adrenaline acid tartrate + lidocaine hydrochloride: clinical use

Prescribing considerations

• Administration requires appropriate training, monitoring and immediate access to resuscitation equipment.
• Avoid intravascular administration; aspirate before and during injection and stop immediately if toxicity develops.
• Inflamed or infected tissue may reduce the local anaesthetic effect.
• Exercise particular caution with epilepsy, respiratory impairment, conduction disease, advanced hepatic disease, severe renal dysfunction, acute porphyria, cardiovascular disease, hypertension, hyperthyroidism, advanced diabetes and congenital arrhythmia syndromes.
• The sodium metabisulphite excipient can rarely cause severe hypersensitivity or bronchospasm, particularly in susceptible people with asthma.

Contraindications and cautions

• Hypersensitivity to lidocaine, adrenaline, any excipient or amide local anaesthetics
• Hypersensitivity to parabens or their PABA metabolite; avoid paraben-containing formulations in relevant ester-local-anaesthetic allergy
• Use of the vasoconstrictor component for anaesthesia of fingers, toes, the tip of the nose, ears or penis

Monitoring

• Maintain verbal contact and observe for early central nervous system toxicity during administration.
• Monitor cardiovascular and respiratory status according to the block and patient risk.
• Consider ECG monitoring with class III anti-arrhythmics.
• Monitor fetal heart rate when a paracervical block is performed.

Clinical pharmacology

Lidocaine is an amide local anaesthetic that blocks nerve conduction. Adrenaline produces local vasoconstriction, reducing systemic absorption and extending local action. Lidocaine is mainly metabolised in the liver, with a small proportion excreted unchanged by the kidneys.

Formulation and product differences

• The selected product is a multi-dose solution containing sodium metabisulphite and methyl parahydroxybenzoate.
• Because it contains preservatives, it must not be used intracisternally, epidurally, intrathecally, by routes accessing cerebrospinal fluid, or intra- or retro-bulbarly.
• The vial requires refrigerated storage and has a limited period of use after first opening.