Amylocaine Hydrochloride 1853 management of acute or chronic pain associated with a well- Spasticity. The management of spasticity (p.1887) involves For the adverse effects of and precautions for central block, see defined anatomical site, especially when the pain is unrespon- physiotherapy and the use of antispastic drugs. Other approaches above. sive to or not adequately controlled by conventional therapy. to treatment include nerve blocks with local anaesthetics; these The route of administration and method used depend on the can improve spasticity but should generally only be used when Peripheral nerve block. Peripheral nerve block anaesthesia site to be blocked but may include peripheral nerve block, au- further muscle relaxation would not increase disability. involves injection into or around a peripheral nerve or plexus tonomic nerve blocks such as sympathetic nerve blocks and supplying the part to be anaesthetised; motor fibres may be coeliac plexus block, and central nerve blocks such as epidur- Stuttering. Local anaesthetics have been tried in the treatment blocked as well as sensory fibres. Brachial plexus block is widely al (including caudal) and spinal block. Local anaesthetics are of stuttering (p.1001). used for procedures involving the arm; lower limb blocks are less used when a temporary effect is required. Neurolytics such as simple although sciatic and femoral blocks may be combined to phenol or alcohol or freezing of the nerve (cryoanalgesia) Local Anaesthetic Techniques permit surgery below the knee. Other peripheral nerve blocks such as those for the head and neck, or intercostal or paraverte- produce more prolonged block, but even so the effects may Local anaesthetics are used in several techniques. In last no more than a few months, and the variable and non- bral blocks for local anaesthesia of the trunk, are mostly highly selective neural damage produced correlates poorly with pain order of increasing level of anaesthesia they are: sur- specialised techniques. Lidocaine, prilocaine, bupivacaine, or relief; some consider the risk of complications to outweigh face or topical anaesthesia; infiltration anaesthesia; and ropivacaine have all been widely used for peripheral nerve the benefits obtained.1 regional nerve block, including peripheral nerve block, blocks. Adrenaline is often added as a vasoconstrictor. The use of nerve blocks in the management of cancer (p.5) has sympathetic nerve block, and central nerve block Pudendal block (usually with prilocaine) may be useful in obstet- declined following the refinement of the use of conventional which includes epidural and spinal (intrathecal or sub- rics before forceps delivery, but as mentioned under Labour Pain analgesics. Some consider that their value may be limited to pa- arachnoid) block. Local anaesthetics may also be given on p.7, the technique of paracervical local anaesthetic block has tients with a life expectancy of 3 months or less2 and that the largely fallen out of favour because of the high incidence of seri- main benefit of nerve blocks in cancer is to produce maximum intravenously for regional anaesthesia in the extremi- ous adverse effects on the fetus. pain relief rapidly. However, others consider that chemical and ties. thermal neurolysis can provide long-term control of severe can- Sympathetic nerve block. Sympathetic nerve block such as cer pain without a substantial incidence of adverse effects.3 Neu- Infiltration anaesthesia stellate ganglion blockade and lumbar sympathectomy is used in rolytic blocks may be of particular value in cancer pain syn- Infiltration anaesthesia is produced by injection of a local anaes- the management of a range of painful conditions and vascular dromes involving the viscera or the torso, but are rarely thetic such as lidocaine or bupivacaine directly into and around diseases (see under Complex Regional Pain Syndrome on p.6). applicable in the management of extremity pain.4 Neuropathic the field of operation without attempting to identify individual Temporary block is obtained using local anaesthetics such as pain is rarely helped by somatic neural block and may even be nerves. The drug used should not be absorbed too rapidly other- lidocaine or bupivacaine but permanent block may be produced aggravated,1 but block of the splanchnic nerves or coeliac plexus wise the anaesthesia will wear off too quickly for practical use; with use of neurolytic agents such as phenol (see Pain, p.1657) with alcohol or phenol is reputed to be effective in relieving se- some local anaesthetics require the addition of a vasoconstrictor or alcohol (see Pain, p.1627). vere intractable pain caused by cancer of the pancreas, stomach, in low concentrations, which can increase the duration of infiltra- tion anaesthesia and reduce peak plasma concentrations of the Surface anaesthesia small intestine, gallbladder, or other abdominal viscera, especial- Surface or topical anaesthesia blocks the sensory nerve endings ly when the cancer has not spread to the parietal peritoneum.5 local anaesthetic. Infiltration anaesthesia is extensively used in dentistry. in the skin or mucous membranes. Many local anaesthetics are Similar neurolytic blocks preceded by a local anaesthetic have effective surface anaesthetics, a notable exception being pro- also been used in patients with severe intractable pain of chronic Anaesthesia of small areas by infiltration techniques requires a caine. Penetration of intact skin by most local anaesthetics is pancreatitis, postcholecystectomy syndrome, or other chronic relatively large amount of local anaesthetic, which is not a prob- poor whereas absorption through mucous membranes may be abdominal visceral diseases unrelieved by medical or surgical lem for minor surgery but would be for more extensive areas that rapid. However, reliable percutaneous anaesthesia can be therapy. required anaesthesia. The amount of local anaesthetic used can achieved by application of a eutectic mixture of lidocaine and Central nerve blocks using local anaesthetics with or without be reduced and the duration of anaesthesia increased by blocking prilocaine to intact skin (see under Surface Anaesthesia in Lido- opioids are used for the management of acute pain such as la- specific nerves that innervate the area. This may be carried out at caine, p.1866). Eutectic mixtures may be of value in providing bour pain (p.7) and postoperative pain (p.4) including that in several levels. In field block anaesthesia subcutaneous injection surface anaesthesia for a number of minor medical or surgical children (p.3); they are also sometimes used for cancer pain.1,6 of a local anaesthetic close to the nerves around the area to be procedures. Tetracaine also provides reliable percutaneous anaesthetised blocks sensory nerve paths. This is a form of infil- Sympathetic nerve blocks using repeated injections of local anaesthesia. Other methods of dermal delivery of local anaes- tration anaesthesia, but the technique requires less drug for a giv- thetics include a transdermal patch of lidocaine (either alone or anaesthetics or neurolytics have been used for sympathetically en area to be anaesthetised. maintained pain. Intravenous regional sympathetic block is an with tetracaine), an iontophoretic drug delivery system incorpo- alternative when a single limb is involved;1 guanethidine is one Intravenous regional anaesthesia rating lidocaine and adrenaline. Anaesthesia of the skin and of the drugs that has been used.7 Intravenous regional anaesthesia (Bier’s block) involves injec- subcutaneous tissues is also discussed under Infiltration Anaes- thesia, above. Injections of local anaesthetics with or without corticosteroids tion of a dilute solution of local anaesthetic into a suitable limb are often used for blocks of localised painful joints. Nerve blocks vein after exsanguination and application of a tourniquet, in There are a number of special uses of topical anaesthesia includ- are also used to block localised painful trigger areas8 such as order to produce anaesthesia distal to it. Arterial flow must re- ing anaesthetising the cornea during ophthalmological proce- postoperative or post-traumatic neuroma formation and for focal main occluded for at least 20 minutes after injection and adrena- dures and the throat and larynx before intubation and bronchos- muscle pain. line should not be used. Intravenous regional anaesthesia may be copy. Absorption from the respiratory tract is rapid and care is For the role of nerve blocks in the management of low back pain, used for short procedures where postoperative pain is not essential to avoid giving a toxic dose. Great care is also necessary see p.7. marked, such as manipulation of fractures and minor surgical when using local anaesthetics to anaesthetise the urethra; if trau- procedures to the limbs. Although a safe procedure when per- ma has occurred, rapid absorption of the drug may occur and 1. Hanks GW, Justins DM. Cancer pain: management. Lancet 1992; 339: 1031–6. formed correctly, complications have arisen; there have been fa- give rise to serious adverse effects. 2. WHO. Cancer pain relief and palliative care: report of a WHO talities associated with the use of bupivacaine, and prilocaine is Local anaesthetics have been included in topical preparations to expert committee. WHO Tech Rep Ser 804, 1990. Also available the drug of choice. Facilities for resuscitation should be availa- relieve the pain of haemorrhoids (p.1697) but good evidence of at: http://libdoc.who.int/trs/WHO_TRS_804.pdf (accessed ble. their efficacy is lacking. Similar uses include pain relief in pruri- 11/08/08) 3. American Society of Anesthesiologists Task Force on Pain Man- Regional nerve block tus ani and anal fissure. Excessive application of local anaesthet- agement, Cancer Pain Section. Practice guidelines for cancer Regional nerve block anaesthesia involves specific blocks at the ics to the rectal mucosa should be avoided as absorption can oc- pain management. Anesthesiology 1996; 84: 1243–7. Also avail- levels of major nerves or spinal roots, and may include peripheral cur; use for periods of no longer than a few days is recommended able at: http://www.asahq.org/publicationsAndServices/ nerve block, sympathetic nerve block, and central nerve block to prevent sensitisation of the anal skin. Local anaesthetics are cancer.html (accessed 11/08/08) including epidural and spinal block. For a discussion of the use sometimes included in topical preparations for the relief of pru- 4. Marshall KA. Managing cancer pain: basic principles and inva- of nerve blocks in the management of pain, see Nerve Blocks, ritus (p.1582). However, they are only marginally effective and sive treatments. Mayo Clin Proc 1996; 71: 472–7. can very occasionally cause sensitisation. The use of local anaes- 5. Bonica JJ. Management of pain with regional analgesia. Post- above. grad Med J 1984; 60: 897–904. thetics in rubefacient and topical analgesic preparations is men- 6. Hunt R, Massolino J. Spinal bupivacaine for the pain of cancer. Central nerve block. Central nerve block includes epidural tioned on p.5. Med J Aust 1989; 150: 350. and spinal block. 7. Hannington-Kiff JG. Relief of causalgia in limbs by regional in- Epidural block (also referred to as extradural or peridural block) travenous guanethidine. BMJ 1979; 2: 367–8. is widely used to provide analgesia or anaesthesia in surgical and 8. Foley KM. The treatment of cancer pain. N Engl J Med 1985; (BANM) 313: 84–95. obstetric procedures. It involves injecting a local anaesthetic Amylocaine Hydrochloride such as lidocaine, bupivacaine, or ropivacaine, alone or with a Amilocaína, hidrocloruro de; Amyleinii Chloridum; Amylocain. Postherpetic neuralgia. For the role of local anaesthetics in small dose of an opioid analgesic into the epidural space in the the management of postherpetic neuralgia, see p.9. lumbar, sacral (caudal block), thoracic, or cervical regions. Intro- Hydrochlor.; Chlorhydrate d’Amyléine. 1-(Dimethylaminome- thyl)-1-methylpropyl benzoate hydrochloride. Premature ejaculation. A cream containing lidocaine 2.5% duction of a cannula into the epidural space enables prolonged and prilocaine 2.5% has been applied topically to the penis for a analgesia or anaesthesia (epidural anaesthesia) to be provided C14H21NO2,HCl = 271.8. desensitising effect in the management of premature ejaculation through the use of ‘top-up’ doses or continuous infusion of the CAS — 532-59-2 (amylocaine hydrochloride); 644-26-8 (p.2181). The cream is usually applied to the penis and covered drugs. A vasoconstrictor is sometimes added to reduce systemic (amylocaine hydrochloride). exposure to the local anaesthetic. A test dose at the intended in- with a condom for a period of time, then washed off before sex- Profile ual intercourse. It has been reported to increase intravaginal ejac- jection site is recommended before starting epidural anaesthesia 1 to ensure that the main dose is not accidentally injected intravas- Amylocaine, a benzoic acid ester, is a local anaesthetic (p.1850) ulatory latency time compared with a placebo cream, and a used mainly as the hydrochloride in a range of preparations for study2 cularly or into the subarachnoid space. of different application times found 20 minutes to be the application to the skin or mucous membranes. It has also been optimum. Longer application times were associated with erec- Spinal block (also referred to as subarachnoid or intrathecal used in preparations for the relief of painful anorectal conditions tion loss because of numbness of the penis, and delayed ejacula- block) is produced by injecting a solution of a suitable drug such and has been included in oral mixtures for the relief of coughs. tion. Decreased vaginal sensitivity in female partners, from re- as bupivacaine within the spinal subarachnoid space, causing sidual anaesthetic, has also been reported.1 temporary paralysis of the nerves with which it comes into con- Preparations 1. Busato W, Galindo CC. Topical anaesthetic use for treating pre- tact. It may be used, for example, to produce spinal anaesthesia Proprietary Preparations (details are given in Part 3) mature ejaculation: a double-blind, randomized, placebo-con- in surgical procedures on the lower body. Vasoconstrictors have trolled study. BJU Int 2004; 93: 1018–21. been added to prolong the duration of the block but the effect is Fr.: Dolodent. 2. Atikeler MK, et al. Optimum usage of prilocaine-lidocaine not always clinically useful and there is a danger of restricting the Multi-ingredient: Belg.: Dentophar; Odonto-Baby; Rectovasol; Braz.: cream in premature ejaculation. Andrologia 2002; 34: 356–9. blood supply to the spinal cord; therefore this practice is not rec- Fonergin; Hemodotti; Cz.: Avenoc; Fr.: Collustan†; Elenol; Parkipan†; Pul- Soft-tissue rheumatism. For the adjunctive use of local ommended. The somatic level at which anaesthesia occurs de- moll; Hong Kong: Frazoline; Ital.: Dentinale; Proctosedyl; Spain: Hemo- dren Compuesto†; Thai.: Bacal; Basina; Biochin†; Izac†; Medcin; Mybacin. anaesthetics in the management of soft-tissue rheumatism, see pends on many factors including the specific gravity or baricity p.13. of the anaesthetic solution used and the positioning of the patient. The symbol † denotes a preparation no longer actively marketed The symbol ⊗ denotes a substance whose use may be restricted in certain sports (see p.vii) 1854 Local Anaesthetics

Articaine Hydrochloride (BANM, USAN, rINNM) Adverse Effects and Treatment Anbesol Maximum Strength; Antibiotic Cold Sore Ointment; Appedrine†; As for Local Anaesthetics in general, p.1850. Auralgan; Bionet; Boil Ease†; Cepacol Extra Strength; Chloraseptic Lozeng- 40045; Articaïne, chlorhydrate d’; Articaini hydrochloridum; Ar- es; Dexatrim†; Endospray†; Kank-A; Lanacane Medicated Cream; Onrectal; tikaiinihydrokloridi; Artikain Hidroklorür; Artikain-hidroklorid; Abuse. Benzocaine has been used as an adulterant or ‘cutting’ Orajel Mouth Sore Medicine; Orajel Ultra Mouth Sore; Osmopak-Plus; Ox- agent in the preparation of cocaine for illicit use and adverse ef- ipor; Rectogel; Rectogel HC; Solarcaine; Sore Throat Lozenges; Tanac; Artikain-hydrochlorid; Artikainhydroklorid; Artikaino hidrochlo- Thermo-Gel; Throat Lozenges; Thunas Pile†; Vagisil; Chile: Aucusik; Cari- ridas; Carticaine Hydrochloride; Carticaini Hydrochloridum; fects such as methaemoglobinaemia have been seen after co- amyl; Kank-Eze; Konirub; Lerfimin; Medikem†; Orajel Compuesto†; Otan- 1 Hidrocloruro de articaína; Hoe-045; Karticainhydroklorid; Kar- caine overdosage as a result of the benzocaine content. drol; Solarcaine Spray Aerosol; Cz.: Dr Rentschler Halstabletten†; Herbadent; Hexoral; Hexoraletten N; Denm.: Dolodent; Hexokain; Fin.: tikaiinihydrokloridi; Kartikain Hidroklorür. Methyl 4-methyl-3-(2- 1. McKinney CD, et al. Benzocaine-adultered street cocaine in as- sociation with methemoglobinemia. Clin Chem 1992; 38: 596–7. Bafucin; Toncils; Fr.: Nestosyl; Sedorrhoide; Ger.: Anaesthesin-Rivanol; propylaminopropionamido)thiophene-2-carboxylate hydrochlo- Combustin Heilsalbe; Dolo-Dobendan; Dorithricin Original; Eulatin NN; ride. Hypersensitivity. The incidence of positive reactions in pa- Frubizin Forte†; Gelum†; Hexoraletten N; Inspirol Halsschmerztabletten†; tients patch tested with benzocaine has ranged from 3.3 to Nordapanin N†; Nordathricin N†; Salistoperm†; Stipo†; Trachiform†; Tyro- Артикаина Гидрохлорид 1,2 solvetten†; Gr.: Myalgesic†; Hong Kong: Borraginol-N; Pharynx; Setrong- 5.9%. Patch testing with benzocaine has been recommended es†; Tyricine; Tyrocaine; Tyrothricin Co; Hung.: Almagel A; Dorithricin; In- C13H20N2O3S,HCl = 320.8. by The International Contact Dermatitis Research Group as an dia: Chloromycetin Ear Drops; Clearwax; Healex; Nit-N-Mite†; Paraxin CAS — 23964-58-1 (articaine); 23964-57-0 (articaine indicator of contact hypersensitivity to local anaesthetics. How- Ear†; Perfocyn; Proctosedyl; Scaboma; Tytin; Waxolve; Indon.: Benzomid; hydrochloride). ever, it was found that of 40 patients who had had positive reac- Borraginol-N; Borraginol-S; FG Ointment; Otolin; Irl.: Dequacaine; Mero- ATC — N01BB08. tions to benzocaine with tetracaine and cinchocaine, 21 were not caine; Tyrozets; Israel: Anadent†; Dentin; Gingisan; Hemo; Kalgaron; Kank- 3 A; Noxacorn; Otomycin; Proctozorin-N; Pronestin; Rafathricin with Benzo- ATC Vet — QN01BB08. allergic to benzocaine alone. caine; Rectozorin; Ital.: Antiscabbia Candioli al DDT Terapeutico; Antiscab- 1. Rudzki E, Kleniewska D. The epidemiology of contact dermati- bia CM; Boma; Dentosedina; Fialetta Odontalgica Dr Knapp; Foille Scottat- tis in Poland. Br J Dermatol 1970; 83: 543–5. ure; Foille Sole; Golamixin; Labocaina; Pinselina Knapp; Prepacort H; Preparazione Antiemorroidaria†; Proctidol; Proctosedyl; Proctosoll; CH3 2. Bandmann H-J, et al. Dermatitis from applied medicaments. Arch Dermatol 1972; 106: 335–7. Sedalen Cort†; Sedilene Procto†; Malaysia: Cetylpyridinium B; Horf; Phar- ynx; Setronges†; Mex.: Cepacaina; Cloran Otico; Graneodin D Mentol; O H3C 3. Beck MH, Holden A. Benzocaine—an unsatisfactory indicator O Ofodex; Otifar; Otolone†; Soldrin; Sufrexal P; Trociletas B; NZ: Auralgan; of topical local anaesthetic sensitization for the UK. Br J Derma- Cepacaine; Cepacol Anaesthetic; Cepacol Cough Discs; Lanacane; Solar- tol 1988; 118: 91–4. caine; Toothache Drops†; Philipp.: Auralgan; United Home Burn Oint- ment; Pol.: Dentosept A; Dermopur; Hemorol; Icy Rub; Puder Plynny; S Precautions Puder Plynny z Anestezyna; Pudroderm; Pudrospan; Rectosec; Sanofil; Sa- NH NH As for Local Anaesthetics in general, p.1851. poven AT; Savarix; Septolete Plus; Variderm; Port.: Afonina; Anginova; Claudemor†; Dek; Dropcina; Halitol†; Hibitane Menta†; Hibitane†; Medi- Interactions fon; Mentocaina R; Otoceril; Solpic†; Tantum Verde; Rus.: Almagel A H CO CH For interactions associated with local anaesthetics, see p.1851. (Алмагель А); Anaesthesol (Анестезол); Heparin Ointment 3 3 (Гепариновая Мазь); Nigepan (Нигепан); Septolete Plus (Септолете Pharmacokinetics Плюс); S.Afr.: AAA†; Auralyt; Aurasept; Aurone Forte; Benzet†; Calasthet- (articaine) See under Local Anaesthetics, p.1852. ic; Cepacaine; Cepacol Cough Discs; Cetoxol; Covancaine; Covotop; End- col Lozenges; Histamed; Medi-Kain†; Medi-Keel A; Orochlor; Otised; Oto- Uses and Administration Phen Forte; Oxipor VHC; Prodol; Trochain; Viodor; Singapore: Pharmacopoeias. In Eur. (see p.vii). Benzocaine, a para-aminobenzoic acid ester, is a local anaesthet- Dorithricin; Pharynx; Spain: Angileptol; Antihemorroidal; Bucodrin; Buco- Ph. Eur. 6.2 (Articaine Hydrochloride). A white or almost white ic used for surface anaesthesia (p.1853); it has low potency and metasana; Bucospray; Callicida Rojo; Callivoro Marthand; Callix; Caltoson crystalline powder. Freely soluble in water and in alcohol. A 1% low systemic toxicity. It is used, often with other drugs such as Balsamico; Cicatral; Cremsol; Dentikrisos; Diformiltricina; Drill; Edifaringen; solution in water has a pH of 4.2 to 5.2. Protect from light. Faringenilo; Faringesic; Gargaril; Garydol; Gradin Del D Andreu†; Grietal- analgesics, antiseptics, antibacterials, antifungals, and antiprurit- gen; Grietalgen Hidrocort†; Hemoal; Hemodren Compuesto†; Hibitane; Profile ics, for the temporary local relief of pain associated with dental Mastiol; Miozets; Nasopomada; Neo Analsona; Oto Difusor†; Oto Vitna†; Articaine hydrochloride is an amide local anaesthetic (p.1850). It conditions, oropharyngeal disorders, haemorrhoids, anal pruri- Otocerum; Otonina†; Otosedol Biotico; Pastillas Koki Ment Tiro; Phonal; tus, and ear pain. Sedofarin; Topicaina†; Tos Mai; Vicks Formula 44†; Swed.: Bafucin; Switz.: has been used as a 1 or 2% solution with or without adrenaline Benzocaine PD; Neocones; Thai.: Auralgan†; Doproct; Iwazin; Sigatricin; for infiltration and regional anaesthesia. A 4% solution of artic- Lozenges containing benzocaine in usual doses of up to 10 mg Trocacin; Troneo†; Turk.: Emedur; Kataljin; Kortos; Ma-Ka-Ta; UK: An- aine hydrochloride with adrenaline is used similarly in dentistry. are used for the relief of sore throat. Gels, pastes, solutions, and thisan Plus; Dequacaine; Intralgin†; Merocaine; Rinstead; Solarcaine; Tyro- A hyperbaric solution of articaine hydrochloride with glucose sprays containing benzocaine in concentrations of up to 20% zets; Wasp-Eze; USA: Aerocaine†; Allergen; Americaine First Aid†; Anbesol; Anbesol Cold Sore Therapy; Auralgan; Auroguard Otic; Auroto†; has been used for spinal block. have been used for surface anaesthesia of the mouth and throat. Babee; Bicozene; Boil Ease; Boyol Salve; Calamycin; Cepacol Anesthetic; Ce- Porphyria. Articaine hydrochloride is considered to be unsafe Benzocaine is used in ear drops, creams, ointments, lotions, pacol Maximum Strength Sore Throat; Cepacol Ultra Sore Throat Plus solutions, sprays, gels, and suppositories in concentrations up to Cough; Cetacaine; Chiggerex; Chloraseptic Sore Throat; Cough-X; Cy-Ge- in patients with porphyria because it has been shown to be por- sic; Cylex; Dendracin Neurodendtraxcin; Dentapaine; Dermacoat; Der- phyrinogenic in in-vitro systems. 20% for topical analgesia and anaesthesia. masept Antifungal; Dermoplast Antibacterial; Double-Action Toothache Benzocaine has also been used as the hydrochloride. Kit; Foille; Fungi-Nail; Hem-Prep; Kank-A; Legatrin Rub; Lipmagik; Maximum Preparations Strength Anbesol; Medicone Derma†; Numzit†; Orabase Lip; Orajel Mouth Obesity. It has been reported1 that despite the inclusion of ben- Aid; Orajel PM; Orasept; Orasol; Otocalm†; Pazo; Rectagene Medicated Proprietary Preparations (details are given in Part 3) zocaine in some over-the-counter appetite suppressants there is Rectal Balm; Rid-a-Pain; Solarcaine; Soothaderm; Sting-Eze; Sting-Kill; Tanac; Austria: Septanest; Ubistesin; Ultracain Dental; Belg.: Ubistesin†; Canad.: no good evidence of its value in obesity (p.2149). Tanac Dual Core; Therevac Plus; Tigan†; Toothache Gel; Triban†; Tympag- Astracaine†; Cz.: Septanest S; Supracain; Ubistesin; Ultracain D-S†; Ult- esic†; Unguentine Maximum Strength; Vagi-Gard Medicated Cream; Vagisil; racain†; Denm.: Septanest; Septocaine; Ubistesin; Fin.: Septocaine; Ubis- 1. Anonymous. A nasal decongestant and a local anesthetic for Z-Xtra; Venez.: Claudemor†; Otan; Otofrin†. tesin; Ultracain D-Suprarenin; Fr.: Alphacaine; Predesic†; Ubistesin Adren- weight control? Med Lett Drugs Ther 1979; 21: 65–6. alinee; Ger.: Ubistesin; Ultracain; Ultracain D-S; Ultracain hyperbar†; Ultracain Suprarenin; Hong Kong: Ubistesin; Hung.: Ubistesin; Ultracain Preparations D-S; Ital.: Alfacaina; Cartidont; Citocartin; Primacaine†; Sarticain; Sep- USP 31: Antipyrine and Benzocaine Otic Solution; Antipyrine, Benzocaine, tanest; Ubistesin; Neth.: Septanest; Ubistesin; Ultracain D-S; Norw.: Sep- and Phenylephrine Hydrochloride Otic Solution; Benzocaine and Menthol Bupivacaine Hydrochloride tocaine; NZ: Septanest; Port.: Alphacaine; Artinibsa; Artinostrum; Megan- Topical Aerosol; Benzocaine Cream; Benzocaine Gel; Benzocaine Lozenges; est; Septanest; Ubistesin; Rus.: Ultracain (Ультракаин); Spain: Articaina Benzocaine Ointment; Benzocaine Otic Solution; Benzocaine Topical Aer- (BANM, USAN, rINNM) C/E; Meganest; Ultracain; Switz.: Alphacaine; Rudocaine; Septanest; Ubis- osol; Benzocaine Topical Solution; Benzocaine, Butamben, and Tetracaine tesin; Ultracaine D-S; Turk.: Ultracain; UK: Septanest; USA: Septocaine. Hydrochloride Gel; Benzocaine, Butamben, and Tetracaine Hydrochloride AH-2250; Bupivacaïne, chlorhydrate de; Bupivacaini hydrochlori- Ointment; Benzocaine, Butamben, and Tetracaine Hydrochloride Topical Aerosol; Benzocaine, Butamben, and Tetracaine Hydrochloride Topical So- dum; Bupivacaini Hydrochloridum Monohydricum; Bupivakaiini- lution. hydrokloridi; Bupivakain Hidroklorür; Bupivakain-hidroklorid; Benzocaine (BAN, rINN) Proprietary Preparations (details are given in Part 3) Bupivakain-hydrochlorid monohydrát; Bupivakainhydroklorid; Anaesthesinum; Anestezin; Anesthamine; Bensokain; Bentsokaii- Arg.: Cerax; Lanacaina†; Lodoc; Austral.: Applicaine; Austria: Anaestherit; Bupivakaino hidrochloridas; Bupiwakainy chlorowodorek; Hidro- Braz.: Solarcaine; Canad.: Anbesol; Anbesol Baby; Anbesol Extra cloruro de bupivacaína; LAC-43; Win-11318. (±)-(1-Butyl-2-pip- ni; Benzocaína; Benzocaïne; Benzocainum; Benzokain; Benzokai- Strength; Baby Orajel; Detane†; Maintain; ManDelay; Orajel; Outgro; Zilac- na; Benzokainas; Ethoform; Éthoforme; Ethyl Aminobenzoate; tin Baby; Zilactin Tooth & Gum Pain Reliever; Zilactin Toothache Swab; eridyl)formo-2′,6′-xylidide hydrochloride monohydrate. Ethylis Aminobenzoas. Ethyl 4-aminobenzoate. Zilactin-B; Chile: Anbesol; Baby Orajel†; BBdent Gel Topico; Dentispray; Бупивакаина Гидрохлорид Foille; Kalmafta; Orajel†; Cz.: Babydent; Ger.: Anaesthesin; Anaesthesin N; Бензокаин Flavamed Halstabletten†; Kontakto Derm†; Labocane; Subcutin N; Zahne- C18H28N2O,HCl,H2O = 342.9. rol N†; Hung.: Babydent; Israel: Anadent; Baby Gel; Lanacane; Maintain; C9H11NO2 = 165.2. Mex.: Auralyt; Gomas Garde B; Graneodin B; NZ: Solarcaine; Pol.: Baby CAS — 2180-92-9 (bupivacaine); 18010-40-7 (anhydrous CAS — 94-09-7. Orajel; Orajel; Port.: Dentispray; Topigel; Rus.: Relief Advance (Релиф bupivacaine hydrochloride); 14252-80-3 (bupivacaine hy- ATC — C05AD03; D04AB04; N01BA05; R02AD01. Адванс); S.Afr.: Kiddigum; Spain: Dentispray; Gartricin†; Hurricaine; Lana- drochloride monohydrate). cane; Nani Pre Dental; UK: AAA; Burneze; Lanacane; Orajel; Ultra Chlo- ATC Vet — QC05AD03; QD04AB04; QN01AX92; raseptic; Ultracare; USA: Americaine Anesthetic†; Americaine Otic†; ATC — N01BB01. QN01BA05; QR02AD01. Americaine†; Baby Anbesol; Baby Orajel; Benz-O-Sthetic; Benzodent; Chig- ATC Vet — QN01BB01. ger-Tox; Dent’s Extra Strength Toothache Gum; Dent’s Maximum Strength Toothache Drops; Dent-O-Kain; Dermoplast; Detane; Hurricaine; Lana- O cane; Medicone; Mycinettes; Numzident†; Orabase Baby; Orabase Gel; Orabase-B; Orajel; OraMagic Plus; Otocain; SensoGARD; Trocaine; Zilac- H3C H3C tin-B Medicated. O O CH3 Multi-ingredient: Arg.: Adermicina; Adermicina A; Algiodent; Angi- notrat; Apracur Bucofaringeo†; Arnecrem†; Aseptobron Caramelos; Asep- N tobron N; Bagociletas; Balsamina; Bucoangin N; Bucotricin; Caext; Callicida; N Caramelos Antibioticos; Caramelos Antibioticos Lefmar; Caramelos Orien- H2N H tal; Carnot Colutorio; Cartiflex; Collubiazol; Coltix†; Cristalomicina; Dermo CH3 Vagisil Crema; Dermosan; Detebencil; Dotrin; Esculeol P; Esmedent con NOTE. The following terms have been used as ‘street names’ (see Fluor; Fanaletas; Filotricin A; Flebotropin†; Fonergine; Gargaletas; Graneod- p.vi) or slang names for various forms of benzocaine: in; Graneodin N; Hexa-Defital; Iodotiazol†; Leroid†; Lyndan; Muco-Ane- (bupivacaine) styl†; Mucobase; Muelita; Nene Dent; Neo Coltirot; No-Tos Pocket; Oral- Coco snow. sone C; Otocalmia; Otoseptil; Parencias†; Pastillas Lorbi; Pastillas Medex; Pharmacopoeias. In Chin., Eur. (see p.vii), Int., Jpn, and US. Pruripelen†; Pulmosan Caramelos; Razagleda Plus†; Salicrem; Sapucai†; Pharmacopoeias. In Chin., Eur. (see p.vii), Int., and US. Ph. Eur. 6.2 (Benzocaine). Colourless crystals or a white or al- Suavisan N; Suavisan†; Sulfanoral T; Tavinex; Austral.: Animine; Auralgan; Ph. Eur. 6.2 (Bupivacaine Hydrochloride). A white or almost Ayrton’s Chilblain; Cepacaine; Cepacol Anaesthetic; Cepacol Cough & Sore most white, crystalline powder. M.p. 89° to 92°. Very slightly Throat; Cornkil†; Le Trim-BM†; Nyal Toothache Drops; Rectinol; Austria: white, crystalline powder or colourless crystals. Soluble in water; soluble in water; freely soluble in alcohol. Protect from light. Dequalinetten; Dorithricin; Herposicc; Sulgan 99; Tyrothricin comp; Ty- freely soluble in alcohol. Protect from light. USP 31 (Benzocaine). Small, white crystals or a white odourless rothricin compositum; Belg.: Transvane; Braz.: Albicon; Amidalin†; Amigd- USP 31 (Bupivacaine Hydrochloride). A white, odourless, crys- crystalline powder. M.p. 88° to 92°. Soluble 1 in 2500 of water, agen; Amigdamicin†; Andolba; Anginotricin; Bromil; Cepacaina; Cetildrops†; talline powder. Freely soluble in water and in alcohol; slightly Claudemor; Dentalivio†; Dequadin; Fenotricin†; Gargotan†; Gingilone; Lar- 1 in 5 of alcohol, 1 in 2 of chloroform, 1 in 4 of ether, and 1 in 30 intil†; Malvatricin Pastilhas; Malvona†; Mentozil†; Mirorroidin†; Neopiridin; soluble in acetone and in chloroform. A 1% solution in water has to 50 of almond oil or olive oil; dissolves in dilute acids. Otovix†; Passilin†; Predmicin; Sanilin; Senol†; Silencium; Traumac; Canad.: a pH of 4.5 to 6.0.