Comparison of 2-Chloroprocaine, Bupivacaine, and Lidocaine for Spinal Anesthesia in Patients Undergoing Knee Arthroscopy in an Outpatient Setting

Abstract

For spinal anesthesia in patients undergoing ambulatory knee arthroscopy, chloroprocaine has the shortest time to complete recovery of sensory and motor block compared with bupivacaine and lidocaine.

Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials

“…The full-text of 123 articles were evaluated, and then, 84 articles were excluded due to the following reasons: no results about the incidence of TNS (n = 42); no other local anesthetics were used (n = 18); conference posters (n = 7); abstracts only (n = 4); protocols (n = 4); healthy subjects (n = 4); non-randomized studies of intervention (n = 2); different anesthetic techniques between groups (n = 1); mixed spinal anesthetics (n = 1); and a brief report (n = 1). Therefore, a total of 39 RCTs were included in the final analysis ( Figure 1) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…All these RCTs compared lidocaine with other local anesthetics (bupivacaine, prilocaine, mepivacaine, levobupivacaine, chloroprocaine, ropivacaine, procaine, articaine, or sameridine) and reported the incidence of TNS. We found that 28 RCTs had two groups [4][5][6][7][8][9][10][11][12]14,15,18,23,26,27,29,30,[34][35][36][37][38][39][40][41][42]44,46] of lidocaine more than other local anesthetics, while 11 RCTs had multiple groups [13,16,17,24,25,28,[31][32][33]43,45]. Five out of 11 RCTs have more than two lidocaine groups [16,24,28,33,43].…”

“…According to the Cochrane guidelines [22], all lidocaine groups were pooled into a single group. In another five RCTs, more than two other local anesthetics were used for spinal anesthesia [17,25,31,32,45]. In the remaining RCT [13], three doses of sameridine were used for spinal anesthesia and the results of three sameridine groups were combined.…”

“…The relationship between the incidence of TNS and baricity or concentration is shown in Figure 5. Sixteen studies used hyperbaric lidocaine [5,6,11,13,15,16,18,28,[32][33][34][35][36]39,42,45], 12 studies used isobaric [14,17,[23][24][25][26][27][29][30][31]41,44], and 4 studies used hypobaric lidocaine for spinal anesthesia [4,7,26,33]. One study had two treatment groups that administered hyperbaric or isobaric lidocaine [43].…”

“…More subsequent studies evaluating the effect of lidocaine on the risk of TNS have been published [2,3]. Furthermore, among them, many studies reported no patients suffering from TNS after spinal anesthesia with lidocaine [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Therefore, it is still controversial on the safety of lidocaine for spinal anesthesia during ambulatory surgery in terms of TNS.…”