Tetracaine and Dicaine IgE (C210, Dr. Fooke) in Novovoronezh

Indications for use

Dicaine is a local anesthetic intended for terminal anesthesia. The anesthetic effect develops 30-90 seconds after applying Dicain to the mucosal surface and persists for another 15-20 minutes.

According to the instructions for Dikain, the use of the product is indicated:

• For some ENT diseases, when the patient requires surgical intervention due to the need to remove polyps, puncture the maxillary cavity, perform surgery on the middle ear, or conchotomy;
• When performing short-term operations on the anterior segment of the eyeball, as well as manipulations related to the removal of a foreign body from the eye, etc.;
• For anesthesia of the larynx during intubation (in general anesthesiology), as well as bronchography, esophagoscopy and bronchoscopy procedures;
• For epidural (epidural) pain relief;
• For anesthesia of the urinary tract before catheterization.

References

1. Lazarenko, L.L., Shabanov, D.V., Ses, T.P. and others. Drug allergy to local anesthetics: various diagnostic strategies. Russian medical journal. Medical Review, 2021. - No. 1. - P. 42-47.
2. Gromovik, M.V., Anisimova, E.N., Latysheva, T.V. and others. Prevalence of hypersensitivity reactions to local anesthetic drugs at dental appointments. Institute of Dentistry, 2021. - No. 4(85). — P. 90-92.
3. Bhole, M., Manson, A., Seneviratne, S. et al. lgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. British journal of anesthesia, 2012. - Vol. 108(6). - P. 903-11.

Contraindications

The instructions for Dikain indicate that the drug is contraindicated for persons with individual intolerance to its components, as well as for children under 10 years of age.

In ophthalmology, Dicaine is not prescribed for keratitis.

The drug should not be used by people undergoing treatment with sulfonamides.

Dicaine should not be used as part of nasal drops.

The drug is used with caution when:

• AV block;
• Heart rhythm disturbances;
• Reducing the level of cholinesterase in the blood plasma;
• Shocked.

Directions for use and dosage

The drug is used primarily for terminal anesthesia, rarely for epidural anesthesia. The substance is very toxic, so the solution is practically unsuitable for conduction and infiltration anesthesia. The highest dose for topical application is 0.1 grams.

In accordance with the instructions, in ophthalmic practice, Dicain is used in 2-3 drops. A strong analgesic effect develops within 1-2 minutes.

To achieve the required anesthetic effect during eye surgery, as a rule, a 0.5% solution is sufficient. To prolong the action and enhance the effectiveness of the drug, add a 0.1% solution of epinephrine to Dicaine (at the rate of 3-5 drops per 10 ml of tetracaine).

For pain relief, measuring intraocular pressure is usually limited to a 0.1% solution.

In otolaryngology, in most cases a solution of 0.25-0.5% is sufficient. For adult patients, up to 3 ml of a 1% solution can be prescribed at the discretion of the doctor. 2 and 3% solutions are used only when absolutely necessary. Spraying or lubricating the larynx and pharynx is done gradually, maintaining intervals and monitoring the patient's condition. To reduce the overall reaction to the drug, the patient is given 0.1 grams of barbamyl 30-60 minutes before pain relief.

In the absence of contraindications to the use of vasoconstrictors, epinephrine hydrochloride is added to Dicaine (1 drop of 0.1% solution for every 1-2 ml of tetracaine). A tampon is soaked in the solution and the surface of the mucous membrane is treated. You should not leave the tampon in the nasal cavity for a long time.

The use of Dicaine for epidural anesthesia requires precautions. The preparation of a 0.25-0.3% solution is carried out under aseptic conditions by mixing Dicain with sterile water for injection and an isotonic solution of sodium chloride, a stabilized solution of hydrochloric acid. Before use, the drug is sterilized by boiling for half an hour, after which a 0.1% solution of epinephrine hydrochloride is added to it at the rate of 1 drop. per 5 ml of anesthesia solution. The product is administered in stages - 15-20 ml. The interval between injections is 5 minutes.

For anesthesia of the urinary tract, up to 10 ml of 0.1% Dicaine solution is used.

DICAINE (Dicainum)

Home Medical Encyclopedia Medicines in alphabet D

Synonyms:

Tetracaine hydrochloride, Amethocaine, Anetaine, Decicaine, Felicaine, Foncaine, Intercaine, Medicaine, Pantocaine, Rexocaine.

Pharmachologic effect.

Strong local anesthetic. It is significantly more active than novocaine and cocaine, but is more toxic. Well absorbed through mucous membranes.

Indications for use.

Dicaine is used only for superficial anesthesia (pain relief).

Method of administration and dose.

In ophthalmic practice, it is used in the form of a 0.1% solution when measuring intraocular pressure (one drop 2 times with an interval of 1-2 minutes). Anesthesia usually develops within 1-2 minutes. When removing foreign bodies and surgical interventions, use 2-3 drops of 0.25-0.5-1% or 2% solution. After 1-2 minutes, pronounced anesthesia develops. It must be taken into account that solutions containing more than 2% dicaine can cause damage to the epithelium (outer layer) of the cornea (the transparent layer of the eye) and significant dilation of the vessels of the conjunctiva (outer layer of the eye). Typically, for anesthesia during eye surgery, a 0.5% solution is sufficient. To lengthen and enhance the anesthetic effect, add a 0.1% solution of adrenaline (3-5 drops per 10 ml of dicaine).

For keratitis (inflammation of the cornea / transparent membrane of the eye /) Dicaine is not used.

In ophthalmological practice, when long-term anesthesia is necessary, eye films with dicaine are used. Each film contains 0.00075 g (0.75 mg) of dicaine.

Dicaine is also used for surface anesthesia in otorhinolaryngological practice during certain surgical interventions (puncture of the maxillary sinus, removal of polyps, conchotomy / removal of the lower or middle turbinate /, surgery on the middle ear). Due to the rapid absorption of dicaine by the mucous membranes of the respiratory tract, great caution should be exercised when using it and carefully monitor the patient's condition. Children under 10 years of age are not anesthetized with Dicaine. In older children

use no more than 1-2 ml of a 0.5-1% solution, in adults - up to 3 ml of a 1% solution (sometimes a 0.25-0.5% solution is sufficient) and only if absolutely necessary - a 2% or 3% solution. To a solution of dicaine (in the absence of contraindications to the use of vasoconstrictors), add 1 drop of a 0.1% solution of adrenaline hydrochloride per 1-2 ml of dicaine. The highest doses of dicaine for adults for anesthesia of the upper respiratory tract are 0.09 g once (3 ml of 3% solution).

Side effect.

The drug is very toxic; caution is required when using it.

Contraindications.

Age up to 10 years, general serious condition of patients. When working with Dicaine, tools and syringes should not contain any alkali residues. Dicaine precipitates in the presence of alkali.

Release form.

Ophthalmic powder and films with dicaine, 30 pieces in dispensing cases.

Storage conditions.

List A. In a well-closed container.

Side effects

With topical use of Dicain, mild allergic reactions, burning sensation, and swelling after instillation are possible.

Dicaine is very toxic (10 times more toxic than novocaine, and 2-5 times more toxic than cocaine). Intoxication with the drug is manifested by anxiety, agitation, convulsions, cardiovascular failure, respiratory distress, nausea, vomiting, and hypotension. In case of overdose, the mucous membrane at the application site should be washed (for this, an isotonic NaCl solution is used) and caffeine and/or another analeptic drug should be administered subcutaneously.

special instructions

If possible, novocaine should be used instead of Dicaine, since it is less toxic.

It is important to remember that solutions containing more than 2% tetracaine can lead to damage to the epithelium of the cornea and significant dilation of conjunctival vessels.

Dicaine may weaken the effect of sulfonamide drugs.

Since the drug is very quickly absorbed by the mucous membranes of the respiratory tract, it is necessary to exercise extreme caution when using it in ENT practice and carefully monitor the patient’s condition.

It is prohibited to administer the solution subarachnoidally.

Medical instruments that come into contact with Dicaine should not contain alkali residues, since tetracaine precipitates under the influence of alkali.

When performing spinal anesthesia with the use of Dicaine, blood pressure monitoring is necessary.

Detailed description of the study

A drug allergy is an abnormal reaction of the human immune system that occurs in response to the ingestion of certain substances contained in a drug into the body. Generally, these substances are harmless to most people.) An allergy to a drug can occur both to the drug itself and to its metabolites. The basis of drug allergies is the immune mechanism.

Allergic reactions account for about 10% of all side effects of drugs. In almost 50% of cases, drug allergies are caused by the use of local anesthetics.

Drugs from the group of local anesthetics are classified according to their chemical structure:

1. Esters: novocaine, procaine, tetracaine;
2. Aminoamides: lidocaine, prilocaine, bupivacaine.

It is known that local anesthetics from the ester group are more allergenic due to their ability to form a metabolite - para-aminobenzoic acid.

Tetracaine (Dicaine) is a drug from the group of local anesthetics. Such drugs reduce the sensitivity of nerve endings at the site of exposure and are widely used in ophthalmological and otorhinolaryngological practice for local anesthesia.

Allergic reactions to tetracaine can be: immediate (occur instantly or in the first hour after the substance enters the body) and delayed type (develop during the first day).

An allergy can manifest itself in the form of a skin rash, accompanied by itching and redness, watery eyes, sneezing, and coughing. Immediate reactions are more dangerous and include:

1. Anaphylactic shock is a life-threatening condition, characterized by a drop in blood pressure, swelling of the tongue, oral mucosa, impaired breathing, consciousness, and pale skin;
2. Quincke's edema: accompanied by swelling of the eyelids, lips, palate, tongue.

An allergic reaction can be aggravated by concomitant pathology and physiological conditions (pregnancy, childhood and old age).

An allergic reaction develops mainly with the participation of immunoglobulins class E (IgE) and class G (IgG). IgE is responsible for the manifestation of immediate allergic reactions. As a rule, allergies are preceded by sensitization (i.e., the first “meeting” with an allergen without characteristic clinical symptoms, during which IgE is produced to a particular substance).

A preliminary diagnosis (allergy to tetracaine) is confirmed using the following diagnostic procedures:

1. Careful collection of allergy history (hereditary history, presence of allergic diseases and reactions to medications);
2. Examination of the patient;
3. Laboratory testing.

To confirm allergic reactions to tetracaine, skin tests and a dosed challenge test (repeated administration of the drug of interest) have traditionally been used. But these studies are used less and less due to a number of limitations.

Determination of specific immunoglobulins of class E to tetracaine in blood serum is a modern and safe laboratory method for confirming an allergy to this anesthetic. The study of specific IgE to tetracaine is carried out by enzyme immunoassay using Dr Fooke test systems.