No

Local Anesthetic

Dental: An amide-type local anesthetic for local infiltration anesthesia; injection near nerve trunks to produce nerve block

Medical: Infiltration anesthesia; peripheral nerve blocks; central neural blocks

B

Heart block, severe hemorrhage, severe hypotension, known hypersensitivity to etidocaine or other amide local anesthetics

Use with caution in patients with cardiac disease and hyperthyroidism; fetal bradycardia may occur up to 20% of the time; use with caution in areas of inflammation or sepsis, in debilitated or elderly patients, and those with severe cardiovascular disease or hepatic dysfunction; some products may contain sulfites

<1%: Myocardial depression, hypotension, bradycardia, cardiovascular collapse, anxiety, restlessness, disorientation, confusion, seizures, drowsiness, unconsciousness, chills, urticaria, nausea, vomiting, transient stinging or burning at injection site, tremor, blurred vision, tinnitus, respiratory arrest, anaphylactoid reactions, shivering

Symptoms of overdose include seizures, hypoventilation, apnea, hypotension, cardiac depression, arrhythmias, cardiac arrest

Treatment is supportive; seizures may be treated with diazepam; hypotension, circulatory collapse respond best to fluids and Trendelenburg position

Due to epinephrine component, use with tricyclic antidepressants or MAO inhibitors could result in increased pressor response; use with nonselective beta-blockers (ie, propranolol) could result in serious hypertension and reflex bradycardia

Blocks nervous conduction through the stabilization of neuronal membranes. By preventing the transient increase in membrane permeability to sodium, the ionic fluxes necessary for initiation and transmission of electrical impulses are inhibited and local anesthesia is induced.

Onset of anesthesia: Within 2-5 minutes

Duration: ~4-10 hours

Absorption: Rapid

Distribution: Wide V_d allows wide distribution into neuronal tissues

Protein binding: High

Metabolism: Extensively in the liver

Elimination: Small amounts excreted in urine

Varies with procedure; use 1% for peripheral nerve block, central nerve block, lumbar peridural caudal; use 1.5% for maxillary infiltration or inferior alveolar nerve block; use 1% or 1.5% for intra-abdominal or pelvic surgery, lower limb surgery, or caesarean section

No data reported

Toxic concentration: >0.1 mg/mL

No information available to require special precautions

No effects or complications reported

Before injecting withdraw syringe plunger to ensure injection is not into vein or artery; have resuscitative equipment nearby

Injection, as hydrochloride: 1% [10 mg/mL] (30 mL)

Injection, as hydrochloride, with epinephrine 1:200,000: 1% [10 mg/mL] (30 mL); 1.5% [15 mg/mL] (20 mL)

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

MacKenzie TA and Young ER, "Local Anesthetic Update," Anesth Prog, 1993, 40(2):29-34.

Wynn RL, "Epinephrine Interactions With Beta-Blockers," Gen Dent, 1994, 42(1):16, 18.

Wynn RL, "Recent Research on Mechanisms of Local Anesthetics," Gen Dent, 1995, 43(4):316-8.

Yagiela JA, "Local Anesthetics," Anesth Prog, 1991, 38(4-5):128-41.