Xylocaine

Xylocaine 2% Jelly is a local anesthetic used to temporarily numb certain areas of the body. It is used as an anesthetic lubricant to insert instruments in the human body for medical procedures (e.g., catheters). It is also used for the treatment of symptoms of painful inflammation of the urethra and bladder. Xylocaine Jelly 2% works by temporarily numbing the skin and surrounding area. If this cream is not enough, may be used injection form of this medicine to provide pain relief for some procedures such as the removal of genital warts. While the active ingredient is Lidocaine, it also contains other inactive ingredients such as carbomer, macrogol glycerol hydroxylstearate, sodium hydroxide, purified water, and others. Xylocaine Jelly 2% belongs to the class of medications called local anesthetics.

Product dosage: 50 gm
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Synonyms Xylocaine Jelly 2% 30gm Xylocaine Jelly 2% 50gm Easycainnie 2% Jelly 30gm

Xylocaine (lidocaine hydrochloride) is a leading amide-type local anesthetic agent trusted by healthcare professionals worldwide for its rapid onset, predictable duration, and well-established safety profile. It is indicated for the production of local or regional anesthesia by infiltration injection, nerve block, and in specific topical formulations. As a cornerstone in pain management strategies across various medical and dental disciplines, Xylocaine provides effective sensory blockade, facilitating a wide range of diagnostic and therapeutic procedures with enhanced patient comfort. Its mechanism of action involves the reversible inhibition of sodium ion influx through nerve cell membranes, thereby preventing the initiation and conduction of nerve impulses.

Features

• Active Ingredient: Lidocaine Hydrochloride.
• Chemical Classification: Amide-type local anesthetic.
• Formulations: Available in multiple concentrations and delivery forms, including injectable solutions (with or without epinephrine), topical ointments, jellies, and sprays.
• Onset of Action: Rapid onset, typically within 2-5 minutes for injectable forms, depending on the technique and concentration used.
• Duration of Action: Provides a predictable and controllable duration of anesthesia, which can be extended with the use of vasoconstrictors like epinephrine.
• pH Adjustment: Formulations are buffered to enhance stability and comfort upon administration.
• Preservation: Contains methylparaben or similar agents as preservatives in multi-dose vials (note: single-dose vials are preservative-free).

Benefits

• Efficient Procedural Workflow: The rapid onset of action allows medical and dental professionals to begin procedures quickly, optimizing clinical time and improving patient throughput.
• Superior Patient Comfort: Effectively blocks pain signals at the site of application or injection, significantly reducing discomfort and anxiety associated with needles, minor surgeries, and other interventions.
• Precise and Predictable Anesthesia: Offers reliable depth and duration of sensory blockade, allowing clinicians to confidently plan and execute procedures with a known window of efficacy.
• Versatile Application: Its availability in various concentrations and with vasoconstrictors makes it suitable for a broad spectrum of techniques, from superficial infiltration to deeper nerve blocks.
• Well-Established Safety Profile: With decades of clinical use and extensive research, its pharmacokinetics, pharmacodynamics, and adverse effect management are thoroughly understood by healthcare providers.

Common use

Xylocaine is ubiquitously employed in medical and dental practice for local and regional anesthesia. Common applications include:

• Infiltration Anesthesia: For numbing a specific, localized area, such as prior to suturing lacerations, performing skin biopsies, excising small lesions, or placing intravenous lines.
• Nerve Block Anesthesia: For blocking sensation in a larger area supplied by a specific nerve or nerve plexus, such as digital blocks for finger/toe procedures, dental blocks (e.g., inferior alveolar nerve block), or intercostal nerve blocks.
• Topical Anesthesia: For surface analgesia on accessible mucous membranes of the mouth, pharynx, larynx, respiratory tract, urethra, and rectum. Used prior to endoscopies, catheter insertions, or to alleviate pain from minor abrasions.
• Obstetric Procedures: For pudendal block and local infiltration during episiotomy and repair.
• Surgical Anesthesia: As a component of tumescent anesthesia for liposuction and for other minor surgical procedures.

Dosage and direction

Dosage varies significantly based on the procedure, tissue vascularity, area to be anesthetized, individual patient tolerance, and the specific formulation (plain or with epinephrine). The smallest dose and lowest concentration that provides effective anesthesia should always be used.

• For Infiltration and Nerve Block: The maximum recommended dose for a healthy adult is 4.5 mg/kg (not to exceed 300 mg) of lidocaine without epinephrine. When combined with epinephrine 1:100,000 to 1:200,000, the maximum dose can be extended to 7 mg/kg (not to exceed 500 mg). Doses must be reduced for debilitated, elderly, or pediatric patients and for those with significant hepatic impairment.
• Administration Technique: Aspiration must be performed before injection to avoid intravascular administration. Injection should be made slowly and with frequent aspiration.
• Topical Administration: Applied in a thin layer to the desired area. Dosage is based on concentration and surface area; care must be taken to avoid excessive application, which can lead to systemic absorption.

Precautions

• Resuscitative Equipment: Equipment and drugs necessary for monitoring and managing cardiorespiratory emergencies (e.g., oxygen, suction, endotracheal tubes, vasopressors, anticonvulsants) must be immediately available.
• Patient Evaluation: A thorough history should be taken to assess suitability, including history of drug sensitivities, allergies (particularly to amide-type anesthetics), and concurrent medical conditions.
• Vascularity and Absorption: Use with extreme caution in areas of high vascularity, inflamed or infected tissues, and patients with severe shock or heart block, as systemic absorption is increased.
• Metabolism: Use caution in patients with hepatic disease, as lidocaine is metabolized primarily in the liver. Reduced doses may be necessary.
• Malignant Hyperthermia: While lidocaine is not a triggering agent, standard monitoring for this condition is advised during any anesthetic procedure.
• Pregnancy and Lactation: Use only if clearly needed. Lidocaine crosses the placental barrier and is excreted in breast milk; the benefit must justify the potential risk to the fetus or infant.

Contraindications

Xylocaine is contraindicated in patients with:

• A known history of hypersensitivity to lidocaine hydrochloride or any other component of the formulation (e.g., methylparaben in multi-dose vials).
• A known history of hypersensitivity to other amide-type local anesthetics.
• The presence of severe shock or heart block.
• The injectable form is contraindicated for spinal anesthesia (epidural or subarachnoid block) and intravenous regional anesthesia (Bier Block) unless the specific product is labeled for such use.
• Application to infected or traumatized areas for topical anesthesia, as systemic absorption may be enhanced.

Possible side effect

Adverse reactions are generally dose-related and result from high plasma levels due to excessive dosage, rapid absorption, inadvertent intravascular injection, or impaired metabolic degradation.

• Central Nervous System: Nervousness, dizziness, blurred vision, tremors, drowsiness, convulsions, unconsciousness, respiratory depression and arrest. excitability may be the first sign of toxicity.
• Cardiovascular System: Bradycardia, hypotension, arrhythmias, including ventricular fibrillation, and cardiovascular collapse, which can lead to cardiac arrest.
• Allergic Reactions: Urticaria, edema, anaphylactoid reactions. True anaphylaxis is rare and is more commonly associated with ester-type anesthetics.
• Local Reactions: Pain at the injection site, persistent sensory or motor deficits (e.g., paresthesia, weakness) which are usually transient but can be prolonged or permanent in rare cases.

Drug interaction

• Antiarrhythmics: Concurrent use with other Class IB antiarrhythmic drugs (e.g., mexiletine, tocainide) may have additive cardiotoxic effects.
• Beta-Blockers: Propranolol and metoprolol can decrease lidocaine metabolism, potentially leading to increased plasma levels and toxicity.
• Cimetidine: Can reduce lidocaine metabolism and clearance, increasing the risk of adverse effects.
• Vasoconstrictors: The addition of epinephrine to lidocaine can interact with drugs that affect vascular tone, such as tricyclic antidepressants (potentiating pressor response) and non-selective beta-blockers (potentiating alpha-adrenergic activity, leading to hypertension and bradycardia).
• CNS Depressants: Sedatives, hypnotics, opioids, and general anesthetics may have additive CNS depressant effects with lidocaine.

Missed dose

The concept of a “missed dose” is not applicable to Xylocaine, as it is administered as a single procedure-based treatment by a healthcare professional, not as a chronic, self-administered medication.

Overdose

Overdose is a medical emergency primarily manifesting as CNS and cardiovascular toxicity.

• Symptoms: Initially may include CNS excitation (nervousness, dizziness, blurred vision, tremors, convulsions) followed by CNS depression (drowsiness, unconsciousness, respiratory arrest). Cardiovascular effects include hypotension, bradycardia, arrhythmias, and cardiac arrest.
• Management:
  1. Airway Management: Ensure a patent airway and administer oxygen. Assist or control ventilation as required.
  2. Seizure Control: Administer a benzodiazepine (e.g., diazepam, midazolam) IV. If seizures persist despite benzodiazepines, consider barbiturates or propofol. Succinylcholine may be needed to facilitate intubation but does not stop CNS seizure activity.
  3. Cardiovascular Support: Treat hypotension and bradycardia with IV fluids and vasopressors (e.g., ephedrine, norepinephrine). Treat arrhythmias according to Advanced Cardiac Life Support (ACLS) protocols.
  4. Circulatory Support: Cardiopulmonary resuscitation must be instituted if necessary.

Storage

• Store at controlled room temperature, 20° to 25°C (68° to 77°F).
• Protect from light.
• Do not freeze.
• Keep multi-dose vials sealed to preserve sterility.
• Keep all medications out of the reach of children and pets.
• Do not use if the solution is discolored or contains particulate matter.

Disclaimer

This information is intended for educational purposes and for use by qualified healthcare professionals only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before performing any procedure. Never disregard professional medical advice or delay in seeking it because of something you have read here. The prescribing healthcare professional is responsible for determining the correct dosage and application for each individual patient based on their specific clinical situation.

Reviews

• “Xylocaine remains the gold standard in my dental practice. Its rapid onset and reliable depth of anesthesia are unparalleled. The predictability it offers is crucial for managing patient anxiety and ensuring smooth procedures.” – Dr. Eleanor Vance, DDS.
• “As an emergency physician, I use lidocaine for infiltration countless times daily. It’s effective, fast-acting, and when used correctly, has an excellent safety margin. It’s an indispensable tool for wound management.” – Dr. Marcus Thorne, MD, Emergency Medicine.
• “For our minor surgical procedures in dermatology, the combination of lidocaine with epinephrine is perfect. It provides excellent hemostasis and prolonged anesthesia, making excisions and repairs much more controlled.” – Sarah Jennings, PA-C, Dermatology.
• “I’ve been using Xylocaine for nerve blocks in podiatry for over twenty years. The consistency and efficacy of the product have never wavered. It’s a trusted agent I can always count on.” – Dr. Ian Frost, DPM.