Comparison of anesthetic effects of intrathecal 1% 2-chloroprocaine versus 0.5% ropivacaine with fentanyl in urological surgeries: A randomized double-blind, interventional study

Abstract

Introduction: Spinal anaesthesia has got inherent advantages like intense motor and sensory blockade,reliability and avoids side effects of multiple drugs. Ropivacaine is safer long acting local anesthetic having greater sensorimotor differentiation. 2-Chloroprocaine (CP) is an amino-ester local anesthetic with a very short half-life; have favorable profile for short procedures. Addition of fentanyl to the local anesthetics for intrathecal injection improve the quality and duration of sensory anesthesia without prolonging motor recovery. Aim: To investigate the anesthetic effect of ropivacaine and chloroprocaine with fentanyl intrathecally for day care urological surgeries, to assess the characteristics of sensorimotor block, mean time to first postoperative rescue analgesia, and adverse effects if any. Methods: This prospective randomized, double blind, interventional study included 30 patients of ASA grades I & II undergoing urological surgeries under spinal anesthesia with intrathecal 3 ml of 1% 2-chloroprocaine with 12.5μg of fentanyl (GroupC) or 1.5 ml of 0.5% ropivacaine with fentanyl 12.5μg (Group R). Results: Mean time to achieve sensory block at T10 level was significantly short with CP (Group C 1.875 ± 0.47, Group R 2.51±0.54 min, (p value <0.001). Mean onset time of the motor block was short with CP (Group C 2.51 ± 0.73 min, Group R 4.74 ±1.08 min, p-value <0.001). Mean duration of sensory and motor block were significantly shorter in Group C compared to Group R (104.4 ± 10.89 min vs 154.16 ± 10.58 min) and (92.96 ± 12.02 min vs 143.66 ± 10.92 min) respectively. Mean time to two segment sensory regression was longer with Ropivacaine ( Group R 118.2 ± 12.48 and Group C 79.73 ± 12.48 min). Difference in Modified Bromage score was significant at 1, 2, 3 and 4 hour postoperatively among two groups with p-value <0.05 showing early regression of motor blockage in Group C in comparison to Group R. Conclusion: Intrathecal chloroprocaine is a good alternative to long acting local anesthetic ropivacaine for short duration urological surgeries, it facilitates early ambulating with minimum side effects. Furthermore, fentanyl as an adjuvant to both ropivacaine and chloroprocaine enhances the duration of analgesia and stabilizes hemodynamic variables.