Fast-acting, powerful and short in duration — spinal blocks are ide-
ally suited for lower-body same-day surgeries, especially as more com-
plex procedures such as total knee replacements migrate to outpa-
tient centers.
Old drug, new option
The use of chloroprocaine as a spinal anesthetic began to develop in
the 2000s, and the FDA approved it for use as a spinal anesthetic in
2017. It had fallen out of favor because of adjutant preservatives that
caused some neurologic problems, according to Michael Aziz, MD, a
professor of anesthesiology and perioperative medicine at Oregon
Health & Science University in Portland. He says those preservatives
are no longer present in modern preparations.
"Preservative-free chloroprocaine anesthetics are well-suited for
ambulatory surgery," he notes. The drug is fast-acting, usually taking
full effect in three to five minutes after injection, but it also breaks
down quickly — making it a great tool for the rapid in-and-out pace of
outpatient surgery.
Dr. Aziz says the blocks reliably last 60 to 90 minutes, and reliably
return motor and bladder function as well. Unless sedatives are used
in tandem, the patient is fully conscious during the operation, and
less likely to suffer the kinds of hangover effects experienced by
patients who undergo general anesthesia.
"I'd say the over the last couple of years, as we've started to see
joint arthroplasties performed in ambulatory centers, chloroprocaine
is being used as a spinal anesthetic," he says. "It also supports knee
procedures — arthroscopy, ACL reconstruction and meniscal sur-
gery."
Cholorprocaine is also terrific for short procedures such as inguinal
hernias and knee scopes, after which you don't want the patient to
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