ESRA19-0573\u20051% 2-chloroprocaine for day case unicompartmental knee replacement

Abstract

Background and aims Rapid return of motor function following spinal anaesthesia has been partially addressed by the use of low dose/concentration bupivacaine with or without opioid. 1% 2-chloroprocaine (2CPC) provides 70 minutes of profound analgesia whilst allowing rapid return to street fitness and reduced incidence of urinary retention. We examined its use for unicompartmental knee replacement (UKR) in the day case setting. Methods 28 patients undergoing UKR had spinal anaesthesia performed with 50 mg 2CPC. Both iPACK and distal femoral triangle nerve blocks were placed for postoperative analgesia. Patients received regular paracetamol, Ibuprofen and Oxycodone MR premedication and post-surgery with intermittent cryocuff to the knee. Surgical, tourniquet time and rescue analgesia were recorded as well as time to return of motor function and first mobilisation Results All had adequate anaesthesia with no intraoperative sedation or additional analgesia. Median surgical time was 62.5 min IQR(56–68). Tourniquet time was 46.5 (43–50). No patient required rescue analgesia in the recovery area. Two patients received one dose each of subcutaneous morphine 10 mg on the ward. Eight patients required oral morphine rescue analgesia. 18 required no additional analgesia over and above the regular regime. Maximum time to return of motor function was 98 minutes post spinal injection. Physiotherapists reported no failures of mobilisation due to prolonged motor block. All patients were able to complete their stair assessment by 4pm on the day of surgery. Conclusions 1% 2-chloroprocaine provides excellent, reliable spinal anaesthesia for UKR without the need for intraoperative supplementation or sedation. The recovery characteristics suggest it is suitable for day-case UKR.