Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants.

Abstract

STUDY OBJECTIVE:

To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours.

DESIGN:

A retrospective cohort review of the electronic medical record over a 14-month period.

SETTING:

The level IV neonatal intensive care unit of a 414-bed free-standing children's hospital.

PATIENTS:

Eighteen infants (mean age, 1.7 ± 1.8 months [0.03-6.3]; mean weight, 3.8 ± 1.3 kg [1.56-6.9]; n = 10 [55%] males) received 1% chloroprocaine for epidural analgesia postoperatively for up to 96-hour duration and met criteria for inclusion.

MEASUREMENTS:

Dosing requirements, placement of epidural catheter, supplementary analgesic therapy, respiratory support, vital signs, and incidence of adverse events associated with local anesthetics were collected.

MAIN RESULTS:

Epidural catheter placement was caudal (n = 8), lumbar (n = 6), or thoracic (n = 4). Mean operative time was 2.48 ± 1 hour (1-5). Initial chloroprocaine dose was 1.3 ± 0.5 mL/h (0.4-2.5) (3.5 ± 1 mg/kg per hour [1.4-5]) with a maximum dose of 1.5 ± 0.6 mL/h (0.4-3) (4.2 ± 1.1 mg/kg per hour [2.2-6.1]). Duration of epidural analgesia was 48.3 ± 21.5 hours (10-96). Duration of epidural infusion did not influence dosing requirement, suggesting the absence of drug tachyphylaxis. All patients received intermittent doses of opioid and nonopioid pain medications while receiving chloroprocaine. Two mechanically ventilated patients required continuous infusion of opioids. No adverse events were directly attributed to chloroprocaine use.

CONCLUSION:

Epidural 1% chloroprocaine, in doses of 0.4-3 mL/h (1.5-6.1 mg/kg per hour), was well tolerated in both mechanically ventilated and spontaneously breathing infants for up to 96 hours with no identified adverse effects or tachyphylaxis.

• Authors: Emma L Ross, Pamela D Reiter, Michael E Murphy, Alan R Bielsky
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 27 Issue 6 Pg. 463-9 (Sep 2015) ISSN: 1873-4529 [Electronic] United States
• PMID: 26219196 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Analgesics, Opioid
• Anesthetics, Local
• Procaine
• chloroprocaine

Topics

• Analgesia, Epidural (methods)
• Analgesics, Opioid (therapeutic use)
• Anesthesia, Epidural
• Anesthetics, Local (administration & dosage, adverse effects, therapeutic use)
• Child, Preschool
• Cohort Studies
• Female
• Humans
• Infant
• Infant, Newborn
• Intensive Care Units, Neonatal
• Male
• Pain, Postoperative (drug therapy)
• Pregnancy
• Procaine (administration & dosage, adverse effects, analogs & derivatives, therapeutic use)
• Respiration, Artificial
• Retrospective Studies
• Tachyphylaxis