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Lidocaine Hydrochloride 2% 30 gm tube
Lidocaine 2% jelly is indicated for prevention and control of pain in male and female urethra during cystoscope, catheterization, exploration by sound and other endourethral operations; for topical treatment of painful urethritis; for adequate analgesia in endoscopy and as an anesthetic lubricant for endotracheal intubation (oral and nasal).
Local & Surface anesthesia
Lidocaine acts mainly by inhibiting sodium influx through sodium specific ion channels in the neuronal cell membrane, in particular the so called voltage-gated sodium channels. When the influx of sodium is interrupted, an action potential cannot arise and signal conduction is inhibited. The receptor site is thought to be located at the cytoplasmic (inner) portion of the sodium channel. Lidocaine binds more readily to sodium channels in activated state, thus onset of neuronal blockade is faster in neurons that are rapidly firing. This is referred to as state dependent blockade.
Dosage & Administration
The dosage varies and depends upon the area to be anesthetized, vascularity of the tissues, individual tolerance, and the technique of anesthesia. The lowest dosage needed to provide effective anesthesia should be administered. Dosages should be reduced for children, elderly and debilitated patients.
For Surface Anesthesia of the Male Adult Urethra: Sterilize the plastic cone for 5 minutes in boiling water, cool, and attach to the tube. Slowly instill approximately 15 gm (300 mg of lidocaine HCl) jelly into the urethra or until the patient has a feeling of tension. A penile clamp is then applied for several minutes. An additional dose of not more than 15 gm (300 mg) can be instilled for adequate anesthesia.
Prior to sounding or cystoscopy, a penile clamp should be applied for 5 to 10 minutes to obtain adequate anesthesia. A total dose of 30 gm (600 mg) is usually required to fill and dilate the male urethra. Prior to catheterization, smaller volumes of 5-10 gm (100-200 mg) are usually adequate for lubrication.
For Surface Anesthesia of the Female Adult Urethra: Sterilize the plastic cone for 5 minutes in boiling water, cool, and attach to the tube. Slowly instill 3-5 gm (60-100 mg) jelly into the urethra. If desired, some jelly may be deposited on a cotton swab and introduced into the urethra. In order to obtain adequate anesthesia, several minutes should be allowed prior to performing urological procedures.
Lubrication for Endotracheal Intubation: Apply a moderate amount of jelly to the external surface of the endotracheal tube shortly before use. Care should be taken to avoid introducing the product into the lumen of the tube.
Lidocaine should be used with caution in patients receiving antiarrhythmic drugs, such as tocainide, since the toxic effects are additive.
Lidocaine jelly is contraindicated in patients with a known history of hypersensitivity to local anaesthetics of the amide type.
Aaphylactoid reactions such as cutaneous lesion, urticaria and oedema; drowsiness , nervousness, dizziness, blurred vision, tremors, convulsions, unconsciousness, respiratory arrest, hypotension, myocardial depression, bradycardia and cardiac arrest.
Pregnancy & Lactation
There is no, or inadequate, evidence of safety of the drug in human pregnancy but it has been in wide use for many years without apparent ill consequence. If drug therapy is needed in pregnancy, this drug can be used if there is no safer alternative. Lidocaine HCl enters the mother’s milk, but in such small quantities that there is generally no risk of affecting the child at therapeutic dose levels.
Precautions & Warnings
If Lidocaine HCl jelly is used concomitantly with other products containing lidocaine, the total dose contributed by all formulations must be kept in mind. No more than 600 mg of lidocaine HCl should be given in any 12 hour period. Absorption from wound surfaces and mucous membranes is relatively high, especially in the bronchial tree. Lidocaine HCl jelly should be used with caution in patients with traumatised mucosa and/or sepsis in the region of the proposed application. Food should not be ingested for 60 minutes following use of local anesthetic preparations in the mouth or throat area because topical anesthesia may impair swallowing and thus enhance the danger of aspiration. This is particularly important in children because of their frequency of eating. Lidocaine HCl should also be used with caution in patients with severe shock or heart block. Excessive dosage, or short intervals between doses, can result in high plasma levels and serious adverse effects.
Acute emergencies from local anesthetics are generally related to high plasma levels encountered during therapeutic use of local anesthetics. If not treated immediately, both convulsions and cardiovascular depression can result in hypoxia, acidosis, bradycardia, arrhythmias, and cardiac arrest. If cardiac arrest occurs, standard cardiopulmonary resuscitative measures should be instituted.
Store in a cool and dry place, protected from light.
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