In 2011 the use of this range of doses of chlororpocaine 1% was reported effective and safe in surgeries lasting 38 ± 23 min, registering a mean time to ambulation of 155–207 min and an incidence of primary and secondary block failure of 1.2 and 0.8%, respectively [10]. Moore JM, Liu SS, Pollock JE, et al. Only few PK studies have been performed of local anaesthetics administered intrathecally [11,12,13] and some understanding comes from computational models of cerebrospinal fluid dynamics. Management: Avoid concurrent use of chloroprocaine and systemic sulfonamide-based antimicrobials whenever possible. A comparative study on the effect of addition of intrathecal buprenorphine to 2-chloroprocaine spinal anesthesia in short duration surgeries. Spinalanästhesie - Klinische Anwendung - Wissen @ AMBOSS On recovery of S2 dermatome to pinprick, the subjects attempted ambulation without assistance. One subject (S030/029) was discontinued from the study before receiving the assigned anaesthesia due to non-compliance. Spinal 2-chloroprocaine: effective dose for ambulatory surgery. PubMed Google Scholar. Careers. Positioning the patient on her left side and elevating the legs may help. These symptoms may actually be representative of a short-term, aseptic (chemical) meningitis induced by the epinephrine/bisulfite, although no further testing was done to confirm or refute this diagnosis. An additional four volunteers complained of non-radiating low backache (in addition to the flu-like symptoms) after 2-chloroprocaine with epinephrine. Production of local anesthesia by infiltration and peripheral nerve block. For statistical analysis, each dermatome above S3 was assigned an integer (i.e., S2 = “1,” T10 = “10,” and T1 = “19”), and all dermatome levels blocked to pinprick were averaged for each dose to determine the estimated time course of sensory anesthesia to pinprick. Crystals of chloroprocaine may develop when exposed to low temperatures; when the vial is returned to room temperature, the crystals will redissolve with shaking; do not use solutions that contain undissolved matter. Privacy On the contrary CABA was quantifiable in most plasma samples. National Library of Medicine Ziel ist eine sensible, sympathische und motorische Blockade. Paracetamol was administered for pain at the site of surgery in 100% of patients in Group 30, 80% of patients in Group 40 and 67% of patients in Group 50. Anesthesia, local injectable and peripheral nerve block: Children >3 years and Adolescents: Maximum dose without epinephrine: 11 mg/kg; for infiltration, concentrations of 0.5% to 1% are recommended; for nerve block, concentrations of 1% to 1.5% are recommended. BMC Anesthesiol 21, 58 (2021). Anesthesia, Intensive Care and Pain Therapy, Istituto Ortopedico Rizzoli, via G.C. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The site is secure. Spinal anaesthesia with Chloroprocaine HCl 1% for elective lower limb procedures of short duration: a prospective, randomised, observer-blind study in adult patients, https://doi.org/10.1186/s12871-021-01279-9, Neuraxial blocks: spinal, regional anaesthesia, Transient neurologic symptoms, complications, Accelera S.r.l., Viale Pasteur, 10 - 20014 Nerviano (MI) - Italy, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 2013 May;57(5):545-52. doi: 10.1111/aas.12071. Would you like email updates of new search results? How often did hospital staff describe possible side effects in a way you could understand?). Monitor therapy, Sulfonamide Antibiotics: Chloroprocaine may diminish the therapeutic effect of Sulfonamide Antibiotics. Spinal procaine with and without epinephrine and its relation to transient radicular irritation. 2019 Dec 1;12(12):CD003006. Recent studies have investigated the safety and efficacy of preservative-free chloroprocaine for use in spinal anesthesia, but few provide the incidence of adverse events such as urinary retention and transient neurologic symptoms. doi: 10.1002/14651858.CD003006.pub4. Spinal 2-chloroprocaine: effective dose for ambulatory surgery 5. Time to regression of two dermatomes of the maximum level, time to resolution of motor block, time to unassisted ambulation, time to resolution of sensory block, time to first analgesic request, time to urinary voiding, time to readiness for home discharge are represented in Table 2. The 60-mg dose caused a significantly larger decrease in systolic blood pressure compared with the 30 mg and 45 mg groups (P = 0.02) (Fig. For more information, please refer to our Privacy Policy. Similar to Foldes and McNall (5), (who used a hyperbaric solution containing approximately 82.5–100 mg) the authors of this study noted sensory anesthesia to high cervical segments at the largest dose, although there were no signs of respiratory problems and assisted ventilation was not required for these volunteers. Eleven patients complained of vague, nonspecific flu-like symptoms (malaise, myalgias, arthralgias, back stiffness, loss of appetite) that did not require treatment or bedrest for up to 48 h after their spinal anesthetics. Therefore, an alternative short-acting local anesthetic for outpatient spinal anesthesia is desirable. As expected, chloroprocaine was not quantifiable in sieric plasma after the spinal injection, whereas the metabolite CABA was quantifiable in most plasma samples. The spinal injection was performed with a Whitacre 25 Gauge needle in lateral decubitus at the intervertebral space L3/L4 or L4/L5 with a midline apporach and the needle bevel oriented towards the upper surgical side. The start and end times of the surgical procedures were recorded. Characteristics of chloroprocaine spinal anesthesia…, Characteristics of chloroprocaine spinal anesthesia by dose (boxplot: median [interquartile range], outliers in…, MeSH All of the spinal anesthetics associated with flu-like symptoms were found to contain epinephrine. Wesselink E, Hurk GJD, Vegt RV, Slagt C, Aa JV, Franssen E, Ven PV, Swart N, Boer C, Leeuw M. Reg Anesth Pain Med. In this pivotal study success rates, onset and remission of motor and . As bupivacaine can produce an excessively long block even in markedly reduced doses, there is considerable debate whether it is appropriate for ambulatory surgery. No patient experienced significant hypotension as defined in the protocol and at the time intervals described in the protocol. Please try again soon. Among the remaining 45 patients, 15 enrolled subjects received chloroprocaine 30 mg, other 15 received chloroprocaine 40 mg, and other 15 received chloroprocaine 50 mg. Forty-five subjects completed the study as planned. Each subject also underwent a simulated clinical discharge pathway. Among the other adverse events, no clinically significant variations values of vital signs were observed during the study with 2 exceptions. Comparisons of dermatome regression over time, isometric force dynamometry, and hemodynamic data were made using repeated-measures analysis of variance with Bonferroni-Dunn correction for multiple comparisons. Under sterile conditions and after local infiltration of the skin with 1% lidocaine, the subarachnoid space was entered at approximately the L2-3 interspace via the midline approach using a 20-gauge introducer and a 24-gauge Sprotte needle. The patients (n=16 patients in each group) received 35, 40, 45 or 50 mg of 10 mg/ml isobaric 2-CP. If pain continued, the nurses were allowed to administer either tramadol or oral morphine or the association paracetamol/tramadol according to the anaesthesiologist’s indication. As there were no statistical differences between the epinephrine-scontaining and no-epinephrine groups, they are combined. Clorotekal is intended for intrathecal administration only; the manufacturer recommends against using for epidural administration. Its use for spinal anesthesia is thus considered “off-label.” All current manufacturers of 2-chloroprocaine distinctly label the product “Not for Spinal Anesthesia.” All subjects in this study were made aware of this information, which was also included within their written informed consent. The spinal anesthetics were separated in time over the course of several summer months and are unlikely to be attributed to a local viral outbreak or other chance cause. Lidocaine is plagued by the frequent symptoms of transient neurologic syndrome (TNS) (1). Before subarachnoid block, a 20-gauge peripheral IV line was placed and an IV infusion of lactated Ringer’s solution was administered. The authors recommend avoiding the use of epinephrine in combination with intrathecal 2-chloroprocaine because of the frequent incidence of side effects associated with the use of epinephrine in this study. Anesth Analg. In this group, there were also 4 volunteers who complained of nonradiating low back pain in addition to their flu-like symptoms. government site. In fact, reducing the duration of surgery to 40 min and restricting indication to surgeries requiring a T12 level of anaesthesia in the present study allowed us to achieve a higher success rate with the lower doses of 30 and 40 mg than in the previous study by Casati et al. No differences in time to complete motor block regression were observed (P=0.3). Liu SS, Ware PD, Allen HW, et al. A randomised, non-inferiority study of chloroprocaine 2% and ... - Nature Anesth Analg 1980; 59: 447–51. Anesth Analg. 2014 Dec;27(6):597-604. doi: 10.1097/ACO.0000000000000126. Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2020 Jul 22. Then, within 15 min, the tubes were stored frozen at − 70 °C until analyses. No statistically significant difference between treatments was detected. 14. Spinal anesthesia with lidocaine or preservative-free 2-chlorprocaine for outpatient knee arthroscopy: a prospective, randomized, double-blind comparison. Solution, Intrathecal, as hydrochloride [preservative free]: Chloroprocaine is an ester-type local anesthetic, which stabilizes the neuronal membranes and prevents initiation and transmission of nerve impulses thereby affecting local anesthetic actions. There were no complaints of flu-like symptoms in the volunteers who received 2-chloroprocaine without epinephrine (Table 2). Spinal 2-chloroprocaine for surgery: an initial 10-month experience. The study have received approval by an independent Ethics Committee (Ethics Committee, Istituto Ortopedico Rizzoli di Bologna - IRCCS, Bologna on 23rd of February 2015). Some simple lifestyle changes can help you reduce your obstructive sleep apnea symptoms. Infiltration or peripheral nerve block: Administer locally as a single injection or continuously through an indwelling catheter (peripheral nerve block). In conclusion, the dose of 30 mg showed a slower onset and a faster offset than the 50 mg dose, without affecting time to readiness for home discharge. Foldes and McNall, using combined data for 82.5 and 100 mg, reported on the total duration of sensory anesthesia (defined as “perception of pinprick at the inguinal fold”–essentially L1) and motor blockade (defined as “ability to flex either knee voluntarily”). Once in the anesthesia induction room, an intravenous (i.v.) Chloroprocaine - StatPearls - NCBI Bookshelf Correspondence to Use reduced doses in debilitated patients and patients with cardiovascular disease. 1983;62:168–73. Dose varies with procedure, desired depth, and duration of anesthesia, desired muscle relaxation, vascularity of tissues, physical condition, and age of patient. chloroprocain spinalanästhesie dosierung difference between landsat collection 1 and 2 on chloroprocain spinalanästhesie dosierung Posted in tatort drei affen jenke von wilmsdorff By Posted on June 2, 2022 The FDA considered that this study contributed with adequate data to recommend approval (September 26, 2017) of the 50 mg dose of 2-chloroprocaine 1% (10 mg/mL) for the indication of single intrathecal injection in adults. Optimal local anesthetic regimen for saddle block in ambulatory anorectal surgery: an evidence-based systematic review. Bookshelf Clorotekal Additional Information - BBraunUSA.com No complications related to spinal anaesthesia were observed and no transient neurologic symptoms (TNS) were reported at the 3-day follow-up. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Vasoactive drugs were administered only if symptoms of hypotension or bradycardia developed. Animal reproduction studies have not been conducted. Mean ± SD urine concentrations of CABA were comparable among groups (Table 4): 1217.7 ± 627.8 ng/ml in Group 30 vs 1603.3 ± 1827.9 ng/ml in Group 40 vs 1679.6 ± 2103.5 ng/ml in Group 50. The choice of local anesthetic for spinal anesthesia in the ambulatory surgery patient remains a problem. The remaining spinal anesthetics were performed without difficulty. Springer Nature. CABA increased in plasma after the spinal injection of the parent compound and reached a peak 30 min post-dose. Renal impairment: Use with caution in patients with severe renal impairment. This study was funded by Sintetica S.A. (address: Via Penate 5, 6850 Mendrisio, Switzerland Tel. Due to the small sample size, collected data were compared using nonparametric tests (Kruskal-Wallis test, Wilcoxon rank-sum test for paiwise comparison). Comparison of 2-Chloroprocaine, bupivacaine, and Lidocaine for spinal anesthesia in patients undergoing knee arthroscopy in an outpatient setting: a double-blind randomized controlled trial. Casati A, Danelli G, Berti M, et al. Although 2-chloroprocaine is approved by the Food and Drug Administration, it is not specifically indicated for use in spinal anesthesia. Reg Anesth Pain Med 2001; 26: 558–64. Provided by the Springer Nature SharedIt content-sharing initiative. Use of Clorotekal via continuous spinal catheters is not recommended (safety has not been established). 3. Transient neurologic symptoms: etiology, risk factors, and management. Acta Anaesthesiol Scand. Alpha-/Beta-Agonists: Chloroprocaine may enhance the hypertensive effect of Alpha-/Beta-Agonists. CAS After written informed consent, we enrolled 45 male and female patients, aged 18–65 years, classified with an American Society of Anaesthesiologists’ (ASA) physical status score I-II, with a body mass index (BMI) of 18–32 Kg/m2, undergoing elective lower limb procedures lasting ≤40 min and with a requested dermatomeric level of sensory block ≥ T12. Forget P, Borovac JA, Thackeray EM, Pace NL. 2006;103:234–8. Anesthesiology 1996; 85: 729–36. Background: However, because of the unreliable effect of epinephrine and the numerous reported side effects in the group of volunteers in this study who received epinephrine as an adjunct to 2-chloroprocaine, the authors recommend avoiding epinephrine in combination with intrathecal 2-chloroprocaine. Bethesda, MD 20894, Web Policies and transmitted securely. Conflict of InterestDavid H. Kim, MD; Richard Kahn, MD; Andrew Lee, MD; Phuong Dinh Mac, BS; Yu-fen Chiu, PhD; Jacques Yadeau, MD, PhD; and Jiabin Liu, MD, PhD declare that they have no conflicts of interest. Regularly drinking tea is thought to have many potential health benefits. Kuhnert BR, Kuhnert PM, Prochaska AL, Gross TL. This site needs JavaScript to work properly. Clinic located in Orange City, specialized in Pain Control, Headache, Migraine, Menstrual Problems, Menopausal Syndrome, and Infertility - (818) 923-6345. chloroprocain spinalanästhesie dosierung 4. In all patients, anaesthesia was sufficient for the planned surgery. Questions/purposes: Spinal 2-CP, 10 mg/ml 35, 40, 45 and 50 mg provide reliable sensory and motor block for ambulatory surgery, while reducing the dose of 2-CP to 35 and 40 mg resulted in a spinal block of faster ambulation. Article Wolters Kluwer Health Clinical studies in volunteers investigated chloroprocaine use for spinal anaesthesia at doses ranging between 30 and 60 mg [1, 2]. Although we did not specifically measure the ability to flex either knee voluntarily, it can be extrapolated from the points in Figure 3 where quadriceps strength begins to reappear after blockade (50 min for plain 2-CP, 100 min for 2-CP with epinephrine). Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers. Avoid rapid injection. For pharmacokinetic (PK) analysis, the concentration of 2-Chloroprocaine was determined in plasma and the concentration of the metabolite 2-chloro-4-aminobenzoic acid (CABA) was determined in plasma and urine at Accelera laboratories (Accelera S.r.l., Viale Pasteur, 10 - 20014 Nerviano (MI) - Italy) using a validated liquid chromatography tandem mass spectrometry (LC-MS/MS) method that can detect both analytes to a lower quantification limit (LQL) of 4 ng/mL for plasma and 50.0 ng/ml for urine. Spinal 2-chloroprocaine: minimum effective dose - PubMed Administration as a paracervical block is not recommended with toxemia of pregnancy, fetal distress, or prematurity. When the sample size in each of the 3 doses groups is 13, a one-way analysis of variance would have 80% power to detect a difference in time to complete spinal block regression (Tea) means at the 0.05 level, characterized by a variance of means (where G = 3) of 249.962, assuming that the common standard deviation is 30.01. The median peak block height (T9) was similar in all four groups (P=0.66). The use of some local anesthetic drugs during labor and delivery may diminish muscle strength and tone for the first day or two of life. The duration of the blockade was assessed using the following previously described (3) modalities: 1) sensory block to pinprick, 2) tolerance to transcutaneous electrical stimulation (TES), 3) tolerance to thigh tourniquet, and 4) motor blockade by electromyography (abdomen), isometric force dynamometry (quadriceps), and modified Bromage scale (lower extremity). The percentage amount of excretion of CABA in the first postoperative urine collection was approximately 1.70% with all three doses (30, 40 and 50 mg). PharmaWiki - Chloroprocain 2-Chloroprocaine (2-CP) is a derivative of procaine, with a rapid onset of action and an even more rapid degree of elimination (plasma half-life, less than 30 seconds) via plasma cholinesterase metabolism. The primary outcome of the study was time to end of anaesthesia (Tea). Anesth Analg 1998; 86: 973–7. 2-CP with epinephrine produced times to complete sensory regression of 153 ± 25, 162 ± 33, and 148 ± 29 min, respectively. The regression of sensory block was defined with the Pinprick test (using a 20-G hypodermic needle) as the restoration of sensory perception at the level of S1. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Chloroprocaine levels of 2.7 ± 0.7 ng/mL were found in maternal blood at delivery in a study of chloroprocaine administered by continuous infusion [14]. Anesth Analg 1980; 59: 452–4. The subjects were instructed to request deflation of the tourniquet when the discomfort level reached a pain score of 5 on a 10-point scale or at a maximum time limit of 120 min. The effects of epinephrine on lidocaine spinal anesthesia: a cross-over study. 2007;104:959–64. Note: Due to chloroprocaine’s fast onset and short duration of action, it is most often used to establish adequate epidural anesthesia (eg, in a parturient prior to delivery) or possibly, for peripheral nerve block in a patient undergoing short (<60 minutes) ambulatory surgery that is not anticipated to produce significant postoperative pain (Alley 2014; Miller 2010). 2-chloroprocaine without epinephrine also provided dose-dependent prolongation of sensory and motor block and time until achievement of discharge criteria (P values from <0.001 to 0.04) for all measures except time to 2-segment regression and tolerance to TES at T10 (Fig. Epidural, paracervical, or pudendal anesthesia may alter the forces of parturition through changes in uterine contractility or maternal expulsive efforts. Ma Zui Xue Za Zhi. PMC The present prospective, randomized, blind-observer study evaluated the efficacy and the tolerability of preservative-free Chloroprocaine HCl 1% at the doses of 30, 40 and 50 mg. As expected, the time to end of anaesthesia (Tea) on average coincided with the resolution of sensory block (TS1). Since its approval for use in spinal anesthesia in Europe in 2012, chloroprocaine has seen a resurgence. Spinal anaesthesia with hyperbaric prilocaine in day-case perianal surgery: randomised controlled trial. Modified Bromage scores (0 = no block, 1 = able to dorsiflex the foot, 2 = able to bend the knee, and 3 = complete motor block) were recorded every 10 min after injection until the resolution of the motor block. Es ist ein Lokalanästhetikum vom Estertyp und entspricht einem einfach chlorierten Procain. In another study performed by the same authors in 1982, chloroprocaine levels of 10.0 ± 1.5 (detected in 8/50) and of 12.05 ± 1.7 ng/mL (detected in 2/30 subjects) were reported [15]. Spinal Anesthesia Using Chloroprocaine is Safe, Effective, and ... 1). 2013;57:545–52. Petersen-Felix S, Zbinden AM, Fischer M, et al. Careful and constant monitoring of the patient's cardiovascular vital signs should be done during and following each local anesthetic injection (Cox 2003; Dickerson 2014). Results from a previous study of spinal injection of Chloroprocaine HCl 1% [6] have been taken in consideration to calculate the required study sample size and normal distribution of data had been assumed. These data can guide clinical selection for dosage of 2-chloroprocaine (without epinephrine) based on the desired duration of clinical anesthesia for various surgical sites. Prolonged neural blockade following regional anesthesia with 2-chloroprocaine. Methemoglobinemia: Has been reported with local anesthetics; clinically significant methemoglobinemia requires immediate treatment along with discontinuation of the anesthetic and other oxidizing agents. Bookshelf No patients required urinary catheterisation. At baseline, the following normal ranges for haemodynamic variables were used: sysotlic blood pressure (SBP): 100–139 mmHg, diastolic blood pressure (DBP): 50–89 mmHg, heart rate (HR): 45–90 beats/min. If the subject was never able to tolerate 60 mA, the testing was terminated at 34 min. Possible explanations for the observed side effects include the effect of the small amount of bisulfite in the epinephrine vials (0.9 mg/mL) and/or the low pH of epinephrine. Yung EM, Abdallah FW, Todaro C, Spence E, Grant A, Brull R. Reg Anesth Pain Med. Your US state privacy rights, Perform preventive measures (eg, limiting cumulative dose, use ultrasound or direct visualization for catheter placement). Brand names: Nesacaine, Nesacaine-MPF, Clorotekal. Chloroprocaine is a short-acting local anaesthetic with a rapid onset of action and an anaesthesia duration up to 60 min. No complications related to spinal anaesthesia were observed and no transient neurologic symptoms (TNS) were reported at the 3-day follow-up. Comparison of lidocaine and 2-chloroprocaine in paracervical block: clinical effects and drug concentrations in mother and child. The right C5-6 dermatome was used as an unblocked reference point. In the past, the spinal use of chloroprocaine in the US was largely described in doses ranging between 20 and 60 mg [8, 9]. Spinalanästhesie communicantes albi ausreicht, sind alle Efferenzen vom Rückenmark zum Grenzstrang unterbrochen), die hämodynamischen Auswirkungen (Blutdruckab- Eur J Anaesthesiol. The most frequent adverse event registered in the study population was postoperative pain at the site of surgery which occurred in 93% of patients receiving the 30 mg dose, 87% of patients in he 40 mg dose and 87% of patients in the 50 mg dose. Since its approval for use in spinal anesthesia in Europe in 2012, chloroprocaine has seen a resurgence. Before The https:// ensures that you are connecting to the Time to urinary voiding was faster in Group 30 compared to Group 40 (p = 0.0412) and to Group 50 (p = 0.0171) in the FAS. If ambulation was successful, they then attempted to void. The progression and regression of both sensory and motor blocks were evaluated blindly. 7. Urinary excretion of CABA was calculated as the amount of metabolite excreted as a percentage of the administered dose (molar ratio). Vd: Depends upon route of administration; high concentrations found in highly perfused organs such as liver, lungs, heart, and brain, Rapidly hydrolyzed by plasma enzymes to 2-chloro-4-aminobenzoic acid and beta-diethylaminoethanol (80% conjugated before elimination), Urine (minimal as unchanged drug in urine; metabolites: Chloro-aminobenzoic acid and beta-diethylaminoethanol primarily excreted unchanged), Up to 60 minutes (patient, type of block, concentration, and method of anesthesia dependent), In vitro, plasma: Neonates: 43 ± 2 seconds; Adults: 21 ± 2 seconds (males), 25 ± 1 second (females). Four volunteers (3 with epinephrine, 1 without) required atropine or ephedrine for heart rate <50 bpm or systolic blood pressure <80 mm Hg during the 29 spinal anesthetics. Using a commercially available surface EMG (MyoTrac2; Thought Technology Ltd., Montreal, PQ) an averaged, rectified measurement was taken during the middle 2 s of a 6-s maximal effort. sharing sensitive information, make sure you’re on a federal Epub 2019 Aug 26. The amount of excretion of CABA was also similar in the three groups: 1.70 ± 0.97% in Group 30 vs 1.76 ± 0.93% in Group 40 vs 1.66 ± 1.29% in Group 50. 2016 Sep-Oct;41(5):576-83. doi: 10.1097/AAP.0000000000000420. Includes Chloroprocaine indications, dosage/administration, pharmacology, mechanism/onset/duration of action, half-life, dosage forms, interactions, warnings, adverse . 2012 May;56(5):667. doi: 10.1111/j.1399-6576.2012.02699.x. FOIA Siddaiah J, Pujari VS, Madalu AS, Bevinaguddaiah Y, Parate LH. A unique interaction between chloroprocaine and epinephrine in the intrathecal space that is not seen with other local anesthetics is possible. One volunteer complained of mild nasal congestion during both anesthetics, when the block height was above T6, but developed flu-like symptoms only after the spinal anesthetic with epinephrine (Table 2). Federal government websites often end in .gov or .mil. Ravindran RS, Bond VK, Tasch MD, et al. We examined the safety, dose-response characteristics, and effects of epinephrine with spinal 2-CP. Monitor therapy, Bupivacaine (Liposomal): Local Anesthetics may enhance the adverse/toxic effect of Bupivacaine (Liposomal). 2004;98:81–8. With the availability of preservative- and antioxidant-free 2-chloroprocaine (2-CP), there may be an acceptable short-acting alternative to lidocaine for spinal anesthesia. Spinal 2-chloroprocaine without epinephrine produced dose-dependent prolongation of sensory block, tolerance to tourniquet pain, motor block, and time until full recovery from anesthesia for all variables assessed with the exception of time to 2-segment regression and tolerance to TES at T10.
