Ampres: Uses, Dosage & Side Effects
An ester-type local anesthetic containing chloroprocaine hydrochloride, used for intrathecal (spinal) anesthesia in short surgical procedures lasting up to 40 minutes in adults
Ampres (chloroprocaine hydrochloride 10 mg/ml) is an ester-type local anesthetic administered intrathecally (into the spinal fluid) to provide spinal anesthesia for short surgical procedures lasting up to 40 minutes. Chloroprocaine is one of the most rapidly metabolized local anesthetics available, making it particularly well-suited for ambulatory (day-case) surgery where rapid patient recovery and early discharge are priorities. This medication is administered only by qualified anesthesiologists in a hospital or clinical setting with full resuscitation equipment immediately available.
Quick Facts About Ampres
Key Takeaways
- Ampres contains chloroprocaine hydrochloride 10 mg/ml, an ester-type local anesthetic used exclusively for intrathecal (spinal) anesthesia in adults undergoing short surgical procedures lasting up to 40 minutes.
- Chloroprocaine has one of the fastest elimination half-lives of any local anesthetic (approximately 11–21 seconds), resulting in rapid metabolism by plasma cholinesterases and a predictably short duration of action.
- The standard adult dose is 40–50 mg (4–5 ml), with onset of surgical anesthesia within 2–5 minutes and clinical block duration of approximately 40–60 minutes, making it ideal for ambulatory (day-case) surgery.
- Ampres must not be used in patients with known hypersensitivity to ester-type local anesthetics or para-aminobenzoic acid (PABA), severe cardiac conduction disorders, or severe anemia.
- Administration must be performed only by experienced anesthesiologists in a clinical setting with full resuscitation equipment and personnel immediately available.
What Is Ampres and What Is It Used For?
Quick Answer: Ampres is a preservative-free solution of chloroprocaine hydrochloride (10 mg/ml) used for intrathecal injection to produce spinal anesthesia in adults. It is specifically indicated for short surgical procedures lasting up to 40 minutes, such as minor orthopedic, urological, gynecological, and general surgical operations performed on an ambulatory basis.
Ampres belongs to a class of medications known as ester-type local anesthetics, specifically the aminobenzoic acid ester group. The active substance, chloroprocaine hydrochloride, works by blocking the transmission of nerve impulses along nerve fibers. When injected into the intrathecal space (the fluid-filled area surrounding the spinal cord), it temporarily prevents sensory, motor, and autonomic nerve signals from traveling between the lower body and the brain, thereby producing regional anesthesia below the level of injection.
Chloroprocaine was first synthesized in the 1950s and has been widely used in obstetric anesthesia via the epidural route for decades. However, the preservative-free formulation represented by Ampres was specifically developed and approved for intrathecal use, filling an important clinical niche for ultra-short-acting spinal anesthesia. The European Medicines Agency (EMA) approved the intrathecal formulation to address the growing demand for short-acting spinal anesthetics in day-case surgery, where traditional long-acting agents such as bupivacaine can delay patient recovery and hospital discharge.
The unique pharmacological profile of chloroprocaine makes it particularly advantageous in ambulatory surgery settings. Its rapid onset (typically 2–5 minutes after injection) combined with its short, predictable duration of action (approximately 40–60 minutes of surgical anesthesia) means patients can be mobilized and discharged significantly earlier than with longer-acting spinal anesthetics. Studies have shown that time to ambulation after chloroprocaine spinal anesthesia is approximately 90–120 minutes, compared to 180–300 minutes or more with standard-dose bupivacaine.
Ampres is used exclusively in adult patients. Safety and efficacy have not been established in children and adolescents under 18 years of age. The medication is only available as a hospital-administered injection and cannot be self-administered by patients.
Ampres is particularly well-suited for day-case surgical procedures including diagnostic and operative arthroscopy, hernia repair, minor urological procedures, hemorrhoidectomy, and gynecological procedures where the expected surgical time does not exceed 40 minutes. The choice of spinal anesthetic should always be made by the anesthesiologist based on the specific clinical scenario and patient characteristics.
What Should You Know Before Receiving Ampres?
Quick Answer: Ampres must not be given to patients with known hypersensitivity to chloroprocaine, ester-type local anesthetics, or para-aminobenzoic acid (PABA). It is also contraindicated in patients with severe cardiac conduction disorders and severe anemia. Several medical conditions require special caution, and the anesthesiologist must be informed of your full medical history before administration.
Contraindications
Ampres is contraindicated and must not be used in the following situations:
- Hypersensitivity: Known allergy to chloroprocaine hydrochloride, esters of para-aminobenzoic acid, other ester-type local anesthetics, or any of the excipients (hydrochloric acid, sodium chloride, water for injections).
- Severe cardiac conduction disorders: Patients with significant impairment of the heart's electrical conduction system, including complete heart block or severe conduction abnormalities.
- Severe anemia: Patients with critically low hemoglobin levels, as reduced oxygen-carrying capacity may increase the risk of complications during spinal anesthesia.
- General or specific contraindications to intrathecal administration: Conditions that make spinal anesthesia inappropriate, such as active infection at the injection site, coagulopathy, increased intracranial pressure, or patient refusal.
Warnings and Precautions
Your anesthesiologist must be informed if any of the following apply to you, as special care may be required:
- Previous severe reactions to any local anesthetic agent
- Signs of skin infection or inflammation at or near the planned injection site
- Central nervous system diseases, including meningitis, poliomyelitis, or spinal cord conditions caused by anemia
- Severe headache or tumors of the brain, spine, or other body parts
- Spinal tuberculosis or recent spinal injury
- Very low blood pressure (hypotension) or decreased blood volume (hypovolemia)
- Blood clotting disorders (coagulopathy) or use of anticoagulant medications
- Acute porphyria (a metabolic disorder affecting heme synthesis)
- Pulmonary edema (fluid in the lungs) or septicemia (blood poisoning)
- Heart disease, including coronary artery disease, valvular disease, or heart failure
- Neurological conditions such as multiple sclerosis, hemiplegia (one-sided paralysis), paraplegia (lower body paralysis), or neuromuscular diseases
Regional anesthesia with Ampres must only be administered by a physician with the necessary knowledge and experience in performing intrathecal injections. The responsible physician must take all measures required to avoid inadvertent intravascular injection and must be able to recognize and treat all potential adverse effects, including systemic toxicity of local anesthetics. Equipment, medications, and personnel capable of managing emergency situations must be immediately available throughout the procedure and during recovery.
Chloroprocaine is metabolized by plasma cholinesterases (pseudocholinesterase). Patients with reduced cholinesterase activity — whether due to genetic variation (atypical cholinesterase), liver disease, pregnancy, or concurrent medications — may experience prolonged effects. Additionally, patients with a history of allergic reactions to PABA-containing products (such as certain sunscreens) or sulfonamide antibiotics may have cross-sensitivity to ester-type local anesthetics.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to become pregnant, you should inform your doctor before receiving Ampres. This medication is not recommended for local or regional anesthesia during pregnancy and should only be used if the clinical benefit is considered to clearly outweigh the potential risks. However, this restriction does not prevent the use of Ampres during labor and delivery, where chloroprocaine spinal anesthesia may be clinically appropriate.
It is currently unknown whether chloroprocaine is excreted in human breast milk. However, given the extremely rapid metabolism of chloroprocaine (elimination half-life of approximately 11–21 seconds), systemic exposure after intrathecal administration at the recommended dose is expected to be very limited. If you are breastfeeding, inform your anesthesiologist so an informed clinical decision can be made regarding the use of Ampres.
Driving and Using Machines
Ampres has a significant effect on the ability to drive and use machines. Even after the spinal block has fully resolved, there may be residual effects on coordination, judgment, and motor function. Your anesthesiologist will advise you on when it is safe to resume driving and operating machinery. As a general guideline, patients should not drive or operate machinery for at least 24 hours after receiving spinal anesthesia, though this may vary depending on individual circumstances, the type of surgery performed, and any other medications administered during the procedure.
Ampres contains less than 1 mmol (23 mg) of sodium per maximum dose (5 ml), meaning it is essentially sodium-free. This is relevant for patients on a sodium-restricted diet.
How Does Ampres Interact with Other Drugs?
Quick Answer: Ampres can interact with several classes of medications, most notably class III antiarrhythmic agents (such as amiodarone), vasopressor drugs, and sulfonamide antibiotics. Because chloroprocaine is metabolized by plasma cholinesterases, any medication or condition that reduces cholinesterase activity may prolong the effects of this anesthetic.
Before receiving Ampres, you must inform your anesthesiologist about all medications you are currently taking, have recently taken, or might be taking. Drug interactions with chloroprocaine can occur through several mechanisms, including additive cardiac effects, altered metabolism, and pharmacodynamic interactions affecting blood pressure and nerve conduction.
Major Interactions
The following drug interactions are considered clinically significant and may require dose adjustments, alternative anesthetic choices, or enhanced monitoring:
| Drug / Class | Mechanism | Clinical Effect | Recommendation |
|---|---|---|---|
| Class III Antiarrhythmics (e.g., amiodarone, dronedarone) | Additive cardiac depressant effects | Increased risk of bradycardia, hypotension, and cardiac conduction abnormalities | Enhanced cardiac monitoring; consider dose reduction or alternative anesthetic |
| Cholinesterase Inhibitors (e.g., neostigmine, donepezil, rivastigmine) | Reduced hydrolysis of chloroprocaine by inhibiting plasma cholinesterases | Prolonged anesthetic effect and increased risk of systemic toxicity | Close monitoring for prolonged block; consider dose reduction |
| Sulfonamide Antibiotics (e.g., sulfamethoxazole, sulfasalazine) | The metabolite PABA competitively inhibits the antibacterial action of sulfonamides | Reduced efficacy of sulfonamide antibiotics | Avoid concurrent use if possible; monitor antimicrobial response |
Other Notable Interactions
| Drug / Class | Mechanism | Clinical Effect | Recommendation |
|---|---|---|---|
| Vasopressor Agents (e.g., ephedrine, phenylephrine) | Pharmacodynamic interaction related to spinal block hemodynamics | Commonly used to treat spinal anesthesia-related hypotension; dose-response may be altered | Standard monitoring; titrate vasopressors to clinical response |
| Opioid Analgesics (e.g., fentanyl, morphine) | Additive central nervous system depression | Enhanced sedation and potential for respiratory depression | Careful dose titration; continuous respiratory monitoring |
| Anticoagulants (e.g., heparin, warfarin, direct oral anticoagulants) | Increased bleeding risk at puncture site | Risk of spinal hematoma with potential neurological sequelae | Follow ESRA/ASRA guidelines for neuraxial anesthesia timing relative to anticoagulant dosing |
| Antihypertensive Medications (e.g., ACE inhibitors, beta-blockers, calcium channel blockers) | Additive hypotensive effects with sympathetic blockade from spinal anesthesia | Exaggerated hypotension during spinal block | Preoperative assessment of blood pressure management; ensure adequate IV hydration |
It is essential that your anesthesiologist has a complete picture of your medication history, including over-the-counter drugs, herbal supplements, and any medications recently discontinued. Certain herbal supplements (such as St. John's wort, ginkgo biloba, and garlic) may affect bleeding risk or interact with anesthetic agents. Patients taking monoamine oxidase inhibitors (MAOIs) should also be identified, as these may increase the risk of hemodynamic instability during neuraxial anesthesia.
What Is the Correct Dosage of Ampres?
Quick Answer: The standard adult dose of Ampres is 40–50 mg (4–5 ml) of chloroprocaine hydrochloride, administered as a single intrathecal injection. Dose reduction may be necessary in patients with reduced general health status or certain concurrent medical conditions. Ampres is not approved for use in children or adolescents.
Ampres is exclusively administered by a qualified anesthesiologist through intrathecal (spinal) injection. The medication is never self-administered by patients. The dose is determined by the treating physician based on the individual patient's clinical circumstances, including body weight, height, physical status, the planned surgical procedure, and expected duration of surgery.
Adults
Standard Adult Dosing
Recommended dose: 40–50 mg (4–5 ml of Ampres 10 mg/ml solution)
Administration route: Single intrathecal (subarachnoid) injection
Onset of action: 2–5 minutes
Duration of surgical block: Approximately 40 minutes
Time to full motor recovery: Approximately 60–90 minutes
Injection rate: Slow injection over 15–30 seconds at the L3/L4 or L4/L5 intervertebral space
The dose should be selected to achieve an adequate level of anesthesia while minimizing the amount of drug administered. Factors that influence the spread and duration of spinal anesthesia include the dose administered, the baricity of the solution (Ampres is isobaric), patient position during and after injection, patient height and body mass index, and the anatomy of the spinal column. The anesthesiologist may adjust the final dose based on these factors and their clinical judgment.
Patients Requiring Dose Reduction
A reduced dose of Ampres may be necessary in the following patient populations:
- Patients with reduced general health status (ASA III–IV classification)
- Patients with vascular occlusive disease (e.g., peripheral arterial disease)
- Patients with atherosclerosis
- Patients with diabetic neuropathy
- Elderly patients with significant comorbidities
The specific dose reduction is determined by the anesthesiologist based on individual patient assessment.
Children and Adolescents
The safety and efficacy of Ampres in children and adolescents under 18 years of age have not been established. No clinical data are available for this age group, and Ampres should not be used in pediatric patients. For children requiring spinal anesthesia, other approved agents with established pediatric safety profiles should be considered under specialist guidance.
Elderly Patients
Elderly patients may be more susceptible to the hemodynamic effects of spinal anesthesia, including hypotension and bradycardia. While no specific dose adjustment is mandated for elderly patients based solely on age, the anesthesiologist should carefully assess each patient's cardiovascular reserve, fluid status, and concurrent medications. A dose at the lower end of the recommended range (40 mg) may be appropriate for elderly patients, particularly those with significant cardiovascular comorbidities. Adequate intravenous fluid preloading and immediate availability of vasopressor agents are important considerations.
Overdose
Because Ampres is administered exclusively by trained anesthesiologists in a controlled clinical setting, accidental overdose is uncommon. However, inadvertent intravascular injection or administration of excessive doses can result in systemic toxicity of local anesthetics. Signs and symptoms of local anesthetic systemic toxicity (LAST) may include:
- Central nervous system effects: Numbness of the tongue, lightheadedness, dizziness, visual disturbances, tinnitus, tremors, muscle twitching, and in severe cases, generalized seizures progressing to loss of consciousness
- Cardiovascular effects: Hypotension, bradycardia, cardiac arrhythmias, and in severe cases, cardiovascular collapse and cardiac arrest
- Respiratory effects: Respiratory depression or arrest, which may occur due to high spinal block affecting respiratory muscles or direct CNS depression
If signs of systemic toxicity occur, administration must be stopped immediately. Management includes maintaining airway patency and oxygenation, controlling seizures with benzodiazepines or propofol, and providing cardiovascular support. Intravenous lipid emulsion (Intralipid 20%) should be considered according to current LAST treatment guidelines. The treatment team should follow institutional and ASRA/ESRA protocols for LAST management.
What Are the Side Effects of Ampres?
Quick Answer: Like all medicines, Ampres can cause side effects, although not everyone experiences them. The most common side effects are hypotension (low blood pressure) and nausea, which occur in more than 1 in 10 patients. Most side effects are transient and related to the spinal block itself, resolving as the anesthesia wears off.
The side effects associated with Ampres are generally similar to those seen with other spinal anesthetic agents and are largely related to the sympathetic nervous system blockade that accompanies spinal anesthesia. The frequency and severity of side effects depend on the dose administered, the level of spinal block achieved, and the individual patient's physiological response.
Sudden life-threatening allergic reactions (anaphylaxis) are rare but can occur. Symptoms may include sudden itching, redness, swelling, sneezing, vomiting, dizziness, excessive sweating, elevated body temperature, and difficulty breathing. If you experience persistent motor, sensory, or autonomic deficits in the lower body after the expected block resolution time, inform your medical team immediately to prevent permanent neurological damage.
Very Common
May affect more than 1 in 10 patients
- Hypotension (low blood pressure)
- Nausea
Common
May affect up to 1 in 10 patients
- Anxiety and restlessness
- Paraesthesia (abnormal sensations such as tingling or numbness)
- Dizziness
- Vomiting
- Difficulty urinating (urinary retention)
Uncommon
May affect up to 1 in 100 patients
- Arterial hypotension (at high doses)
- Bradycardia (slow heart rate)
- Tremors and convulsions
- Numbness of the tongue
- Hearing disturbances and visual disturbances
- Speech disorders
- Loss of consciousness
Rare
May affect up to 1 in 1,000 patients
- Anaphylaxis (life-threatening allergic reaction)
- Neuropathy (nerve damage)
- Drowsiness progressing to loss of consciousness and respiratory arrest
- Total spinal block
- Hypotension secondary to spinal block
- Loss of bladder and bowel control
- Loss of perineal sensation and sexual function
- Arachnoiditis (inflammation of the arachnoid membrane)
- Cauda equina syndrome (compression of lower spinal nerves)
- Permanent neurological injury
- Diplopia (double vision)
- Cardiac arrhythmia
- Myocardial depression and cardiac arrest (risk higher with high doses or inadvertent intravascular injection)
- Respiratory failure
Hypotension is the most frequently reported adverse effect of spinal anesthesia with chloroprocaine, as with all spinal anesthetics. This occurs because the sympathetic nerve blockade causes vasodilation in the lower body, leading to blood pooling and a reduction in cardiac preload. The anesthesia team routinely manages this with intravenous fluids and, if needed, vasopressor medications such as ephedrine or phenylephrine.
Post-dural puncture headache (PDPH) may occur following any intrathecal injection due to the spinal needle puncture of the dura mater, regardless of the anesthetic agent used. The incidence depends primarily on needle type and size. Using small-gauge, pencil-point (atraumatic) needles significantly reduces the risk. PDPH typically presents as a headache that worsens in the upright position and improves when lying flat.
Transient neurological symptoms (TNS), characterized by pain or dysesthesia in the buttocks, legs, or lower back that appears within 24 hours of spinal anesthesia and resolves within days, have been reported with various local anesthetics used intrathecally. Current evidence suggests that the incidence of TNS is lower with chloroprocaine compared to lidocaine, making it a preferred choice for short-acting spinal anesthesia in settings where TNS has been a clinical concern.
How Should Ampres Be Stored?
Quick Answer: Ampres should be stored at or below 25°C, protected from cold and light, and must never be frozen. It is for single use only and must be used immediately after opening. Any unused solution must be discarded.
Proper storage of Ampres is essential to maintain the stability, sterility, and efficacy of the solution. As a hospital-administered medication, storage is handled by pharmacy and clinical staff. However, understanding the storage requirements helps ensure the medication remains safe and effective throughout its shelf life.
- Temperature: Store at or below 25°C (77°F). Do not refrigerate or freeze.
- Light protection: Keep the ampoules in the outer carton to protect from light. Chloroprocaine solution is light-sensitive and may degrade upon prolonged exposure.
- Cold protection: Store in a cool, dry place but do not expose to freezing temperatures, as this may alter the physicochemical properties of the solution.
- Expiry date: Do not use after the expiry date stated on the ampoules and outer carton. The expiry date refers to the last day of the stated month.
- Single use: Ampres ampoules are for single use only. Use immediately after opening. Any unused portion must be discarded and should not be stored for later use.
- Visual inspection: Do not use if the solution is not clear and free from particles. Before administration, the solution should be visually inspected for clarity and absence of particulate matter.
Since Ampres is used exclusively in hospital settings, the hospital pharmacy is responsible for proper storage and disposal. Medications should not be disposed of via household waste or sewage systems. These measures are designed to protect the environment and ensure public safety.
Keep all medicines out of the sight and reach of children. Although Ampres is a hospital-administered medication that would not typically be stored in a home setting, this precaution is a standard element of medication safety.
What Does Ampres Contain?
Quick Answer: Each 5 ml ampoule of Ampres contains 50 mg of chloroprocaine hydrochloride (10 mg/ml) as the active substance. The inactive ingredients are hydrochloric acid (for pH adjustment), sodium chloride (for isotonicity), and water for injections.
Active Substance
The active pharmaceutical ingredient in Ampres is chloroprocaine hydrochloride. Each milliliter of solution contains 10 mg of chloroprocaine hydrochloride. Each glass ampoule contains 5 ml of solution, providing a total of 50 mg of active substance per ampoule.
Chloroprocaine (chemical name: 2-chloro-4-aminobenzoic acid 2-(diethylamino)ethyl ester hydrochloride) is a para-aminobenzoic acid ester-type local anesthetic. It was first developed in the 1950s as a derivative of procaine, with the addition of a chlorine atom at the 2-position of the benzene ring, which significantly enhanced its potency and speed of onset compared to the parent compound. The molecular weight of chloroprocaine hydrochloride is 307.22 g/mol.
Inactive Ingredients (Excipients)
- Hydrochloric acid 3.7%: Used for pH adjustment to ensure the solution is within the acceptable pH range for intrathecal injection (typically pH 3.0–4.0)
- Sodium chloride: Added to achieve isotonicity with cerebrospinal fluid, which is essential for an isobaric spinal anesthetic formulation
- Water for injections: The solvent used to prepare the sterile solution
Importantly, Ampres is a preservative-free formulation. This is a critical distinction from some older chloroprocaine preparations (such as those used epidurally), which historically contained preservatives that were associated with neurotoxicity when inadvertently injected intrathecally. The absence of preservatives, bisulfites, and EDTA in the Ampres formulation ensures suitability for safe intrathecal administration.
Appearance and Packaging
Ampres is a clear, colorless solution for injection. It is supplied in clear, colorless Type I glass ampoules. Each carton contains 10 ampoules, each containing 5 ml of solution. The glass ampoules are designed for single use; after opening, any remaining solution should be discarded immediately.
Frequently Asked Questions About Ampres
Ampres (chloroprocaine hydrochloride 10 mg/ml) is an ester-type local anesthetic used for intrathecal (spinal) anesthesia in adults. It is specifically indicated for short surgical procedures lasting up to 40 minutes, including minor orthopedic procedures, hernia repairs, urological operations, and gynecological surgeries. Its rapid onset and short duration make it particularly well-suited for ambulatory (day-case) surgery, where early patient mobilization and discharge are important goals.
At the standard dose of 40–50 mg, Ampres provides surgical-level anesthesia for approximately 40 minutes. Motor block typically resolves within 60–90 minutes after injection, which is considerably shorter than the 3–5 hours commonly seen with longer-acting spinal anesthetics such as bupivacaine. Most patients can walk unassisted within 90–120 minutes of the injection, and same-day discharge is often possible within 3–4 hours after surgery.
The most common side effects are hypotension (low blood pressure) and nausea, which are very common and may affect more than 1 in 10 patients. Common side effects (up to 1 in 10 patients) include anxiety, restlessness, paraesthesia (tingling), dizziness, vomiting, and difficulty urinating. These effects are generally related to the spinal block and are usually transient, resolving as the anesthesia wears off. Your medical team will monitor you closely and treat these symptoms as needed.
Ampres is not generally recommended for regional anesthesia during pregnancy and should only be used when the clinical benefit clearly outweighs potential risks. However, it can be used for labor and delivery when clinically appropriate. Regarding breastfeeding, it is unknown whether chloroprocaine is excreted in breast milk, though its extremely rapid metabolism (half-life of 11–21 seconds) suggests minimal systemic exposure. Inform your doctor if you are pregnant or breastfeeding so the best anesthetic option can be selected for your situation.
The key difference is duration of action and recovery profile. Chloroprocaine (Ampres) is an ester-type local anesthetic with an elimination half-life of approximately 11–21 seconds, compared to bupivacaine (an amide-type anesthetic) with a half-life of 2–3 hours. This translates to faster recovery: patients can typically walk within 90–120 minutes after chloroprocaine spinal anesthesia versus 3–5 hours or more with standard-dose bupivacaine. Additionally, chloroprocaine carries a lower risk of transient neurological symptoms (TNS) compared to intrathecal lidocaine, another short-acting option.
Chloroprocaine has a theoretical safety advantage in patients with liver disease compared to amide-type local anesthetics, because it is metabolized primarily by plasma cholinesterases rather than hepatic enzymes. However, patients with severe liver disease may have reduced plasma cholinesterase activity, which could prolong the effects of the drug. Your anesthesiologist will assess your individual liver function and cholinesterase status before deciding whether Ampres is the most appropriate anesthetic choice for you.
References
- European Medicines Agency (EMA). Ampres Summary of Product Characteristics. B. Braun Melsungen AG. Last revised 2020.
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- Lacasse MA, Roy JD, Bherer L, et al. Comparison of intrathecal chloroprocaine and lidocaine for short outpatient procedures. Can J Anaesth. 2014;61(8):764-770.
- Sell A, Tein T, Pitkanen M. Spinal 2-chloroprocaine: effective dose for ambulatory surgery. Acta Anaesthesiol Scand. 2008;52(5):695-699.
- Goldblum E, Atchabahian A. The use of 2-chloroprocaine for spinal anaesthesia. Acta Anaesthesiol Scand. 2013;57(5):545-552.
- Yoos JR, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with small-dose bupivacaine in volunteers. Anesth Analg. 2005;100(2):566-572.
- American Society of Regional Anesthesia and Pain Medicine (ASRA). Practice Advisory on Local Anesthetic Systemic Toxicity. Reg Anesth Pain Med. 2020;45(2):111-149.
- European Society of Regional Anaesthesia and Pain Therapy (ESRA). Guidelines on Neuraxial Blockade and Anticoagulation. 2023 Update.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: WHO; 2023.
- Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity. Reg Anesth Pain Med. 2018;43(2):113-123.
- Kouri ME, Kopacz DJ. Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers. Anesth Analg. 2004;98(1):75-80.
- British National Formulary (BNF). Local Anaesthesia – Chloroprocaine. National Institute for Health and Care Excellence (NICE). 2025.
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