Outcomes with intrathecal 2-chloroprocaine 3% 60 mg and fentanyl 15 μg for cervical cerclage: a retrospective quality assurance study (2021 – 2023)

Background: In a prior study at our institution comparing intrathecal chloroprocaine to bupivacaine for spinal anesthesia for cervical cerclage, the use of intrathecal 2- chloroprocaine 3% 50 mg with fentanyl 15 μg was associated with intraoperative discomfort in 9% of patients, prompting a practice change to increase the dose to 60 mg. We report outcomes from two years of experience with the higher dose. Methods: We conducted a retrospective chart review of patients who underwent transvaginal cervical cerclage with spinal anesthesia with 2-chloroprocaine 3% 60 mg and fentanyl 15 μg (July 2021 − July 2023). Outcomes included surgery duration, anesthetic supplementation, time from spinal injection to meet discharge criteria, and postoperative concerns documented during postoperative day 1 phone calls (n=122, available from July 2022). Results: A total of 208 patients were included. The median surgery duration was 17 [11–25] min. A lower supplementation rate was observed with 60 mg (2% vs 9% (2/22)), but the study lacked statistical power to confirm a significant difference (P = 0.104); none required general anesthesia. The median time from spinal injection to discharge was 186 [163–218] min, compared with 158 [137–188] min in the prior 50 mg cohort (median difference −15.0 min (−20.5 to −9.5, P < 0.001). No patients reported transient neurologic symptoms, difficulty ambulating, or voiding. One reported back pain, and three reported abdominal discomfort. Conclusion: Intrathecal 2-chloroprocaine 3% 60 mg with fentanyl showed fewer anesthetic failures (but this was not statistically significant) and a modestly longer discharge time than 50 mg.