The use of 2-chloroprocaine for spinal anaesthesia

Spinal anaesthesia is a safe and reliable anaesthetic modality for surgical procedures on the lower part of the body. However, because of the description of transient neurologic symptoms (TNS), most practitioners have abandoned intrathecal lidocaine. Chloroprocaine (2-chloroprocaine, CP) has been one candidate to replace lidocaine for short procedures, despite the fact that neurologic sequelae have been described following the intrathecal injection of large doses of preservative-containing CP intended for epidural use. The National Library of Medicine's Medline and the EMBASE databases were searched for the time period 1966 to April 2012. Fourteen studies of the use of intrathecal CP were analysed, including seven volunteer and seven clinical studies. Preservative-free CP appears to be a reliable local anaesthetic for short procedures. The duration of the surgical block can be adjusted by varying the dose between 30 and 60 mg. Two double-blind randomised controlled studies demonstrate decreased time to ambulation and discharge when CP is used for spinal anaesthesia when compared with other local anaesthetics. The addition of fentanyl appears to prolong the surgical block without significantly prolonging the time to discharge. There have been five possible cases of TNS following CP spinal anaesthesia in over 4000 patients, and a regressive incomplete cauda equina syndrome has been described. The short duration of spinal CP makes it a strong contender for outpatient anaesthesia. It appears to have a lower risk of TNS than lidocaine.