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

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...

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Autores principales:	Breebaart MB, Saerens L, Branders J, Casaer S, Sermeus L, Van Houwe P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	ambulatory surgery bladder function chloroprocaine dexmedetomidine knee arthroscopy spinal anesthesia Anesthesiology RD78.3-87.3
Acceso en línea:	https://doaj.org/article/344e452d3ab74f9e8c0b62c0abe40e94
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spelling	oai:doaj.org-article:344e452d3ab74f9e8c0b62c0abe40e942021-11-21T19:08:51ZSpinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial1178-7112https://doaj.org/article/344e452d3ab74f9e8c0b62c0abe40e942021-11-01T00:00:00Zhttps://www.dovepress.com/spinal-or-intravenous-dexmedetomidine-for-spinal-anesthesia-with-chlor-peer-reviewed-fulltext-article-LRAhttps://doaj.org/toc/1178-7112Margaretha 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 margaretha.breebaart@uza.bePurpose: 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 < 0.01). First voiding as well as discharge from the hospital was prolonged in the Spinal Dex-group by approximately 40 minutes p < 0.01. There was no significant difference between groups regarding treatment of hypotension, sedation, micturition problems or the use of postoperative analgesics (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 anesthesiaBreebaart MBSaerens LBranders JCasaer SSermeus LVan Houwe PDove Medical Pressarticleambulatory surgerybladder functionchloroprocainedexmedetomidineknee arthroscopyspinal anesthesiaAnesthesiologyRD78.3-87.3ENLocal and Regional Anesthesia, Vol Volume 14, Pp 153-160 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ambulatory surgery bladder function chloroprocaine dexmedetomidine knee arthroscopy spinal anesthesia Anesthesiology RD78.3-87.3
spellingShingle	ambulatory surgery bladder function chloroprocaine dexmedetomidine knee arthroscopy spinal anesthesia Anesthesiology RD78.3-87.3 Breebaart MB Saerens L Branders J Casaer S Sermeus L Van Houwe P Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial
description	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 margaretha.breebaart@uza.bePurpose: 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 < 0.01). First voiding as well as discharge from the hospital was prolonged in the Spinal Dex-group by approximately 40 minutes p < 0.01. There was no significant difference between groups regarding treatment of hypotension, sedation, micturition problems or the use of postoperative analgesics (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
format	article
author	Breebaart MB Saerens L Branders J Casaer S Sermeus L Van Houwe P
author_facet	Breebaart MB Saerens L Branders J Casaer S Sermeus L Van Houwe P
author_sort	Breebaart MB
title	Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial
title_short	Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial
title_full	Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial
title_fullStr	Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial
title_full_unstemmed	Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial
title_sort	spinal or intravenous dexmedetomidine for spinal anesthesia with chloroprocaine in ambulatory knee arthroscopies: a double-blind randomized trial
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/344e452d3ab74f9e8c0b62c0abe40e94
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Spinal or Intravenous Dexmedetomidine for Spinal Anesthesia with Chloroprocaine in Ambulatory Knee Arthroscopies: A Double-Blind Randomized Trial

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