Dan J Kopacz1. 1. Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98111, USA. Dan.Kopacz@vmmc.org
Abstract
BACKGROUND AND OBJECTIVES: Recent studies using preservative-free 2-chloroprocaine (2-CP) for spinal anesthesia have shown it to be a reliable short-acting agent in the 30-mg to 60-mg range. Investigations of doses below this range have not been performed. METHODS: To establish the minimum effective dose for spinal anesthesia, this randomized, double-blind, crossover study investigates the characteristics of spinal 2-CP 10 mg and 20 mg in 8 volunteers and compares the results with previous data obtained for 30 to 60 mg in the same human model. RESULTS:Peak block height, regression to L1, tolerance to tourniquet, and transcutaneous electrical stimulation all increased with increasing doses from 10 to 60 mg ( P <.0001). Likewise, time to complete block regression, ambulation, and micturition also increased with increasing spinal 2-CP dosage ( P <.0001). Degree of motor block generally increased with increasing doses from 10 to 60 mg; however, no differences existed between the 20-mg and 30-mg and between the 40-mg and 60-mg doses. CONCLUSIONS:Spinal 2-CP 40 mg and 60 mg provide rapid and reliable sensory and motor block. Although the 20-mg and 30-mg doses can produce sensory anesthesia adequate for brief surgical procedures, less motor block and some sacral sparing should be anticipated. Because the 10-mg dose produces only brief and inconsistent sensory anesthesia, it can be considered a no-effect dose.
RCT Entities:
BACKGROUND AND OBJECTIVES: Recent studies using preservative-free 2-chloroprocaine (2-CP) for spinal anesthesia have shown it to be a reliable short-acting agent in the 30-mg to 60-mg range. Investigations of doses below this range have not been performed. METHODS: To establish the minimum effective dose for spinal anesthesia, this randomized, double-blind, crossover study investigates the characteristics of spinal 2-CP 10 mg and 20 mg in 8 volunteers and compares the results with previous data obtained for 30 to 60 mg in the same human model. RESULTS: Peak block height, regression to L1, tolerance to tourniquet, and transcutaneous electrical stimulation all increased with increasing doses from 10 to 60 mg ( P <.0001). Likewise, time to complete block regression, ambulation, and micturition also increased with increasing spinal 2-CP dosage ( P <.0001). Degree of motor block generally increased with increasing doses from 10 to 60 mg; however, no differences existed between the 20-mg and 30-mg and between the 40-mg and 60-mg doses. CONCLUSIONS: Spinal 2-CP 40 mg and 60 mg provide rapid and reliable sensory and motor block. Although the 20-mg and 30-mg doses can produce sensory anesthesia adequate for brief surgical procedures, less motor block and some sacral sparing should be anticipated. Because the 10-mg dose produces only brief and inconsistent sensory anesthesia, it can be considered a no-effect dose.