Chloroprocaine (Nesacaine)

Category:

  • Local anesthetic

Description:

  • Local anesthetic

Indications:

  • Infiltration and peripheral nerve block

  • Central nerve block including lumbar and caudal epidural blocks (without preservatives)

Contraindications:

  • Hypersensitivity to drugs of the PABA ester group

Precautions:

  • Pregnancy category C

  • Lumbar and caudal epidural anesthesia should be used with extreme caution inpersons with the following conditions: existing neurological disease, spinal deformities, septicemia, and severe hypertension

Adverse Reactions (Side Effects):

  • CNS: anxiety, disorientation, drowsiness, loss of consciousness, restlessness, seizures

  • CV: bradycardia, cardiac arrest, dysrhythmias, myocardial depression, hypotension, hypertension

  • EENT: blurred vision, pupil constriction, tinnitus

  • RESP: respiratory arrest, status asthmaticus

  • SKIN: allergic reactions, burning, edema, rash, skin discoloration at injection site, tissue necrosis, urticaria

Dosage:

Administered via injection

  • Adult:   

    • Max single recommended doses without epinephrine:

      • 11 mg/kg

      • not to exceed a max total dose of 800mg; 

    • with epinephrine (1:200,000) 

      • 14 mg/kg

      • not to exceed a max total dose of 1000mg

    • Lumbar and caudal epidural block: 

      • 15-25ml of a 2% or 3% preservative-free solution

      • repeated doses may be given at 40-60 minute intervals

    • Infiltration and peripheral nerve block (1-2%): 

      • Mandibular 2-3 ml

      • infraorbital 0.5-1 ml

      • brachial plexus 30-40 ml

      • digital (without epinephrine) 3-4 ml

      • pudendal 10 ml each side

      • paracervical 3 ml per each of up to 4 sites

    • Lumbar epidural anesthesia: 

      • 15-25 ml

      • repeated doses 10-20 ml at 40-50 minute intervals

  • Child > 3 years:  

    • Max single recommended dose 11 mg/kg

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