Procaine Hydrochloride (7 brand names, 1 dosage form, 1 route)
Available dosage forms: INJECTABLE.
Routes of administration: INJECTION.
Brand Names
- ACHROMYCIN
- NOVOCAIN
- PROCAINE HYDROCHLORIDE
- PROCAINE HYDROCHLORIDE W/ EPINEPHRINE
- RAVOCAINE AND NOVOCAIN W/ LEVOPHED
- RAVOCAINE AND NOVOCAIN W/ NEO-COBEFRIN
- TETRACYN
Indications and Usage
NOVOCAIN is indicated for spinal anesthesia.
Dosage and Administration
As with all local anesthetics, the dose of NOVOCAIN varies and depends upon the area to be anesthetized, the vascularity of the tissues, the number of neuronal segments to be blocked, individual tolerance, and the technique of anesthesia. The lowest dose needed to provide effective anesthesia should be administered. For specific techniques and procedures, refer to standard textbooks.RECOMMENDED DOSAGE FOR SPINAL ANESTHESIA Extent of AnesthesiaNOVOCAIN10% SolutionTotal Dose(mg)Site of Injection(lumbar interspace) Volume of 10% Solution(mL)Volume of Dilution(mL) Perineum0.50.5504th Perineum and lowerextremities111003rd or 4th Up to costal margin212002nd, 3rd or 4th The diluent may be sterile normal saline, sterile distilled water, spinal fluid; and for hyperbaric technique, sterile dextrose solution.The usual rate of injection is 1 mL per 5 seconds. Full anesthesia and fixation usually occur in 5 minutes.STERILIZATIONThe drug in intact ampuls is sterile. The preferred method of destroying bacteria on the exterior of ampuls before opening is heat sterilization (autoclaving). Immersion in antiseptic solution is not recommended.Autoclave at 15-pound pressure, at 121°C (250°F), for 15 minutes. The diluent dextrose may show some brown discoloration due to caramelization.Protect solutions from light.
Contraindications
Spinal anesthesia with NOVOCAIN is contraindicated in patients with generalized septicemia: sepsis at the proposed injection site; certain diseases of the cerebrospinal system, e.g., meningitis, syphilis; and a known hypersensitivity to the drug, drugs of a similar chemical configuration, or aminobenzoic acid or its derivatives. The decision as to whether or not spinal anesthesia should be used in an individual case should be made by the physician after weighing the advantages with the risks and possible complications.
Adverse Reactions
Systemic adverse reactions involving the central nervous system and the cardiovascular system usually result from high plasma levels due to excessive dosage, rapid absorption, or inadvertent intravascular injection. In addition, use of inappropriate doses or techniques may result in extensive spinal blockade leading to hypotension and respiratory arrest.A small number of reactions may result from hypersensitivity, idiosyncrasy, or diminished tolerance to normal dosage.Excitatory CNS effects (nervousness, dizziness, blurred vision, tremors) commonly represent the initial signs of local anesthetic systemic toxicity. However, these reactions may be very brief or absent in some patients in which case the first manifestation of toxicity may be drowsiness or convulsions merging into unconsciousness and respiratory arrest.Cardiovascular system reactions include depression of the myocardium, hypotension (or sometimes hypertension), bradycardia, and even cardiac arrest.Allergic reactions are characterized by cutaneous lesions of delayed onset, or urticaria, edema, and other manifestations of allergy. The detection of sensitivity by skin testing is of limited value. As with other local anesthetics, hypersensitivity, idiosyncrasy and anaphylactoid reactions have occurred rarely. The reaction may be abrupt and severe and is not usually dose related. The following adverse reactions may occur with spinal anesthesia: Central Nervous System: postspinal headache, meningismus, arachnoiditis, palsies, or spinal nerve paralysis. Cardiovascular: hypotension due to vasomotor paralysis and pooling of the blood in the venous bed. Respiratory: respiratory impairment or paralysis due to the level of anesthesia extending to the upper thoracic and cervical segments. Gastrointestinal: nausea and vomiting.Treatment of Reactions. Toxic effects of local anesthetics require symptomatic treatment: there is no specific cure. The physician should be prepared to maintain an airway and to support ventil