Lidocaine local anaesthesia

Infiltration anaesthesia is applied fan-shaped, with as few needle punctures as possible, in close proximity of the wound or the skin area to be treated. An aspiration should always take place to avoid intravascular injection. Suitable alternatives are lidocaine (lignocaine) or prilocaine for injection 5-10 mg/ml, with or without adrenaline. When making an incision of an abscess it is sometimes difficult to use a local anaesthetic if there is a pronounced inflammatory reaction, since the effect of the anaesthetic is reduced due to an increased acidity level. While adrenaline reduces bleeding and delays dispersion of the anaesthetic, local anaesthetic/adrenaline combinations are contraindicated for local anaesthesia of digits, on the face or where the skin survival is at risk. 

Local anaesthesia is effected as intracutaneous skin wheal using a thin needle, whereas for bathyanaesthesia a long injection needle is applied. Lidocaine is recommended as an anaesthetic (0.5% or 1.0%). With the continuous injection of anaesthetic, a sharp pain is reached in the peritoneum, where a preperitoneal depot is then placed. 

Similar to Voltaren Emulgel, oily droplets of an eutectic mixture of lidocaine and prilocaine are dispersed in a hydrogel to provide local anaesthesia of the skin for injections and surgical treatment (Emla cream). A further possibility is the dermal administration of a liposome dispersion as a spray (Heparin PUR ratiopharm Spriihgel). After administration, water and isopropyl alcohol evaporate partially to result in an increase of concentration and thereby in a transition from the initial liposome dispersion to a lamellar liquid crystal. The therapeutic effect thus appears to be influenced favorably by the presence of lecithins alone, rather than by the degree of dispersion of liposomes. 

Local anaesthetics Lidocaine hydrochloride Minims Lignocaine and Fluorescein Local anaesthesia POM medicine for administration (not for sale or supply)... 

An elderly man with long standing brady-tachycardia was successfully treated for atrial flutter firstly with a temporary pacemaker (later withdrawn) and 600 mg amiodarone daily. Ten days later, and 25 minutes after a permanent pacemaker was inserted under local anaesthesia with 15 mL of 2% lidocaine, severe sinus bradycardia and long sinoatrial arrest developed. He was effectively treated with atropine plus isoprenaline, and cardiac massage. ... 

One man receiving intravenous lidocaine had a seizure about two days after starting treatment with amiodarone, and another man with sick sinus syndrome taking amiodarone had a sinoatrial arrest during placement of a pacemaker under local anaesthesia with lidocaine. There is conflicting evidence as to whether or not amiodarone affects the pharmacokinetics of intravenous lido-... 

One case of anaphylactic shock (27 ) and one of generalized exfoliative dermatitis (28 ) after the use of lidocaine as a local anaesthetic have been described. The intravenous administration of lidocaine in patients with myocardial infarction sometimes also leads to undesirable side effects, of which hypotension is the best known. The problem is mainly one for the cardiologist, but since inadvertent intravenous injection during local anaesthesia may occur, the anaesthetist must be aware of it. A case of sinusbradycar-dia after a bolus injection of 50 mg (29 -) and an atrioventricular block after 800 mg, given in the course of 12 hours (30 ) have been described. Two fatalities, one due to ventricular fibrillation after 50 mg and one to sinus arrest after 100 mg, have been re-... 

III.b.8.1. Skin. Surface anaesthesia of the skin can be produced with help of a cream containing a eutectic mixture of local anaesthetics (EMLA), which is a water/oil emulsion of equal parts of prilocaine and lidocaine with particularly good penetration capacity. EMLA is applied under occlusion, around 40-60 minutes before the planned intervention. This is an effective way of producing anaesthesia before needle punctures and minor, painful, procedures. The method is excellent, particularly in paediatrics, to reduce fear and pain. 

Intravenous. A double cuff is applied to the arm, inflated above arterial pressure after elevating the limb to drain the venous system, and the veins filled with local anaesthetic, e.g. 0.5-1% lidocaine without adrenaline (epinephrine). The arm is anaesthetised in 6-8 min, and the effect lasts for up to 40 min if the cuff remains inflated. The cuff must not be deflated for at least 20 minutes. The technique is useful in providing anaesthesia for the treatment of injuries speedily and conveniently, and many patients can leave hospital soon after the procedure. The technique must be meticulously conducted, for if the full dose of local anaesthetic is accidentally suddenly released into the general circulation severe toxicity and even cardiac arrest may result. Bupivacaine is no longer used for intravenous regional anaesthesia as cardiac arrest caused by it is particularly resistant to treatment. Patients should be fasted and someone skilled in resuscitation must be present. 

It is a local anaesthetic of the amide type which is employed for surface, infiltration and nerve block anaesthesia. Its duration of action is in between the shorter-acting lidocaine and longer-acting mepivacaine. It possesses less vaso-dilator activity than lidocaine and hence may be used without adrenaline. Therefore, solutions of prilocaine hydrochloride are specifically beneficial for such patients who cannot tolerate vasopressor agents patients having cardiovascular disorders, diabetes, hypertension and thyrotoxicosis. 

It is a local anaesthetic used for infiltration, peridural, nerve block, and caudal anaesthesia. It is found to be twiee as potent as procaine. It has been reported that its duration of action is significantly longer than that of lidocaine, even without adrenaline. Henee, it is of particular importance in subjects showing contraindication to adrenaline. 

The local anaesthetics mentioned in this section are listed in Table 5.1 , (p.91). The interactions discussed in this section mainly involve the interaction of drugs with local anaesthetics used for epidural or spinal anaesthesia. The interactions of lidocaine used asanantiarrhythmicisdealtwith in Antiarrhythmics , (p.243). 

Twenty patients undergoing surgery were given repeated 1-mg intravenous doses of midazolam as induction anaesthesia every 30 seconds until they failed to respond to three repeated commands to squeeze the anaesthetist s hand. This was considered as the induction end-point titrated dose. It was found that the 10 who had been given prior spinal anaesthesia with tetracaine 12 mg needed only half the dose of midazolam (7.6 mg) than the 10 other patients who had not received tetracaine (14.7 mg). The reasons are not known. The authors of this report simply advise care in this situation. In another study in which patients were given intravenous midazolam following an intramuscular injection of either bupivacaine, lidocaine or saline, it was found that both anaesthetics enhanced the effect of midazolam. This effect was dose-dependent and it was concluded that the use of lidocaine or bupivacaine for regional blocks or local infiltration could alter the effect of midazolam from sedative to hypnotic. ... 

The neuromuscular blockade due to suxamethonium (succinyl-choline) can be increased and prolonged by lidocaine, procaine and possibly procainamide. These local anaesthetics all have some neuromuscular blocking activity and may theoretically also enhance the block produced by competitive neuromuscular blockers. Increased toxicity occurred when mivacurium and prilocaine were given together for regional anaesthesia. 

Uses cinchocaine is used as an anaesthetic agent for spinal anaesthesia a component in rectal medications used in inflammation of the anus and for the symptomatic treatment of hemorrhoids and fissures in the anus local anesthetic agent Cross lidocaine. PA A... 

Spinal anaesthesia (spinal block or sub-arachnoid block) is used to administer the injection into the subarachnoid space. Several local anaesthetics are used for spinal anaesthesia such as procaine, lidocaine, tetracaine, and bupivacaine. Vasoconstrictors such as adrenaline (0.1-0.2 mg) and phenylephrine (0.5-2 mg) can be added to subarachnoid blocks to decrease vascular uptake and prolong diuation of action. 

Zaric D, Pace NL. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics. Cochrane Database Syst Rev 2009 ... 

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