Dosing and uses of Nesacaine (chloroprocaine)
Adult dosage forms and strengths
injectable solution
- 1%
- 2%
- 3%
Caudal & Lumbar Epidural Block
Use chloroprocaine without preservatives
Caudal/epidural block: 2%-3% (preservative-free) total dose 300-750 mg q40-50min
Lumbar/sacral region: 40-75 mg for each segment to be anesthetized
Infiltration & Peripheral Nerve Block
Infiltration/peripheral nerve block: 1%-2%
Mandibular (2% solution): 40-60 mg (2-3 mL)
Infraorbital (2% solution): 10-20 mg (0.5-1 mL)
Brachial plexus (2% solution): 600-800 mg (30-40 mL)
Digital: 1% without epinephrine
Pudendal (2% solution): 200 mg (10 mL)
Paracervical (1% solution): 30 mg (3 mL) per site
Single doses should not exceed 800 mg; single dose with epinephrine should not exceed 1000 mg
Cervical/thoracic region: 30-60 mg for each segment to be anesthetized
Other Indications & Uses
Epidural/caudal anesthesia; peripheral/sympathetic nerve block
Pediatric dosage forms and strengths
Safety & efficacy not established
Nesacaine (chloroprocaine) adverse (side) effects
Frequency not defined
Common
- Anxiety
- Dizziness
- Restlessness
- Tremor
- Tinnitus
- Blurred vision
Rare (serious)
- Bradyarrhythmia
- Cardiac arrest
- Hypotension
- Excitation
- Depression
- Seizure
- Anaphylaxis
- Respiratory arrest
Warnings
Contraindications
Hypersensitivity to para-aminobenzoic acid (PABA) or parabens
Cautions
Use extreme caution with lumbar & caudal epidural anesthesia in person w/existing neurological dz, spinal deformities, septicemia, severe HTn
Chloroprocaine should not be used for subarachnoid administration
Use preservative-free preparations for spinal or epidural anesthesia
DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear, etc)
Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action
Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)
Pregnancy and lactation
Pregnancy category: C
Lactation: excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Nesacaine (chloroprocaine)
Duration: the greater the degree of vasodilation produced by the local anesthetic, the faster the rate of absorption & shorter the duration of action
Protein bound: highly
Metabolism: liver
Metabolites: ester- & amide-type local anesthetics
Excretion: urine (principally)
Mechanism of action
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability & increasing action potential threshold
