Adult Dosing

Local anesthesia

• With epinephrine (1: 200,000): 14 mg/kg, up to 1,000 mg
• Without epinephrine: 11 mg/kg, up to 800 mg

Regional anesthesia

• Test Dose: 90-100 mg; repeat the dose if epidural catheter is displaced
• Mandibular anesthesia: 40-60 mg of 2% conc. (2-3 ml)
• Infraorbital anesthesia: 10-20 mg of 2% conc. (0.5-1 ml)
• Brachial plexus anesthesia: 600-800 mg of 2% conc. (30-40 ml)
• Digital (without epinephrine) anesthesia: 30-40 mg of 1% conc. (3-4 ml)
• Pudental anesthesia: 400 mg (200 mg on each side) of 2% conc. (10 ml on each side)
• Paracervical anesthesia: Max 120 mg of 1% conc. (2 ml per ea of 4 sides)
• Caudal epidural anesthesia: Initial dose: 300-750 mg (15-25 ml of 2% conc.); may repeat at 40-60 mins intervals
• Lumbar epidural anesthesia: 40-75 mg per segment (2 - 2.5 ml of 2% or 3% conc.); Max dose: 300-750 mg

Pediatric Dosing

Local anesthesia

• Child >3 yrs: Max 11 mg/kg; concentration 0.5-1%

Regional anesthesia

• Child >3 yrs: Max 11 mg/kg; concentration 1-1.5%

• Local anesthesia (preservative containing solutions)
• Peripheral, sympathetic, and epidural (including caudal) block anesthesia (preservative free solutions)

• Hypersensitivity to drugs containing PABA-ester group

• N/A

Renal dose adjustment

• Use with caution; dose adjustments not defined

Hepatic Dose Adjustment

• Use with caution; dose adjustments not defined

• Chloroprocaine should only be administered by a clinician having adequate knowledge for management of dose related toxicities and acute emergencies in a medical facility with adequate resources
• Administer test dose and monitor CNS and cardiovascular toxicity; signs of intrathecal administration
• Post-marketing reports of chrondrolysis in patients who received intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures
• Careful and constant monitoring of cardiovascular and respiratory (adequacy of ventilation) vital signs and the patient’s state of consciousness should be accomplished after each local anesthetic injection.
• Risk of severe persistent hypertension if vasopressors are administered in presence of ergot-type oxytocic drugs
• To avoid intravascular injection, frequent aspirations before and during administration of chloroprocaine are recommended
• Repeated doses of local anesthetics may cause significant increases in plasma levels due to slow accumulation; reduce dose in elderly, debilitated, and children
• Local anesthetics with vasoconstrictors should be used cautiously in patients with peripheral vascular disease and hypertensive vascular disease
• In retrobulbar block, lack of corneal sensation precedes external ocular muscle akinesia; do not rely on lack of corneal sensation
• Monitor cardiovascular and respiratory vital signs

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Hypotension
• Heart block
• Impaired cardiac function
• Severe hypertension
• Neurological impairment
• Spinal deformities
• Septicemia
• Elderly/debilitated/acutely ill patients

Pregnancy Category:C

Breastfeeding: Safety unknown; an alternate drug may be preferred, especially while nursing a newborn or preterm infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 13 September 2010). Manufacturer advises caution.

• CNS: Excitation, depression, headache, restlessness, anxiety, dizziness, tinnitus, blurred vision, tremors, convulsions, drowsiness, unconsciousness
• NEURO: Spinal block (varying degrees), hypotension, loss of bladder and bowel control, loss of perineal sensation and sexual function, arachnoiditis; persistent motor, sensory, autonomic deficit of lower spinal segments
• CVS: Myocardial depression, hypotension, bradycardia, ventricular arrhythmias, cardiac arrest
• MUSC: Backache
• HYPERSENSITIVITY: Anaphylactoid reactions, sneezing, nausea, vomiting, dizziness, tachycardia, syncope, excessive sweating, pyrexia

• Ester anesthetic; Inhibits sodium influx through voltage gated sodium channels in the neuronal cell membrane of peripheral nerves, thus inhibiting nerve impulse initiation and conduction
• Bioavailability : Variable depending upon the total dose and concentration
• Metabolized by plasma
• Renally excreted
• Half-life: 19-23 seconds (males); 24-26 seconds (females)

US Trade Name(s)

• Nesacaine
• Nesacaine-MPF

US Availability

chloroprocaine (generic)

• INJ: 20 mg/mL (20, 30 mL vial)
• INJ: 30 mg/mL (20, 30 mL vial)

Nesacaine

• INJ: 10 mg/mL (30 mL vial)
• INJ: 20 mg/mL (20, 30 mL vial)
• INJ: 30 mg/mL (20 mL vial)

Nesacaine-MPF

• INJ: 20 mg/mL
• INJ: 30 mg/mL

Canadian Trade Name(s)

• Nesacaine-CE

Canadian Availability

Nesacaine-CE

• INJ: 20 mg/mL

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Anesthesia

Local Anesthetics; Injectable