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Spinal 2-chloroprocaine for pediatric orthopedic surgery: a retrospective dosing analysis by age, weight, and procedure

rapm · 2026-06-18 · canonical JSON source

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Spinal anesthesia is a safe, well-established analgesic technique that offers several advantages over general anesthesia, particularly for ambulatory surgeries. Spinal anesthesia can avoid airway manipulation and is known to be hemodynamically stable.1 Among short-acting local anesthetics, 2-chloroprocaine is a rapidly metabolized amino-ester increasingly used in adult ambulatory practice. It has been employed for continuous postoperative epidural infusions in neonates and infants.2 The safety profile of 2-chloroprocaine is favorable: systemic toxicity effects reported in infants have been self-limited with no long-term sequelae, and adult studies show shorter post-anesthesia care times compared with lidocaine without increasing transient neurologic symptoms.3 4 Currently, no studies characterize single-shot 2-chloroprocaine spinal use in children. As such, this is the first large institutional experience reporting dosing ranges for single-shot spinal 2-chloroprocaine for pediatric and adolescent orthopedic surgery.