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Archive April 2020 XXI, No. 4

Spinal Anesthesia Is the Smart Choice

Jared Bilski


Joe Paone

Joe Paone


ONE AND DONE Spinal anesthesia requires one shot, has a quick onset and can provide full numbness and paralysis for less than an hour.

One of outpatient surgery's hottest specialties is fueling the rise of spinal anesthesia. "Before we performed total joints in surgery centers, we hadn't utilized spinal anesthesia for any other procedures," says Mike MacKinnon, CRNA, who practices in Arizona. "Now we're using low-dose spinals — 0.8 cc to 1.0 cc of 0.75% bupivacaine — for total knees."

Mr. MacKinnon says this low dose lets surgeons perform total knees with sedation plus an adductor canal block and iPACK or popliteal plexus block. "The spinal wears off within 30 minutes to an hour in post-op, allowing the patient to start physiotherapy almost immediately," he adds. "The blocks also keep them pain free for up to 30 hours."

Surgeons are better able to perform total knees with a spinal block placed because of the significant benefit total paralysis of the lower extremity provides, according to Mr. MacKinnon.

Fast-acting, powerful and short in duration — spinal blocks are ideally suited for lower-body same-day surgeries, especially as more complex procedures such as total knee replacements migrate to outpatient 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.

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