Spinal Chloroprocaine Versus Bupivacaine Without Opioid Adjuvant for Transvaginal Cervical Cerclage Placement: A Pragmatic Retrospective Cohort Study (2018–2023)

( Int J Obstet Anesth . 2025;61:104323. doi:10.1016/j.ijoa.2024.104323.) Transvaginal cervical cerclage procedures to treat cervical insufficiency are typically carried out using neuraxial anesthesia. However, there is little data available regarding how effective spinal anesthesia using chloroprocaine alone—without fentanyl—is for this type of surgery. Traditionally, bupivacaine has been the local anesthetic of choice, offering prolonged pain relief and potentially delaying discharge. Chloroprocaine, introduced as a short-acting alternative in 2004, has the potential to provide sufficient anesthesia while allowing for quicker recovery and discharge. The study aimed to evaluate outcomes between the two anesthetics, stratified by their estimated effective dose for 90% of patients (ED90), to determine the adequacy of anesthesia and recovery metrics.