Classifications: local anesthetic (ester-type); Therapeutic: local anesthetic
Pregnancy Category: C
1%, 2%, 10% injection
Decreases sodium flux into nerve cell, thus depressing initial depolarization and preventing propagation and conduction
of the nerve impulse.
Local anesthetic action produces loss of sensation and motor activity in circumscribed areas of the body close to the injection
or application site.
Spinal anesthesia and epidural and peripheral nerve block by injection and infiltration methods.
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
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
Adult: SC 10% solution diluted with NS at 1 mL/5 sec
Infiltration Anesthesia/Peripheral Nerve Block
Adult: SC 0.250.5% solution
- 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 0.51 mL epinephrine 1:1000/100 mL anesthetic solution for vasoconstrictive effect (1:200,0001:100,000).
- 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
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:
, 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
of forceps delivery (all with caudal or epidural anesthesia).
May antagonize effects of sulfonamides
; increased risk of hypotension with maoi
Rapidly from injection site. Onset:
25 min. Duration:
1 h. Metabolism:
Hydrolyzed by plasma
80% of metabolites excreted in urine. Half-Life:
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.