BNF for Children 2011-2012

BNFC 2011–2012 15.2 Local anaesthesia 653MepivacaineMepivacaine is an amide-type local anaesthetic usedfor dental anaesthesia (see Dental Anaesthesia, p. 649).MEPIVACAINE HYDROCHLORIDECautions see Cautions of Local Anaesthetics, p. 649Contra-indications see Contra-indications of LocalAnaesthetics, p. 650Hepatic impairment use with caution; increased riskof side-effects in severe impairmentRenal impairment use with caution; increased risk ofside-effectsPregnancy use with caution in early pregnancyBreast-feeding use with cautionSide-effects see Toxicity and Side-effects, p. 650Indication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightInfiltration anaesthesia and nerve block indentistryChild 3–18 years consult expert dental sourcesScandonest c 3% Plain (Septodont) AInjection, mepivacaine hydrochloride 30 mg/mL, netprice 2.2-mL cartridge = 36pWith adrenalineFor prescribing information on adrenaline, see section2.7.2; see Use of Vasoconstrictors, p. 649.Scandonest c 2% Special (Septodont) AInjection, mepivacaine hydrochloride 20 mg/mL,adrenaline 1 in 100 000 (10 micrograms/mL), netprice 2.2-mL cartridge = 36pExcipients include sulphitesPrilocainePrilocaine is a local anaesthetic of low toxicity which issimilar to lidocaine. If used in high doses, methaemoglobinaemiamay occur which can be treated with anintravenous injection of methylthioninium chloride1% using a dose of 1–2 mg/kg given over 5 minutes.The dose may be repeated after 30–60 minutes ifnecessary. Neonates and infants under 6 months areparticularly susceptible to methaemoglobinaemia.PRILOCAINE HYDROCHLORIDECautions see Cautions of Local Anaesthetics, p. 649;severe or untreated hypertension; concomitant drugswhich cause methaemoglobinaemia; acute porphyria(section 9.8.2); interactions: Appendix 1 (prilocaine)Contra-indications see Contra-indications of LocalAnaesthetics, p. 650; anaemia, or congenital oracquired methaemoglobinaemiaHepatic impairment use with caution; lower dosesmay be required for intrathecal anaesthesiaRenal impairment use with caution; lower doses maybe required for intrathecal anaesthesiaPregnancy large doses during delivery can causeneonatal respiratory depression, hypotonia, andbradycardia after epidural block; avoid paracervical orpudendal block in obstetrics (neonatal methaemoglobinaemiareported); use lower doses for intrathecaluse during late pregnancyBreast-feeding present in milk but not known to beharmfulSide-effects see notes above and Toxicity and Sideeffects,p. 650; also hypertensionIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightInfiltration anaesthesia (higher strengths fordental use only), nerve blockSee under preparations below, seek expertadvice—important: see also under Administration,p. 649Citanest 1% c (AstraZeneca) AInjection, prilocaine hydrochloride 10 mg/mL, netprice 50-mL multidose vial = £2.01DoseChild 6 months–12 years up to 5 mg/kg adjustedaccording to site of administration and response; max.400 mgChild 12–18 years 100–200 mg/minute, or in incrementaldoses, to max. total dose 400 mg (adjustedaccording to site of administration and response)With lidocaineSee Lidocaine, p. 652For dental useNote Consult expert dental sources for specific advice inrelation to dose of prilocaine for dental anaesthesiaCitanest 3% with Octapressin c (Dentsply) AInjection, prilocaine hydrochloride 30 mg/mL, felypressin0.03 unit/mL, net price 2.2-mL cartridge andself-aspirating cartridge (both) = 47pRopivacaineRopivacaine is an amide-type local anaesthetic agentsimilar to bupivacaine. It is less cardiotoxic than bupivacaine,but also less potent.ROPIVACAINE HYDROCHLORIDECautions see Cautions of Local Anaesthetics, p. 649;also acute porphyria (section 9.8.2); interactions:Appendix 1 (ropivacaine)Contra-indications see Contra-indications of LocalAnaesthetics, p. 650Hepatic impairment use with caution in severeimpairmentRenal impairment use with caution in severe impairment;increased risk of systemic toxicity in chronicrenal failurePregnancy not known to be harmful; do not use forparacervical block in obstetricsBreast-feeding not known to be harmfulSide-effects see Toxicity and Side-effects, p. 650; alsohypertension, pyrexia; less commonly syncope andhypothermia15 Anaesthesia