Classifications: local anesthetic (ester-type); Therapeutic: local anesthetic
Pregnancy Category: C
1%, 2%, 3% injection
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.
Produces anesthetic effect, but not used for spinal, topical, or IV regional anesthesia.
Infiltration anesthesia and for peripheral, sympathetic, and epidural (including caudal) block anesthesia.
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.
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: 12% solution: max of 800 mg without epinephrine, 1 g with epinephrine
Caudal and Epidural Block (Without Preservatives)
Adult: 23% solution: max of 800 mg without epinephrine, 1 g with epinephrine
- 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:
, 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.
May antagonize effects of sulfonamides
; increased risk of hypotension with mao inhibitors
, antihypertensive agents
612 min. Duration:
3060 min without epinephrine; 6090 min with epinephrine
Hydrolyzed by plasma pseudocholinesterases. Elimination:
Excreted by kidneys.
Assessment & Drug Effects
- Monitor vital signs throughout period of drug use.
- Have immediately available resuscitation equipment, oxygen, resuscitative drugs, and vasopressors when chloroprocaine is
Patient & Family Education
- Report urinary retention or urinary or fecal incontinence.