MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Local anaesthesia

Drug saftey update

 December 2018: Oral lidocaine-containing products for infant teething: only to be available under the supervision of a pharmacist

Important safety information

The licensed doses stated may not be appropriate in some settings and expert advice should be sought.

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

Lidocaine is effectively absorbed from mucous membranes and is a useful surface anaesthetic in concentrations up to 10%. Except for surface anaesthesia and dental anaesthesia, solutions should not usually exceed 1% in strength. The duration of the block (with adrenaline) is about 90 minutes.

For Instillagel see urological surgery

Bupivacaine has a longer duration of action than other local anaesthetics. It has a slow onset of action, taking up to 30 minutes for full effect. It is often used in lumbar epidural blockade and is particularly suitable for continuous epidural analgesia in labour, or for postoperative pain relief. It is the principal drug used for spinal anaesthesia. Hyperbaric solutions containing glucose may be used for spinal block.

Levobupivacaine, an isomer of bupivacaine, has anaesthetic and analgesic properties similar to bupivacaine; it is claimed to have fewer adverse effects.

Prilocaine is a local anaesthetic of low toxicity which is similar to lidocaine. Prilocaine (Prilotekal®) hyperbaric solution for injection is indicated for spinal anaesthesia in short-term surgical procedures ONLY where patients are expected to be discharged on the day of surgery as it has a quicker recovery time than bupivacaine heavy but it is more expensive.

Ropivacaine is an amide-type local anaesthetic agent similar to bupivacaine. It is less cardiotoxic than bupivacaine, but also less potent.

Pack Price
1 ml
15 ml
Pack Price
1 ml £0.09
100 gram
15 ml £47.39
5 ml
Pack Price
15 gram £8.28
Pack Price
30 gram £14.90
5 gram £2.98
Pack Price
10 ampoule £2.50
Pack Price
10 ampoule £2.59
Pack Price
10 vial £22.00
Pack Price
10 ampoule £2.37
Pack Price
10 ampoule £2.70
Pack Price
30 plaster (6 x 5 plasters) £72.40
Pack Price
25 gram (5 x 5g + 12 dressings) £11.70
30 gram £12.30
5 gram £2.25
5 gram (1 x 5g + 2 dressings) £2.99

Important safety information

Adrenaline/epinephrine must be used in a low concentration when administered with a local anaesthetic. The total dose of adrenaline should not exceed 500 micrograms and it is essential not to exceed a concentration of 1 in 200000 (5 micrograms/mL) if more than 50mL of the mixture is to be injected.

Pack Price
5 vial
Pack Price
5 vial £9.66
Pack Price
5 vial £8.85

Used for buccal anaesthesia only in sentinel node scan

Pack Price
15 gram £4.00
Pack Price
18 gram (12 x 1.5gram)
2 gram £1.08

Important safety information

Adrenaline/epinephrine must be used in a low concentration when administered with a local anaesthetic. The total dose of adrenaline should not exceed 500 micrograms and it is essential not to exceed a concentration of 1 in 200000 (5 micrograms/mL) if more than 50mL of the mixture is to be injected.

Pack Price
10 ampoule £46.00
Pack Price
10 ampoule £51.75