Article Text

Download PDFPDF
The Chloroprocaine Controversy: I. A Hypothesis to Explain the Neural Complications of Chloroprocaine Epidural
  1. Aaron J. Gissen, MD,
  2. Sanjay Datta, MD and
  3. Donald Lambert, PhD, MD
  1. From the Harvard Medical School and the Department of Anesthesia, Brigham and Women's Hospital Boston, Massachusetts


Epidural anesthesia using chloroprocaine (especially in the pregnant woman) has recently been associated with a number of persistent serious neurological complications. Fortunately, this occurrence is infrequent but the underlying causes are unknown. We present the thesis that the complications seen (anterior spinal artery syndrome, cauda equina syndrome) are vascular in origin. The basic cause of clinical complications is a “waterfalls phenomenon,” following the introduction of excessive fluid volume intrathecally associated with systemic hypotension. Serious decrease in tissue perfusion results from cerebrospinal fluid hypertension because of low spinal space compliance and decreased vascular perfusion pressure. We suggest a therapeutic regime in the presence of a total spinal following an attempted epidural block.

  • Spinal space compliance
  • Physiologic waterfall
  • Anterior spinal artery syndrome
  • Cauda equina syndrome
  • Total spinal following epidural

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Supported by NIH Grant #R01/GM 30160‐02 and a grant from Astra Pharmaceutical Products Corporation.

    Address reprint requests to: Dr. Gissen: Department of Anesthesia, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.