BNF for Children 2011-2012

652 15.2 Local anaesthesia BNFC 2011–201215 AnaesthesiaChild 12–18 years according to weight of childand nature of procedure, max. 200 mg, repeatednot more often than every 4 hoursSurface anaesthesia see preparations belowVentricular arrhythmias, neonatal seizures section2.3.2Intravenous regional anaesthesia and nerveblocks seek expert adviceDental anaesthesia seek expert adviceImportantThe licensed doses stated above may not be appropriatein some settings and expert advice should besoughtLidocaine hydrochloride injectionsLidocaine (Non-proprietary) AInjection, lidocaine hydrochloride 5 mg/mL (0.5%),net price 10-mL amp = 35p; 10 mg/mL (1%), 2-mLamp = 25p, 5-mL amp = 26p, 10-mL amp = 39p, 10-mL prefilled syringe = £4.53, 20-mL amp = 75p;20 mg/mL (2%), 2-mL amp = 32p, 5-mL amp = 31pWith adrenalineFor prescribing information on adrenaline see section2.7.2; see also Use of Vasoconstrictors, p. 649.Xylocaine c (AstraZeneca) AInjection, anhydrous lidocaine hydrochloride 10 mg/mL (1%), adrenaline 1 in 200 000 (5 micrograms/mL),net price 20-mL vial = 99pExcipients include sulphitesInjection, anhydrous lidocaine hydrochloride 20 mg/mL (2%), adrenaline 1 in 200 000 (5 micrograms/mL),net price 20-mL vial = £1.04Excipients include sulphitesLidocaine injections for dental useA variety of lidocaine injections with adrenaline areavailable in dental cartridges; brand names includeLignospan Special c , Rexocaine c , and Xylocaine c .For prescribing information on adrenaline see section2.7.2; see also Use of Vasoconstrictors, p. 649.Note Consult expert dental sources for specific advice inrelation to dose of lidocaine for dental anaesthesiaLidocaine for surface anaesthesiaInstillagel c (CliniMed)Gel, lidocaine hydrochloride 2%, chlorhexidinegluconate solution 0.25%, in a sterile lubricant basis indisposable syringe, net price 6-mL syringe = £1.41,11-mL syringe = £1.58Excipients include hydroxybenzoates (parabens)Laryngojet c (UCB Pharma) ASolution, lidocaine hydrochloride 40 mg/mL (4%),net price per unit (4-mL vial and disposable sterilecannula with cover and vial injector) = £5.10DoseAnaesthesia of mucous membranes of oropharynx,trachea, and respiratory tractChild up to 0.075 mL/kg (3 mg/kg) as a single dosesprayed, instilled (if a cavity) or applied with a swab;reduce dose according to size, age, and condition of child,max. 5 mL (200 mg)LMX 4 c (Ferndale)Cream, lidocaine 4 %, net price 5-g tube = £2.98; 5 5-g tube with 10 occlusive dressings = £16.90Excipients include benzyl alcohol and propylene glycolDoseAnaesthesia before venous cannulation or venepunctureChild 1 month–18 years apply thick layer (1–2.5 g; childunder 1 year max. 1 g) to small area (2.5 cm 2.5 cm) ofnon–irritated skin at least 30 minutes before procedure;max. application time 5 hours (child 1–3 months, 60minutes; child 3 months–1 year, 4 hours); remove creamwith gauze and perform procedure after approximately 5minutesXylocaine c (AstraZeneca)Spray, lidocaine 10% (100 mg/g) supplying 10 mglidocaine/dose; 500 spray doses per container, netprice 50-mL bottle = £3.13DoseBronchoscopy, laryngoscopy, oesophagoscopy,endotracheal intubationChild up to 18 years up to 3 mg/kgWith prilocaineFor prescribing information on prilocaine, see p. 653.EMLA c (AstraZeneca)Cream, lidocaine 2.5%, prilocaine 2.5%, net price 5-gtube = £1.73; 30-g tube (surgical pack) = £10.25; 5 5-g tube with 12 occlusive dressings (premedicationpack) = £9.75DoseAnaesthesia before minor skin procedures includingvenepunctureNeonate apply max. 1 g under occlusive dressing formax. 1 hour before procedure; max. 1 dose in 24 hoursChild 1–3 months or body-weight less than 5 kg applymax. 1 g under occlusive dressing for max. 1 hour beforeprocedure; max. 1 dose in 24 hoursChild 3 months–1 year and body-weight over 5 kgapply max. 2 g under occlusive dressing for max. 4 hoursbefore procedure; max. 2 doses in 24 hoursChild 1–18 years apply thick layer under occlusivedressing 1–5 hours before procedure (2–5 hours beforeprocedures on large areas e.g. split skin grafting); max. 2doses in 24 hours for child 1–12 yearsNote Shorter application time of 15–30 minutes is recommendedfor children with atopic dermatitisLidocaine for ear, nose, and oropharyngeal useFor prescribing information on phenylephrine, seesection 2.7.2.Lidocaine with Phenylephrine (Non-proprietary)Topical solution, lidocaine hydrochloride 5%,phenylephrine hydrochloride 0.5%, net price 2.5 mL(with nasal applicator) = £9.98DoseAnaesthesia before nasal surgery, endoscopy, laryngoscopy,or removal of foreign bodies from the noseChild 12–18 years up to max. 8 sprays