Apologies - my posting was not clear. Prions in the
Prilocaine w/o preservative 0.5% was the standard drug
for Biers IVRA, I believe, until last year when Astra,
who I thought were the only manufacturers worldwide,
withdrew it. The options seemed to be prilocaine with
preservative (pharmacy here warn of risk of reaction
with the volume administered) or lignocaine
(Australian connections told us used widely there for
many years without problem).
Consequently we opted for ligocaine approx 3mg/kg, in
practice 200mg. Dilution prior to injection probably
My expoerience has been that there is a significant
failure rate at this dose, necessitating a higher dose
of 300mg in selected larger patients. Incidentally, it
is presumably the forearm vascular compartment volume
which is important, not the patients weight).
I think care over speed of injection is more important
Is this clearer? Sorry, I just like to keep my
Very interested to find there is still preservative
free prilocaine around, especially as one reply
suggests it is being manufactured still. I am not
prepared to go back to this though unless the
continued supply is secure.
Have those using prilocaine with preservative found
this to be a problem?
No-one else seems to be using lignocaine for IVRA
--- Adrian Fogarty <[log in to unmask]> wrote:
> ----- Original Message -----
> From: Steve Meek
> > >Just wondering what other EDs are doing about the
> > >withdrawal of prilocaine without preservative
> > >year.
> Am I the only one being confused by this
> correspondence? What is the
> significance of "preservative" in all of this, can
> someone please explain?
> What is "preservative", why do some preparations
> have it while others don't,
> and does it matter?
> We continue to receive supplies of prilocaine (with
> preservative I think)
> although it's now in irritating vials of 20mls of
> 1%, instead of 40mls of
> 0.5%. That's not a major problem however; I figure
> diluting the former with
> 20mls of water or saline will effectively produce
> the same end result - do
> we really need a trial to prove this?
> Adrian Fogarty
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