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15.2 Local anaesthesia

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Important: Drugs in this section should be used only by doctors with anaesthetic training and should not be administered parenterally unless resuscitation equipment is available.

 

Bupivacaine

Bupivacaine

  • Bupivacaine hydrochloride epidural injection 0.25%, 25mg in 10mL amp
  • Bupivacaine hydrochloride epidural injection 0.5%, 50mg in 10mL amp
  • Bupivacaine hydrochloride epidural infusion 0.125% in NaCl 0.9% in 250mL (U) 

 

Bupivacaine with Glucose (Marcain Heavy)

  • Bupivacaine 20mg (0.5%) with glucose 320mg in 4mL spinal injection

 

Bupivacaine with Adrenaline

  • Bupivacaine 25mg (0.25%) with adrenaline 50 micrograms (1 in 200,000) in 10mL amp
  • Bupivacaine 50mg (0.5%) with adrenaline 50 micrograms (1 in 200,000) in 10mL amp

 

 

Levobupivacaine

Levobupivacaine

  • 25mg in 10mL (0.25%) amp
  • 50mg in 10mL (0.5%) amp

 

 

Lidocaine

Lidocaine hydrochloride

  • Lidocaine hydrochloride 10mg/mL (1%), 5mL amp, 20mL amp
  • Lidocaine hydrochloride 20mg/mL (2%), 5mL amp

 

Lidocaine with Adrenaline

  • Lidocaine 100mg (1%) with adrenaline 50 micrograms (1 in 200,000) in 10mL amp (special order)
  • Lidocaine 200mg (2%) with adrenaline 50 micrograms (1 in 200,000) in 10mL amp (special order)

 

Lidocaine injections for dental use

  • Lidocaine 44mg (2%) with adrenaline 27.5 micrograms (1 in 80,000) in 2.2mL dental cartridge

 

Lidocaine with Glucose

  • Lidocaine 0.4% with glucose 5% in 500mL IV infusion

 

Lidocaine for surface anaesthesia

Lidocaine 4% topical solution

  • 30mL (U)

 

Instillagel®

  • Lidocaine 2% with Chlorhexidine Gluconate Solution 0.25% sterile lubricant 6mL and 11mL syringe (Not from Pharmacy)

 

Lidocaine 5%  (Amber 2)

  • Ointment 15g

 

Lidocaine 10% (Xylocaine®)   (Amber 2)

  • 10mg/dose Spray, 50mL Bottle

 

Lidocaine   (Amber 2)

  • Plasters, lidocaine 5% (700 mg/medicated plaster),

Note:

  1. Lidocaine medicated plasters are licensed and included in the formulary for postherpetic neuralgia and should only be used following initiation by the Pain Clinic.
  2. Unlicensed Use: Lidocaine medicated plasters are also included in the formulary for unlicensed use only in the treatment of neuropathic pain in selected patients as recommended by the pain clinic, in patients with fractured rib and co-existing respiratory disease and in selected palliative patients with mesothelioma or chest wall disease.

 

 

Lidocaine for ear, nose and Oropharyngeal use

Lidocaine 5% with Phenylephrine 0.5%

  • Topical solution with nasal applicator (2.5mL)

 

 

Lidocaine with prilocaine

  • Lidocaine 2.5%, Prilocaine 2.5%, 5g with dressings

 

Mepivacaine

Mepivacaine Hydrochloride

  • Injection 30mg/mL (3%), 2.2mL cartridges

 

Prilocaine

Prilocaine

  • Citanest 3% with Octapressin® = Prilocaine hydrochloride 30mg/mL (3%), Felypressin 0.03 units/mL, 1.8mL self-aspirating glass cartridges

 

Ropivacaine

Ropivacaine

  • 75mg in 10mL amp
  • 20mg in 10mL amp
  • 400mg in 200mL infusion

 

Tetracaine

Tetracaine  (Amber 2)

  • 4% gel 1.5g

 

 

Miscellaneous non-BNF

Cocaine 10%

  • Sterile solution, 3mL bottle (U) CD

 

 

Ethyl Chloride Spray

  • 100mL

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Return to Chapter: 15. Anaesthesia

Last updated by: Dupe Fagbenro on 05-03-2019 15:49