psychoneurosis.severe angina.shock.susceptibility to
angle-closure glaucoma
CAUTIONS, FURTHER INFORMATION
▶Use of vasoconstrictorsIn patients with severe hypertension
or unstable cardiac rhythm, the use of adrenaline with a
local anaesthetic may be hazardous. For these patients an
anaesthetic without adrenaline should be used.
lINTERACTIONS→Appendix 1 : articaine.
sympathomimetics, vasoconstrictor
lSIDE-EFFECTSFace oedema.gingivitis.headache.nausea
.sensation abnormal
SIDE-EFFECTS, FURTHER INFORMATIONToxic effects after
administration of local anaesthetics are a result of
excessively high plasma concentrations; severe toxicity
usually results from inadvertent intravascular injection.
The toxicity mainly involves the central nervous and
cardiovascular systems. The onset of toxicity can be
unpredictable and delayed. Monitor as per local protocol
for at least 30 minutes after administration.
lALLERGY AND CROSS-SENSITIVITY
▶Hypersensitivity and cross-sensitivityHypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.
lPREGNANCYUse only if potential benefit outweighs risk—
no information available.
lBREAST FEEDINGAvoid breast-feeding for 48 hours after
administration.
lHEPATIC IMPAIRMENTUse with caution; increased risk of
side-effects in severe impairment.
lRENAL IMPAIRMENTManufacturers advise use with
caution in severe impairment.
lMONITORING REQUIREMENTSConsider monitoring blood
pressure and ECG (advised with systemic
adrenaline/epinephrine).lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
EXCIPIENTS:May contain Sulfites
▶Septanest(Septodont Ltd)
Adrenaline (as Adrenaline acid tartrate) 10 microgram per 1 ml,
Articaine hydrochloride 40 mg per 1 mlSeptanest 1 in 100 , 000
solution for injection cartridges| 50 cartridgeP£ 24. 95
Adrenaline (as Adrenaline acid tartrate) 5 microgram per 1 ml,
Articaine hydrochloride 40 mg per 1 mlSeptanest 1 in 200 , 000
solution for injection cartridges| 50 cartridgeP£ 24. 95Bupivacaine hydrochloride
lINDICATIONS AND DOSE
Surgical anaesthesia|Acute pain
▶BY REGIONAL ADMINISTRATION
▶Child:Doses adjusted according to child’s physical
status and nature of procedure, seek expert advice
(consult product literature or local protocols)
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose
should be calculated on the basis of ideal body-weight.IMPORTANT SAFETY INFORMATION
The licensed doses stated may not be appropriate in
some settings and expert advice should be sought.
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airwaymanagement, and should not be administered
parenterally unless adequate resuscitation equipment is
available.lCONTRA-INDICATIONSApplication to the middle ear (can
cause ototoxicity).avoid injection into infected tissues.
avoid injection into inflamed tissues.complete heart block
.preparations containing preservatives should not be used
for caudal, epidural, or spinal block, or for intravenous
regional anaesthesia (Bier’s block).should not be applied
to damaged skin
CONTRA-INDICATIONS, FURTHER INFORMATION
▶Injection siteLocal anaesthetics should not be injected into
inflamed or infected tissues nor should they be applied to
damaged skin. Increased absorption into the blood
increases the possibility of systemic side-effects, and the
local anaesthetic effect may also be reduced by altered
local pH.
lCAUTIONSCardiovascular disease.cerebral atheroma.
children (consider dose reduction).debilitated patients
(consider dose reduction).epilepsy.hypertension.
hypotension.hypovolaemia.impaired cardiac conduction
.impaired respiratory function.myasthenia gravis.
myocardial depression may be more severe and more
resistant to treatment.shock
lINTERACTIONS→Appendix 1 : anaesthetics, local
lSIDE-EFFECTS
▶Common or very commonArrhythmias.dizziness.
hypertension.hypotension.nausea.paraesthesia.
urinary retention.vomiting
▶UncommonNeurotoxicity
▶Rare or very rareArachnoiditis.cardiac arrest.diplopia.
nerve disorders.paraplegia.paresis.respiratory
depression
SIDE-EFFECTS, FURTHER INFORMATIONToxic effects after
administration of local anaesthetics are a result of
excessively high plasma concentrations; severe toxicity
usually results from inadvertent intravascular injection.
The systemic toxicity of local anaesthetics mainly involves
the central nervous and cardiovascular systems. The onset
of toxicity can be unpredictable and delayed. Monitor as
per local protocol for at least 30 minutes after
administration.
lALLERGY AND CROSS-SENSITIVITY
▶Hypersensitivity and cross-sensitivityHypersensitivity
reactions occur mainly with the ester-type local
anaesthetics, such as tetracaine; reactions are less
frequent with the amide types, such as articaine,
bupivacaine, levobupivacaine, lidocaine, mepivacaine,
prilocaine, and ropivacaine. Cross-sensitivity reactions
may be avoided by using the alternative chemical type.
lPREGNANCYLarge doses during delivery can cause
neonatal respiratory depression, hypotonia, and
bradycardia after epidural block.
Dose adjustmentsUse lower doses for intrathecal use
during late pregnancy.
lBREAST FEEDINGAmount too small to be harmful.
lHEPATIC IMPAIRMENTUse with caution in severe
impairment.
lRENAL IMPAIRMENTUse with caution in severe
impairment.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: solution for injection, infusion,
solution for infusion
Solution for injection
▶Bupivacaine hydrochloride (Non-proprietary)
Bupivacaine hydrochloride 2.5 mg per 1 mlBupivacaine
25 mg/ 10 ml ( 0. 25 %) solution for injection vials| 10 vialPs824 Local anaesthesia BNFC 2018 – 2019
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