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Chloroprocaine for epidural anesthesia in infants and children

Giorgio Veneziano1,2, Joseph D Tobias1,2,3

  • 1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.

Paediatric Anaesthesia
|March 22, 2017
PubMed

Insights

Chloroprocaine offers a safer alternative for pediatric epidural anesthesia, reducing risks associated with amide local anesthetics in infants. This ester anesthetic is rapidly metabolized, making it ideal for neonates and children.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Continuous epidural infusions provide significant benefits for pediatric anesthesia and analgesia, including earlier extubation and improved bowel function.
  • Neonates and infants have reduced metabolic capacity for amide local anesthetics, increasing the risk of local anesthetic toxicity.
  • Systemic medications carry risks, including uncertain long-term neurocognitive effects from volatile anesthetic agents.

Purpose of the Study:

  • To review the existing literature on the use of 2-chloroprocaine for regional anesthesia in infants and children.
  • To highlight 2-chloroprocaine as a potentially safer alternative to amide local anesthetics in pediatric populations.
  • To discuss dosing regimens and applications of 2-chloroprocaine in this specific patient group.

Main Methods:

  • Literature review of studies involving 2-chloroprocaine in pediatric regional anesthesia.
  • Analysis of pharmacokinetic and safety data relevant to infants and children.
  • Compilation of information on dosing and clinical applications.

Main Results:

  • 2-chloroprocaine, an ester local anesthetic, is rapidly metabolized in plasma across all age groups.
  • This rapid metabolism makes it an attractive option for neonates and infants with impaired metabolic capacity.
  • It is particularly useful when high infusion rates are required or in cases of liver impairment.

Conclusions:

  • 2-chloroprocaine presents a favorable safety profile for pediatric regional anesthesia due to its rapid hydrolysis.
  • It offers a viable alternative to amide local anesthetics, mitigating toxicity risks in vulnerable infant populations.
  • Further research and established protocols can optimize its use in pediatric surgical settings.

Keywords:
analgesiaanesthesia, epiduralanesthesia, regionalanesthetics, localinfantpediatrics

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