Home Drug Guide Chloroprocaine Hydrochloride

Drug Guide

Generic Name

Chloroprocaine Hydrochloride

Brand Names Nesacaine, Nesacaine-mpf, Clorotekal, Iheezo

Classification

Therapeutic: Local anesthetic

Pharmacological: Ester type local anesthetic

FDA Approved Indications

Local anesthesia for surgical procedures, dental procedures, and infiltration anesthesia

Mechanism of Action

Chloroprocaine blocks nerve impulse conduction by reversibly binding to voltage-gated sodium channels, stabilizing neuronal membranes and preventing the initiation and propagation of nerve impulses.

Dosage and Administration

Adult: Dose varies based on procedure; typically, 30-60 mg injected locally. Exact dosage should be individualized based on site, procedure, and patient factors.

Pediatric: Use and dosage depend on age and weight; consult specific pediatric guidelines.

Geriatric: Use caution; consider dose reduction due to potential decreased hepatic and renal function.

Renal Impairment: Adjust dose as needed; monitor for toxicity.

Hepatic Impairment: Use with caution; hepatic metabolism may be affected, potentially prolonging effects.

Pharmacokinetics

Absorption: Rapid from injection site, but absorption varies based on vascularity.

Distribution: Widely distributed, crosses the placenta, detectable in breast milk.

Metabolism: Metabolized in plasma by cholinesterases (esterase hydrolysis).

Excretion: Renally excreted as metabolites.

Half Life: Approximately 21 minutes in healthy individuals.

Contraindications

Hypersensitivity to chloroprocaine or other ester-type local anesthetics.
Schwann cell tumors involving the spinal cord (if used epidurally).

Precautions

Use with caution in patients with systemic infections, bleeding disorders, or in areas with potential infection. Monitor for neurotoxicity or allergic reactions.

Adverse Reactions - Common

Temporary numbness or tingling (Common)
Localized swelling or inflammation (Common)

Adverse Reactions - Serious

Allergic reactions including anaphylaxis (Rare)
Cardiovascular effects such as hypotension or arrhythmias (rare) (Rare)

Drug-Drug Interactions

Concomitant use with other local anesthetics may increase toxicity.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for allergic reactions, neurotoxicity, cardiovascular response, and effectiveness.

Diagnoses:

Risk for allergic reaction
Impaired tissue integrity

Implementation: Administer in accordance with protocol, monitor site and patient response, ensure resuscitative equipment available.

Evaluation: Effectiveness of anesthesia, absence of adverse reactions, patient comfort.

Patient/Family Teaching

Report any signs of allergic reactions immediately.
Do not ingest or inhale any unknown substances containing local anesthetics.
Inform healthcare providers of all allergies and current medications.

Special Considerations

Black Box Warnings:

None noted specifically for chloroprocaine.

Genetic Factors: N/A

Lab Test Interference: May interfere with certain allergy testing due to allergic reactions.

Overdose Management

Signs/Symptoms: Circumoral numbness, tinnitus, dizziness, seizures, cardiac arrest.

Treatment: Discontinue drug, provide supportive care, airway management, seizure control with benzodiazepines if necessary, cardiovascular support, and hemodynamic stabilization.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

Stability: Stable in unopened vials for specified shelf life; consult product label.