• Basic Info
• Top Questions
• Clinical Info
• Interactions

Uses

Local or Regional Anesthesia

Local or regional analgesia or anesthesia in surgical, dental, and diagnostic procedures.

Dosage and Administration

General

• Determine dosage based on anesthetic procedure, area to be anesthetized, vascularity of tissues, number of neuronal segments to be blocked, depth and duration of anesthesia, degree of muscular relaxation, individual tolerance, and physical condition of the patient. Use smallest dose and concentration required to produce the desired effect.

Administration

Injection

For solution and drug compatibility information, see Compatibility under Stability.

Administer by local infiltration, peripheral nerve block, or subarachnoid (spinal) block.

Consult specialized references for specific techniques and procedures for administering local anesthetics.

For local infiltration or peripheral nerve block, inject slowly and avoid rapid injection of large volumes; when feasible, administer in fractional (incremental) doses.

For subarachnoid (spinal) block, use 2-mL single-dose ampuls containing procaine hydrochloride 10% only. Position patient properly prior to spinal anesthesia.

For disinfection of container surface, autoclave once at 15 PSI and 121°C for 15 minutes (diluent dextrose may show some brown discoloration due to caramelization); immersion in antiseptic solution not recommended. Reautoclaving not recommended because it increases likelihood of crystal formation.

Dilution

For local infiltration, dilute appropriate dose of 1% procaine hydrochloride injection with 0.9% sodium chloride to obtain final concentration of 0.25 or 0.5%. May add 0.5–1 mL of epinephrine 0.1% to each 100 mL of anesthetic solution (to provide final epinephrine concentration of 1:200,000 to 1:100,000) for vasoconstrictive effect.

For peripheral nerve block, dilute appropriate dose of 1% procaine hydrochloride injection with 0.9% sodium chloride to obtain final concentration of 0.5%. Alternatively, may use 1% procaine hydrochloride injection without diluting. May add 0.5–1 mL of epinephrine 0.1% to each 100 mL of anesthetic solution (to provide a final epinephrine concentration of 1:200,000 to 1:100,000) for vasoconstrictive effect.

For subarachnoid (spinal) block, dilute appropriate dose of 10% procaine hydrochloride injection with sterile 0.9% sodium chloride injection, sterile water for injection, CSF, or, for hyperbaric technique, sterile dextrose injection. For anesthesia of the perineum, dilute 0.5 mL of the 10% procaine hydrochloride injection (50 mg) with an equal volume of diluent. For anesthesia of the perineum and lower extremities, dilute 1 mL of the 10% injection (100 mg) with an equal volume of diluent. For anesthesia extending up to the costal margin, dilute 2 mL of the 10% injection (200 mg) with 1 mL of diluent.

Rate of Administration

For subarachnoid (spinal) block, usual rate of injection is 1 mL/5 seconds.

Dosage

Available as procaine hydrochloride; dosage expressed in terms of the salt.

Pediatric Patients

Local or Regional Anesthesia

Local Infiltration

Up to 15 mg/kg as a 0.5% solution.

Adults

Local or Regional Anesthesia

Local Infiltration

Usually, 350–600 mg, administered as diluted solution (i.e., 140–240 mL of a 0.25% solution or 70–120 mL of a 0.5% solution).

Peripheral Nerve Block

Up to 1 g, administered undiluted (i.e., 100 mL of a 1% injection) or as diluted solution (i.e., 200 mL of a 0.5% solution).

Subarachnoid (Spinal) Block

Prescribing Limits

Pediatric Patients

Local or Regional Anesthesia

Local Infiltration

Maximum 15 mg/kg as a 0.5% solution.

Adults

Local or Regional Anesthesia

Local Infiltration, Peripheral Nerve Block

Maximum 1 g per injection.

Special Populations

Dosage in Hepatic Impairment

Reduce dosage in patients with hepatic disease.

Geriatric Patients

Reduce dosage based on age, weight, and physical status.

Other Populations

Reduce dosage in patients with cardiac disease, debilitated patients, and acutely ill patients.

Reduce dosage in obstetric patients and patients with increased intra-abdominal pressure.