Chloroprocaine with or without Fentanyl for perianal day care procedures under Subarachnoid block: A Randomized Controlled Study

Introduction: Chloroprocaine is a short acting local anesthetic with rapid onset and recovery making it a suitable for choice for spinal anesthesia in day care procedures. However, it provides little or no post-operative analgesia when administered alone. The present study aims to explore the effect of adding fentanyl to intrathecal chloroprocaine for subarachnoid block (SAB) for perianal day care surgery.Materials and Methods: This was a prospective randomised controlled study conducted on 40 ASA I/II patients between 18-60yrs. after written informed consent. Patients were allocated in one of the two groups using a computer generated random number table. Group CF (chloroprocaine with fentanyl): received 40mg of 1% isobaric chloroprocaine with 20μg of fentanyl for SAB and Group CN (chloroprocaine): received 40mg 1% isobaric chloroprocaine with 0.4ml normal saline for SAB. Onset of drug, time to achieve maximum sensory and motor block, maximum level of sensory block and time to two dermatomal regression, request first rescue analgesic and home readiness were recorded.Results: Patients receiving fentanyl as additive had delayed motor recovery (86.75±9.21min) compared to patients receiving chloroprocaine (78.16±10.02min) (p=0.08). Time to request of first rescue analgesic (p=0.001) and time to achieve home readiness was significantly prolonged with fentanyl addition as compared to chloroprocaine alone (88.20±07.38min and 82.74±07.89min respectively; p=0.032).Conclusion: Addition of fentanyl provides prolonged analgesia but slightly delays motor recovery and time to achieve home readiness. Chloroprocaine with fentanyl is a safe alternative to chloroprocaine alone for patients undergoing day care procedures.