Formulary Chapter 15: Anaesthesia - Full Chapter
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15.02 |
Local anaesthesia |
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15.02 |
Articaine |
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15.02 |
Bupivacaine |
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Bupivacaine Hydrochloride
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Formulary
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- 0.25% & 0.5% injection 10ml
- 0.25% & 0.5% + adrenaline 1 in 200,000 inj. 10ml
- 0.5% in glucose 8% injection (Marcain Heavy)
- 0.1% & 0.125% unlicensed in sodium chloride 0.9% infusions
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Liposomal Bupivacaine (Exparel® )
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Formulary
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- 133mg/10ml & 266mg/20ml prolonged-release dispersion for injection.
- Alternative to local anaesthetic infusion via an indwelling brachial plexus nerve catheter for major shoulder/upper limb surgery.
- Audit of outcomes to be presented to trust Drug and therapeutic Committee's and Formulary Working Group within 12 months (from April 2024).
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15.02 |
Levobupivacaine |
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Levobupivacaine (Chirocaine®)
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Formulary
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- 0.25%, 25mg in 10ml & 0.5%, 50mg in 10ml & 0.75%, 75mg in 10ml injections
- 0.625mg/ml & 1.25mg/ml infusion bags
- for local infiltration in hip and knee replacement surgery.
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15.02 |
Lidocaine |
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Lidocaine
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Formulary
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- Injections (plain)
- 0.5% 10ml
- 1% 2ml, 5ml, & 10ml (10mg/ml)
- approved for use in post-operative pain management subject to local protocols with a review of adverse events to be submitted by October 2018
- 2% 2ml, 5ml & 20ml injection (20mg/ml)
- 5% 2ml Heavy injection (50mg/ml)
- 5% 10ml injection (50mg/ml) unlicensed
- Topical preparations
- 1% & 2% gel with chlorhexidine 0.25%
- 4% topical solution (some packs unlicensed)
- 5% ointment
- 2% spray unlicensed
- 100mg lollipops unlicensed
- Lidocaine 4%, adrenaline 0.1% & tetracaine 0.5% (LAT gel®) unlicensed
- approved for use in anaesthetising lacerations particularly in the paediatric population – not to be used in children weighing under 15kg.
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Lidocaine 2.5% with Prilocaine 2.5% (EMLA®)
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Formulary
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Lidocaine 4% cream (LMX4®)
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Formulary
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Lidocaine 5% and Phenylephrine 0.5%
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Formulary
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- 5% lidocaine & 0.5% phenylephrine solution with
applicator
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Lidocaine Spray
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Formulary
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- Metered dose spray (10mg/spray)
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Lidocaine with Adrenaline Injections
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Formulary
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15.02 |
Mepivacaine |
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15.02 |
Prilocaine |
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Prilocaine Hydrochloride
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Formulary
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- 0.5% 10ml injection unlicensed, 1% 20ml injection.
- 4% 2ml injection (cartridges).
- 2% 5ml injection (cartridges)
- Only to be used in patients undergoing spinal anaesthesia for day surgery where the procedure is anticipated to last less than 90 minutes.
- 3% & felypressin injection (cartridges).
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15.02 |
Chloroprocaine |
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Chloroprocaine hydrochloride (Ampres®)
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Formulary
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- 50mg/5ml ampoules & 400mg/20ml vials.
- Approved for spinal nerve and peripheral blocks. To be reviewed in April 2022.
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15.02 |
Ropivacaine |
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Ropivacaine Hydrochloride
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Formulary
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- 0.2% (200mL) infusion
- approved for peripheral nerve block infusions for post-operative pain
- 0.75% (10mL)
- approved for use in setting of conversion from labour epidural analgesia to surgical analgesia for emergency caesarean section
- 0.2% (10mL) solution for injection
- approved as an option for ambulatory day case hand surgery
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15.02 |
Tetracaine |
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Tetracaine (Amethocaine) (Ametop®)
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Formulary
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15.02 |
Other local anaesthetics |
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Articaine Hydrochloride with Adrenaline
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Formulary
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- Articaine 4% & adrenaline 1 in 100,000 injection
- approved for mandibular procedures in patients in whom nerve blocks are contraindicated.
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Cocaine
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Formulary
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- 4% nasal solution (drops) unlicensed
25% paste (1g syringe pack) unlicensed
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Cocaine with Adrenaline
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Formulary
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- 4% solution with adrenaline unlicensed
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Ethyl Chloride Spray
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Formulary
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Mepivacaine
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Formulary
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Mepivacaine IV
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Formulary
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PR Freeze Spray
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Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
Status |
Description |
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Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing. |
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Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care. |
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Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs. |
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Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care. |
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NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria. |
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UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review. |
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NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status. |
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