Chloroprocaine for epidural anesthesia in infants and children

Abstract

The authors discuss their experience with chloroprocaine for epidural anesthesia in five pediatric patients. While bupivacaine remains the most commonly used local anesthetic in children, recent reports of toxicity document the risks of this agent. The major advantage of chloroprocaine is its rapid metabolism, which thereby minimizes the risks of toxicity, especially in patients with preexisting problems such as young age or underlying hepatic dysfunction, which may limit the metabolism of local anesthetics of the amide class. In three cases, the epidural infusion was combined with the general anesthetic. The cases included hepatic resection, repair of bladder exstrophy, and correction of duodenal atresia. In two other cases, epidural anesthesia was used instead of general anesthesia in a former preterm infant who was undergoing inguinal herniorrhaphy and for lower extremity orthopedic procedures in a child with myotonic dystrophy. In all cases, chloroprocaine was chosen because of preexisting or associated conditions that might increase the risk of bupivacaine toxicity, such as hepatic resection, repeated dosing in a neonate, or the need for higher concentrations of local anesthetic to achieve adequate surgical conditions. Adequate intraoperative conditions were achieved in all five patients. No complications related to chloroprocaine epidural anesthesia were noted. This initial experience suggests that chloroprocaine offers an acceptable alternative to bupivacaine for epidural anesthesia in the pediatric population.