Short-acting spinal anaesthetic

Ampres, a 1% solution of chloroprocaine hydrochloride, is fast acting and provides effective pain relief.[1] But its short duration has been shown to reduce time from surgery to discharge by 76 minutes, compared to bupivacaine.[2]

Patients given Ampres are also less likely to experience urinary retention,[3] a common cause of delayed discharge after bupivacaine, and it has not been associated with transient neurological symptoms (TNS).[4]

At this concentration, and free of the preservatives which were added to chloroprocaine hydrochloride in the past, this new formulation has been described as having, ‘Ideal properties for short spinal anaesthesia, mainly in the day-surgery domain’.[5]

Day surgery is increasingly popular. From 1996 to 2003 the number of procedures rose from 55.7% to 67.2%[6] and one of the ‘high impact changes’ recommended by the NHS Modernisation Agency is ‘Treating day surgery (rather than inpatient surgery) as the norm for elective surgery'[7].

It is estimated that this measure alone would release nearly half a million inpatient bed days a year.[8] Day surgery is cost-effective, cuts waiting times, is popular with patients, reduces the risk of hospital acquired infections and leads to better outcomes for patients.[9]

However, despite the evidence base for spinal anaesthesia, most Day Surgery Units use general anaesthesia and this excludes many higher-risk patients, such as those who are obese or suffer from cardiorespiratory disease.[10]

Spinal or subarachnoid block is not only suitable for these higher risk patients, but other advantages include fewer problems with respiratory function, reduced deep vein thrombosis, reduced post-operative nausea and vomiting and an immediate return to normal oral intake — an important consideration for patients with diabetes.[11]

The British Association of Day Surgery has called for wider use of spinal anaesthesia and has stated: “We believe that wider use of SAB [spinal or subarachnoid block] in day surgery is advantageous to the patient and contributes to efficient use of limited healthcare resources.”

The Healthcare Commission has identified 25 procedures which, in most cases, can be carried out safely as a day case.[12] Spinal anaesthesia would be appropriate for some of these procedures such as arthroscopy and stripping varicose veins.

Ampres (chloroprooacaine) is licensed in the UK for spinal anaesthesia in adults where the planned surgical procedure does not exceed 40 minutes. As with all local anaesthetics, known side-effects of hypotension and bradycardia may occur.

1. Delft JV, Christina D. Ultra short-acting local anaesthetic agents: Chloroporcaine hydrochloride 1% Intrathecal. 2009; Perimed 20-26
2. Marie-Andrée Lacasse, Jean-Denis Roy et al: Comparison of bupivacaine and 2-chloroprocaine for spinal anaesthesia for outpatient surgery: a double-blind randomized trial 2011; Can Anaesth; 58:384-391
3. Delft JV, Christina D. Ultra short-acting local anaesthetic agents: Chloroporcaine hydrochloride 1% Intrathecal. 2009; Perimed 20-26
4. Delft JV, Christina D. Ultra short-acting local anaesthetic agents: Chloroporcaine hydrochloride 1% Intrathecal. 2009; Perimed 20-26
5. Delft JV, Christina D. Ultra short-acting local anaesthetic agents: Chloroporcaine hydrochloride 1% Intrathecal. 2009; Perimed 20-26
6. Dr Foster’s Case Notes. Trends in day surgery rates. BMJ 2005;331:803
7. http://www.institute.nhs.uk/quality_and_service_improvement_tools/qualit…
8. http://www.institute.nhs.uk/quality_and_service_improvement_tools/qualit…
9. http://www.institute.nhs.uk/quality_and_service_improvement_tools/qualit…
10. Watson B, Allen J, Smith I. British Association of Day Surgery. Spinal Anaesthesia — A Practical Guide 2004
11. Watson B, Allen J, Smith I. British Association of Day Surgery. Spinal Anaesthesia — A Practical Guide 2004
12. Healthcare Commission: Day Surgery July 2005  http://archive.cqc.org.uk/_db/_documents/04018390.pdf