• Hongwei Xu, Huiping Li, Yunxia Zuo, Baxian Yang, Yuke Tian, Qulian Guo, Jianguo Xu, and Chaoran Wu.
• Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West-China Hospital of Sichuan University, Guoxuexiang 37, Chengdu, Sichuan, 610041, China.
• J Clin Anesth. 2016 Dec 1; 35: 313-320.

Study ObjectiveTo investigate the effects and optimal concentration of chloroprocaine for epidural analgesia after lower limb orthopedic surgery.DesignProspective, randomized, observational, multicenter clinical study.SettingOperating room, postoperative recovery area, university hospital.PatientsOne hundred and twenty patients from 4 hospitals were enrolled and randomized into 5 groups after lower limb orthopedic surgery under epidural anesthesia with lidocaine.InterventionsEpidural 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.MeasurementsSystolic 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 ResultsPatients 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.ConclusionsEpidural 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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