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Helsinki, Finland

Forster J.G.,Orthopedic Hospital Orton
Current Opinion in Anaesthesiology | Year: 2014

Purpose of review There has been a renewed interest in the short-acting local anesthetics articaine, chloroprocaine, and prilocaine for ambulatory spinal anesthesia because of numerous potentially beneficial factors both clinically and economically speaking. This review covers the current advances of the past 1 to 2 years. Recent findings Literature search revealed a pleasing quantity of relevant articles. In various randomized, controlled trials (many different designs), chloroprocaine, articaine, and prilocaine performed mainly well as regards fast onset, satisfying block, and quick recovery. With these anesthetics transient neurologic symptoms were very rarely seen. Regarding urinary retention useful guidelines for bladder volume management were presented. In addition, various interesting features relating to unilateral spinal anesthesia and economical aspects were investigated. Summary Intrathecal articaine (off-label use for the time being), chloroprocaine, and prilocaine (the latter two officially approval in several European countries) remain a very appealing option in the ambulatory setting. Chloroprocaine may have a slight edge as regards ultra-short and short surgery, whereas articaine and prilocaine may suit well for somewhat longer procedures. Future follow-up investigations should establish possible differences between these local anesthetics, also with respect to other anesthetic techniques and to economical aspects. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Forster J.G.,Orthopedic Hospital Orton | Rosenberg P.H.,University of Helsinki
Current Opinion in Anaesthesiology | Year: 2011

Purpose of Review: In recent years, several older (first intrathecal use in the 1950s, 1960s, and 1970s) local anesthetics have been investigated as spinal anesthetics in ambulatory surgery because these drugs are claimed to cause less transient neurologic symptoms (TNS) than lidocaine which was the main spinal anesthetic for surgery of short-duration for decades. The review covers the current literature. Recent Findings: Several recent reports have dealt with the short-acting chloroprocaine and articaine and the intermediate-duration-acting prilocaine. Mepivacaine, another intermediate-acting drug, was applied in one trial only. Various dosages of these drugs either alone or with a small dose of fentanyl were compared with each other, with lidocaine, or with the currently most commonly used low-dose bupivacaine technique. The recovery from both motor and sensory block was usually reasonably fast. However, occasionally recovery after mepivacaine and prilocaine was prolonged which fits ill in a fast-flow ambulatory setting. TNS cases were very rarely reported. Summary: The newest results corroborate (at least for chloroprocaine, articaine, and prilocaine) previous data that these drugs provide reliable and mostly well tolerated spinal blocks associated with an apparently smaller risk for postanesthesic TNS as compared with lidocaine. Further studies are warranted regarding broader indications, possible usefulness of adjuvants, and for the exploration of the side-effect profiles in detail. To what extent the observed revival of these older, rather well characterized local anesthetics leads to a wider use of spinal anesthesia in the ambulatory setting remains to be seen. This is also dependent on various organizational and local traditional factors. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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