BNF for Children 2011-2012

BNFC 2011–2012 15.2 Local anaesthesia 651Infusion, anhydrous bupivacaine hydrochloride1 mg/mL (0.1%), net price 100 mL = £8.41, 250 mL =£10.59; 1.25 mg/mL (0.125%), 250 mL = £10.80Marcain c (AstraZeneca) AInjection, anhydrous bupivacaine hydrochloride2.5 mg/mL (Marcain c 0.25%), net price 10-mLPolyamp c = £1.06; 5 mg/mL (Marcain c 0.5%), 10-mL Polyamp c = £1.21Marcain Heavy c (AstraZeneca) AInjection, anhydrous bupivacaine hydrochloride5 mg/mL (0.5%), glucose 80 mg/mL, net price 4-mLamp = £1.21With adrenalineFor prescribing information on adrenaline, see section2.7.2; see also Use of Vasoconstrictors, p. 649Bupivacaine and Adrenaline (Non-proprietary) AInjection, anhydrous bupivacaine hydrochloride2.5 mg/mL (0.25%), adrenaline 1 in 200 000 (5 micrograms/mL),net price 10-mL amp = £1.40Injection, anhydrous bupivacaine hydrochloride5 mg/mL (0.5%), adrenaline 1 in 200 000 (5 micrograms/mL),net price 10-mL amp = £1.50LevobupivacaineLevobupivacaine, an isomer of bupivacaine, has anaestheticand analgesic properties similar to bupivacainebut is thought to have fewer adverse effects.LEVOBUPIVACAINENote Levobupivacaine is an isomer of bupivacaineCautions see Cautions of Local Anaesthetics, p. 649;cardiovascular disease; interactions: Appendix 1(levobupivacaine)Contra-indications see Contra-indications of LocalAnaesthetics, p. 650Hepatic impairment use with cautionPregnancy large doses during delivery can causeneonatal respiratory depression, hypotonia, andbradycardia after epidural block; avoid if possible infirst trimester—toxicity in animal studies; may causefetal distress syndrome; do not use for paracervicalblock in obstetrics; do not use 7.5 mg/mL strength inobstetricsBreast-feeding amount too small to be harmfulSide-effects see Toxicity and Side-effects, p. 650; alsosweating, pyrexia, anaemiaLicensed use not licensed for use in children exceptfor analgesia by ilioinguinal or iliohypogastric blockIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightAdjusted according to child’s physical status andnature of procedure, seek expert advice—important:see also under Administration, p. 649Chirocaine c (Abbott) AInjection, levobupivacaine (as hydrochloride) 2.5 mg/mL, net price 10-mL amp = £1.42; 5 mg/mL, 10-mLamp = £1.62; 7.5 mg/mL, 10-mL amp = £2.43Note For 1.25 mg/mL concentration dilute standard solutionswith sodium chloride 0.9%Infusion, levobupivacaine (as hydrochloride)625 micrograms/mL, net price 100 mL = £6.63,200 mL = £10.37; 1.25 mg/mL, net price 100 mL =£7.26, 200 mL = £12.20LidocaineLidocaine is effectively absorbed from mucous membranesand is a useful surface anaesthetic in concentrationsup to 10%. Except for surface anaesthesia anddental anaesthesia, solutions should not usually exceed1% in strength. The duration of the block (with adrenaline)is about 90 minutes.Application of a mixture of lidocaine and prilocaine(EMLA c ) under an occlusive dressing provides surfaceanaesthesia for 1–2 hours. EMLA c does not appear tobe effective in providing local anaesthesia for heellancing in neonates.LIDOCAINE HYDROCHLORIDE(Lignocaine hydrochloride)Cautions see Cautions of Local Anaesthetics, p. 649and section 2.3.2; hypertension; topical preparationscan damage plastic cuffs of endotracheal tubesContra-indications see notes above, Contra-indicationsof Local Anaesthetics (p. 650), and section 2.3.2Hepatic impairment section 2.3.2Renal impairment section 2.3.2Pregnancy large doses can cause fetal bradycardia;large doses during delivery can cause neonatal respiratorydepression, hypotonia, or bradycardia afterparacervical or epidural blockBreast-feeding section 2.3.2Side-effects see Toxicity and Side-effects, p. 650 andsection 2.3.2; also methaemoglobinaemia (see Prilocaine(p. 653) for treatment), nystagmus, rash; hypoglycaemiaalso reported following intrathecal orextradural administrationLicensed use EMLA c cream not licensed for use inchildren under 1 yearIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightInfiltration anaesthesia. By injection(see also Administration, p. 649, and Importantwarning below)Neonate according to nature of procedure, up to3 mg/kg (0.3 mL/kg of 1% solution), repeated notmore often than every 4 hoursChild 1 month–12 years according to nature ofprocedure, up to 3 mg/kg (0.3 mL/kg of 1% solution),repeated not more often than every 4 hours15 Anaesthesia