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Category: Volume 08 Issue 11 November 2020
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Title: Chloroprocaine spinal Aanaesthesia and the effects of added Clonidine

Authors: Dr Satyen Verma, Dr Sarfaraz Ahmad, Dr Akash Gupta, Dr Malti Agarwal, Dr Ram Pal Singh, Dr Vigneshwaran Swaminathan

 DOI: https://dx.doi.org/10.18535/jmscr/v8i11.100

Abstract

Background and Aim: 2-Chloroprocaine (C13H19ClN2O2) an ultra-short acting, ester derivative of benzoic acid, is being investigated intrathecally in small doses (30 to 60 mg) and it was find reliable for procedures of short duration. Clonidine (C9H9Cl2N3) an imidazoline derivative, centrally-acting alpha2-adrenergic agonist, improves the quality of spinal bupivacaine and ropivacaine. It has not been studied in combination with 2-CP. So we conducted this study to evaluate effect of adding clonidine to spinal Chloroprocaine.

Methods: In this prospective randomized controlled study, spinal 2-CP (30 mg) with and without clonidine (30 mcg) in 60 adult patients posted for elective surgery of lower abdomen or lower limb. Patients were randomly divided randomly in 2 groups who received intrathecally either chloroprocaine (30mg+0.2 ml saline) or chloroprocaine (30 mg) with clonidine (30 mcg, 0.2ml). Hemodynamic changes, onset and duration of sensory blockade, onset and duration of motor blockade, 2-segment regression time,

Peak height for sensory block, time to attain peak height for sensory block were studied in both the groups.

Results: Mean systolic and diastolic blood pressures were significantly more decreased in group of patients who received clonidine with intrathecal chloroprocaine. Duration of sensory block averaged 3.90 ± 1.12 sec and 5.10 ± 1.55 sec without clonidine, time of peak heights of sensory block averaged 7.70 ± 1.56 sec with clonidine and 5.84 ± 1.61 sec without clonidine, duration of sensory blockade averaged 101.00 ± 14.99 min with clonidine and 54.77 ± 7.91 min without clonidine,  mean 2-segment regression time was 76.63 ± 15.69 min with clonidine and 40.90 ± 6.99 min without clonidine, onset of motor blockade was averaged 4.40 ± 1.28 sec with clonidine and 6.5 ± 1.20 sec without clonidine, mean duration of motor blockade was 91.80 ± 14.47 min with clonidine and 48.30 ± 8.97 min without clonidine.

Conclusion: We found significantly enhancement in duration of motor and sensory blockade, peak height of sensory anaesthesia and 2 segment regression time by adding clonidine to intrathecal chloroprocaine. No significant adverse effects were seen in the patients while conducting the study. We found Chloroprocaine to be an effective and safe alternative for lower limb and lower abdominal surgeries of short duration.

Keywords: Chloroprocaine, Clonidine, Spinal Anaesthesia, Motor blockade, Sensory blockade.

References

  1. Miller R, Cohen N, Eriksson L, Fleisher L, Wiener-Kronish J, Young W. Miller's anesthesia. 8th ed. 2015. p. 1688
  2. Davis BR, Kopacz DJ. Spinal 2-chloroprocaine: the effect of added clonidine. Anesthesia & Analgesia. 2005 Feb 1;100(2):559-65.
  3. Foldes FF, McNall PG. 2-Chloroprocaine: a new local anesthetic agent. Anesthesiology: The Journal of the American Society of Anesthesiologists. 1952 May 1;13(3):287-96.
  4. Miller R, Cohen N, Eriksson L, Fleisher L, Wiener-Kronish J, Young W. Miller's anesthesia. 8th ed. 2015. p. 1696
  5. Rockemann MG, Seeling W, Brinkmann A, Goertz AW, Hauber N, Junge J, Georgieff M. Analgesic and hemodynamic effects of epidural clonidine, clonidine/morphine, and morphine after pancreatic surgery--a double-blind study. Anesthesia & Analgesia. 1995 May 1;80(5):869-74.
  6. Casati A, Fanelli G, Danelli G, Berti M, Ghisi D, Brivio M, Putzu M et al. Spinal anesthesia with lidocaine or preservative-free 2-chlorprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison. Anesthesia & Analgesia. 2007 Apr 1;104(4):959-64.
  7. Förster JG. Short-acting spinal anesthesia in the ambulatory setting. Current Opinion in Anesthesiology. 2014 Dec 1;27(6):597-604.
  8. Dobrydnjov I, Axelsson K, Thorn S-E, et al. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinalherniorrhaphy: a randomized double-blinded study. Anesth Analg 2003;96:1496 –503.
  9. De Kock M, Gautier P, Fanard L, et al. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy. Anesthesiology 2001;94:574–8.
  10. Dobrydnjov I, Samarutel J. Enhancement of intrathecal lidocaine by addition of local and systemic clonidine. Acta Anaesthesiol Scand 1999;43:556–62.
  11. Niemi L. Effects of intrathecal clonidine on duration of bupivacaine spinal anaesthesia, haemodynamics, and postoperative analgesia in patients undergoing knee arthroscopy. Acta Anaesthesiol Scand 1994;38:724–8.
  12. Bonnet F, Brun Buisson V, Francois Y, et al. Effects of oral an subarachnoid clonidine on spinal anesthesia with bupivacaine. Reg Anesth Pain Med 1990;15:211– 4.
  13. Kouri ME, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers. Anesthesia & Analgesia. 2004 Jan 1;98(1):75-80.
  14. Casati A, Danelli G, Berti M, Fioro A, Fanelli A, Benassi C et al. Intrathecal 2-chloroprocaine for lower limb outpatient surgery: a prospective, randomized, double-blind, clinical evaluation. Anesthesia & Analgesia. 2006 Jul 1;103(1):234-8.
  15. Dobrydnjov I, Axelsson K, Thörn SE, Matthiesen P, Klockhoff H, Holmström B, Gupta A. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Anesthesia & Analgesia. 2003 May 1;96(5):1496-503.
  16. Gonter AF, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with procaine in volunteers. Anesthesia & Analgesia. 2005 Feb 1;100(2):573-9.
  17. Siddaiah J, Pujari VS, Madalu AS, Bevinaguddaiah Y, Parate LH. A comparative study on the effect of addition of intrathecal buprenorphine to 2-chloroprocaine spinal anesthesia in short duration surgeries. Journal of Anaesthesiology, Clinical Pharmacology. 2019 Oct;35(4):533-9.
  18. Teunkens A, Vermeulen K, Van Gerven E, Fieuws S, Van de Velde M, Rex S. Comparison of 2-chloroprocaine, bupivacaine, and lidocaine for spinal anesthesia in patients undergoing knee arthroscopy in an outpatient setting: a double-blind randomized controlled trial. Regional Anesthesia & Pain Medicine. 2016 Sep 1;41(5):576-83.
  19. Lacasse MA, Roy JD, Forget J, Vandenbroucke F, Seal RF et al. Comparison of bupivacaine and 2-chloroprocaine for spinal anesthesia for outpatient surgery: a double-blind randomized trial. Canadian Journal of Anesthesia/Journal canadiend'anesthésie. 2011 Apr 1;58(4):384-91.
  20. Casati A, Danelli G, Berti M, Fioro A, Fanelli A, Benassi C et al. Intrathecal 2-chloroprocaine for lower limb outpatient surgery: a prospective, randomized, double-blind, clinical evaluation. Anesthesia & Analgesia. 2006 Jul 1;103(1):234-8.
  21. Camponovo C, Wulf H, Ghisi D, Fanelli A, Riva T, Cristina D, Vassiliou T, Leschka K, Fanelli G. Intrathecal 1% 2‐chloroprocaine vs. 0.5% bupivacaine in ambulatory surgery: a prospective, observer‐blinded, randomised, controlled trial. Acta Anaesthesiologica Scandinavica. 2014 May;58(5):560-6.
  22. Agarwal D, Chopra M, Mohta M, Sethi AK. Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries. Saudi journal of anaesthesia. 2014 Apr;8(2):209-14.
  23. Agarwal D, Chopra M, Mohta M, Sethi AK. Clonidine as an adjuvant to hyperbaric bupivacaine for spinal anesthesia in elderly patients undergoing lower limb orthopedic surgeries. Saudi journal of anaesthesia. 2014 Apr;8(2):209-14.
  24. De Kock M, Gautier P, Fanard L, Hody JL, Lavand’homme P. Intrathecal Ropivacaine and Clonidine for Ambulatory Knee ArthroscopyA Dose–Response Study. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2001 Apr 1;94(4):574-8
  25. Dobrydnjov I, Axelsson K, Thörn SE, Matthiesen P, Klockhoff H, Holmström B, Gupta A. Clonidine combined with small-dose bupivacaine during spinal anesthesia for inguinal herniorrhaphy: a randomized double-blinded study. Anesthesia & Analgesia. 2003 May 1;96(5):1496-503.
  26. Singh G, Aulakh GS, Aulakh NK, Singh RM, Bose A, Katayal S, Aulakh BS. Effect of intrathecal clonidine versus fentanyl on bupivacaine spinal block in transurethral resection of prostate surgeries. Anesthesia, essays and researches. 2016 Jan;10(1):65-70.
  27. Kanazi GE, Aouad MT, Jabbour‐Khoury SI, Al Jazzar MD, Alameddine MM, Al‐Yaman R, Bulbul M, Baraka AS. Effect of low‐dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta anaesthesiologica scandinavica. 2006 Feb;50(2):222-7.

Corresponding Author

Dr Akash Gupta

Assistant Professor, Department of Anaesthesia, RMCH, Bareilly