injection into inflamed tissues.complete heart block.
congenital methaemoglobinaemia.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.children (consider dose
reduction).debilitated patients (consider dose reduction).
epilepsy.hypovolaemia.impaired cardiac conduction.
impaired respiratory function.myasthenia gravis.
neonates and infants under 6 months are particularly
susceptible to methaemoglobinaemia.severe or untreated
hypertension.shock
lINTERACTIONS→Appendix 1 : anaesthetics, local
lSIDE-EFFECTS
▶Common or very commonArrhythmias.dizziness.
hypertension.hypotension.nausea.paraesthesia.
vomiting
▶UncommonNeurotoxicity
▶Rare or very rareCardiac arrest.methaemoglobinaemia.
nerve disorders
▶Frequency not knownDiplopia.respiratory depression
SIDE-EFFECTS, FURTHER INFORMATION
Toxic effectsToxic effects after administration of local
anaesthetics are a result of excessively high plasma
concentrations; severe toxicity usually results from
inadvertent intravascular injection or too rapid 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.
MethaemoglobinaemiaMethaemoglobinaemia can be
treated with an intravenous injection of methylthioninium
chloride.
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. Avoid paracervical or
pudendal block in obstetrics (neonatal
methaemoglobinaemia reported).
Dose adjustmentsUse lower doses for intrathecal use
during late pregnancy.
lBREAST FEEDINGPresent in milk but not known to be
harmful.
lHEPATIC IMPAIRMENTUse with caution.
Dose adjustmentsLower doses may be required for
intrathecal anaesthesia.
lRENAL IMPAIRMENTUse with caution.
Dose adjustmentsLower doses may be required for
intrathecal anaesthesia.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Citanest(Aspen Pharma Trading Ltd)
Prilocaine hydrochloride 10 mg per 1 mlCitanest 1 % solution for
injection 50 ml vials| 1 vialP£ 5. 06Prilocaine with felypressin
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, prilocaine hydrochloride p. 829.lINDICATIONS AND DOSE
Dental anaesthesia
▶BY REGIONAL ADMINISTRATION
▶Child:Consult expert dental sources for specific advicelINTERACTIONS→Appendix 1 : anaesthetics, local
lSIDE-EFFECTSBradycardia.cardiac arrest.dizziness.
drowsiness.hypotension.loss of consciousness.
methaemoglobinaemia.myocardial contractility
decreased.nervousness.respiratory arrest.seizure.
tremor.vision blurredlMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
▶Citanest with Octapressin(Dentsply Ltd)
Prilocaine hydrochloride 30 mg per 1 ml, Felypressin.03 unit per
1mlCitanest 3 % with Octapressin Dental 0. 066 units/ 2. 2 ml solution
for injection self aspirating cartridges| 50 cartridgePsRopivacaine hydrochloride
lINDICATIONS AND DOSE
Acute pain|Surgical anaesthesia
▶BY REGIONAL ADMINISTRATION
▶Child:Adjust according to child’s physical status and
nature of procedure, seek expert advice
DOSESATEXTREMESOFBODY-WEIGHT
▶To avoid excessive dosage in obese patients, dose may
need to be calculated on the basis of ideal bodyweight.lUNLICENSED USE 2 mg/mL strength not licensed for use in
children under 12 years except for acute pain management
by caudal epidural block and continuous epidural infusion.
7. 5 mg/mL and 10 mg/mL strengths not licensed for use in
children under 12 years.IMPORTANT SAFETY INFORMATION
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, 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 the830 Local anaesthesia BNFC 2018 – 2019
Anaesthesia15