BNF for Children (BNFC) 2018-2019

local anaesthetic effect may also be reduced by altered
local pH.
lCAUTIONSAcute porphyrias p. 603 .cardiovascular
disease.children (consider dose reduction).debilitated
patients (consider dose reduction).epilepsy.
hypovolaemia.impaired cardiac conduction.impaired
respiratory function.myasthenia gravis.shock

lINTERACTIONS→Appendix 1 : anaesthetics, local

lSIDE-EFFECTS
▶Common or very commonArrhythmias.back pain.chills.
dizziness.headache.hypertension.hypotension.nausea
.sensation abnormal.urinary retention.vomiting
▶UncommonAnxiety.dyspnoea.hypothermia.
neurotoxicity.syncope
▶Rare or very rareCardiac arrest
▶Frequency not knownDyskinesia

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.

lPREGNANCYNot known to be harmful. Do not use for
paracervical block in obstetrics.

lBREAST FEEDINGNot known to be harmful.

lHEPATIC IMPAIRMENTUse with caution in severe
impairment.
lRENAL IMPAIRMENTCaution in severe impairment.
Increased risk of systemic toxicity in chronic renal failure.

lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for injection
ELECTROLYTES:May contain Sodium
▶Ropivacaine hydrochloride (Non-proprietary)
Ropivacaine hydrochloride 2 mg per 1 mlRopivacaine 20 mg/ 10 ml
solution for injection ampoules| 10 ampouleP£ 16. 50 (Hospital
only)
Ropivacaine hydrochloride 7.5 mg per 1 mlRopivacaine
75 mg/ 10 ml solution for injection ampoules| 10 ampouleP
£ 25. 00 (Hospital only)
Ropivacaine hydrochloride 10 mg per 1 mlRopivacaine
100 mg/ 10 ml solution for injection ampoules| 10 ampouleP
£ 30. 00 (Hospital only)
▶Naropin(Aspen Pharma Trading Ltd)
Ropivacaine hydrochloride 2 mg per 1 mlNaropin 20 mg/ 10 ml
solution for injection ampoules| 5 ampouleP£ 12. 79
Ropivacaine hydrochloride 7.5 mg per 1 mlNaropin 75 mg/ 10 ml
solution for injection ampoules| 5 ampouleP£ 15. 90
Ropivacaine hydrochloride 10 mg per 1 mlNaropin 100 mg/ 10 ml
solution for injection ampoules| 5 ampouleP£ 19. 22
Infusion
ELECTROLYTES:May contain Sodium
▶Ropivacaine hydrochloride (Non-proprietary)
Ropivacaine hydrochloride 2 mg per 1 mlRopivacaine
400 mg/ 200 ml infusion bags| 10 bagP£ 137. 00 (Hospital only)
▶Naropin(Aspen Pharma Trading Ltd)
Ropivacaine hydrochloride 2 mg per 1 mlNaropin 400 mg/ 200 ml
infusion Polybags| 5 bagP£ 86. 70

Tetracaine

(Amethocaine)

lINDICATIONS AND DOSE

Anaesthesia before venepuncture or venous cannulation

▶TO THE SKIN

▶Neonate:Apply contents of tube (or appropriate

proportion) to site of venepuncture or venous

cannulation and cover with occlusive dressing; remove

gel and dressing after 30 minutes for venepuncture and

after 45 minutes for venous cannulation.

▶Child 1 month–4 years:Apply contents of up to 1 tube

(applied at separate sites at a single time or appropriate

proportion) to site of venepuncture or venous

cannulation and cover with occlusive dressing; remove

gel and dressing after 30 minutes for venepuncture and

after 45 minutes for venous cannulation

▶Child 5–17 years:Apply contents of up to 5 tubes

(applied at separate sites at a single time or appropriate

proportion) to site of venepuncture or venous

cannulation and cover with occlusive dressing; remove

gel and dressing after 30 minutes for venepuncture and

after 45 minutes for venous cannulation

lUNLICENSED USENot licensed for use in neonates.

lCONTRA-INDICATIONSShould not be applied to damaged

skin

lINTERACTIONS→Appendix 1 : anaesthetics, local

lSIDE-EFFECTSOedema.skin reactions

SIDE-EFFECTS, FURTHER INFORMATIONThe systemic

toxicity of local anaesthetics mainly involves the central

nervous system; systemic side effects unlikely as minimal

absorption following topical application.

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.

lBREAST FEEDINGNot known to be harmful.

lPATIENT AND CARER ADVICE

Medicines for Children leaflet: Tetracaine gel for local

anaesthesiawww.medicinesforchildren.org.uk/tetracaine-gel-

for-local-anaesthesia

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug.

Gel

EXCIPIENTS:May contain Hydroxybenzoates (parabens)

▶Ametop(Alliance Pharmaceuticals Ltd)

Tetracaine 40 mg per 1 gramAmetop 4 % gel| 1. 5 gramp£ 1. 08

BNFC 2018 – 2019 Local anaesthesia 831

Anaesthesia

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