title: Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants.
abstract: OBJECTIVE
  To describe the use and adverse effects of chloroprocaine for epidural analgesia in young infants for infusion durations greater than 3.5 hours.
  
  
  METHODS
  A retrospective cohort review of the electronic medical record over a 14-month period.
  
  
  METHODS
  The level IV neonatal intensive care unit of a 414-bed free-standing children's hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Dosing requirements, placement of epidural catheter, supplementary analgesic therapy, respiratory support, vital signs, and incidence of adverse events associated with local anesthetics were collected.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Pharmacy, Children's Hospital Colorado, 13123 East 16th Ave Campus Box 375, Aurora, CO, USA. Electronic address: emma.ross16@gmail.com.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Ross
authors.affiliation: Department of Pharmacy, Children's Hospital Colorado, 13123 East 16th Ave Campus Box 375, Aurora, CO, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, University of Colorado School of Pharmacy, Mail Stop C238, Pharmacy and Pharmaceutical Sciences Building, 12850 East Montview Boulevard, Aurora, CO, USA.
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Reiter
authors.affiliation: Department of Pharmacy, Children's Hospital Colorado, 13123 East 16th Ave Campus Box 375, Aurora, CO, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Murphy
authors.affiliation: Department of Anesthesiology, Children's Hospital Colorado, 13123 East 16th Ave Campus Box 090, Aurora, CO, USA; University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Bielsky
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011247:Pregnancy; D011343:Procaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013618:Tachyphylaxis
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine
keywords: Analgesia; Chloroprocaine; Epidural; Infant; Pain; Postoperative