Impact of Short-Acting Spinal Anesthetic on Discharge from Postanesthetic Care Unit: A Retrospective Analysis

Chloroprocaine has recently regained accessibility as a short-acting local anesthetic in Canada. It offers an alternative to bupivacaine, the predominant spinal anesthetic used at Vancouver Coastal Health sites in Vancouver, British Columbia.

To compare the recovery profile of surgical patients who received either chloroprocaine or bupivacaine for spinal anesthesia.

This multicentre retrospective cohort study involved adult patients who received chloroprocaine or bupivacaine as spinal anesthetic for short-duration surgery. The primary outcome was the time from admission to the postanesthesia care unit (PACU) to discharge from the PACU. Time from PACU admission to discharge readiness was also assessed, along with the perioperative variables of type of operation performed, duration of surgery, dose of anesthetic, dose of intraoperative analgesic, and number of days from operation to hospital discharge.

The study involved 145 patients aged 30 to 94 years: 72 who received chloroprocaine and 73 who received bupivacaine. For the primary outcome, there was a nonsignificant shorter time from PACU admission to discharge for the chloroprocaine cohort (mean difference 36 minutes, p = 0.07). There was a significant difference favouring chloroprocaine over bupivacaine in the time from PACU admission to meeting PACU discharge criteria (mean difference 48 minutes, p < 0.001). Chloroprocaine was associated with significantly shorter surgery duration (mean difference 5 minutes, p = 0.026). Regression analysis showed a significant correlation between the anesthetic given and the time to meeting PACU discharge eligibility (p < 0.001).

Use of chloroprocaine was associated with earlier time to patients meeting PACU discharge criteria. These findings support the potential benefit of chloroprocaine over bupivacaine in terms of achieving earlier PACU discharge readiness, although this difference did not consistently translate into earlier actual PACU discharge.