Comparing intrathecal 1% 2-chloroprocaine and 0.5% bupivacaine for patients undergoing saddle block in daycare surgeries with respect to recovery and home readiness: A prospective double blind randomised study

Abstract

Preservative free 2-chloroprocaine seems to be a better alternative to lidocaine and bupivacaine for day care procedures, because of its short duration of action. This study was designed to compare 2-chlorprocaine with low dose bupivacaine for saddle block in elective perineal surgeries on day care basis in terms of recovery and home readiness. To compare 1% 2- chloroprocaine with 0.5% bupivacaine with respect to time taken to obtain discharge criteria from post-anaesthesia care unit (PACU) to post-operative ward, from hospital to home and time taken for ambulation and micturition. This is a prospective, randomized, double blind, parallel group clinical study, conducted on ASA class I and II patients undergoing elective perineal surgeries on daycare basis in MIMS teaching hospital, Mandya. After obtaining approval from institutional ethical committee, a total of 100 patients were enrolled in this study. Saddle anaesthesia was achieved with 7.5 mg 0.5% hyperbaric bupivacaine (Group B, n = 49) or 1% 2- chloroprocaine 40 mg (Group C, n = 50). After completion of surgery, patients were monitored in PACU and postoperative ward using modified Aldrete’s score and PADSS. After discharging, patients were contacted at 24 hours and followed up for 7 days via telephone to assess potential complications of saddle block. Data analysis was done using IBM SPSS version 20. Chi-square test, Fisher’s exact test and independent t-test were used to compare the variables. P value of <0.05 is considered statistically significant. Mean time required to attain discharge eligibility from hospital in Group B was 296.24 min and Group C was 213.3 min with a difference of 83 mins (P < 0.001). Mean duration of time spent in PACU in Group B was 105.18 min and Group C was 27.22 min (P < 0.001). Time to unassisted ambulation and micturition was also significantly lower in Group C. None of the patient in both study groups required additional analgesia in the intraoperative period. However, 26% patients in Group C experienced more pain in the post-operative period compared to Group B (4%) (P = 0.04). Chloroprocaine provides satisfactory anaesthesia with advantage of faster regression of block, early ambulation and micturition, and thus early discharge from the hospital.