Hongwei Xu1, Huiping Li1, Yunxia Zuo1, Baxian Yang2, Yuke Tian3, Qulian Guo4, Jianguo Xu5, Chaoran Wu6. 1. Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West-China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, Sichuan, 610041, China. 2. Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South St, Xicheng District, Beijing, 100044, China. 3. Department of Anesthesiology, Huazhong University of Science and Technology Affiliated Tongji Hospital, 1095 Jie Fang Ave, Wuhan 430030, China. 4. Department of Anesthesiology, Xiangya Hospital of Central-South University, 87 Xiangya Rd, Changsha, Hunan, 410008, China. 5. Department of Anesthesiology, Nanjing General Hospital of Nanjing Military Command, 305 East Zhongshan Rd, Xuanwu District, Nanjing, Jiangsu, 210002, China. 6. Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West-China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, Sichuan, 610041, China. Electronic address: chaoranwu@aliyun.com.
Abstract
STUDY OBJECTIVE: To investigate the effects and optimal concentration of chloroprocaine for epidural analgesia after lower limb orthopedic surgery. DESIGN: Prospective, randomized, observational, multicenter clinical study. SETTING: Operating room, postoperative recovery area, university hospital. PATIENTS: One hundred and twenty patients from 4 hospitals were enrolled and randomized into 5 groups after lower limb orthopedic surgery under epidural anesthesia with lidocaine. INTERVENTIONS:Epidural chloroprocaine mixed with 0.4μg/mL fentanyl was administered via a patient-controlled analgesia pump at the concentration of 0.6%, 0.8%, 1.0%, 1.2%, or 1.4% after the surgery. MEASUREMENTS: Systolic blood pressure, heart rate, visual analog score at rest and during activity, as well as the Bromage score at 0 minute, 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, and 48 hours after the surgery were recorded and compared. Use of morphine and incidence of adverse effects were also recorded. MAIN RESULTS: Patients given 1.2% chloroprocaine showed the lowest visual analog score compared with other groups. There was no significant difference in the Bromage score among 5 groups. The Bromage score returned to 0 in 89.7% of the patients 48 hours after surgery. No difference in postoperative morphine usage, blood pressure, or heart rate was found among 5 groups. CONCLUSIONS: Epidural 1.2% chloroprocaine with 0.4μg/mL fentanyl could generate proper analgesic effects with little influence on mobility in patients undergoing lower limb orthopedic surgery. In addition, it could generate a good sense and movement separation, facilitating the early functional training.
RCT Entities:
STUDY OBJECTIVE: To investigate the effects and optimal concentration of chloroprocaine for epidural analgesia after lower limb orthopedic surgery. DESIGN: Prospective, randomized, observational, multicenter clinical study. SETTING: Operating room, postoperative recovery area, university hospital. PATIENTS: One hundred and twenty patients from 4 hospitals were enrolled and randomized into 5 groups after lower limb orthopedic surgery under epidural anesthesia with lidocaine. INTERVENTIONS: Epidural chloroprocaine mixed with 0.4μg/mL fentanyl was administered via a patient-controlled analgesia pump at the concentration of 0.6%, 0.8%, 1.0%, 1.2%, or 1.4% after the surgery. MEASUREMENTS: Systolic blood pressure, heart rate, visual analog score at rest and during activity, as well as the Bromage score at 0 minute, 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, and 48 hours after the surgery were recorded and compared. Use of morphine and incidence of adverse effects were also recorded. MAIN RESULTS:Patients given 1.2% chloroprocaine showed the lowest visual analog score compared with other groups. There was no significant difference in the Bromage score among 5 groups. The Bromage score returned to 0 in 89.7% of the patients 48 hours after surgery. No difference in postoperative morphine usage, blood pressure, or heart rate was found among 5 groups. CONCLUSIONS: Epidural 1.2% chloroprocaine with 0.4μg/mL fentanyl could generate proper analgesic effects with little influence on mobility in patients undergoing lower limb orthopedic surgery. In addition, it could generate a good sense and movement separation, facilitating the early functional training.