PROCAINE HYDROCHLORIDE

(proe'kane)

Novocain
Classifications: local anesthetic (ester-type);
Therapeutic: local anesthetic
Pregnancy Category: C

Availability

1%, 2%, 10% injection

Action

Decreases sodium flux into nerve cell, thus depressing initial depolarization and preventing propagation and conduction of the nerve impulse.

Therapeutic Effect

Local anesthetic action produces loss of sensation and motor activity in circumscribed areas of the body close to the injection or application site.

Uses

Spinal anesthesia and epidural and peripheral nerve block by injection and infiltration methods.

Contraindications

Known hypersensitivity to procaine or to other drugs of similar chemical structure, to PABA, and to parabens; generalized septicemia, inflammation, or sepsis at proposed injection site; cerebrospinal diseases (e.g., meningitis, syphilis); heart block, hypotension, hypertension; bowel pathology, GI hemorrhage; coagulopathy, anticoagulants, thrombocytopenia; pregnancy (category C).

Cautious Use

Debilitated, older adults, or acutely ill patients; obstetric delivery; increased intraabdominal pressure; known drug allergies and sensitivities; impaired cardiac function, dysrhythmias; shock; lactation.

Route & Dosage

Spinal Anesthesia
Adult: SC 10% solution diluted with NS at 1 mL/5 sec

Infiltration Anesthesia/Peripheral Nerve Block
Adult: SC 0.25–0.5% solution

Administration

Subcutaneous

Reconstitute solution: To prepare 60 mL of a 0.5% solution (5 mg/mL), dilute 30 mL of 1% solution with 30 mL sterile distilled water. Add 0.5–1 mL epinephrine 1:1000/100 mL anesthetic solution for vasoconstrictive effect (1:200,000–1:100,000).
Do not use solutions that are cloudy, discolored, or that contain crystals. Discard unused portion of solutions not containing a preservative. Avoid use of solution with preservative for spinal, epidural, or caudal block.
Inject slowly with frequent aspirations to avoid inadvertent intravascular administration, which can lead to a systemic reaction.

INCOMPATIBILITIES Solution/additive: Aminophylline, amobarbital, chlorothiazide, magnesium sulfate, phenobarbital, phenytoin, secobarbital, sodium bicarbonate.

Adverse Effects (≥1%)

CNS: Anxiety, nervousness, dizziness, circumoral paresthesia, tremors, drowsiness, sedation, convulsions, respiratory arrest. With spinal anesthesia: postspinal headache, arachnoiditis, palsies, spinal nerve paralysis, meningism. Special Senses: Tinnitus, blurred vision. CV: Myocardial depression, arrhythmias including bradycardia (also fetal bradycardia); hypotension. GI: Nausea, vomiting. Skin: Cutaneous lesions of delayed onset, urticaria, pruritus, angioneurotic edema, sweating, syncope, anaphylactoid reaction. Urogenital: Urinary retention, fecal or urinary incontinence, loss of perineal sensation and sexual function, slowing of labor and increased incidence of forceps delivery (all with caudal or epidural anesthesia).

Interactions

Drug: May antagonize effects of sulfonamides; increased risk of hypotension with maois, antihypertensives.

Pharmacokinetics

Absorption: Rapidly from injection site. Onset: 2–5 min. Duration: 1 h. Metabolism: Hydrolyzed by plasma pseudocholinesterases. Elimination: 80% of metabolites excreted in urine. Half-Life: 7.7 min.

Nursing Implications

Assessment & Drug Effects

Be aware that reactions during dental procedure are usually mild, transient, and produced by epinephrine added to local anesthetic (e.g., headache, palpitation, tachycardia, hypertension, dizziness).
Use procaine with epinephrine with caution in body areas with limited blood supply (e.g., fingers, toes, ears, nose). If used, inspect particular area for evidence of reduced perfusion (vasospasm): Pale, cold, sensitive skin.
Hypotension is the most important complication of spinal anesthesia. Risk period is during first 30 min after induction and is intensified by changes in position that promote decreased venous return, or by preexisting hypertension, pregnancy, old age, or hypovolemia.

Patient & Family Education

Understand that that there will be temporary loss of sensation in the area of the injection.
Do not consume hot liquids or foods until sensation returns when drug used for dental procedure.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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