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Anesthetic & recovery profiles of chloroprocaine versus mepivacaine for spinal anesthesia in parturients undergoing cervical cerclage
Abstract Number: SAT-03
Abstract Type: Original Research
Transvaginal cervical cerclages are routinely performed under neuraxial anesthesia. Longer acting neuraxial techniques are usually less desirable as a cerclage is typically an outpatient surgery procedure; and discharge is dependent upon the patient’s ability to void and ambulate. Therefore, this study is investigating the difference between intermediate and short acting neuraxial anesthetics, mepivacaine and chloroprocaine, to determine efficacy and length of PACU stay.
Materials and Methods:
This is a prospective, randomized, controlled, double blinded trial using two accepted doses of intrathecal chloroprocaine and mepivacaine as part of a spinal anesthetic. 36 patients were enrolled in the study following a review of medical records. Informed written consent was obtained from each patient. Each patient was randomly assigned to receive either 45 mg of 1.5 % mepivacaine with fentanyl 10 mcg or 45 mg of 3% chloroprocaine with fentanyl 10 mcg intrathecally. Two of the 36 patients were excluded from the study due to a deviation from the study protocol. One patient had a non-functioning spinal requiring a second neuraxial attempt, while the other did not receive the correct study dose.
After time out was performed, the lumbar area was prepped and draped in sterile fashion. After localization of the skin and subcutaneous tissue with 3mL 1% lidocaine, a spinal technique was performed by an anesthesia provider. The patient was then laid supine for transvaginal cervical cerclage. At this time, a blinded anesthesia provider assumed care of the patient. Blood pressure was monitored at 1 minute intervals, with any reading greater than 10% less than baseline treated with IV vasopressor as per standard of care. Dermatomal level was checked by sensation to pinprick at 5, 10, and 15 minutes following intrathecal dose administration, as well as 30 and 60 minutes after completion of the procedure. Any adverse events or use of adjuvant intravenous analgesics were recorded.
The groups were compared using a paired t-test. No significant difference in age (t=0.43, p=0.67), BMI (t= 0.85, p=0.39), or gestational age (t=1.1,p=0.28) existed between the mepivacaine and chloroprocaine groups. Median block height reached at 10 minutes was also the same between groups with a greater deviation in the chloroprocaine group. However, there was a statistically significant difference in the length of time from spinal dose to ambulation (p=0.0136) and micturition (p=0.0103). The mean length of time to ambulation and micturation for the chloroprocaine group was 152.2 minutes and 159.5 minutes, respectively compared with 210 and 214.9 minutes for mepivacaine. Therefore, we concluded that the PACU stay could be significantly shortened for these procedures when using chloroprocaine.