Index of drugs

Auxiliary anesthesia. Nerve blocks like the brachial plexus block, intercostal blockade. Central blocks with epidural and spinal anesthesia.

1 ml of solution contains 20 mg Lidocaine hydrochloride.

Locally anesthetic agent with amide structure with fast onset and medium duration of action. Lidocaine causes reversible suppression of the nerve impulse conduction due to the reduction of the cell membrane permeability of the neuron for sodium ions. The 2% epidural solution works for 1.5-2 hours and up to 5 hours for peripheral nerve blocks. The epidural space is absorbed in two phases with T_0,5 respectively, 9.3 and 82 minutes. Absorption from the subarachnoid space is monophasic, and T_0,5 is 71 minutes. Lidocaine binds to 65% of plasma proteins. It is eliminated from the body through hepatic metabolism. The main metabolite is xylidine monoethyl glycinate (MEGX) with T_0,5 10 h. N-dealkylation to MEGX is mediated by CYP1A2 and CYP3A4. Only 3% of the drug is excreted unchanged. T_0,5 lidocaine in the elimination phase is 1.6 h, pKa is 7.9.

Hypersensitivity to local anesthetics from the amides group or to any of the excipients. General contraindications for the use of particular types of local anesthesia. Do not use for epidural anesthesia in patients with significant hypotension (eg in cardiogenic or hypovolemic shock).

Regional anesthesia should be performed in facilities with the necessary equipment to monitor and resuscitate the patient by trained personnel. Special care should be taken in patients with cardiac insufficiency - in these patients, clinically significant hypotension should be avoided due to disturbed compensatory mechanisms. In patients with hypovolaemia with various aetiologies (bleeding dehydration) or in patients with impaired venous return, caused for example by significant ascites, a large tumor in the abdomen or an advanced pregnancy, there may be a significant reduction in blood pressure. Caution should be exercised in patients with IIst left ventricular block. or III. with severe liver disease or reduced hepatic flow and severe renal impairment. During epidural anesthesia, intercostal muscles may be paralyzed, which in patients with pleural effusion may lead to respiratory distress. In patients with sepsis, there is a greater risk of abscess within the spinal canal in the postoperative period. Regional anesthesia around the head and neck (including retrobulbar anesthesia, dental anesthesia, stellate anesthesia) is associated with a higher risk of intra-arterial drug delivery. In rare cases, during retrobulbar anesthesia, the preparation may enter the subarachnoid space, which may lead to temporary blindness, cardiac arrest, apnea and convulsions. In the case of periocular and retrobulbar anesthesia, permanent ocular dysfunction may occur. Patients taking Class III antiarrhythmics should be carefully monitored (ECG) during anesthesia.

Lidocaine was used in a large number of pregnant women and during labor - no effects on the reproductive process, an increase in congenital malformations or other direct or indirect effects on the child were observed. In the case of perinatal analgesia, more often than other anesthesia techniques, fetal side effects such as bradycardia may occur. After application in therapeutic doses lidocaine penetrates into breast milk in amounts that do not affect the child.

Very common: hypotension, nausea. Common: hypertension, vomiting, paresthesia, dizziness, bradycardia. Uncommon: o.u.n symptoms (seizures, numbness around the mouth, numbness of the tongue, hyperaesthesia, visual disturbances, loss of consciousness, muscle tremors, tinnitus, speech problems).Rare: neuropathy, peripheral nerve injury, arachnoiditis, cardiac arrest, arrhythmia, respiratory depression, diplopia, allergic reactions (in the most severe cases, anaphylactic shock).

All precautions should be taken to avoid accidental intravascular administration of the drug through thorough aspiration. If high doses are administered (eg under epidural anesthesia), initially 3-5 ml of the epinephrine formulation should be given as the test dose. Intravascular administration of the drug can be diagnosed based on transient cardiac acceleration. For 5 minutes after the test dose, physiological activities should be monitored and verbal contact should be maintained with the patient. The main dose administered slowly - 25-50 mg / min or administered in divided doses; simultaneously control physiological functions and maintain verbal contact with the patient. If even mild symptoms of toxicity occur, the medicine should be discontinued immediately. It is also recommended to give a test dose (3-5 ml) to avoid unintentional subarachnoid arrest. The dose of the drug to be administered to the patient depends on the size of the area to be anesthetized, its vascularity, the number of segments to be anesthetized, the technique of anesthesia and individual tolerance to the drug.Adults and children over 12 years. Surgical anesthesia. Epidural anesthesia (the dose includes the test dose): in the lumbar region - 15-25 ml of a 20 mg / ml solution (300-500 mg); in the thoracic region - 10-15 ml of a solution of 15 mg / ml (150-225 mg) or concentration 20 mg / ml (200-300 mg); in the sacral region - 20-30 ml of a solution of 10 mg / ml (200-300 mg) or 15-25 ml of a concentration of 20 mg / ml (300-500 mg).Sectional intravenous anesthesia (Bier'a): upper limb - 40 ml of a 5 mg / ml solution (200 mg); lower limb (thigh band) - 60 ml of a 5 mg / ml solution (300 mg); lower limb (band on the lower leg) - 40 ml of the 5 mg / ml solution (200 mg); intra-articular blockage - ≤60 ml of a 5 mg / ml solution (≤300 mg) or ≤40 ml of a 10 mg / ml solution (≤400 mg).Anesthesia of peripheral nerves (small nerves anesthesia and exudative). Auxiliary anesthesia: ≤80 ml of a 5 mg / ml solution (≤400 mg) or ≤40 ml of a 10 mg / ml solution (≤400 mg). Anesthesia of the finger nerves by Oberst method: 1-5 ml of a 10 mg / ml solution (10-50 mg). Anesthesia of intercostal nerves (at the same time no more than 8 nerves) dose per 1 nerve: 2-5 ml of a solution of 10 mg / ml (20-50 mg) or 2-4 ml of a concentration of 15 mg / ml (30-60 mg) . Retrobulbaral anesthesia: 4 ml at a concentration of 20 mg / ml (80 mg). Periocular anesthesia: 10-15 ml at a concentration of 10 mg / ml (100-150 mg). Anesthesia of the pudendal nerves (each side): 10 ml of a 10 mg / ml solution (100 mg).Shoulder plexus. Cervical blockage: 40-50 ml of a 10 mg / ml solution (400-500 mg) or 30-50 ml of a 15 mg / ml solution (450-600 mg). Supraclavicular access, between inclined muscles, perivascular subclavian blockade - Winnie: 30-40 ml of a 10 mg / ml solution (400-500 mg) or 20-30 ml of a 15 mg / ml solution (300-450 mg) . Sciatic nerve: 15-20 ml of a 15 mg / ml solution (225-300 mg) or 15-20 ml of a 20 mg / ml solution (300-400 mg); 3 in 1 - thigh, veil and lateral nerve: 30-40 ml of a 10 mg / ml (300-400 mg) solution or 30 ml of a 15 mg / ml solution (450 mg).Children from 1 to 12 years: 5 mg / kg A 10-μg / ml solution is used in cross-sectional epidural anesthesia. In children, elderly patients and patients in poor general condition, the dose should be reduced.