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Chloroprocaine

    Brands

    DEA Class; Rx

    Common Brand Names; Nesacaine, Clorotekal

    • Local Anesthetics, Esters; 
    • Local Anesthetics, Parenteral

    Short-acting ester-type local anesthetic
    Used for infiltration anesthesia; peripheral, sympathetic, epidural, caudal, subarachnoid, intravenous regional (Bier’s method) blocks; and ocular surface anesthesia
    Not effective as a topical anesthetic

    Indicated for regional anesthesia.

    For local anesthesia via infiltration anesthesia or nerve block anesthesia.

    For use in obstetric anesthesia.
    For ophthalmic anesthesia.

    Hypersensitivity to para-aminobenzoic acid (PABA) or parabens

    Lumbar and caudal epidural anesthesia should be used with extreme caution in persons with the following conditions: Existing neurological disease, spinal deformities, septicemia, and severe hypertension

    General and specific contraindications to spinal anesthesia regardless of the local anesthetic use, should be taken into account (eg, decompensated cardiac insufficiency, hypovolemic shock, coagulopathy)

    IV regional anesthesia (the anesthetic agent is introduced into the limb and allowed to set in while tourniquets retain the agent within the desired area)

    Serious problems with cardiac conduction

    Local infection at the site of proposed lumbar puncture

    Septicemia

    Procedural pain (16%)

    Hypotension (4.9%)

    Injection site pain (3.7%)

    Common

    • Anxiety

    • Dizziness

    • Restlessness

    • Tremor

    • Tinnitus

    • Blurred vision

    Rare (serious)

    • Bradyarrhythmia

    • Cardiac arrest

    • Hypotension

    • Excitation

    • Depression

    • Seizure

    • Anaphylaxis

    • Respiratory arrest

    Local anesthetics should only be administered by clinicians who are well versed in diagnosis and management of dose-related toxicity and other acute emergencies which might arise from the block to be employed, and then only after insuring the immediate availability of oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resources needed for proper management of toxic reactions and related emergencies

    Hypotension and bradycardia are well known side effects of all local anesthetics

    Neurological damage may occur after spinal anesthesia, manifesting as paresthesia, loss of sensitivity, motor weakness, paralysis, cauda equina syndrome; occasionally these symptoms persist and can be permanent

    Use extreme caution with lumbar and caudal epidural anesthesia in person with existing neurological disease, spinal deformities, septicemia, severe hypertension, heart block, high grade cardiac decompensation, advanced liver or kidney impairment, elderly patients and patients in poor general condition, genetic cholinesterase deficiency, severe anemia, congenital or acquired bleeding disorder, and patients taking anticoagulants

    Use preservative free preparations for spinal or epidural anesthesia

    DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear)

    Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action

    Monitor patient’s state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity

    Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)

    Hypersensitivity reactions reported; cross-reactivity among ester-type local anesthetics may occur (see Contraindications)

    Respiratory arrest reported with local anesthetics

    Data are limited regarding use in pregnant women

    Data are not available on the presence of chloroprocaine in human milk, the effects on the breastfed infant, or the effects on milk production

    The development and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal condition

    The dose of local anesthetics differs with the anesthetic procedure; the area to be anesthetized; the vascularity of the tissues; the number of neuronal segments to be blocked; the intensity of the block; the degree of muscle relaxation required; the duration of anesthesia desired; individual tolerance; and the physical condition of the patient.

    Adults

    50 mg/dose intrathecally; 11 mg/kg for other parenteral routes, not to exceed 800 mg/dose when given without epinephrine. With epinephrine (1:200,000), 14 mg/kg, not to exceed 1,000 mg. 3 drops/dose for ophthalmic gel.

    Geriatric

    50 mg/dose intrathecally. 11 mg/kg for other parenteral routes, not to exceed 800 mg/dose when given without epinephrine. With epinephrine (1:200,000), 14 mg/kg, not to exceed 1,000 mg. 3 drops/dose for ophthalmic gel.

    Adolescents

    11 mg/kg. Concentrations of 0.5% to 1% are suggested for infiltration, and 1% to 1.5% are recommended for nerve block. Safety and efficacy of the ophthalmic gel and intrathecal chloroprocaine have not been established.

    Children

    4 years and older: 11 mg/kg. Concentrations of 0.5% to 1% are suggested for infiltration, and 1% to 1.5% are recommended for nerve block. Safety and efficacy of the ophthalmic gel and intrathecal chloroprocaine have not been established.
    3 years and younger: Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Chloroprocaine  Hydrochloride

    solution, injection for nerve block

    • 1% (Nesacaine)
    • 2% (Nesacaine, Nesacaine MPF [preservative free])
    • 3% (Nesacaine MPF)

    solution, intrathecal injection

    • 10mg/mL (Clorotekal)
    • Supplied as 50mg/5mL chloroprocaine HCl (equivalent to 44.05mg/5mL [8.81mg/mL] chloroprocaine)