Advertisement

Canadian Journal of Anaesthesia

, Volume 46, Issue 10, pp 939–945 | Cite as

Non-alkalinized and alkalinized 2-chloroprocainevs lidocaine for intravenous regional anesthesia during outpatient hand surgery

  • Patrick A. Lavin
  • Cynthia L. Henderson
  • Himat Vaghadia
Reports of Investigation

Abstract

Purpose

Chloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-chloroprocaine 0.5% with lidocaine for IVRA.

Methods

In twoseparate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-chloroprocaine 0.5%, alkalinized 2-chloroprocaine 0.5% or lidocaine 0.5% for IVRA. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared.

Results

There was no difference in time to sensory or motor block in either group. Patients who received plain chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine (P < 0.05). Comparing alkalinized chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives.

Conclusion

In conclusion, alkalinized chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain chloroprocaine for IVRA produced more minor side effects than lidocaine.

Keywords

Lidocaine Alfentanil Thrombophlebitis Motor Block Prilocaine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

La chloroprocaine est un agent idéal pour l’anesthésie régionale intraveineuse (ARIV) étant donné sa rapidité d’action et l’hydrolyse des esters. En élevant le pH des anesthésiques locaux, on peut accélérer le début de l’action et augmenter l’intensité des blocages nerveux. Nous avons comparé la 2-chloroprocaïne simple 0,5 % et alcalinisée avec la lidocaïne pour une ARIV.

Méthode

Il y a eu deux étudesséparées, à double insu, auprès de 78 patients dont l’opération d’une main avait été prévue en chirurgie d’un jour et qui ont été répartis au hasard afin de recevoir 40 mL de 2-chloroprocaïne simple 0,5%, ou alcalinisée, ou de la lidocaïne 0,5% pour une ARIV. Le temps nécessaire pour atteindre le blocage sensitif et moteur, les besoins d’analgésie supplémentaire et les effets secondaires ont été comparés.

Résultats

Il n’y a pas eu de différence intergroupe quant au temps nécessaire au blocage sensitif et moteur. Les patients qui ont reçu la chloroprocaïne simple ont demandé plus d’opioïdes supplémentaires et ont présenté une plus forte incidence de goût métallique et d’urticaire que les patients qui ont reçu la lidocaïne (P < 0,05). Par contre, il n’y a pas eu de différence intergroupe entre les patients qui ont reçu la chloroprocaïne alcalinisée et ceux qui ont reçu la lidocaïne.

Conclusion

La chloroprocaïne alcalinisée a été jugée efficace comme agent d’ARIV, mais n’a pas présenté d’avantage par rapport à la lidocaïne. La chloroprocaïne simple a produit plus d’effets secondaires mineurs que la lidocaïne.

References

  1. 1.
    Henderson CL, Warriner CB, McEwen JA, Merrick PM. A North American survey of intravenous regional anesthesia. Anesth Analg 1997; 85: 858–63.PubMedCrossRefGoogle Scholar
  2. 2.
    Dunbar RW, Mazze RI. Intravenous regional anesthesia: experience with 779 cases. Anesth Analg 1967; 46: 806–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Dickler DJ, Friedman PL, Susman IC. Intravenous regional anesthesia with chloroprocaine. Anesthesiology 1965; 26: 244–5.CrossRefGoogle Scholar
  4. 4.
    Palas TAR. 0.5% Chloroprocaine vs. 0.5% lidocaine for intravenous regional anesthesia (IVRA) of the lower extremity. Reg Anesth 1993; 18(Suppl): 98.Google Scholar
  5. 5.
    Armstrong P, Brockway M, Wildsmith JA. Alkalinisation of prilocaine for intravenous regional anaesthesia. Anaesthesia 1990; 45: 11–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Armstrong P, Watters J, Whitfield A. Alkalinisation of prilocaine for intravenous regional anaesthesia. Suitability for clinical use. Anaesthesia 1990; 45: 935–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Benlabed M, Jullien P, Guelmi K, Hamza J, Bonhomme L, Benhamou D. Alkalinization of 0.5% lidocaine for intravenous regional anesthesia. Reg Anesth 1990; 15: 59–60.PubMedGoogle Scholar
  8. 8.
    Armstrong P, Power I, Wildsmith JAW. Addition of fentanyl to prilocaine for intravenous regional anaesthesia. Anaesthesia 1991; 46: 278–80.PubMedCrossRefGoogle Scholar
  9. 9.
    Pitkanen M, Kytta J, Rosenberg PH. Comparison of 2-chloroprocaine and prilocaine for intravenous regional anaesthesia of the arm: a clinical study. Anaesthesia 1993; 48: 1091–3.PubMedGoogle Scholar
  10. 10.
    Pitkanen MT, Suzuki N, Rosenberg PH. Intravenous regional anaesthesia with 0.5% prilocaine or 0.5% chloroprocainie. A double-blind comparison in volunteers. Anaesthesia 1992; 47: 618–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Bader AM, Concepcion M, Hurley RJ, Arthur GR. Comparison of lidocaine and prilocaine for intravenous regional anesthesia. Anesthesiology 1988; 69: 409–12.PubMedCrossRefGoogle Scholar
  12. 12.
    Korzeniewski P, Lang SA. Incidence of CNS side effects and thrombophlebitis in intravenous regional anaesthesia with 2-chloroprocaine or xylocaine. Can J Anaesth 1991; 38: A3.Google Scholar
  13. 13.
    Foldes FF, Molloy R, McNall PG, Koukal LR. Comparison of toxicity of intravenously given local anesthetic agents in man. JAMA 1960; 172: 1493–8.Google Scholar
  14. 14.
    Zsigmond EK, Eilderton TE. Survey of local anesthetic toxicity in the families of patients with atypical plasma cholinesterase. J Oral Surgery 1975; 33: 833–7.Google Scholar
  15. 15.
    Covino BG, Wildsmith JAW. Clinical pharmacology of local anesthetic agents.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott-Raven, 1998: 97–128.Google Scholar
  16. 16.
    Harris WH, Slater EM, Bell HM. Regional anesthesia by the intravenous route. JAMA 1965; 194: 1273–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Suzuki N, Pitkanen M, Sariola H, Palas T, Rosenberg PH. The effect of plain 0.5% 2-chloroprocaine on venous endothelium after intravenous regional anaesthesia in the rabbit. Acta Anaesthesiol Scand 1994; 38: 653–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Palas T. 0.5% chloroprocaine for intravenous regional anesthesia. Reg Anesth 1996; 21: S37.Google Scholar
  19. 19.
    Wong K, Strichartz GR, Raymond SA. On the mechanism of potentiation of local anesthetics by bicarbonate buffer: drug structure-activity studies on isolated peripheral nerve. Anesth Analg 1993; 76: 131–43.PubMedCrossRefGoogle Scholar
  20. 20.
    Ackerman WE, Juneja MM, Denson DD, et al. The effect of pH and pCO2 on epidural analgesia with 2% 2-chloroprocaine. Anesth Analg 1989; 68: 593–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Chestnut DH, Geiger M, Bates JN, Choi WW. The influence of pH adjusted 2-chloroprocaine on the quality and duration of subsequent epidural bupivicaine analgesia during labor: a randomized double blind study. Anesthesiology 1989; 70: 437–41.PubMedCrossRefGoogle Scholar
  22. 22.
    DiFazio CA, Carron H, Grosslight KR, Moscicki JC, Balding WR, Johns RA. Comparison of pH-adjusted lidocaine solutions for epidural anesthesia. Anesth Analg 1986; 65: 760–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Tucker GT, Mather LE. Properties, absorption and disposition of local anesthetic agents.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott-Raven, 1998: 56.Google Scholar
  24. 24.
    Peterfreund RA, Datta S, Ostheimer GW. pH adjustment of local anesthetic solutions with sodium bicarbonate: laboratory evaluation of alkalinization and precipitation. Reg Anesth 1989; 14: 265–70.PubMedGoogle Scholar
  25. 25.
    Palas TAR, Gerber HR. Intravenous regional anesthesia for operations in the lower limb: effect of two different concentrations of chloroprocaine. Reg Anesth 1982; 7: 29–32.Google Scholar
  26. 26.
    Holmes CM. Intravenous regional neural blockade.In: Cousins MJ, Bridenbaugh PO (Eds.). Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia: Lippincott-Raven, 1998: 398.Google Scholar

Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Patrick A. Lavin
    • 1
  • Cynthia L. Henderson
    • 1
  • Himat Vaghadia
    • 1
  1. 1.Department of AnesthesiaVancouver General Hospital, University of British ColumbiaVancouverCanada

Personalised recommendations