Intrathecal hyperbaric 2% prilocaine versus 0.4% plain ropivacaine for same-day arthroscopic knee surgery: a prospective randomized double-blind controlled study

Abstract

Intrathecal hyperbaric 2% prilocaine versus 0.4% plain ropivacaine for same-day arthroscopic knee surgery: a prospective randomized double-blind controlled study Prilocaïne 2 % hyperbare versus ropivacaïne 0,4 % en injection intrathécale pour une arthroscopie du genou en chirurgie ambulatoire: une étude randomisée contrôlée prospective à double insu AbstractBackground Short-duration spinal anesthesia is a good option for ambulatory knee surgery. Hyperbaric 2% prilocaine has short onset and rapid recovery times and, therefore, may be well suited in this setting. The aim of this study was to compare the times to reach motor block, motor block resolution, and discharge from the postanesthesia care unit (PACU) between hyperbaric 2% prilocaine and 0.4% plain ropivacaine.Methods In this prospective randomized double-blind study, 140 patients (ages 18-80 yr and American Society of Anesthesiologists physical status I-II) scheduled for elective unilateral arthroscopic knee surgery lasting \ 45 min were allocated to either 3 mL of 2% prilocaine (60 mg) or 3 mL of 0.4% plain ropivacaine (12 mg). Time to reach complete recovery of motor block, time to reach criteria for discharge, as well as side effects up to 48 hr after discharge were recorded. Results The median (interquartile range [IQR]) time to recovery from the motor block was faster in the 2% prilocaine group compared with the 0.4% ropivacaine group (180 [169-240] min vs 240 [180-300] min, respectively; median difference, 60 min, 95% confidence interval (CI), 23 to 97 min; P = 0.036). The median [IQR] time to reach discharge criteria was similar between the two groups (330 min vs, 335 [290-395] min; median difference 5 min, 95% CI, -25 to 35 min; P = 0.330). The incidence of side effects was low and similar in both groups. No case of transient neurologic symptoms occurred in either group. Conclusion The recovery of motor block was faster after intrathecal administration of hyperbaric 2% prilocaine compared with 0.4% plain ropivacaine; however, discharge time was similar between the two groups. Both drugs showed a similar risk profile. RésuméContexte La rachianesthésie de courte durée est une bonne option lorsqu'on pratique une chirurgie ambulatoire du genou. Le délai d'action de la prilocaïne 2 % hyperbare est court et son temps de récupération rapide; cet agent

Prilocaine hydrochloride 2% hyperbaric solution for intrathecal injection: a clinical review

“…With 60 mg of hyperbaric 2% prilocaine, Aguirre, Camponovo and Ratsh showed no case of POUR in 144 lower limb ambulatory surgeries, reporting mean times to first micturition ranging between 218 and 306 min 22,23,32. Nevertheless, after a properly designed observational study, using the same dosage of intrathecal 2% hyperbaric prilocaine, Kreutziger et al showed a high rate of urinary retention (23%) in 86 relatively low-risk patients (mean age 46 years without urogenital pathologies, lower limb minor orthopedic procedures).…”

“…In the same type of ambulatory surgery, Aguirre et al compared 60 mg of 2% hyperbaric prilocaine with 12 mg of 0.4% plain ropivacaine 32. The offset of motor block was faster after intrathecal administration of prilocaine (180 vs 240 min).…”

In reply: Is 60 mg a suitable dosage for same-day spinal prilocaine?

“…1,2 As discussed in our paper, we decided to perform spinal anesthesia with 60 mg of 2% hyperbaric prilocaine instead of 40 mg as suggested in the article by Camponovo et al because their report specified that 13% of patients had required additional intraoperative analgesia. A regional anesthesia regimen in which one patient in ten needs supplemental analgesia does not fulfill our clinical quality criteria and cannot be recommended as the standard of care.…”

Reviving older drugs to deal with anesthesia drug shortages

“…ont comparé l'utilisation de 60 mg de prilocaïne 2 % hyperbare à 12 mg de ropivacaïne 0,4 % pour une arthroscopie du genou réalisée en clinique ambulatoire. 9 Le critère d'évaluation principal, soit le temps moyen jusqu'à résolution du bloc moteur, était significativement plus court dans le groupe prilocaïne 2 % que dans le groupe ropivacaïne 0,4 % (180 min vs. 240 min, respectivement; différence moyenne, 60 min; intervalle de confiance [IC] 95 % de différence, 23 à 97; P \ 0,036). Cependant, cette réduction de temps jusqu'à la résolution du bloc ne s'est pas traduite en une différence en matière de temps jusqu'au congé de la salle de réveil (330 min pour la prilocaïne vs. 335 min pour la ropivacaïne; différence moyenne, 5 min; IC 95 %, -25 à 35; P = 0,330) étant donné qu'on attendait la première miction avant d'accorder le congé aux patients.…”

“…In this issue of the Journal, Aguirre et al compare hyperbaric 2% prilocaine 60 mg with 0.4% plain ropivacaine 12 mg for same-day discharge arthroscopic knee surgery. 9 The primary outcome, median time to motor block resolution, was significantly shorter in the 2% prilocaine group than in the 0.4% ropivacaine group (180 min vs 240 min, respectively; mean difference, 60 min; 95% confidence interval [CI] of difference, 23 to 97; P \ 0.036). Nevertheless, this did not translate to a difference in PACU discharge time (330 min for prilocaine vs 335 min for ropivacaine; mean difference, 5 min; 95% CI, -25 to 35; P = 0.330) as patients were required to void prior to discharge.…”