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.
Lidocaine Plasters are NOT recommended for routine prescribing due to low clinical effectiveness and lack of robust evidence as per NHS England and NICE Guidelines.
Lidocaine Plasters should only be initiated on the advice or recommendation of a pain specialist for the licensed indication of post-herpetic neuralgia for those patients who have been treated in line with NICE [CG173] but are still experiencing neuropathic pain associated with previous herpes zoster infection.
An individual management plan should be put in place for each patient specifying the duration of treatment, clear directions for reviews to take place and criteria outlining when prescribing should be continued or stopped.
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.
