East Region Formulary

20ml volume ampoules are for theatre use only.

Consult product literature.

Prescribing Notes:

Local anaesthetics can be very toxic and therefore great care should be taken to avoid inadvertent injection into a vein or accidental overdose.
Vasoconstrictors (adrenaline) should not be injected into extremities.
Choice of local anaesthetic, concentration and the presence of a vasoconstrictor can depend on total dosage required, site of insertion/application and intended surgical procedure.
Maximum doses of each agent also depend on total dose, site of injection, presence of vasoconstrictor and vascular state of the tissues.
Levobupivacaine is less cardiotoxic than bupivacaine and can be used for high dose blocks which have a significant potential for accidental intravenous placement.
Lower concentrations of anaesthetics cause less stinging on injection; irritation is reduced by warming anaesthetic solutions prior to injection.
The total dose of adrenaline should not exceed 500micrograms (i.e. 5ml of a 1 in 10,000 solution, or 0.5ml of a 1 in 1000 solution).
Lidocaine has a faster onset of action and is less toxic than bupivacaine. However, bupivacaine has the advantage of a longer duration of action.
Lidocaine is a rapidly-acting local anaesthetic. The site of injection determines the concentration to be used e.g. 0.5% for infiltration, 1% for minor nerve block, up to 2% for major nerve block. To prolong the effect of lidocaine and to reduce the likelihood of systemic toxicity large doses of adrenaline should not be used without the co-administration of adrenaline as a vasoconstrictor. Because of the risk of ischaemic necrosis, adrenaline should not be added to injections used in appendages, clinicians should ensure lipid infusion is available.

History Notes

27/10/2022

East Region Formulary content agreed.

Dose as per specialist.

Prescribing Notes:

Choice of local anaesthetic, concentration and the presence of a vasoconstrictor can depend on total dosage required, site of insertion/application and intended surgical procedure.
Maximum doses of each agent also depend on total dose, site of injection, presence of vasoconstrictor and vascular state of the tissues.
Lower concentrations of anaesthetics cause less stinging on injection; irritation is reduced by warming anaesthetic solutions prior to injection.
Major nerve blocks, plexus, epidural and spinal blocks should only be performed by specialists.
Ethyl chloride spray is occasionally used as a cold stimulus to test the height of epidural or spinal block. It is also used in general practice when rapid topical anaesthesia is required for a short procedure. It is now available in metal cans, which do not explode or shatter when dropped. Its use in glass vial sprays is no longer recommended due to the risk of fire, explosion and serious inhalational overdose for all in the vicinity if dropped or broken.

History Notes

27/10/2022

East Region Formulary content agreed.

Seek expert advice.

Prescribing Notes:

Choice of local anaesthetic, concentration and the presence of a vasoconstrictor can depend on total dosage required, site of insertion/application and intended surgical procedure.
Maximum doses of each agent also depend on total dose, site of injection, presence of vasoconstrictor and vascular state of the tissues.
Levobupivacaine is less cardiotoxic than bupivacaine and can be used for high dose blocks which have a significant potential for accidental intravenous placement.
Lower concentrations of anaesthetics cause less stinging on injection; irritation is reduced by warming anaesthetic solutions prior to injection.
Lidocaine has a faster onset of action and is less toxic than bupivacaine. However, bupivacaine has the advantage of a longer duration of action.
Major nerve blocks, plexus, epidural and spinal blocks should only be performed by specialists.
Ethyl chloride spray is occasionally used as a cold stimulus to test the height of epidural or spinal block. It is also used in general practice when rapid topical anaesthesia is required for a short procedure. It is now available in metal cans, which do not explode or shatter when dropped. Its use in glass vial sprays is no longer recommended due to the risk of fire, explosion and serious inhalational overdose for all in the vicinity if dropped or broken.

History Notes

27/10/2022

East Region Formulary content agreed.

20ml volume ampoules are for theatre use only.

Seek expert advice and see BNF.

Prescribing Notes:

Choice of local anaesthetic, concentration and the presence of a vasoconstrictor can depend on total dosage required, site of insertion/application and intended surgical procedure.
Maximum doses of each agent also depend on total dose, site of injection, presence of vasoconstrictor and vascular state of the tissues.
Levobupivacaine is less cardiotoxic than bupivacaine and can be used for high dose blocks which have a significant potential for accidental intravenous placement.
Lower concentrations of anaesthetics cause less stinging on injection; irritation is reduced by warming anaesthetic solutions prior to injection.
Lidocaine has a faster onset of action and is less toxic than bupivacaine. However, bupivacaine has the advantage of a longer duration of action.
Major nerve blocks, plexus, epidural and spinal blocks should only be performed by specialists.
Ethyl chloride spray is occasionally used as a cold stimulus to test the height of epidural or spinal block. It is also used in general practice when rapid topical anaesthesia is required for a short procedure. It is now available in metal cans, which do not explode or shatter when dropped. Its use in glass vial sprays is no longer recommended due to the risk of fire, explosion and serious inhalational overdose for all in the vicinity if dropped or broken.

History Notes

27/10/2022

East Region Formulary content agreed.

Seek expert advice and see BNF.

History Notes

27/10/2022

East Region Formulary content agreed.

Seek expert advice and see BNF.

History Notes

27/10/2022

East Region Formulary content agreed.

Seek expert advice and see BNF.

History Notes

27/10/2022

East Region Formulary content agreed.

Seek expert advice and see BNF.

History Notes

27/10/2022

East Region Formulary content agreed.