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 Now it has been replaced by longer-lasting and deeper-acting anesthetics based on Articaine.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”
Lidocaine price, where to buy
How much ampoules cost depends on the packaging and manufacturer.
The price of Lidocaine in 10% ampoules is 40-80 rubles per 10 pieces.
You can buy Lidocaine spray 10% for a price starting from 200 rubles. A numbing spray that contains lidocaine may be more expensive. The price of Lidocaine spray in Ukrainian pharmacies is on average 200 UAH. per package.
The price of Lidocaine gel is from 200 rubles per tube.
You can buy an aerosol, cream or ointment with lidocaine at any pharmacy.
A cathegel with lidocaine costs from 145 rubles.
buy a patch with lidocaine Versatis at a price of 530 rubles.
The price of lidocaine tablets depends on the drug and its manufacturer.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Cathegel with lidocaine gel 12.5 g Montavit Pharmaceuticals Fabrik GmbH RUB
197 order - Lidocaine solution for injection. 20 mg/ml 2 ml 10 pcs. Grotex LLC
127 RUR order
- Lidocaine Bufus solution for injection. 2% 2ml 10 pcs. AO Renewal of PFC
107 RUR order
- Lidocaine hydrochloride 2% tube drops. 1.5 ml 5 pcs. Federal State Unitary Enterprise Moscow Endocrine Plant
32 RUR order
- Lidocaine drops hl. 2% 5 ml vial. No. 1JSC Sintez
20 rub. order
Pharmacy Dialogue
- Lidocaine (spray 10% 38g)Egis
RUB 324 order
- Lidocaine-Vial (spray 10% 38g) Jewim Pharmaceutical (Shandong)
220 rub. order
- Katedzhel gel (tube 12.5 g with lidocaine No. 1 syringe tube) Montavit Fabrik
RUB 187 order
- Lidocaine Bufus (amp. 2% 2ml No. 10)Update of PFC JSC
100 rub. order
- Lidocaine Bufus (amp. 10% 2ml No. 10)Update of PFC JSC
117 RUR order
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Pharmacy24
- Lidocaine 2% 2 ml No. 100 ampoules solution ZAT FZ Egis, Ugorshchina
661 UAH.order - Cathegel with lidocaine 12.5g N1 syringe tube urethral gel Pharmaceuticalutische Factory Montavit GmbH, Austria
72 UAH order
- Lidocaine-Darnitsa 2% 2 ml No. 10 solution
13 UAH order
- Cathegel with lidocaine 12.5 g No. 5 gel Pharmaceuticals Factory Montavit GmbH, Austria
410 UAH. order
- Lidocaine hydrochloride 2% 2 ml No. 10 solution
11 UAH order
PaniPharmacy
- Lidocaine ampoule Lidocaine 20 mg/ml amp. 2ml No. 10 Ukraine, Lubnyfarm PJSC
14 UAH order
- LIDOCAINE ampoule Lidocaine solution d/in. 2% amp. 2ml No. 100 Hungary, Egis
740 UAH. order
- LIDOCAINE ampoule Lidocaine solution d/in. 2% amp. 2ml No. 10 Ukraine, Health LLC
10 UAH.order
- Katedzhel with lidocaine gel Katedzhel with lidocaine gel urethra. spr-tube 12.5 g N 1 Austria, Montavit
93 UAH order
- LIDOCAINE liquid Lidocaine spray 10% 38g Ukraine, Zdorovye LLC
199 UAH order
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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.
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.
Pharmacokinetics and pharmacodynamics
The highest concentration in the blood after intravenous administration is observed after 5-15 minutes, if the infusion is carried out slowly without a saturating initial dose, the maximum concentration is observed after 5-6 hours, and in people with acute myocardial infarction it can be achieved after a long time - up to 10 hours. Binds to plasma proteins by 50-80%. It is quickly distributed in the body and penetrates the placental and blood-brain barriers.
Metabolism mainly occurs in the liver; microsomal enzymes , resulting in the formation of active metabolites - glycine xylidide and monoethylglycine xylidide . People with liver disease have a slower metabolism. Excretion occurs in bile and urine.
If lidocaine cream or other agents are applied topically, absorption depends on the dose and also on the site where the lidocaine cream or gel is applied. Absorption is affected by the rate of perfusion in the mucosa.
There is good absorption in the respiratory tract, so care must be taken to prevent the administration of the drug in toxic doses.
After injections of lidocaine intramuscularly, almost complete absorption is noted. It is distributed quickly and binds to proteins, depending on the concentration of the active ingredient, by 60-80%.
The half-life depends on the dose administered, it is 1-2 hours.
If an aerosol is used, its effect appears within 1 minute and lasts 1-2 minutes. There is a gradual disappearance of the achieved decrease in sensitivity over 15 minutes.
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.).
