The following obstetric procedures are commonly performed with spinal anesthesia on labor and
delivery: bilateral tubal ligation, external cephalic version, cerclage insertion, cerclage
removal, minimally invasive fetal surgery, and evacuation of retained products of conception.
Bupivacaine is currently the standard spinal medication for these procedures because of its
long history of safe use, its low incidence of transient neurologic symptoms, and its ability
to provide a dependable, dense block with a high degree of maternal satisfaction. While
bupivacaine has the aforementioned advantages, it unfortunately has a long duration of
action, up to 240-380 minutes, which far exceeds the time necessary to complete most
obstetric procedures. Clorotekal®, the first Food and Drug Administration approved
chloroprocaine solution created for spinal injection, is a potential alternative. When
compared with bupivacaine spinals, chloroprocaine spinals have been shown to facilitate
clinically significant shorter times to resolution of motor and sensory block, first
ambulation, micturition, and discharge readiness. The objective of this study is to determine
if a strategy of spinal anesthesia with chloroprocaine will reduce the duration of motor
block, compared with equivalent block with hyperbaric bupivacaine..
BACKGROUND: One previous study has confirmed that the marginally hyperbaric solutions of
bupivacaine can maintain good quality of anesthesia and get a more steadily hemodynamic
status than commonly hyperbaric solutions, some authors confirmed the plain ropivacaine for
cesarean section have a higher failure rate and commonly hyperbaric solutions of ropivacaine
have a higher incidence of side reaction. It is unclear what the efficacy of spinal
marginally hyperbaric ropivacaine for elective cesarean delivery.We hypothesized that the
marginally hyperbaric ropivacaine will get a similar efficacy to commonly hyperbaric
solutions but a more steadily hemodynamic status.
OBJECTIVE In this prospective, randomized, double-blinded study, Investigator will compare
the clinical efficacy and adverse effect of spinal anesthesia with commonly hyperbaric and
marginally hyperbaric ropivacaine for elective cesarean delivery.
Main outcome measures: The maximum cephalad sensory block level; the change of continuous
cerebral oxygen desaturation (ScO2) over time; the incidence of hypotension and nausea and
vomiting; the change of invasive arterial pressure; the consumption of ephedrine; the
incidence of shivering; the onset time to T8 dermatome; the quality of anesthesia (efficacy
of motor block and sensory block)
Considering fast-track principles, an ideal spinal anesthetic should have minimal
complications and above all fast recovery so reducing in-hospital stay.
Between 1/8/2015 and 1/1/2016, a total of 101 patients attending the surgeon’s practice with
an umbilical or unilateral inguinal hernia and no contra-indications for surgery were
included in this study. Patients were given 10.5mg bupivacaine (B-group), 40mg hyperbaric
2-chloroprocaïne (C-group) or 60mg prilocaïne (P-group), each with added sufentanil (2µg).
Motor block was assessed using the Bromage scale. Sensory block was measured by determining
the peak level dermatome. Intraoperative hemodynamic parameters were listed. Resolution of
sensory and motor block, time to void and home readiness were defined as clinical endpoints.
