Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial

Abstract

Margaretha B Breebaart,1,2 Lies Saerens,3 Jordi Branders,2 Sari Casaer,3 Luc Sermeus,4 Patrick Van Houwe3 1Department of Medicine and Healthcare Sciences, University of Antwerp, Wilrijk, Belgium; 2Department of Anesthesia, Antwerp University Hospital, Edegem, Belgium; 3Department of Anesthesia, GZA Hospitals, Wilrijk, Belgium; 4Department of Anesthesia, Université Catholique de Louvain, Brussel, BelgiumCorrespondence: Margaretha B Breebaart Email [email protected]: Chloroprocaine provides spinal anesthesia for day-case surgery lasting up to 40 minutes. Intravenous and spinal dexmedetomidine can prolong spinal anesthesia, but no data are available for the combination with chloroprocaine. This double-blind randomized controlled trial compares chloroprocaine with spinal or intravenous dexmedetomidine regarding block characteristics, micturition, and discharge times.Patients and Methods: After ethical approval and informed consent, 135 patients scheduled for knee arthroscopy were randomized to receive either 40mg spinal chloroprocaine (Chloro-group), 40mg chloroprocaine with 5 mcg spinal dexmedetomidine (Spinal Dex-group) or 40mg chloroprocaine with 0.5 mcg/kg IV dexmedetomidine (IV DEXgroup). Block characteristics, hemodynamic variables and the use of analgesics were registered. Voiding and discharge times were noted. A scoring system was used for micturition problems and sedation. Transient neurological symptoms (TNS) and other late side effects were evaluated after one week.Results: Demographic data were similar between groups. Block onset times and intensity of motor block were comparable between groups. The time to L2 and Bromage 1 regression was prolonged in the SpinalDEx-group by approximately 30 minutes compared to the other groups (p 0.8). One patient experienced TNS.Conclusion: Intrathecal but not intravenous (0.5 mcg/kg) dexmedetomidine can prolong chloroprocaine (40mg) spinal anesthesia when surgery is expected to last over 40 minutes. Despite a similar incidence of adverse effects, this also led to a postponed hospital discharge time.Keywords: ambulatory surgery, bladder function, chloroprocaine, dexmedetomidine, knee arthroscopy, spinal anesthesia

Keywords

• ambulatory surgery
• bladder function
• chloroprocaine
• dexmedetomidine
• knee arthroscopy
• spinal anesthesia