General Introduction: Lidocaine CAS 137-58-6

Lidocaine cas 137-58-6, also known as lignocaine, is a local anaesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or nerve blocks, lidocaine typically begins working within several minutes and lasts for half an hour to three hours. Lidocaine mixtures may also be applied directly to the skin or mucous membranes to numb the area. It is often mixed with a small amount of adrenaline (epinephrine) to prolong its local effects and decrease bleeding.

If injected intravenously, it may cause cerebral effects such as confusion, changes in vision, numbness, tingling, and vomiting. It can cause low blood pressure and an irregular heart rate. There are concerns that injecting it into a joint can cause problems with the cartilage. It appears to be generally safe for use in pregnancy. A lower dose may be required in those with liver problems. It is usually safe to use in those allergic to tetracaine or benzocaine. Lidocaine is an antiarrhythmic medication of the class Ib type. This means it works by blocking sodium channels and thus decreasing the rate of contractions in the heart. When injected near nerves, the nerves cannot conduct signals to or from the brain.

Lidocaine was discovered in 1946 and went on sale in 1948. It is on the World Health Organization’s List of Essential Medicines. It is available as a generic medication. In 2019, it was the 219th most commonly prescribed medication in the United States, with more than 2 million prescriptions.

Lidocaine CAS 137-58-6 Medical uses

Local numbing agent

The efficacy profile of lidocaine as a local anaesthetic is characterized by a rapid onset of action and intermediate duration of efficacy. Therefore, lidocaine is suitable for infiltration, block, and surface anaesthesia. Longer-acting substances such as bupivacaine are sometimes given preference for spinal and epidural anaesthesias; lidocaine, though, has the advantage of a rapid onset of action. Adrenaline vasoconstrictors arteries, reducing bleeding and delaying the resorption of lidocaine, almost doubling the duration of anaesthesia.

Lidocaine is one of the most commonly used local anaesthetics in dentistry. It can be administered in multiple ways, most often as a nerve block or infiltration, depending on the type of treatment carried out and the area of the mouth worked on.

For surface anaesthesia, several formulations can be used for endoscopies, before intubations, etc. Buffering the pH of lidocaine makes local numbing less painful. Lidocaine drops can be used on the eyes for short ophthalmic procedures. There is tentative evidence for topical lidocaine for neuropathic pain and skin graft donor site pain. As a local numbing agent, it is used for the treatment of premature ejaculation.

An adhesive transdermal patch containing a 5% concentration of lidocaine in a hydrogel bandage, is approved by the US FDA for reducing nerve pain caused by shingles. The transdermal patch is also used for pain from other causes, such as compressed nerves and persistent nerve pain after some surgeries.

Heart arrhythmia

Lidocaine is also the most important class-1b antiarrhythmic drug; it is used intravenously for the treatment of ventricular arrhythmias (for acute myocardial infarction, digoxin poisoning, cardioversion, or cardiac catheterization) if amiodarone is not available or contraindicated. Lidocaine should be given for this indication after defibrillation, CPR, and vasopressors have been initiated. A routine preventive dose is no longer recommended after myocardial infarction as the overall benefit is not convincing.

Epilepsy

A 2013 review on treatment for neonatal seizures recommended intravenous lidocaine as a second-line treatment if phenobarbital fails to stop seizures.

Other

Intravenous lidocaine infusions are also used to treat chronic pain and acute surgical pain as an opiate-sparing technique. The quality of evidence for this use is poor so it is difficult to compare it to a placebo or an epidural.

Inhaled lidocaine can be used as a cough suppressor acting peripherally to reduce the cough reflex. This application can be implemented as a safety and comfort measure for patients who have to be intubated, as it reduces the incidence of coughing and any tracheal damage it might cause when emerging from anaesthesia.

Lidocaine, along with ethanol, ammonia, and acetic acid, may also help in treating jellyfish stings, both numbing the affected area and preventing further nematocyst discharge.

For gastritis, drinking a viscous lidocaine formulation may help with the pain.

Lidocaine CAS 137-58-6 Adverse effects

Interactions

Any drugs that are also ligands of CYP3A4 and CYP1A2 can potentially increase serum levels and potential for toxicity or decrease serum levels and efficacy, depending on whether they induce or inhibit the enzymes, respectively. Drugs that may increase the chance of methemoglobinemia should also be considered carefully. Dronedarone and liposomal morphine are both absolutely a contraindication, as they may increase serum levels, but hundreds of other drugs require monitoring for interaction.

Contraindications

Absolute contraindications for the use of lidocaine include:

• Heart block, second or third-degree (without pacemaker)
• Severe sinoatrial block (without pacemaker)
• Serious adverse drug reaction to lidocaine or amide local anesthetics
• Hypersensitivity to corn and corn-related products (corn-derived dextrose is used in the mixed injections)
• Concurrent treatment with quinidine, flecainide, disopyramide, procainamide (class I antiarrhythmic agents)
• Prior use of amiodarone hydrochloride
• Adams-Stokes syndrome
• Wolff-Parkinson-White syndrome
• Lidocaine viscous is not recommended by the FDA to treat teething pain in children and infants.

Exercise caution in patients with any of these:

• Hypotension not due to arrhythmia
• Bradycardia
• Accelerated idioventricular rhythm
• Elderly
• Ehlers–Danlos syndromes; efficiency of local anesthetics can be reduced
• Pseudocholinesterase deficiency
• Intra-articular infusion (this is not an approved indication and can cause chondrolysis)
• Porphyria, especially acute intermittent porphyria; lidocaine has been classified as porphyrogenic because of the hepatic enzymes it induces, although clinical evidence suggests it is not. Bupivacaine is a safe alternative in this case.
• Impaired liver function – people with lowered hepatic function may have an adverse reaction with repeated administration of lidocaine because the drug is metabolized by the liver. Adverse reactions may include neurological symptoms (e.g. dizziness, nausea, muscle twitches, vomiting, or seizures).

Overdosage

Overdoses of lidocaine may result from excessive administration by topical or parenteral routes, accidental oral ingestion of topical preparations by children (who are more susceptible to overdose), accidental intravenous (rather than subcutaneous, intrathecal, or paracervical) injection, or from prolonged use of subcutaneous infiltration anesthesia during cosmetic surgery.

Such overdoses have often led to severe toxicity or death in both children and adults. Lidocaine and its two major metabolites may be quantified in blood, plasma, or serum to confirm the diagnosis in potential poisoning victims or to assist forensic investigation in a case of fatal overdose.

Lidocaine is often given intravenously as an antiarrhythmic agent in critical cardiac-care situations. Treatment with intravenous lipid emulsions (used for parenteral feeding) to reverse the effects of local anesthetic toxicity is becoming more common.

Postarthroscopic glenohumeral chondrolysis

Lidocaine in large amounts may be toxic to cartilage and intra-articular infusions can lead to postarthroscopic glenohumeral chondrolysis.