Short-acting spinal anesthesia in the ambulatory setting

There has been a renewed interest in the short-acting local anesthetics articaine, chloroprocaine, and prilocaine for ambulatory spinal anesthesia because of numerous potentially beneficial factors both clinically and economically speaking. This review covers the current advances of the past 1 to 2 years.

Literature search revealed a pleasing quantity of relevant articles. In various randomized, controlled trials (many different designs), chloroprocaine, articaine, and prilocaine performed mainly well as regards fast onset, satisfying block, and quick recovery. With these anesthetics transient neurologic symptoms were very rarely seen. Regarding urinary retention useful guidelines for bladder volume management were presented. In addition, various interesting features relating to unilateral spinal anesthesia and economical aspects were investigated.

Intrathecal articaine (off-label use for the time being), chloroprocaine, and prilocaine (the latter two officially approval in several European countries) remain a very appealing option in the ambulatory setting. Chloroprocaine may have a slight edge as regards ultra-short and short surgery, whereas articaine and prilocaine may suit well for somewhat longer procedures. Future follow-up investigations should establish possible differences between these local anesthetics, also with respect to other anesthetic techniques and to economical aspects.