassisted ambulation. Moreover, a short acting spinal anaesthetic is expected to contribute to good patient satisfaction as patients appreciate to regain autonomy after surgery without unnecessarily prolonged (motor)block.

Although not licensed in the Netherlands for spinal anaesthesia, for this purpose lidocaine has been the drug of choice for decades. Spinal lidocaine, however, has been associated with an unacceptable number (20–30%) of transient neurologic symptoms (TNSs) which make this local anaesthetic less favourable for intrathecal use.1,2

The symptoms of TNS can appear in a few hours or within up to 24 hours; that is, well after a full recovery has been made from an uneventful spinal anaesthesia. These symptoms consist of pain originating in the gluteal region and radiating to both lower extremities. These symptoms are not unique to lidocaine and are known to occur with other local anaesthetics as well. However lidocaine used for spinal anaesthesia causes symptoms of TNS more frequently than with other local anaesthetics.2 Urinary retention is another undesirable adverse event that is associated with spinal anaesthesia which may lead to interventions like catheterisation, hospital admission and extended length of stay. 3

 

In recent years, both chloroprocaine and prilocaine have gained interest as short-acting spinal anaesthetics seemingly without the issue of urinary retention needing catheterisation or TNSs.4-13 Prilocaine is available and licensed in the Netherlands for spinal anaesthesia since 2013. Chloroprocaine (e.g. 10 mg/ml) is licensed in 2013 in Germany for spinal anaesthesia and in 8 other European countries (AT, ES, FR, IE, IT, PL, UK). In the Netherlands chloroprocaine is expected to be licensed in 2016. From that point, chloroprocaine and prilocaine will be the only two short acting anaesthetics with a license for spinal administration in the Netherlands. So far, these two drugs have not been clinically compared as to whether one would be more preferable than the other in an ambulatory surgery setting regarding quick postoperative mobilization and patient comfort.