l INDICATIONS AND DOSE

Infiltration anaesthesia and nerve block in dentistry  Child 3–17 years: Consult expert dental sources  Adult: Consult expert dental sources

DOSES AT EXTREMES OF BODY-WEIGHT  

To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight 

IMPORTANT SAFETY INFORMATION

Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

l CONTRA-INDICATIONS

Avoid injection into infected tissues . avoid injection into inflamed tissues . intravenous regional anaesthesia (Bier’s block). preparations containing preservatives should not be used for caudal, epidural, or spinal block . severe atrio-ventricular conduction disorders not controlled by a pacemaker

CONTRA-INDICATIONS, FURTHER INFORMATION

 Injection site Manufacturer advises the local anaesthetic effect may be reduced when injected into an inflamed or infected area, due to altered local pH. Increased absorption into the blood also increases the possibility of systemic side-effects.

l CAUTIONS

Cardiovascular disease . children (consider dose reduction). debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy . hypovolaemia . impaired cardiac conduction . impaired respiratory function . myasthenia gravis . shock

l INTERACTIONS → Appendix 1:

anaesthetics, local

l SIDE-EFFECTS

 Common or very common Arrhythmias . dizziness . hypertension . hypotension . nausea . paraesthesia . vomiting ? Uncommon Neurotoxicity  Rare or very rare Arachnoiditis . cardiac arrest. diplopia . nerve disorders .respiratory depression

SIDE-EFFECTS, FURTHER INFORMATION

Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection or too rapid injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.

l ALLERGY AND CROSS-SENSITIVITY

 Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

l PREGNANCY

Use with caution in early pregnancy.

l BREAST FEEDING

Use with caution

. l HEPATIC IMPAIRMENT

Manufacturer advises caution; increased risk of toxic plasma concentrations in severe impairment.

l RENAL IMPAIRMENT

Use with caution; increased risk of side-effects.