15.2 Local anaesthesia (UHPNT)

Important: Drugs in this section should be used only by doctors with anaesthetic training and should not be administered parenterally unless resuscitation equipment is available.

Bupivacaine

Bupivacaine hydrochloride
  • Injection 2.5mg/ml (0.25%), 25mg/10ml ampoule
  • Injection 5mg/ml (0.5%), 50mg/10ml ampoule
  • Injection 75mg/10ml (0.75%) ampoule
  • Injection 300mg in 10ml (3%) ampoule (unlicensed) Pain Clinic only
  • 312.5mg/250ml (0.125% in NaCl 0.9%) (unlicensed) for epidural use
  • 625mg/500ml (0.125% in NaCl 0.9%) (unlicensed) for epidural/perineural block infusion
  • 835mg/500ml (0.167% in NaCl 0.9%) (unlicensed) for epidural/perineural block infusion
Bupivacaine with glucose
  • Bupivacaine 20mg (0.5%) with glucose 320mg in 4ml spinal injection
Bupivacaine with adrenaline
  • Injection 25mg (0.5%) with adrenaline 50 micrograms (1 in 200,000) in 10ml ampoule
  • Injection 50mg (0.5%) with adrenaline 50 micrograms (1 in 200,000) in 10ml ampoule
Bupivacaine with fentanyl
  • 0.1% with fentanyl 2 micrograms/ml 250ml, 500ml for epidural infusion
  • 0.1% with fentanyl 1mg/ml, 500ml (unlicensed) for epidural infusion
Bupivacaine with diamorphine
  • 0.167% with diamorphine 50 micrograms/ml, 500ml (unlicensed) for epidural infusion

Chloroprocaine

Chloroprocaine hydrochloride
  • Injection 10mg/ml, 5ml ampoule

Levobupivacaine

Levobupivacaine
  • Injection 2.5mg/ml (0.25%), 10ml ampoule
  • Injection 2.5mg/ml (0.25%), 10ml ampoule overwrapped
  • Injection 5mg/ml (0.5%), 10ml ampoule
  • Injection 5mg/ml (0.5%), 10ml ampoule overwrapped

Lidocaine

Lidocaine hydrochloride
  • Injection 20mg in 2ml (1%) (£0.96 = 1 ampoule)
  • Injection 50mg in 5ml (1%) (£0.44 = 1 ampoule)
  • Injection 100mg in 5ml (2%) (£0.27 = 1 ampoule)
  • Spray 10mg/dose (£6.29 = 50ml bottle)
  • Ointment 5% (15g)
  • Injection 50mg in 10ml (0.5%) vial
  • Injection 200mg in 20ml (1%) ampoule
  • Injection 200mg in 20ml (1%) vial preserved
  • Injection 100mg in 5ml (2%) prefilled syringe
  • Injection 400mg in 20ml (2%) ampoule
  • Topical solution 4% (30ml) (unlicensed)
Lidocaine with adrenaline
  • Injection 10mg/ml (1%) with adrenaline 5 micrograms (1 in 200,000) (£1.93 = 20ml ampoule)
  • Dental cartridge 44mg/2.2ml (2%) with adrenaline 27.5 micrograms/2.2ml (1 in 80,000) (£0.47 = 1 cartridge)
  • Injection 200mg (1%) with adrenaline 100 micrograms (1 in 200,000) in 20ml vial preserved
  • Injection 400mg (2%) with adrenaline 100 micrograms (1 in 200,000) in 20ml vial preserved
Emla® Cream
  • Lidocaine 2.5%, prilocaine 2.5%, 30g, 5g (£2.25 = 5g)
Lidocaine 700mg (5% w/w)
  • Ralvo® medicated plaster (£61.54 = 30)

Indications

  • Post-herpetic neuralgia only (see Management of neuropathic pain) (but see notes below)
  • Not to be used for non-neuropathic pain e.g. fibromyalgia, musculoskeletal pain, headache etc.

Dose

  • Apply once daily for up to 12 hours, followed by a 12-hour plaster-free period; discontinue if no response after 4 weeks; up to 3 plasters may be used to cover large areas; plasters may be cut.

Notes

  1. Following national guidance from NHS England, not recommended for initiation in primary care. Click here for more information
  2. Only indicated for the treatment of post-herpetic neuralgia, following initiation by specialist pain team
  3. Lidocaine plasters are only licensed for use in post herpetic neuralgia; there is a paucity of data from double blind RCTs demonstrating efficacy in other neuropathic conditions. Pain specialists may occasionally recommend a trial of lidocaine plasters in difficult to treat cases of other forms of neuropathic pain. If successful, GPs may be asked to continue prescribing with ongoing review from pain specialists
  4. Lidocaine plasters can result in gradual desensitisation of the nerves, leading to improvement in symptoms; the plaster may be discontinued if this should occur. Prescribers should therefore consider a trial withdrawal of therapy to reassess ongoing need at appropriate intervals
Instillagel®
  • Lidocaine 2% with chlorhexidine gluconate solution 0.25% sterile lubricant 11ml syringe
Lidocaine with glucose
  • IV infusion 1g (0.2%) with glucose 25g (5%) in 500ml
Lidocaine 5% with Phenylephrine 0.5%
  • Nasal spray (2.5ml)

Mepivacaine

Mepivacaine hydrochloride
  • Injection 30mg/ml (3%) 2.2ml cartridge (£0.44)

Prilocaine

Prilocaine with Felypressin

(30mg in 1ml (3%) with 0.03units in 1ml)

  • Solution for injection self aspirating cartridges 2.2ml (£0.47)
Prilocaine
  • Injection 50mg (0.5%) 10ml ampoule unpreserved (unlicensed)
  • Injection 10mg/ml (1%) 50ml multi-dose vial

Notes

  1. For Bier's Block 0.5% prilocaine must be used.

Ropivacaine

Ropivacaine
  • Injection 7.5mg/ml, 10ml ampoule

Tetracaine

Tetracaine
  • 4% gel 1.5g (£1.08)

 

Home > Formulary > Chapters > 15. Anaesthesia > Western Locality, University Hospitals Plymouth NHS Trust > 15.2 Local anaesthesia (UHPNT)

 

  • First line
  • Second line
  • Specialist
  • Hospital