Chloroprocaine 400mg/20ml solution for injection vials

Chloroprocaine and lidocaine bicarbonate are commonly used for epidural anesthesia because of their rapid onset, particularly in the case of conversion from epidural labor analgesia to emergency cesarean section. However, it is unclear whether lidocaine bicarbonate combined with fentanyl has an advantage over chloroprocaine alone in emergency cesarean section. In this study, 102 women who underwent elective cesarean section received 15 mL 3% chloroprocaine and 1 mL saline (CP group) or 15 mL 1.73% lidocaine bicarbonate and 1 mL fentanyl 50 μg (LF group) for epidural anesthesia. Nociceptive block level was assessed by pinprick and recorded every minute. The primary outcome was the onset time to T6 block. The median onset time to T6 analgesia was 10 [10, 10] min in the CP group and 10 [7, 10] min in the LF group (COX model for CP versus LF, HR 0.47, 95% CI 0.23–0.95, p = 0.035). The median onset time to T8 analgesia was 7 [5, 9] min in CP group and 5 [4, 7] min in LF group (COX model for CP versus LF, HR 0.61, 95% CI 0.39–0.95, p = 0.027). The proportion of hypotension episodes occurring before delivery in LF group was lower than that in CP group ( p = 0.011). The incidence of block level ≥ T4 after supplemental dosing in the LF group was lower than that in the CP group ( p = 0.031). Compared with 3% chloroprocaine, 1.73% lidocaine bicarbonate combined with fentanyl 50 μg has a slightly faster onset time and less hypotension in epidural anesthesia for cesarean section. Clinical Trial Registration: http://www.chictr.org.cn/index.html , identifier ChiCTR2200056180.

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INTRODUCTION: A significant number of women who undergo neuraxial labor analgesia experience breakthrough pain. Prompt mitigation of breakthrough pain is essential to improve maternal and fetal outcomes. We evaluated epidural chloroprocaine compared with ropivacaine in alleviating labor breakthrough pain. METHODS: We performed a double-blind randomized controlled clinical trial between May and July 2023. Eligible parturients received epidural analgesia with ropivacaine and sufentanil. Those with breakthrough pain were randomized to receive either 0.125% epidural ropivacaine (group R) or chloroprocaine at concentrations of 0.5% (group C1), 1.0% (group C2), or 1.5% (group C3), all in a volume of 6 mL. The primary outcome was the treatment success rate, indicated by a decrease of at least 4 points on the numerical rating scale pain score 9 min after analgesic injection. Secondary outcomes and adverse effects were also recorded. RESULTS: Out of 323 patients receiving epidural analgesia, 192 experienced breakthrough pain. After exclusion of three patients because of protocol deviation, there were 47, 48, 47, and 47 patients in group R, C1, C2, and C3, respectively. Group C3 demonstrated a higher treatment success rate (39/47, 83.0%) in managing breakthrough pain than group R (26/47, 55.3%), group C1 (12/48, 25.0%), and group C2 (30/47, 63.8%) (p < 0.001). Group C3 had lower numerical rating scale scores at 6 and 9 min after injection and required fewer patient-controlled epidural boluses than other groups. In addition, group C3 reported greater satisfaction than the other groups (p < 0.001). No significant differences were observed in obstetric or neonatal outcomes across these groups. CONCLUSION: Parturients experiencing breakthrough pain could receive 1.5% epidural chloroprocaine, rather than lower chloroprocaine concentrations and ropivacaine, to achieve more rapid and better pain relief with higher patient satisfaction. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2300071069, http://www.chictr.org.cn/index.aspx .

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Purpose: To compare the efficacy and safety of a novel ophthalmic anesthetic, chloroprocaine 3% gel to tetracaine 0.5% eye drops in patients undergoing cataract surgery with phacoemulsification. Methods: This was a prospective, randomized, multicenter, active-controlled, masked-observer, parallel group competitive equivalence study. The study comprised 338 patients having routine cataract extraction by clear corneal phacoemulsification, randomized to receive 3 drops of chloroprocaine gel ( n = 166) or tetracaine eye drops ( n = 172) before surgery. The primary objective of the study was to assess the equivalence of chloroprocaine gel to tetracaine eye drops as proportion of patients with successful ocular surface anesthesia, without any supplementation just before intraocular lens implantation. Safety measurements were pain, irritation, burning, stinging, photophobia, and foreign body sensation, graded by the patient and objective ocular signs. Results: Equivalence was demonstrated, with a somewhat higher success rate of chloroprocaine gel: 152/166 (92.0%) chloroprocaine versus 153/172 (90.5%) tetracaine patients achieved ocular surface anesthesia with no supplementation. Difference in proportions was 1.5% confidence interval [95% CI: (−3.6 to 6.6)] and 90% CI fell within (−10 to 10). Mean onset of anesthesia was 1.35 ± 0.87 min for chloroprocaine and 1.57 ± 1.85 for tetracaine ( P = 0.083). Mean duration of anesthesia was 21.57 ± 12.26 min for chloroprocaine and 22.04 ± 12.58 for tetracaine ( P = 0.574). No treatment emergent adverse events related to chloroprocaine were reported and no relevant findings related to local tolerance or vital signs were observed in both arms. Conclusions: Results obtained from the present cataract study demonstrated that chloroprocaine 3% ophthalmic gel is safe and effective, representing a valid alternative in ocular topical anesthesia. Clinical Trial Registration number: NCT04685538.

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Background: While propofol is a commonly utilized medication for sedation during gastrointestinal endoscopy, it is associated with adverse effects such as hypotension and injection pain. This trial was conducted to test the hypothesis that chloroprocaine can reduce the requirement for propofol and alleviate injection pain during gastrointestinal endoscopy. Methods: until the end of examination. Patients in Group C received the same volume of saline. Subsequently, all patients were intravenously administered sufentanil at a dose of 0.05 μg/kg. Thirty seconds later, propofol was uniformly infused intravenously at a rate of 60 mL/min using an infusion pump. The primary outcome was the consumption of propofol. Secondary outcomes included the incidence of hypoxemia, hypotension, bradycardia, injection pain, and coughing/body movement during examination. The recovery time, PACU stay time, postoperative pain score, and endoscopists' satisfaction score were also recorded. Results: Group CP demonstrated a significantly lower total requirement for propofol compared to Group C, with means of (119±14) mg and (148±18) mg respectively, P<0.001. This trend was also observed for both the first and supplemental doses. There were no significant differences between the two groups regarding intraoperative adverse events. The incidence of injection pain in Group CP was lower than that in Group C (P=0.007). The recovery time [(4.7±1.4) vs (6.6±1.3), P<0.001], PACU stay time [(13.0±2.9) vs (16.7±3.0), P<0.001] and postoperative pain score [(1.9±0.7) vs (2.5±0.7), P=0.002] in Group CP were lower than those in Group C. Conclusion: Intravenous chloroprocaine reduces the requirement for propofol, alleviates propofol injection pain, and improves recovery in patients undergoing gastrointestinal endoscopy.

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Objective Previous studies have shown that the postoperative delirium rate does not differ between anesthetic techniques in randomized controlled trials. Subjective concerns such as anxiety and pain are often not adequately addressed in randomized controlled trials and reported to be associated with postoperative delirium. Shared decision-making is reported to have an impact on anxiety and pain. Therefore, the aim of this study was to evaluate the effect of shared decision-making while making a choice between spinal and general anesthesia on postoperative delirium incidence. Methods This prospective, observational, two-armed cohort study included 192 patients who underwent lower extremity, lower abdominal, pelvic, or perineal short-time surgery that lasted &lt;90 min. The three-talk shared decision-making model was used to make the choice for the type of anesthesia. Depending on the shared decision-making process, either spinal anesthesia with short-acting local anesthetics (prilocaine hydrochloride or chloroprocaine hydrochloride) or general anesthesia was performed according to a standardized protocol including intraoperative electroencephalogram monitoring. Patients’ anxiety and pain levels were measured before and after the surgery using validated scales. Results Based on their shared decision-making choice of anesthesia, 97 patients were allocated to the spinal anesthesia group and 95 to the general anesthesia group. Postoperative delirium occurred less frequently after spinal anesthesia (2.1%) than after general anesthesia (16.8%; p &lt; 0.001). No postoperative delirium was observed in patients who received only spinal anesthesia, as chosen using the shared decision-making model (spinal anesthesia: 0%, general anesthesia 16.8%; p &lt; 0.001). Anxiety and pain levels did not differ between the two groups. Conclusions The incidence of postoperative delirium was lower in patients who were administered spinal anesthesia than in those who were administered general anesthesia after using a shared decision-making approach. Integrating patients’ perspectives and treatment preferences might change postoperative outcomes and should be taken into consideration in future trials. Trial registration: clinicaltrials.gov: NCT03715244 https://clinicaltrials.gov/study/NCT03715244?intr=NCT03715244&amp;rank=1

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BACKGROUND: 3% chloroprocaine (CP) has been reported as the common local anesthetic used in pregnant women undergoing urgent cesarean delivery during labor analgesia period. However, 0.75% ropivacaine is considered a promising and effective alternative. Therefore, we conducted a randomized controlled trial to compare the effectiveness and safety of 0.75% ropivacaine with 3% chloroprocaine for extended epidural anesthesia in pregnant women. METHODS: We conducted a double-blind, randomized, controlled, single-center study from November 1, 2022, to April 30, 2023. We selected forty-five pregnant women undergoing urgent cesarean delivery during labor analgesia period and randomized them to receive either 0.75% ropivacaine or 3% chloroprocaine in a 1:1 ratio. The primary outcome was the time to loss of cold sensation at the T4 level. RESULTS: There was a significant difference between the two groups in the time to achieve loss of cold sensation (303, 95%CI 255 to 402 S vs. 372, 95%CI 297 to 630 S, p = 0.024). There was no significant difference the degree of motor block (p = 0.185) at the Th4 level. Fewer pregnant women required additional local anesthetics in the ropivacaine group compared to the chloroprocaine group (4.5% VS. 34.8%, p = 0.011). The ropivacaine group had lower intraoperative VAS scores (p = 0.023) and higher patient satisfaction scores (p = 0.040) than the chloroprocaine group. The incidence of intraoperative complications was similar between the two groups, and no serious complications were observed. CONCLUSIONS: Our study found that 0.75% ropivacaine was associated with less intraoperative pain treatment, higher patient satisfaction and reduced the onset time compared to 3% chloroprocaine in pregnant women undergoing urgent cesarean delivery during labor analgesia period. Therefore, 0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period. CLINICAL TRIAL NUMBER AND REGISTRY URL: The registration number: ChiCTR2200065201; http://www.chictr.org.cn , Principal investigator: MEN, Date of registration: 31/10/2022.

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Background: Preservative-free chloroprocaine (CP) 1% is being investigated for short surgeries but lacks immediate postoperative analgesia. Adding opioids to local anesthetic increases the quality of spinal anesthesia with prolongation of postoperative analgesia. Aim: The aim of this study is to compare the postoperative analgesic efficacy of intrathecal nalbuphine versus intrathecal fentanyl as an adjuvant to chlorprocaine 1% for short surgical lower limb procedures. Materials and Methods: After ethical committee approval, a prospective randomized double-blind comparative study was conducted on 90 patients of the American Society of Anesthesiologists classes 1 and 2, aged between 18 and 60 years who were scheduled for elective short surgical lower limb procedures. Group CP ( n = 30) received CP 1% 40 mg (4 ml) plus saline (0.5 ml), Group CP with fentanyl (CF) ( n = 30) received CP 1% 40 mg (4 ml) plus fentanyl 25 mcg (0.5 ml), and Group CP with nalbuphine (CN) ( n = 30) received CP 1% 40 mg (4 ml) plus nalbuphine 0.8 mg (0.5 ml) intrathecally. After performing subarachnoid block, the parameters observed were – Onset, height, duration of sensory and motor blockade, duration of postoperative analgesia, hemodynamics, and adverse effects between the three groups noted. Results: The onset of sensory and motor block (min) is faster in Group CF (4.2 ± 0.2, 3.4 ± 0.4) compared to Group CN (4.8 ± 0.4, 3.7 ± 0.4) and Group CP (6.2 ± 0.4, 4 ± 0.4) ( P &lt; 0.001). The total sensory duration and motor duration are prolonged in Group CN (96.5 ± 5.2, 90 ± 3.9) compared to Group CF (94 ± 4, 87 ± 4.5) and Group CP (77 ± 3, 74 ± 4.5) ( P &lt; 0.001). The duration of postoperative analgesia was prolonged in Group CN (130 ± 5.3) compared to Group CF (111 ± 6.2) and Group C (93 ± 4.2) ( P &lt; 0.001). Conclusion: We conclude that intrathecal nalbuphine prolongs postoperative analgesia maximally compared to intrathecal fentanyl as an adjuvant to CP 1% for short surgical lower limb procedures.

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Local anesthetics are essential in dental practice, but their systemic effects can pose significant risks for medically compromised patients. This review aims to identify and evaluate the safest local anesthetic agents for use in dental procedures in patients with systemic medical conditions to minimize adverse outcomes and improve clinical safety. To achieve this, a comprehensive literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published from January 2000 to April 2025. Thirty-five studies addressing local anesthetic use in patients with cardiovascular disease, hepatic or renal impairment, diabetes, thyroid disorders, bleeding tendencies, pregnancy, elderly populations, and amide allergies were included. Data were synthesized to develop clinical recommendations for anesthetic selection based on systemic conditions. Lidocaine remains the standard amide anesthetic, with a strong safety profile in pregnancy and diabetes. Mepivacaine, due to minimal vasodilation, is preferred in cardiovascular and thyroid disorders. Articaine's rapid plasma metabolism benefits patients with liver or kidney impairment. Prilocaine is effective for hepatic impairment but poses methemoglobinemia risks, especially in pregnancy. Chloroprocaine, an ester anesthetic, is recommended for patients with confirmed amide allergies. Emerging strategies, such as buffered formulations, low epinephrine anesthetics, and ultrasound guided techniques, may enhance safety in high risk groups. Local anesthetic selection must be tailored to each patient's medical status. Mepivacaine, lidocaine, and articaine are among the safest agents for various systemic conditions. An evidence based, condition specific approach enhances safety and treatment outcomes in medically compromised dental patients.

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INTRODUCTION: Spinal anesthesia is commonly used for total knee and hip arthroplasties (TKA/THA). The rising popularity of ambulatory TKA and THAs require anesthetic techniques that provide rapid recovery of motor and sensory function while minimizing side effects like postoperative urinary retention. This single-center retrospective observational study compares the recovery profile of patients undergoing TKA and THA under chloroprocaine spinals compared to hyperbaric and isobaric bupivacaine spinals. METHODS: One hundred and twelve patients undergoing primary TKA and THA under spinal anesthesia at University of Florida Health were identified between September 1, 2019 and February 21, 2020. Their electronic medical records were reviewed. Patients were categorized based on the local anesthetic used in the spinal. Various demographic, intraoperative, and postoperative data were compiled and compared, including duration of surgery, time to physical therapy, time to post-anesthesia care unit (PACU) discharge, and time to spontaneous micturition. RESULTS: Time to spontaneous micturition and PACU discharge were significantly lower in the chloroprocaine spinal group compared to the hyperbaric bupivacaine group by 193 minutes and 42 minutes, respectively. Fewer patients receiving chloroprocaine spinals had their first physical therapy session limited by residual motor weakness compared to those in both bupivacaine groups. Additionally, mean duration of surgery was shorter in the chloroprocaine group compared to both bupivacaine groups (89 minutes compared to 111 minutes). Time to physical therapy completion was not different. All groups had <10% conversion to general anesthesia. CONCLUSION: Chloroprocaine spinals can be feasible options for TKAs and THAs with improved postoperative recovery profiles compared to bupivacaine spinals.

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