CHLOROPROCAINE HYDROCHLORIDE
| CHLOROPROCAINE HYDROCHLORIDe (klor-oh-proe'kane) Nesacaine, Nesacaine-CE  Classifications: local anesthetic (ester-type); Therapeutic: local anesthetic Prototype: Procaine Pregnancy Category: C |
Availability
1%, 2%, 3% injection
Action
Short-acting ester-type local anesthetic similar to procaine. Decreases sodium influx into nerve cells, thus preventing initial depolarization, propagation, and conduction of the nerve impulse.
Therapeutic Effect
Produces anesthetic effect, but not used for spinal, topical, or IV regional anesthesia.
Uses
Infiltration anesthesia and for peripheral, sympathetic, and epidural (including caudal) block anesthesia.
Contraindications
Known sensitivity to ester-type anesthetics, bisulfites, parabens (preservative) or PABA; intercurrent use of bupivacaine; coagulopathy; anticoagulant therapy; pregnancy (category C). Safe use children <12 y not established.
Cautious Use
Cardiac function impairment; history of drug hypersensitivity; debilitated, older adult, or acutely ill patients; neurologic disease, myasthenia gravis; dysrhythmias; sepsis; lactation.
Route & Dosage
| Infiltration and Nerve Block Adult: 1–2% solution: max of 800 mg without epinephrine, 1 g with epinephrine Caudal and Epidural Block (Without Preservatives) Adult: 2–3% solution: max of 800 mg without epinephrine, 1 g with epinephrine |
Administration
Caudal/Epidural- A test dose (3 mL of 3% solution or 5 mL of 2% solution) may be given before epidural use to check for intravascular or subarachnoid injection. Signs of intravascular injection: "epinephrine response" (tachycardia, circumoral pallor, palpitations, nervousness). Signs of subarachnoid injection: motor paralysis and extensive sensory anesthesia.
- If patient is moved with potential displacement of epidural catheter, test dose is repeated. At least 5 min should elapse between each test dose. Total dose for anesthesia is administered in fractional doses.
- Nesacaine formulation incorporates parabens (preservative) and sodium bisulfite; Nesacaine-CE is preservative-free but incorporates sodium bisulfite. Both parabens and bisulfites may initiate an allergic reaction in some individuals. Determine patient's sensitivity before administration of drug.
- Chloroprocaine is incompatible with alkali hydroxides and their carbonates: soaps, iodine, iodides, silver salts. Avoid use of any of these agents for skin or mucous membrane disinfection before chloroprocaine administration.
- Do not administer solution that is colored. Discard partially used solutions that are preservative-free.
- Store vials at 15°–30° C (59°–86° F); protect from freezing and from direct light.
Adverse Effects (≥1%)
Body as a Whole: Sneezing, anaphylactoid reactions. CV: Myocardial depression, hypotension, arrhythmias, bradycardia, cardiac arrest. GI: Nausea, vomiting. CNS: Anxiety, nervousness, tremors, sedation, circumoral paresthesia, convulsions followed by drowsiness, respiratory arrest. Skin: Cutaneous lesions of delayed onset; urticaria. Special Senses: Blurred or double vision, tinnitus. Other: With caudal or epidural anesthesia: urinary retention, fecal or urinary incontinence, slowing of labor and increased incidence of forceps delivery, headache, backache, edema, status asthmaticus.Interactions
Drug: May antagonize effects of sulfonamides; increased risk of hypotension with mao inhibitors, antihypertensive agents.Pharmacokinetics
Onset: 6–12 min. Duration: 30–60 min without epinephrine; 60–90 min with epinephrine. Metabolism: Hydrolyzed by plasma pseudocholinesterases. Elimination: Excreted by kidneys.Nursing Implications
Assessment & Drug Effects
- Monitor vital signs throughout period of drug use.
- Have immediately available resuscitation equipment, oxygen, resuscitative drugs, and vasopressors when chloroprocaine is in use.
Patient & Family Education
- Report urinary retention or urinary or fecal incontinence.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; 
Prototype drug