COMPARISON OF 1% CHLOROPROCAINE IN SUB-ARACHNOID BLOCK WITH OR WITHOUT FENTANYL FOR ENHANCED RECOVERY AFTER PERIANAL SURGERIES
Keywords:1% chloroprocaine, perianal surgery, fentanyl, spinal anesthesia
Objective: Spinal anesthesia is a reliable and safe technique for procedures of lower abdomen, perianal surgeries, and lower limbs. The current availability of short acting local anesthetic agents like preservative free 1% chloroprocaine has renewed the interest for this technique in short- and ultra-short procedures. Opioids continue to be the most commonly added adjuvants in local anesthetics for potentiation of analgesic action. In this study, we investigated the effect of intrathecal fentanyl as an adjuvant to 1% chloroprocaine in patients undergoing perianal surgeries.
Methods: This prospective, randomized, and comparative study was conducted in 80 ASA Physical status I and II adult patients (age 20–80 years) undergoing perianal surgeries under spinal anesthesia. Group A patients received 1% chloroprocaine 3 ml (30 mg) and 0.4ml saline and Group B patients received 1% chloroprocaine 3 ml (30 mg) with fentanyl 0.4 ml (20 μg). Primary objectives were duration of analgesia and time to unassisted ambulation. Onset and duration of sensory and motor blockade, maximum height of sensory block, 2 segment regression, hemodynamic parameters, time to voiding, home discharge eligibility, and any side effects were also recorded.
Results: There were no significant differences in demographic characteristics and hemodynamic parameters. The duration of sensory block and duration of analgesia were statistically prolonged in Group B than Group A (p<0.001) without affecting recovery from motor block and time to unassisted ambulation. The adverse effects were comparable in both the groups.
Conclusion: The addition of fentanyl to 1% chloroprocaine intrathecally prolonged the duration of analgesia and sensory block in patients undergoing perianal surgeries.
Förster JG. Short-acting spinal anesthesia in the ambulatory setting. Curr Opin Anaesthesiol 2014;27:597-604. doi: 10.1097/ ACO.0000000000000126, PMID 25211156
Camponovo C. Spinal 1% 2-chloroprocaine versus general anesthesia for ultra-short outpatient procedures: A retrospective analysis. Acta Biomed 2014;85:265-8. PMID 25567463
Lacasse MA, Roy JD, Forget J, Vandenbroucke F, Seal RF, Beaulieu D, et al. Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: A double-blind randomized trial. Can J Anaesth 2011;58:384-91. doi: 10.1007/s12630-010-9450-x, PMID 21203878
Hindle A. Intrathecal opioids in the management of acute postoperative pain. Continu Educ Anaesth Crit Care Pain 2008;8:81-5. doi: 10.1093/ bjaceaccp/mkn016
Vath JS, Kopacz DJ. Spinal 2-chloroprocaine: The effect of added fentanyl. Anesth Analg 2004;98:89-94. doi: 10.1213/01. ANE.0000093360.02058.ED, PMID 14693593
Goldblum E, Atchabahian A. The use of 2-chloroprocaine for spinal anaesthesia. Acta Anaesthesiol Scand 2013;57:545-52. doi: 10.1111/ aas.12071, PMID 23320599
Reisner LS, Hochman BN, Plumer MH. Persistent neurologic deficit and adhesive arachnoiditis following intrathecal 2-chloroprocaine injection. Anesth Analg 1980;59:452-4. doi: 10.1213/00000539- 198006000-00014, PMID 7189987
Ghisi D, Bonarelli S. Ambulatory surgery with chloroprocaine spinal anesthesia: A review. Ambul Anesth 2015;2:111-20. doi: 10.2147/ AA.S64884
Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases 2017;5:307-23. doi: 10.12998/wjcc.v5.i8.307, PMID 28868303
Nagar A, Khandelwal R, Goyal PK, Pareek S, Bharti DK. Comparing anaesthetic effects of intrathecal 2-chloroprocaine with or without fentanyl in ambulatory surgeries-a prospective and randomised control study. Indian J Clin Anaesth 2020;7:619-24. doi: 10.18231/j. ijca.2020.112
Madhusudhana Rao DB, Amar CH. A comparative study between chloroprocaine and chloroprocaine with fentanyl in diagnostic knee arthroscopies under spinal anesthesia. Int J Sci Eng Res (IJSR) 2020;9:474-77.
Singariya G, Choudhary K, Kamal M, Bihani P, Pahuja H, Saini P. Comparison of analgesic efficacy of intrathecal 1% 2-chloroprocaine with or without fentanyl in elective caesarean section: A prospective, double-blind, randomised study. Indian J Anaesth 2021;65:102-7. doi: 10.4103/ija.IJA_816_20, PMID 33776083
Bhaskara B, Prabhakar SA, Rangadhamaiah R. Intrathecal 1% 2-chloroprocaine with fentanyl in comparison with ropivacaine (0.5%) with fentanyl in day care perianal surgery: Prospective randomized comparative study. Anesth Essays Res 2019;13:471-5. doi: 10.4103/ aer.AER_100_19, PMID 31602063
Suryanarayana, Krishna Sagar SR, Ramachandraiah R. A comparative study of intrathecal 2-chloroprocaine with fentanyl versus 2-chloroprocaine alone in patients undergoing infraum-bilical surgeries. Int J Med Anesthesiol 2020;3:302-5. doi: 10.33545/26643766.2020. v3.i1e.105
How to Cite
Copyright (c) 2022 Dr. Tripat Kaur Bindra, Dr. Davinder Chawla, Dr. Ashwani Kumar, Dr. Gurlivleen Kaur, Dr. Amit Kaur
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.