Intrathecal chloroprocaine vs. lidocaine in day-case surgery : recovery, discharge and effect of pre-hydration on micturition

BackgroundThis randomised, double blind prospective study compares intrathecal lidocaine with chloroprocaine in day-case surgery and the influence of a 500ml pre-load intravenously. We tested the hypothesis that chloroprocaine provides faster recovery and discharge in day-case surgery. Secondary we studied the influence of a preload compared with fluid restriction on discharge time and micturition problems. MethodsOne hundred patients undergoing day-case arthroscopy were randomised to receive either lidocaine (L) 60mg or chloroprocaine (CP) 40mg intrathecally and this with (L+, CP+) or without (L-, CP-) a 500ml pre-load of crystalloid. Block characteristics, micturition and discharge times were registered. Bladder volumes were monitored by ultrasound. Micturition problems received a micturition score. ResultsOnset and quality of the block were comparable between groups. Time to regain Bromage 1 and L2 regression were shorter for the CP group compared with the L group. Voiding (16844min) and discharge (178 +/- 52min) were approximately 40min faster for the CP group compared with the L group. Pre-load provided faster bladder filling but there were no differences in voiding time within the CP or L group. The CP+ group (166 +/- 36min) was discharged faster than both L groups (226 +/- 57min, 227 +/- 59min). More serious micturition problems occurred in the L+ group compared with both CP groups. ConclusionChloroprocaine is suitable for day-case surgery because of faster block regression and discharge than lidocaine. A 500ml pre-load may not affect discharge but did not increase micturition problems for chloroprocaine. (C) 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd