Xylocaine Injection

Production of local or regional anaesth by infiltration; IV regional anaesth; peripheral nerve block (eg, intercostal block); major plexus block (eg, brachial plexus block); epidural block; subarachnoid block.

Use lowest effective dose based on patient's status & type of regional anaesth intended. Dose should not exceed 3 mg/kg. Adult Infiltration 20 mL of 1% inj or 10 mL of 2% inj. IV regional anaesth 200 mg per single inj, slowly releasing the tourniquet in Bier's block. Nerve block Paravertebral: 3-5 mL of 1% inj. Pudendal: 10 mL of 1% inj on each side. Paracervical: 10 mL of 1% inj. Stellate ganglion block Cervical: 5 mL of 1% inj. Lumbar: 10 mL of 1% inj. Epidural anaesth Dose determined by number of segments to be anaesthetised (2-3 mL per segment). Thoracic: 10-20 mL of 1% inj. Lumbar: 5-10 mL of 2% inj. Epidural analgesia Lumbar/Caudal: 10-20 mL of 1% inj.

Allergy or hypersensitivity to amide-type local anaesth. Epidural & spinal anaesth in patients w/ uncorrected hypotension or coagulation disorders or in patients receiving anticoagulation treatment. Inflammation &/or sepsis in the region of the proposed inj &/or in the presence of septicaemia. General contraindications related to epidural anaesth, regardless of local anaesth used.

Resuscitative equipment & drugs, including O₂, should be immediately available to manage possible adverse reactions involving CVS, resp system or CNS. Always inj slowly w/ frequent aspirations to avoid inadvertent intravascular inj. Post-marketing reports of chondrolysis in patients receiving IA continuous infusions of local anaesth following arthroscopic & other surgical procedures. Should not be used for post-op IA continuous infusion. Carefully & constantly monitor CV & resp vital signs & patient's state of consciousness after each local anaesth inj. Risk of epidural/spinal haematoma when neuraxial anaesth is employed in patients anticoagulated or scheduled to be anticoagulated w/ LMWH or heparinoids. Frequently monitor for signs & symptoms of neurological impairment. Safety & effectiveness depend on proper dosage, correct technique & adequate precautions. Repeated inj may cause accumulation of lidocaine or its metabolites & result in toxic effects. Central nerve blocks may cause CV depression, especially in the presence of hypovolaemia. Epidural anaesth may lead to hypotension & bradycardia. Use w/ extreme caution in epidural, caudal & spinal anaesth in case of serious diseases of the CNS or spinal cord. Reports of CV collapse & apnoea following use of local anaesth inj for retrobulbar block. Retro- & peribulbar inj of local anaesth carry a low risk of persistent ocular muscle dysfunction. May have very mild effect on mental function & may temporarily impair locomotion & coordination. Patients being treated w/ class III antiarrhythmic drugs (eg, amiodarone) should be under close surveillance & ECG monitoring. Caution in patients w/ epilepsy, impaired cardiac conduction, bradycardia, severe shock or digitalis intoxication; impaired CV function; pre-existing abnormal neurological pathology eg, myasthenia gravis; known drug sensitivities; acute porphyria. Avoid accidental arteriovenous inj in patients w/ Stokes-Adams syndrome or Wolff-Parkinson-White syndrome. Consider possibility of drug accumulation in patients w/ hepatic &/or renal impairment. Foetal bradycardia/tachycardia frequently follows paracervical block & may be associated w/ foetal acidosis & hypoxia. Crosses placental barrier after epidural administration to women in labour. Passes into breast milk.

CNS manifestations (excitatory &/or depressant); CV manifestations (usually depressant); maternal hypotension; allergic reactions; neurological reactions.

Potentiation of cardiac effects w/ other local anaesth or agents structurally related to amide-type local anaesth eg, certain antiarrhythmic drugs (eg, disopyramide, procainamide, mexiletine). Reduced clearance w/ amiodarone; cimetidine. Reduced metabolism w/ propranolol, metoprolol, & possibly other β-blockers. Enhanced metabolism w/ phenytoin & other antiepileptic drugs (eg, phenobarb, primidone, carbamazepine). Additive cardiac depressant effects w/ phenytoin. Decreased min effective conc of inhalational anaesth (eg, nitrous oxide). Excessive neuromuscular blockade w/ skeletal muscle relaxants (eg, suxamethonium). Risk of precipitation w/ alkaline soln.

Anaesthetics - Local & General

N01BB02 - lidocaine ; Belongs to the class of amides. Used as local anesthetics.

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