Spinal 2-Chloroprocaine: A Comparison with Small-Dose Bupivacaine in Volunteers

In Brief Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. Preservative-free 2-chloroprocaine (2-CP) has reemerged as an alternative for outpatient spinal anesthesia. We designed this double-blind, randomized, crossover, volunteer study to compare 40 mg of 2-CP with small-dose (7.5 mg) bupivacaine with measures of pinprick anesthesia, motor strength, tolerance to tourniquet and electrical stimulation, and simulated discharge criteria. Peak block height (2-CP average T7 [range T3–10]; bupivacaine average T9 [range T4–L1]), regression to L1 (2-CP 64 ± 10 versus bupivacaine 87 ± 41 min), and tourniquet tolerance (2-CP 52 ± 11 versus bupivacaine 60 ± 27 min) did not differ between drugs (P = 0.15, 0.12, and 0.40, respectively). However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 ± 14, bupivacaine 191 ± 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine. IMPLICATIONS: Spinal 2-chloroprocaine (2-CP) (40 mg) provides rapid onset, and reliable blockade, without signs of transient neurologic symptoms. Compared with spinal bupivacaine (7.5 mg), 2-CP produces more reliable motor blockade and faster block resolution. Spinal 2-CP is an excellent choice for outpatient procedures in which rapid fulfillment of discharge criteria is desired.