l MEDICINAL 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 ml Citanest 1% solution for

injection 50ml vials | 1 vial P £5.06

▶ Prilotekal (Sintetica Ltd)

Prilocaine hydrochloride 20 mg per 1 ml Prilotekal 100mg/5ml

solution for injection ampoules | 10 ampoule P £78.80

Prilocaine with felypressin

The properties listed below are those particular to the

combination only. For the properties of the components

please consider, prilocaine hydrochloride p. 1356.

l INDICATIONS AND DOSE

Dental anaesthesia

▶ BY REGIONAL ADMINISTRATION

▶ Adult: Consult expert dental sources for specific advice

l INTERACTIONS → Appendix 1: anaesthetics, local

l SIDE-EFFECTS Bradycardia . cardiac arrest. dizziness . drowsiness . hypotension . loss of consciousness . methaemoglobinaemia . myocardial contractility

decreased . nervousness .respiratory arrest. seizure . tremor. vision blurred

l MEDICINAL 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

1 ml Citanest 3% with Octapressin Dental 0.066units/2.2ml solution

for injection self aspirating cartridges | 50 cartridge P s

Ropivacaine hydrochloride

l INDICATIONS AND DOSE

Acute pain, peripheral nerve block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 10–20 mg/hour, dose administered as a

continuous infusion or by intermittent injection using

a 2 mg/mL (0.2%) solution

Acute pain, field block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 2–200 mg, dose administered using a 2 mg/mL

(0.2%) solution

Acute pain, lumbar epidural block

▶ BY LUMBAR EPIDURAL

▶ Adult: 20–40 mg, followed by 20–30 mg at least every

30 minutes, dose administered using a 2 mg/mL (0.2%)

solution

Acute labour pain

▶ BY CONTINUOUS EPIDURAL INFUSION

▶ Adult: 12–20 mg/hour, dose administered using a

2 mg/mL (0.2%) solution

Acute postoperative pain

▶ BY CONTINUOUS EPIDURAL INFUSION

▶ Adult: Up to 28 mg/hour, dose administered using a

2 mg/mL (0.2%) solution

Postoperative pain, thoracic epidural block

▶ BY CONTINUOUS EPIDURAL INFUSION

▶ Adult: 12–28 mg/hour, dose administered using a

2 mg/mL (0.2%) solution

Surgical anaesthesia, field block

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 7.5–225 mg, dose administered using a

7.5 mg/mL (0.75%) solution

Surgical anaesthesia, major nerve block (brachial plexus

block)

▶ BY REGIONAL ADMINISTRATION

▶ Adult: 225–300 mg, dose administered using a

7.5 mg/mL (0.75%) solution

Surgical anaesthesia, thoracic epidural block (to establish

block for postoperative pain)

▶ BY THORACIC EPIDURAL

▶ Adult: 38–113 mg, dose administered using a

7.5 mg/mL (0.75%) solution

Surgical anaesthesia for caesarean section

▶ BY LUMBAR EPIDURAL

▶ Adult: 113–150 mg, to be administered in incremental

doses using a 7.5 mg/mL (0.75%) solution

Surgical anaesthesia, lumbar epidural block

▶ BY LUMBAR EPIDURAL

▶ Adult: 113–200 mg, dose administered using a

7.5 mg/mL (0.75%) or 10 mg/mL (1%) solution

DOSES AT EXTREMES OF BODY-WEIGHT

▶ To avoid excessive dosage in obese patients, dose may

need to be calculated on the basis of ideal bodyweight.

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.

l CONTRA-INDICATIONS Application 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 site Local 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.

l CAUTIONS Acute porphyrias p. 1058 . cardiovascular

disease . debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy . hypovolaemia . impaired cardiac conduction . impaired respiratory

function . myasthenia gravis . shock

l INTERACTIONS → Appendix 1: anaesthetics, local

l SIDE-EFFECTS

▶ Common or very common Arrhythmias . back pain . chills . dizziness . headache . hypertension . hypotension . nausea . sensation abnormal . urinary retention . vomiting

▶ Uncommon Anxiety . dyspnoea . hypothermia . neurotoxicity . syncope

▶ Rare or very rare Cardiac arrest

▶ Frequency not known Dyskinesia

SIDE-EFFECTS, FURTHER INFORMATION Toxic 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.

l ALLERGY AND CROSS-SENSITIVITY

▶ Hypersensitivity and cross-sensitivity Hypersensitivity

reactions occur mainly with the ester-type local

BNF 78 Local anaesthesia 1357

Anaesthesia

15