Drugs List

Therapeutic Indications

Uses

Anaesthesia - spinal

Spinal anaesthesia in adults where the planned surgical procedure should not exceed 40 minutes.

Administration

For intrathecal use.

Slowly inject the entire dose and check the patient's vital functions extremely carefully maintaining continuous verbal contact.

Contraindications

Children under 18 years
Hypovolaemic shock
Recent anticoagulant therapy
Cardiac conduction defects
Cardiogenic shock
Coagulopathy
Pregnancy
Severe anaemia

Precautions and Warnings

Administration site infection
Elderly
Inflammation of injection site
Plasma cholinesterase deficiency
Acute porphyria
Arteriosclerosis
Breastfeeding
Diabetic nephropathy
Hemiplegia
Multiple sclerosis
Neuromuscular disorder
Paraplegia
Severe hepatic disorder
Severe renal impairment

Refer to product information for use in peridural/spinal anaesthesia
Advise ability to drive/operate machinery may be affected by side effects
Treatment to be initiated and supervised by a specialist
Administer injection slowly
Aspirate prior to injection to avoid intravascular administration
Avoid local anaesthetics if inflammation in region of proposed injection
Discard any unused portion
Discontinue immediately if toxic symptoms occur, especially in epidural use
Do not inject near site of skin infection
Do not use if any signs of precipitate or particulate matter apparent
For single use only
Resuscitation facilities must be immediately available
Monitor vital signs, respiration & cardiac function
Use only when equipment adequate for cardiac/respiratory monitoring/support
Reduce dose in elderly
Start treatment at lowest recommended dose
Female: Ensure adequate contraception during treatment

Pregnancy and Lactation

Pregnancy

Chloroprocaine is contraindicated in pregnancy.

Animal studies are insufficient with respect to effects on pregnancy and foetal development.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution during breastfeeding.

It is not known whether chloroprocaine/metabolites are excreted in human milk.

Based on the low excretion of other local anaesthetics into breast milk and the extremely short half-life of chloroprocaine, it is unlikely to adversely affect the breastfed infant. However an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactic reaction
Anaphylactoid reaction
Angioneurotic oedema
Anxiety
Arachnoiditis
Backache
Blurred vision
Bradycardia
Cardiac arrest
Cardiovascular depression
Cauda equina syndrome
CNS toxicity
Convulsions
Diplopia
Dizziness
Drowsiness
Erythema
Faecal incontinence
Headache
Hearing disturbances
Hypertension
Laryngeal oedema
Loss of sphincter control
Motor disturbances
Muscle weakness
Myocardial depression
Nausea
Neurological damage
Neuropathy
Paraesthesia
Paralysis
Pruritus
Respiratory arrest
Respiratory depression
Restlessness
Rise in body temperature
Severe hypotension
Sexual dysfunction
Shaking
Sneezing
Speech disturbances
Sweating
Syncope
Tachycardia
Tinnitus
Tongue numbness
Tremor
Unconsciousness
Urinary incontinence
Urticaria
Visual disturbances
Vomiting

Presentation

Injectable formulations of chloroprocaine hydrochloride.

Drugs List

Therapeutic Indications

Uses

Anaesthesia - spinal

Spinal anaesthesia in adults where the planned surgical procedure should not exceed 40 minutes.

Dosage

Due to the complexity and specialist nature of using anaesthesia, specific dosing information on this agent is not included.

When using this agent, specialist literature, national guidelines and Trust policies should be consulted to ensure appropriate dosage and assessment of all relevant patient factors.

Additional Dosage Information

Administration

For intrathecal use.

Slowly inject the entire dose and check the patient's vital functions extremely carefully maintaining continuous verbal contact.

Contraindications

Children under 18 years
Hypovolaemic shock
Recent anticoagulant therapy
Cardiac conduction defects
Cardiogenic shock
Coagulopathy
Pregnancy
Severe anaemia

Precautions and Warnings

Administration site infection
Elderly
Inflammation of injection site
Plasma cholinesterase deficiency
Acute porphyria
Arteriosclerosis
Breastfeeding
Diabetic nephropathy
Hemiplegia
Multiple sclerosis
Neuromuscular disorder
Paraplegia
Severe hepatic disorder
Severe renal impairment

Refer to product information for use in peridural/spinal anaesthesia
Advise ability to drive/operate machinery may be affected by side effects
Treatment to be initiated and supervised by a specialist
Administer injection slowly
Aspirate prior to injection to avoid intravascular administration
Avoid local anaesthetics if inflammation in region of proposed injection
Discard any unused portion
Discontinue immediately if toxic symptoms occur, especially in epidural use
Do not inject near site of skin infection
Do not use if any signs of precipitate or particulate matter apparent
For single use only
Resuscitation facilities must be immediately available
Monitor vital signs, respiration & cardiac function
Use only when equipment adequate for cardiac/respiratory monitoring/support
Reduce dose in elderly
Start treatment at lowest recommended dose
Female: Ensure adequate contraception during treatment

Pregnancy and Lactation

Pregnancy

Chloroprocaine is contraindicated in pregnancy.

Animal studies are insufficient with respect to effects on pregnancy and foetal development.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution during breastfeeding.

It is not known whether chloroprocaine/metabolites are excreted in human milk.

Based on the low excretion of other local anaesthetics into breast milk and the extremely short half-life of chloroprocaine, it is unlikely to adversely affect the breastfed infant. However an alternate drug may be preferred, especially while nursing a newborn or preterm infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anaphylactic reaction
Anaphylactoid reaction
Angioneurotic oedema
Anxiety
Arachnoiditis
Backache
Blurred vision
Bradycardia
Cardiac arrest
Cardiovascular depression
Cauda equina syndrome
CNS toxicity
Convulsions
Diplopia
Dizziness
Drowsiness
Erythema
Faecal incontinence
Headache
Hearing disturbances
Hypertension
Laryngeal oedema
Loss of sphincter control
Motor disturbances
Muscle weakness
Myocardial depression
Nausea
Neurological damage
Neuropathy
Paraesthesia
Paralysis
Pruritus
Respiratory arrest
Respiratory depression
Restlessness
Rise in body temperature
Severe hypotension
Sexual dysfunction
Shaking
Sneezing
Speech disturbances
Sweating
Syncope
Tachycardia
Tinnitus
Tongue numbness
Tremor
Unconsciousness
Urinary incontinence
Urticaria
Visual disturbances
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2018

Reference Sources

Summary of Product Characteristics: Ampres 10mg/ml solution for injection. Sintetica Limited. Revised March 2017.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Chloroprocaine Last revised: 3 November 2017.
Last accessed: 6 June 2018.