Alcohol (70%) versus alcoholic chlorhexidine solution (0.5%) in skin antisepsis for neuraxial blocks: a randomized clinical trial

Abstract

Objective: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. Method: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. Results: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. Conclusion: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.

Skin antiseptic solutions for a central neuraxial block. How to do it in daily clinical practice

“…In a study comparing 0.5% alcoholic chlorhexidine with 70% hydrated ethyl alcohol for skin antisepsis for neuraxial blocks, it was shown that 70% alcohol was more effective in reducing the number of colony forming units (CFU/cm²) after two minutes, and there was no difference between the two groups in terms of skin colonization at the end of the procedure. 14 To verify whether two applications of chlorhexidine/ethanol solution are more effective than one for skin disinfection before neuraxial anesthesia, the result showed that the application of chlorhexidine/ethanol once is sufficient to disinfect the skin for regional anesthesia, and that the 2 nd application may be delayed in an emergency situation, and this 2 nd application increases the risk of translocation of chlorhexidine to the subarachnoid space. 15…”

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“…In a study comparing 0.5% alcoholic chlorhexidine with 70% hydrated ethyl alcohol for skin antisepsis for neuraxial blocks, it was shown that 70% alcohol was more effective in reducing the number of colony forming units (CFU/cm²) after two minutes, and there was no difference between the two groups in terms of skin colonization at the end of the procedure. 14 To verify whether two applications of chlorhexidine/ethanol solution are more effective than one for skin disinfection before neuraxial anesthesia, the result showed that the application of chlorhexidine/ethanol once is sufficient to disinfect the skin for regional anesthesia, and that the 2 nd application may be delayed in an emergency situation, and this 2 nd application increases the risk of translocation of chlorhexidine to the subarachnoid space. 15…”