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Advances in Therapy Jan 2020Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine) offer an alternative to general anesthesia for short-duration surgical procedures,... (Clinical Trial)
Clinical Trial Observational Study
INTRODUCTION
Available short-acting intrathecal anesthetic agents (chloroprocaine and prilocaine) offer an alternative to general anesthesia for short-duration surgical procedures, especially ambulatory surgeries. Factors determining the choice of anesthesia for short-duration procedures have not been previously identified.
METHODS
This observational, prospective, multicenter, cohort study was conducted between July 2015 and July 2016, in 33 private or public hospitals performing ambulatory surgery. The primary objective was to determine the factors influencing the choice of anesthetic technique (spinal or general anesthesia). Secondary outcomes included efficacy of the anesthesia, time to hospital discharge, and patient satisfaction.
RESULTS
Among 592 patients enrolled, 309 received spinal anesthesia and 283 underwent general anesthesia. In both study arms, the most frequently performed surgical procedures were orthopedic and urologic (43.3% and 30.7%, respectively); 66.1% of patients were free to choose their type of anesthesia, 21.8% chose one of the techniques because they were afraid of the other, 16.8% based their choice on the expected ease of recovery, 19.2% considered their degree of anxiety/stress, and 16.9% chose the technique on the basis of its efficacy. The median times to micturition and to unassisted ambulation were significantly shorter in the general anesthesia arm compared with the spinal anesthesia arm (225.5 [98; 560] min vs. 259.0 [109; 789] min; p = 0.0011 and 215.0 [30; 545] min vs. 240.0 [40; 1420]; p = 0.0115, respectively). The median time to hospital discharge was equivalent in both study arms. In the spinal anesthesia arm, patients who received chloroprocaine and prilocaine recovered faster than patients who received bupivacaine. The time to ambulation and the time to hospital discharge were shorter (p < 0.001). The overall success rate of spinal anesthesia was 91.6%, and no significant difference was observed between chloroprocaine, prilocaine, and bupivacaine. The patients' global satisfaction with anesthesia and surgery was over 90% in both study arms.
CONCLUSIONS
Patient's choice, patient fear of the alternative technique, patient stress/anxiety, the expected ease of recovery, and the efficacy of the technique were identified as the main factors influencing patient choice of short-acting local anesthesia or general anesthesia. Spinal anesthesia with short-acting local anesthetics was preferred to general anesthesia in ambulatory surgeries and was associated with a high degree of patient satisfaction.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT02529501. Registered on June 23, 2015. Date of enrollment of the first participant July 21, 2015.
Topics: Adult; Ambulatory Surgical Procedures; Anesthesia, General; Anesthesia, Spinal; Anesthetics, Local; Bupivacaine; Cohort Studies; Female; Humans; Male; Middle Aged; Patient Satisfaction; Procaine; Prospective Studies; Time Factors
PubMed: 31828612
DOI: 10.1007/s12325-019-01171-6 -
Comparison of epidural anesthesia with chloroprocaine and lidocaine for outpatient knee arthroscopy.Journal of Orthopaedic Surgery (Hong... 2019This study aimed to compare clinical efficacy and safety of chloroprocaine and lidocaine in epidural anesthesia for outpatient knee arthroscopy. Eighty patients... (Randomized Controlled Trial)
Randomized Controlled Trial
This study aimed to compare clinical efficacy and safety of chloroprocaine and lidocaine in epidural anesthesia for outpatient knee arthroscopy. Eighty patients undergoing knee arthroscopy were randomly allocated to receive 3% 2-chloroprocaine (group C, = 40) or 2% lidocaine (group L, = 40) for epidural block. Latency to anesthesia onset, highest block level, time to achieve peak effect, time to complete sensory and motor block regression, vital signs including respiration and hemodynamics, and complications during follow-up were recorded. No significant differences were found in the latency to anesthesia onset and peak effect, duration of anesthesia efficacy, and the time for recovery of sensory function between the two groups. However, the latency to maximal block of pain sensation and the time needed to recover motor function were significantly shorter in group C than in group L ( < 0.05). No adverse effects or neurologic complications were found in both groups. In conclusion, epidural chloroprocaine elicits rapid anesthetic effects, fast sensor and motor block, and faster recovery of motor function compared to lidocaine. These characteristics make chloroprocaine better than lidocaine as the choice of epidural anesthesia in short clinical operations such as knee arthroscopy.
Topics: Adult; Ambulatory Surgical Procedures; Anesthesia, Epidural; Anesthetics, Local; Arthroscopy; Double-Blind Method; Female; Humans; Knee Joint; Lidocaine; Male; Outpatients; Procaine; Prospective Studies; Time Factors
PubMed: 31370751
DOI: 10.1177/2309499019865534 -
Digestion 2004
Topics: Anesthetics, Local; Clinical Trials as Topic; Evidence-Based Medicine; Germany; Humans; Infusions, Intravenous; Pain; Pancreatitis; Practice Guidelines as Topic; Procaine; Societies, Medical
PubMed: 14755146
DOI: 10.1159/000076540 -
Canadian Medical Association Journal Dec 1948
Topics: Administration, Intravenous; Humans; Procaine
PubMed: 18894017
DOI: No ID Found -
Anesthesiology Aug 2008
Topics: Anesthesia, Spinal; Anesthetics, Local; Cauda Equina; Female; Humans; Middle Aged; Peripheral Nervous System Diseases; Procaine
PubMed: 18648243
DOI: 10.1097/ALN.0b013e31817fdeb8 -
British Medical Journal Oct 1948
Topics: Administration, Intravenous; Blood Transfusion; Platelet Transfusion; Procaine
PubMed: 18933533
DOI: 10.1136/bmj.2.4582.787-a -
British Journal of Pharmacology Apr 19791. When rat stomach fundus muscle was incubated for 30 min in Tyrode solution from which calcium chloride had been omitted, there was an almost complete abolition of the...
1. When rat stomach fundus muscle was incubated for 30 min in Tyrode solution from which calcium chloride had been omitted, there was an almost complete abolition of the contractile response to 5-hydroxytryptamine (5-HT) while that to acetylcholine (ACh) was still present. 2. The maximum tension obtainable with ACh remained the same in external calcium concentrations ranging from 0.45 to 3.6 mM, but the pD2 value increased. 3. A concentration of at least 0.9 mM calcium was needed to maintain a maximum contraction with 5-HT, and the pD2 for this agent also increased significantly with increase in calcium content of the medium. 4. The effects of procaine on the responses of the muscle to 5-HT and ACh were similar to the respective changes induced by lowering the calcium concentration, and were reduced by the addition of calcium. 5. Concentrations of 2.2 x 10(-7) to 3.6 x 10(-5) M procaine reduced the effects of both 5-HT and KCl and suppressed the maximum responses. 6. The maximum responses to KCl and 5-HT were restored at higher concentrations of procaine (greater than 3.6 x 10(-4) M), while the effect of ACh was reduced. 7. It is suggested that 5-HT, like KCl, is almost entirely dependent on extracellular calcium for inducing muscle contraction, while ACh may utilize calcium from bound stores.
Topics: Acetylcholine; Animals; Calcium; Drug Interactions; In Vitro Techniques; Male; Muscle Contraction; Muscle, Smooth; Potassium Chloride; Procaine; Rats; Serotonin; Stomach
PubMed: 435684
DOI: 10.1111/j.1476-5381.1979.tb07869.x -
The Journal of General Physiology Mar 1966The effects of tetrodotoxin, procaine, and manganese ions were examined on the Ca spike of the barnacle muscle fiber injected with Ca-binding agent as well as on the...
The effects of tetrodotoxin, procaine, and manganese ions were examined on the Ca spike of the barnacle muscle fiber injected with Ca-binding agent as well as on the action potential of the ventricular muscle fiber of the frog heart. Although tetrodotoxin and procaine very effectively suppress the "Na spike" of other tissues, no suppressing effects are found on "Ca spike" of the barnacle fiber, while the initiation of the Ca spike is competitively inhibited by manganese ions. The initial rate of rise of the ventricular action potential is suppressed by tetrodotoxin and procaine but the plateau phase of the action potential is little affected. In contrast the suppressing effect of manganese ions is mainly on the plateau phase. The results suggest that the plateau phase of the ventricular action potential is related to the conductance increase in the membrane to Ca ions even though Na conductance change may also contribute to the plateau.
Topics: Animals; Anura; Calcium; Crustacea; Electrophysiology; Heart; In Vitro Techniques; Manganese; Muscles; Procaine; Sodium; Tetrodotoxin; Toxins, Biological
PubMed: 5943615
DOI: 10.1085/jgp.49.4.793 -
Anesthesiology Aug 1994There are significant physiologic differences between spinal and epidural anesthesia. Consequently, these two types of regional anesthesia may influence thermoregulatory... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
There are significant physiologic differences between spinal and epidural anesthesia. Consequently, these two types of regional anesthesia may influence thermoregulatory processing differently. Accordingly, in volunteers and in patients, we tested the null hypothesis that the core-temperature thresholds triggering thermoregulatory sweating, vasoconstriction, and shivering are similar during epidural and spinal anesthesia.
METHODS
Six male volunteers participated on three consecutive study days: epidural or spinal anesthesia were randomly assigned on the 1st and 3rd days (approximately T10 level); no anesthesia was given on the 2nd day. On each day, the volunteers were initially warmed until they started to sweat, and subsequently cooled by central venous infusion of cold fluid until they shivered. Mean skin temperature was kept constant near 36 degrees C throughout each study. The tympanic membrane temperatures triggering a sweating rate of 40 g.m-2.h-1, a finger flow less than 0.1 ml/min, and a marked and sustained increase in oxygen consumption (approximately 30%) were considered the thermoregulatory thresholds for sweating, vasoconstriction, and shivering, respectively. Twenty-one patients were randomly assigned to receive epidural (n = 10) or spinal (n = 11) anesthesia for knee and calf surgery (approximately T10 level). As in the volunteers, the shivering threshold was defined as the tympanic membrane temperature triggering a sustained increase in oxygen consumption.
RESULTS
The thresholds and ranges were similar during epidural and spinal anesthesia in the volunteers. However, the sweating-to-vasoconstriction (inter-threshold) range, the vasoconstriction-to-shivering range, and the sweating-to-shivering range all were significantly increased by regional anesthesia. The shivering thresholds in patients assigned to epidural and spinal anesthesia were virtually identical.
CONCLUSIONS
Comparable sweating, vasoconstriction, and shivering thresholds during epidural and spinal anesthesia suggest that thermoregulatory processing is similar during each type of regional anesthesia. However, thermoregulatory control was impaired during regional anesthesia, as indicated by the significantly enlarged inter-threshold and sweating-to-shivering ranges.
Topics: Adult; Anesthesia, Epidural; Anesthesia, Spinal; Anesthetics, Local; Body Temperature Regulation; Humans; Male; Monitoring, Physiologic; Procaine; Reference Values; Shivering; Sweating; Vasoconstriction
PubMed: 8053576
DOI: 10.1097/00000542-199408000-00004 -
British Journal of Pharmacology Feb 19691. The uptake, efflux and pharmacological actions of procaine hydrochloride were studied on isolated hearts of female guinea-pigs. The hearts were perfused with Krebs...
1. The uptake, efflux and pharmacological actions of procaine hydrochloride were studied on isolated hearts of female guinea-pigs. The hearts were perfused with Krebs solution containing (14)C-procaine (0.1-500 mug/ml.) by the Langendorff technique at 37 degrees C, using a constant flow pump. Hearts and cardiac effluent were assayed for procaine by liquid scintillation spectrometry.2. Accumulation of procaine did not appear to involve active transport mechanisms for the following reasons. The rate of procaine uptake was most rapid at the highest perfusion concentration (500 mug/ml.), when it was three times faster than at the lowest concentration (0.1 mug/ml.); it was not affected by lowering the temperature to 3 degrees C. The ratio of the concentration of procaine in the heart to the concentration in the perfusing fluid decreased with increasing concentration in the perfusion fluid.3. When the efflux of (14)C-procaine from hearts previously perfused with procaine-containing Krebs solution for 10 min was compared with the efflux of (14)C-inulin, the patterns of efflux of both compounds were similar, and showed at least two exponential components. At the highest concentration of procaine (500 mug/ml.) the efflux of procaine was more rapid than that of inulin.4. A relationship was found between the pharmacological action of procaine, the rate of uptake and the level of procaine in the heart. When the procaine-containing perfusion fluid was changed to a procaine-free solution, the heart rate increased rapidly, and there was a rapid decline in the levels of procaine in the hearts.5. It is concluded that guinea-pig hearts accumulate procaine by a passive diffusion process, and that the pattern and rate of efflux indicate that the drug is loosely bound. If it is permissible to extrapolate from these findings to the antiarrhythmic effect in man, the short duration of its action may be due to loose binding rather than to rapid metabolic inactivation.
Topics: Animals; Anti-Arrhythmia Agents; Binding Sites; Carbon Isotopes; Female; Guinea Pigs; Heart; Heart Rate; In Vitro Techniques; Inulin; Myocardium; Procaine
PubMed: 5774045
DOI: 10.1111/j.1476-5381.1969.tb07991.x