Spinal 2-chloroprocaine for surgery: an initial 10-month experience

Area of Science:

• Anesthesiology
• Pharmacology
• Surgical Innovation

Background:

• Lidocaine spinal anesthesia frequently causes transient neurologic symptoms (TNS) in surgical patients.
• Spinal 2-chloroprocaine (2-CP) is being explored as a short-acting anesthetic alternative.
• Previous volunteer studies showed no TNS with 2-CP at doses up to 60 mg.

Purpose of the Study:

• To evaluate the clinical experience and safety of spinal 2-chloroprocaine (2-CP) in surgical patients.
• To assess the efficacy and recovery profile of 2-CP for ambulatory surgery.
• To compare 2-CP's safety profile regarding TNS versus lidocaine.

Main Methods:

• Retrospective analysis of surgical patients receiving spinal 2-CP.
• Review of patient data over the first 10 months of clinical use.
• Analysis of common dosages (30-40 mg 2-CP with or without fentanyl) and procedure types (orthopedic, general, gynecologic, genitourinary).

Main Results:

• Spinal 2-CP was used for various ambulatory surgeries, with 30 or 40 mg being the most common dose.
• Mean peak block height was T6-T8, with surgical procedures averaging 32.3 minutes.
• Patients experienced predictable block regression, with ambulation and discharge times of approximately 155 and 208 minutes, respectively.
• Crucially, no patients reported transient neurologic symptoms (TNS) post-surgery.

Conclusions:

• Spinal 2-chloroprocaine (2-CP) is a safe and effective anesthetic for ambulatory surgical procedures lasting up to one hour.
• 2-CP provides a predictable regression of block height and avoids TNS.
• It presents a viable alternative to lidocaine and procaine for specific surgical populations.