A multicenter study of the analgesic effects of epidural chloroprocaine after lower limb orthopedic surgery.

STUDY

OBJECTIVE

To investigate the effects and optimal concentration of chloroprocaine for epidural analgesia after lower limb orthopedic surgery.

DESIGN

Prospective, randomized, observational, multicenter clinical study.

SETTING

Operating room, postoperative recovery area, university hospital.

PATIENTS: One hundred and twenty patients from 4 hospitals were enrolled and randomized into 5 groups after lower limb orthopedic surgery under epidural anesthesia with lidocaine.

INTERVENTIONS: Epidural chloroprocaine mixed with 0.4μg/mL fentanyl was administered via a patient-controlled analgesia pump at the concentration of 0.6%, 0.8%, 1.0%, 1.2%, or 1.4% after the surgery.

MEASUREMENTS: Systolic blood pressure, heart rate, visual analog score at rest and during activity, as well as the Bromage score at 0 minute, 30 minutes, 1 hour, 2 hours, 4 hours, 8 hours, 24 hours, and 48 hours after the surgery were recorded and compared. Use of morphine and incidence of adverse effects were also recorded.

MAIN

RESULTS

Patients given 1.2% chloroprocaine showed the lowest visual analog score compared with other groups. There was no significant difference in the Bromage score among 5 groups. The Bromage score returned to 0 in 89.7% of the patients 48 hours after surgery. No difference in postoperative morphine usage, blood pressure, or heart rate was found among 5 groups.

CONCLUSIONS

Epidural 1.2% chloroprocaine with 0.4μg/mL fentanyl could generate proper analgesic effects with little influence on mobility in patients undergoing lower limb orthopedic surgery. In addition, it could generate a good sense and movement separation, facilitating the early functional training.