Local Anaesthetic

Lidocaine

Xylocaine, Lignocaine

• Most popular and recommended for most procedures

• Usual formulation: 2% lignocaine (20mg/ml) in 1:80,000 adrenaline

• Contains adrenaline, so do not use if adrenaline is contraindicated

• Most effective LA and provides the most profound and long-lasting (1½ - 2 hours) anaesthesia.

• Safe limit = 4.4mg/kg (7 cartridges in a 70kg patient)

Articaine

Septanest, Anestadent

• 3% or 4% concentrations

• Quick onset, very effective and diffuses well

• Contraindications = neurotoxicity – debatable if should be used or not in ID blocks

Mepivacaine

Scandonest 3% Plain Mepivacaine

• Formulation without vaso-constrictor for specific medical situations.

• No-methylparaben formulation to avoid allergic reactions on sensitive patients

• shorter acting duration due to lack of vasoconstrictor - typically around 30 mins

Prilocaine 

Citanest

• Used as an alternative to lignocaine

• Slower onset and less profound shorter-lasting anaesthesia

• Less toxic

• Usually 2ml cartridge of 3%/4% prilocaine with felypressin

• Safe limit + 6mg/kg (6 cartridges of 3% prilocaine or 4 cartridges of 4% prilocaine in a 70kg patient)

• Contraindications = hypersensitivity, pregnancy, methaemoglobinaemia

• Citanest with Octapressin is a unique, latex free and adrenaline free local anaesthetic that is indicated for the production of local anaesthesia in routine dental procedures and oral surgery by means of infiltration and nerve block techniques.  Citanest with Octapressin uses Felypressin as a vasoconstrictor instead of epinephrine, allowing use on more diverse patients. Prilocaine, the active ingredient in Citanest, is less toxic systemically versus other local amide based anaesthetics.

Bupivacaine

Marcaine

• Slower onset – up to 30 minutes

• Long-lasting – up to 8 hours as it is highly tissue-bound

• Used for pre- and post-op analgesia in patients having a GA, premed, epidural block

• Usually formulation:

0.25% bupivicaine +/- 1: 400,000 adrenaline

0.5% bupivicaine +/- 1: 200,000 adrenaline

• Initially inject a little solution, wait for the soft tissues to be anaesthetised, and then inject the rest of the solution slowly. This prevents the pain associated with distension of the soft tissues if you inject too fast

• Always inject into taught tissues

• Advise patient to take slow deep breaths

• Have assistant nearby with aspirator to aspirate any solution which may leak into mouth

• Don't have the needle under lateral tension (bent) in the tissues