Lidocaine instructions for use in dentistry

From this article you will learn:

what lidocaine-based drugs are used in dentistry,
How much stronger is lidocaine than novocaine?
What anesthetics are even stronger than lidocaine.

The article was written by a dental surgeon with more than 19 years of experience.

Lidocaine is a drug that is a local anesthetic, which is used for pain relief during the treatment and extraction of teeth, as well as when opening purulent abscesses. The analgesic effect of this drug is approximately 2 times higher than the effectiveness of novocaine, but 1.5-2 times inferior to ultracaine. For lidocaine, the instructions for use of the drug in dentistry contain information about the following forms of release:

lidocaine in ampoules and carpules,
lidocaine spray,
lidocaine gel.

Below we will analyze in detail the use of each form, their pros and cons.

Lidocaine in ampoules -

Available in ampoules of 2 ml. Composition of the drug: 1 ml of solution contains 20 mg of lidocaine hydrochloride (this corresponds to a 2% solution), as well as excipients - 6 mg of sodium chloride and sodium hydroxide solution, + water for injection.

Lidocaine: reviews This anesthetic once replaced novocaine, and was several times stronger than it. You need to understand that novocaine has practically no effect in inflamed tissues during suppuration. The effect of lidocaine does not depend on the presence or absence of inflammation.

Typically, a dose of 4-5 ml of lidocaine is used for anesthesia in dentistry (if lidocaine is used without the addition of adrenaline). The duration of action from the moment of injection is from 30 to 90 minutes, which depends on numerous factors: the speed of blood flow, which washes the anesthetic out of the tissues, the type of anesthesia (in the upper jaw, anesthesia lasts significantly less than in the lower jaw with conduction anesthesia).

However, now we can safely say that lidocaine, like novocaine, are anesthetics of the past. Now it has been replaced by longer-lasting and deeper-acting anesthetics based on Articaine. These anesthetics include, for example, Ultracain, Septanest, Ubistezin and others. These anesthetics are several times stronger than lidocaine, and their duration of action is also several times longer.

The undoubted advantages of lidocaine include:

low cost, which makes it a good free anesthetic in government clinics (10 ampoules cost about 40 rubles in a pharmacy),
antiarrhythmic effect on the heart, which makes it the drug of choice for the treatment and removal of teeth in patients with cardiac arrhythmias.

pharmachologic effect

Lidocaine - what is it?

Wikipedia indicates that lidocaine is a derivative of acetanilide in chemical structure. It has a pronounced antiarrhythmic and local anesthetic effect.

The pharmacological group to which the active substance belongs is local anesthetics .

Inhibits nerve conduction by blocking sodium channels in nerve fibers and nerve endings, thereby providing a local anesthetic effect.

If we compare the anesthetic effect of procaine , then lidocaine is 2-6 times superior to it. Also, its effects develop faster and last longer. How long the drug lasts depends on the interaction with other drugs. If the drug is used simultaneously with Epinephrine , then the effect lasts more than 2 hours. When applied topically, vasodilation is observed, but no local irritating effect is noted.

In the body, it stabilizes the cell membrane, blocks sodium channels, increases the level of membrane permeability for potassium ions, which determines its antiarrhythmic effect .

Under its influence, repolarization in the ventricles is accelerated, the fourth phase of depolarization in Purkinje fibers is inhibited, without affecting the electrophysiological state of the atria.

It does not have a significant effect on myocardial contractility and conductivity. The negative inotropic effect is slightly pronounced, it manifests itself for a short time and only if the drug is administered in large doses.

Lidocaine in carpules -

All modern anesthetics have not been produced in ampoules for a very long time; they are produced in disposable capsules. The carpule already contains a dose of anesthetic; it is inserted into the carpule syringe (Fig. 1), then a disposable very thin needle is screwed on, and the syringe is ready for anesthesia.

Lidocaine carpule and carpule syringe:

An example of lidocaine anesthesia in carpules is the drug Xylonor, produced by the French company Septadont. But carpules with lidocaine are also produced by other companies. To increase the duration and depth of anesthesia, in addition to lidocaine itself, the anesthetic carpules also contain special additives (epinephrine, adrenaline or norepinephrine), which constrict the blood vessels at the site of anesthesia, thereby preventing the rapid leaching of the anesthetic.

The use of carpule syringes and carpules greatly simplifies the administration of anesthesia for the doctor, and thanks to very thin needles, it reduces pain for the patient. Read all the most detailed information on modern anesthesia in our article: “Everything about anesthesia in dental practice”

Interaction

When used with other drugs, a number of interaction reactions may develop:

When taking Cimetidine and beta-blockers, the risk of toxic effects increases.
With simultaneous use, the cardiotonic effect of digitoxin .
Enhances muscle relaxation of curare-like drugs .
The negative inotropic effect is enhanced by concomitant administration of Verapamil , ajmaline , quinidine and amiodarone .
The effectiveness of lidocaine is reduced by inducers of microsomal liver enzymes.
When taking vasoconstrictors ( methoxamine , epinephrine , phenylephrine ) simultaneously, the local anesthetic effect of lidocaine may increase, and blood pressure may also increase and tachycardia .
Lidocaine reduces the effect of antimyasthenic drugs .
When used simultaneously with procainamide hallucinations may occur .
Extends and enhances the effect of muscle relaxants .
When taking mecamylamine , guanethidine , trimethaphan and guanadrel , the risk of a marked decrease in blood pressure and bradycardia increases.
When phenytoin and lidocaine are used together, the resorptive effect of lidocaine is likely to decrease, and an undesirable cardiodepressive effect may also develop.
When taking MAO inhibitors , the local anesthetic effect of lidocaine may be enhanced, and a decrease in blood pressure may also be observed. Parenteral lidocaine should not be prescribed to patients taking MAO inhibitors.
polymyxin B are coadministered , it is important to monitor the patient's respiratory function.
The inhibitory effect on respiration and the central nervous system may be enhanced if lidocaine is taken together with sedatives and hypnotics, as well as with hexenal , sodium thiopental , and opioid analgesics .
If lidocaine is administered intravenously to people taking cimetidine, a number of negative effects may occur - drowsiness , drowsiness , paresthesia , bradycardia . If there is a need to combine these agents, it is necessary to reduce the dose of lidocaine.
If the areas where lidocaine was injected were treated with disinfection solutions that contain heavy metals, the likelihood of local reactions increases.

Lidocaine spray 10% –

This is a metered spray for topical use. In dentistry, it is used to relieve pain in the oral mucosa (24stoma.ru). One press sprays exactly 4.8 mg of lidocaine. The canister contains 38 grams of lidocaine, which is enough for 650 doses. The spray also contains excipients such as: 96% alcohol, peppermint oil and propylene glycol. Pleasant to the taste.

Lidocaine spray begins to act within 1 minute after spraying onto the mucous membrane, and the effect itself continues for 5-6 minutes. The drug can also be used in children under 2 years of age.

Lidocaine spray: reviews instructions lidocaine spray includes the following areas of application of the drug in dentistry -

reduction of the gag reflex during dental treatment (spraying on the root of the tongue),
for superficial anesthesia of the oral mucosa before local anesthesia (in this case, the injection will not be so painful).

Lidocaine spray: price You can buy lidocaine spray in almost any pharmacy with a prescription for about 350 rubles. However, as a rule, you will never be asked for a recipe.

Side effects

When used, the following side effects may develop:

Central nervous system: headache, euphoria , drowsiness , dizziness , disturbances of consciousness, weakness, convulsions, disorientation , paresthesia , nystagmus , tremor , neurotic reactions, photophobia , tinnitus, etc.
Blood vessels and heart: decreased pressure, chest pain, collapse, bradycardia (possible cardiac arrest), peripheral vasodilation.
Allergy symptoms: rash , itching , urticaria , angioedema , anaphylactic manifestations.
Gastrointestinal tract: vomiting , nausea .
Other manifestations: feeling of cold or heat, persistent anesthesia , hypothermia , methemoglobinemia , erectile dysfunction .
Local manifestations: a slight burning sensation that disappears within 1 minute.

Lidocaine gel –

There are both professional lidocaine-based gels for dental clinics and those that can be bought at any pharmacy. An example of a common gel with lidocaine is the drug “Kamistad”. This gel contains lidocaine and chamomile extract as active ingredients. Created specifically for application to the oral mucosa. It has an analgesic and slight anti-inflammatory effect.

Lidocaine gel: price The cost of the drug Kamistad is about 230 rubles. If we talk about analogues for anesthesia of the mucous membrane, then the Cholisal gel has a slightly less pronounced, but longer-lasting analgesic effect. The latter also has a pronounced anti-inflammatory effect. The cost of the last drug is about 300 rubles.

Lidocaine during pregnancy and lactation -

Lidocaine cannot be used as a local anesthetic during pregnancy. However, lidocaine spray can be used, because in the doses used, it does not pose a danger to the fetus. During lactation, the drug should not be prescribed either in the form of a spray or for local anesthesia.

The safest drug for pregnant and lactating women is Ultracaine “DS” (instructions for the drug).

Lidocaine: contraindications for use

allergy to lidocaine components,
significant impairment of liver function,
sick sinus syndrome,
2-3 degree atrioventricular block,
severe bradycardia,
myasthenia gravis, cardiogenic shock.

Sources:

1. Higher prof. the author's education in surgical dentistry, 2. Based on personal experience as a dental surgeon, 3. National Library of Medicine (USA), 4. “Local anesthesia in dentistry” (Baart J.), 5. “Propaedeutics of surgical dentistry” (Soloviev M.).

Overdose

If an overdose is noted, the patient’s first signs of intoxication may be nausea , dizziness , vomiting , a feeling of euphoria , asthenia , and decreased blood pressure. Later, spasms of facial muscles develop, turning into spasms of skeletal muscles. The patient also has bradycardia , psychomotor agitation, collapse, and asystole . If an overdose occurs during childbirth, the newborn may develop bradycardia , apnea , and depression of the respiratory center .

In case of overdose, it is necessary to stop administering the drug and inhale oxygen. Next, symptomatic breathing is carried out. If seizures develop, 10 mg of diazepam should be administered. In case of bradycardia, the administration of m-anticholinergic blockers (atropine) and vasoconstrictors . Hemodialysis will be ineffective.