Spinal block chloroprocaine

A prospective randomised double-blind controlled trial comparing lidocaine and chloroprocaine for outpatient transurethral prostatectomy yielded similar clinical end points (primary end point duration of spinal block) [36 ]. Four patients in the lidocaine group developed TNS and one patient in the chloroprocaine group developed an acute cauda equina syndrome, which fully recovered after several weeks. Based on this, the authors conclude that they cannot recommend lidocaine in view of the high incidence of TNS and recommend close follow-up for chloroprocaine to ensure its safety profile. 

The recent case of a parturient who developed a massive spinal block with hemi-cranial palsy after a test dose of 2.5 ml of 2% chloroprocaine, administered with the patient in the sitting position, demonstrates the dangers of giving a test dose of a hypo-baric solution with the patient in this position (21 ). One always has to bear in mind the possibility of infection after epidural and spinal anaesthesia. The recommendation has been made to place a bacterial filter between the syringe and the catheter. Five out of 101 syringes were contaminated by skin commensals, but all the catheter tips remained sterile when a bacterial filter was used. 

The primary site of action of epidurally administered agents is on the spinal nerve roots. As with spinal anesthesia, the choice of drug to be used is determined primarily by the duration of anesthesia desired. However, when a catheter has been placed, short-acting drugs can be administered repeatedly. Bupivacaine is typically used when a long duration of surgical block is needed. Lidocaine is used most often for intermediate length procedures chloroprocaine is used when only a very short duration of anesthesia is required. 

Chloroprocaine is used in situations requiring fast-acting pain relief. It is also used in infiltration anesthesia, blocking peripheral nerve transmission, and in spinal and epidural anesthesia. Nesacaine is a synonym for chloroprocaine. 

The choice of local anesthetic for infiltration, peripheral nerve blocks, and central neuraxis (spinal/epidural) blockade is usually based on the duration of action required. Procaine and chloroprocaine are short-acting lidocaine, mepivacaine, and prilocaine have an intermediate duration of action and tetracaine, bupivacaine, levobupivacaine, and ropivacaine are long-... 

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