936

Abstract

Introduction: Chloroprocaine is metabolized by plasma cholinesterases and possesses an extremely short half-life. These features make it ideal for infants with immature hepatic function/drug metabolism and may minimize the risk of toxicity. However, only one small study has described intra-operative chloroprocaine during brief surgical episodes (< 3.5 hours) in neonates. Methods: This was an IRB approved, retrospective, electronic medical record review of infants admitted to a children's hospital during a 14-month period who received chloroprocaine for epidural analgesia. Dosing requirements, concomitant analgesia therapy, and possible adverse events related to chloroprocaine were collected. Data are presented as mean ±SD (range) or median when significant skewness was detected. Results: Eighteen patients (age 1.7 ± 1.8 mo (0.03-6.3); weight 3.8 ± 1.3kg (1.56-6.9); 55% male) were enrolled. Surgical classifications included GI (n=13), pulmonary (n=3), ENT (n=1), and orthopedic (n=1). Mean operative time was 2.48 ± 1 hr (1-5). Epidural catheter placement was caudal (n=8), lumbar (n=6), or thoracic (n=4). Epidural analgesia was initiated intra-operatively in 10 patients (55.5%). The remaining infants had their epidural initiated 2.86 ± 2.74 hr (0.76-9.37) post-operatively. Sixty-six percent of epidurals also contained clonidine. The initial dose of chloroprocaine was 3.5 ± 1 mg/kg/hr (1.4-5) with a maximum dose of 4.2 ± 1.1 mg/kg/hr (2.07-6.1). Mean cumulative dose was 177.3 ± 80.6 mg/kg (45-348). Duration of epidural analgesia was 48.3 ± 21.5 hr (10-96). All patients received intermittent doses of opiate and non-opiate pain medications while receiving chloroprocaine, but only two patients (on mechanical ventilation) required continuous infusion opiates. One patient received continuous dexmedetomidine. Median time to extubation post-operatively was 1.56 hrs. No adverse events associated with chloroprocaine use were identified during infusion or within 24 hrs after discontinuation. Conclusions: Epidural chloroprocaine, in doses of 1.5-6.1 mg/kg/hr, can provide adequate analgesia in young infants for up to 96 hrs with no identified adverse effects.