ANESTHETICS (Parenteral-Local)

Some commonly used brand names are:

In the U.S.?

• Carbocaine ⁷
• Carbocaine with Neo-Cobefrin ⁷
• Chirocaine ⁵
• Citanest Forte ⁸
• Citanest Plain ⁸
• Dalcaine ⁶
• Dilocaine ⁶
• Duranest ⁴
• Duranest-MPF ⁴
• Isocaine ⁷
• L-Caine ⁶
• Lidoject-1 ⁶
• Lidoject-2 ⁶
• Marcaine ²
• Marcaine Spinal ²
• Nesacaine ³
• Nesacaine-MPF ³
• Novocain ⁹
• Octocaine ⁶
• Polocaine ⁷
• Polocaine-MPF ⁷
• Pontocaine ¹⁰
• Sensorcaine ²
• Sensorcaine-MPF ²
• Sensorcaine-MPF Spinal ²
• Septocaine ¹
• Xylocaine ⁶
• Xylocaine-MPF ⁶
• Xylocaine-MPF with Glucose ⁶

In Canada?

• Astracaine 4% ¹
• Astracaine 4% Forte ¹
• Carbocaine ⁷
• Citanest Forte ⁸
• Citanest Plain ⁸
• Isocaine 2% ⁷
• Isocaine 3% ⁷
• Marcaine ²
• Nesacaine-CE ³
• Novocain ⁹
• Octocaine-50 ⁶
• Octocaine-100 ⁶
• Polocaine ⁷
• Pontocaine ¹⁰
• Sensorcaine ²
• Sensorcaine Forte ²
• Ultracaine D-S ¹
• Ultracaine D-S Forte ¹
• Xylocaine ⁶
• Xylocaine Test Dose ⁶
• Xylocaine 5% Spinal ⁶

Another commonly used name for lidocaine is lignocaine.

Category

• Anesthetic, local

Description

Parenteral-local anesthetics (an-ess-THET-iks) are given by injection to cause loss of feelingbefore and during surgery, dental procedures (including dental surgery), orlabor and delivery. These medicines do not cause loss of consciousness.

These medicines are given only by or under the immediate supervision ofa medical doctor or dentist, or by a specially trained nurse, in the doctor'soffice or in a hospital.

These medicines are available in the following dosage forms:

Parenteral
• Articaine
  • Injection (U.S. and Canada)
• Bupivacaine
  • Injection (U.S. and Canada)
• Chloroprocaine
  • Injection (U.S. and Canada)
• Etidocaine
  • Injection (U.S.)
• Levobupivacaine
  • Injection (U.S.)
• Lidocaine
  • Injection (U.S. and Canada)
• Mepivacaine
  • Injection (U.S. and Canada)
• Prilocaine
  • Injection (U.S. and Canada)
• Procaine
  • Injection (U.S. and Canada)
• Tetracaine
  • Injection (U.S. and Canada)

Before Receiving This Medicine

In deciding to use a medicine, the risks of using the medicine must beweighed against the good it will do. This is a decision you and your medicaldoctor, dentist, or nurse will make. For local anesthetics, the followingshould be considered:

Allergies?Tell your medical doctor, dentist, or nurse if youhave ever had any unusual or allergic reaction to a local anesthetic or toepinephrine (e.g., Adrenalin). Also tell your medical doctor, dentist, nurse,or pharmacist if you are allergic to any other substances, such as sulfitesor other preservatives, especially aminobenzoic acid (also called para-aminobenzoicacid [PABA]).

Pregnancy?Local anesthetics have not been reported to causebirth defects in humans.

Use of a local anesthetic during labor and delivery may rarely cause unwantedeffects. These medicines may increase the length of labor by making it moredifficult for the mother to bear down (push). They may also cause unwantedeffects in the fetus or newborn baby, especially if certain medical problemsare present at the time of delivery. Before receiving a local anesthetic forlabor and delivery, you should discuss with your doctor the good that thismedicine will do as well as the risks of receiving it.

Breast-feeding?It is not known whether local anesthetics passinto breast milk. However, these medicines have not been reported to causeproblems in nursing babies.

Children?Children may be especially sensitive to the effectsof parenteral-local anesthetics. This may increase the chance of side effects.

Older adults?Elderly people are especially sensitive to the effectsof parenteral-local anesthetics. This may increase the chance of side effects.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your medical doctor, dentist,or nurse may want to change the dose, or other precautions may be necessary.It is very important that you tell the person in charge if you are taking:

• Beta-adrenergic blocking agents (carteolol [e.g., Cartrol], carvedilol[e.g., Coreg], labetolol [e.g., Normodyne], nadolol [e.g., Corgard], oxprenolol[e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol[e.g., Inderal], sotalol [e.g., Sotacor], timolol [e.g., Blocadren]) or
• Carteolol (ophthalmic) (e.g., Ocupress) or
• Levobunolol (ophthalmic) (e.g., Betagan) or
• Metipranolol (ophthalmic) (e.g., OptiPranolol) or
• Timolol (ophthalmic) (e.g., Timoptic)?Use of some local anestheticswith these medicines may increase the risk of high blood pressure or a slowheart rate

• Central nervous system (CNS) depressants (medicines that cause drowsiness)?Useof local anesthetics with these medicines may increase the risk that drowsinesswill occur

• Digoxin (e.g., Lanoxin)?Use of some local anesthetics withthis medicine may increase the risk of irregular heartbeats

• Haloperidol (e.g., Haldol) or
• Phenothiazines (e.g., Phenergan)?Use of these medicines mayreduce the effectiveness of the local anesthetic

• Tricyclic antidepressants (amitriptyline [e.g., Elavil], amoxapine[e.g., Asendin], clomipramine [e.g., Anafranil], desipramine [e.g., Norpramin],doxepin [e.g., Sinequan], imipramine [e.g., Tofranil], nortriptyline [e.g.,Aventyl], protriptyline [e.g., Vivactil], trimipramine [e.g., Surmontil])or
• Maprotiline (e.g., Ludiomil)?Use of some local anestheticswith these medicines may increase the chance of some problems, including high blood pressure and irregular heartbeats

• Any other medicine, prescription or nonprescription (over-the-counter[OTC]), or
• ``Street'' drugs, such as amphetamines (``uppers''), barbiturates(``downers''), cocaine (including ``crack''), marijuana, phencyclidine (PCP,``angel dust''), and heroin or other narcotics?Serious side effectsmay occur if anyone gives you a local anesthetic without knowing that youhave taken another medicine

Other medical problems?The presence of other medicalproblems may affect the use of local anesthetics. Make sure you tell yourmedical doctor, dentist, or nurse if you have anyother medical problems, especially:

• Asthma?Increased chance of allergic-like reactions with useof some local anesthetics

• Brain infection or tumor or
• Blood clotting disorders?Increased chance of bleeding withinjection of local anesthetics

• Diabetes mellitus (sugar diabetes)?Use of local anestheticscan cause stress on your heart if you have diabetes mellitus

• Heart disease?Use of local anesthetics can worsen some kindsof heart disease

• History of migraine headaches?Use of local anesthetics canworsen headaches

• Hypertension (high blood pressure) or
• Hypotension (low blood pressure)?Use of local anesthetics cancause hypotension or hypertension

• Hyperthyroidism?Use of some local anesthetics can cause stresson your heart if you have hyperthyroidism

• Kidney disease or
• Liver disease?Increased chance of side effects

• Methemoglobinemia?Prilocaine may make this condition worse

• Peripheral vascular disease?Use of some local anesthetics canmake this condition worse or can cause your blood pressure to increase

• Skin infection or inflammation?Your physician may not wantto inject the local anesthetic into infected or inflamed skin because thelocal anesthetic may not work as well

Proper Use of This Medicine

Dosing?The dose of a local anesthetic will be different for differentpatients. Your health care professional will decide on the right amount foryou, depending on:

• Your age;
• Your general physical condition;
• The reason the local anesthetic is being given; and
• Other medicines you are taking or will receive before or after thelocal anesthetic is given.

Precautions After Receiving This Medicine

For patients going home before the numbness or loss of feeling caused bya local anesthetic wears off:

• During the time that the injected area feels numb, serious injurycan occur without your knowing about it. Be especially careful to avoid injuryuntil the anesthetic wears off or feeling returns to the area.
• If you have received a local anesthetic injection in your mouth,do not chew gum or food while your mouth feels numb. You may injure yourselfby biting your tongue or the inside of your cheeks.

Side Effects of This Medicine

Along with its needed effects,a medicine may cause some unwanted effects. Although not all of these sideeffects may occur, if they do occur they may need medical attention. Whileyou are in the hospital or your medical doctor's or dentist's office, yourmedical doctor, dentist, or nurse will carefully follow the effects of anymedicine you have received. However, some effects may not be noticed untillater.

Check with your dentistor medical doctor immediately if any of the following side effectsoccur:

Less common or rare

Bluish lips and fingernails; breathingproblems; chest pain; convulsions (seizures); dizziness; drowsiness; fatigue; fever; headache; irregular heartbeat; itching; nausea and/orvomiting; pale skin, troubled breathing, exertional,unusual bleeding or bruising, unusual tiredness or weakness; raised red swellings on the skin, lips, tongue, or in the throat; rapid heart rate; restlessness; unusual tiredness or weakness

Check with your dentist or medical doctor assoon as possible if any of the following side effects occur:

Less common or rare

Back pain; constipation; difficulty in opening the mouth; inabilityto hold bowel movement and/or urine; loss of sexualfunction; paralysis of legs; persistent numbness; prolonged numbness or tinglingof lips and mouth; shivering; skin rash; tingling or ?pins and needles?sensation

Other side effects not listed above may also occur in some patients. Ifyou notice any other effects, check with your medical doctor or dentist.