Regional and local anesthesia should be carried out by experienced specialists in an appropriately equipped room, with availability of equipment and preparations ready for immediate use,necessary for monitoring cardiac activity and resuscitation. Personnel performing anesthesia should be qualified and trained in the technique of performing anesthesia, should be familiar with the diagnosis and treatment of systemic toxic reactions, adverse events and reactions, and other complications.
It should be used with caution in patients with myasthenia gravis, epilepsy, chronic heart failure, bradycardia and respiratory depression, as well as in combination with drugs interacting with lidocaine and leading to increased bioavailability, potentiation of effects (eg, phenytoin) or lengthening ( for example, in hepatic or terminal renal failure, in which lidocaine metabolites can be accumulated). Patients receiving class III antiarrhythmic drugs (for example, amiodarone) it is necessary to establish close monitoring and ECG monitoring, since the influence on the heart can be potentiated.
There were post-registration reports on chondrolisis in patients who had a long intra-articular infusion of local anesthetics after the operation.In most cases, chondrolisis was noted in the shoulder joint. Due to the many contributing factors and the inconsistency of the scientific literature on the mechanism for effecting the effect, a cause-and-effect relationship has not been identified. Prolonged intra-articular infusion is not an approved indication for the use of lidocaine. Intramuscular injection of lidocaine may increase the activity of creatine phosphokinase, which may make it difficult to diagnose acute myocardial infarction.
Shown, that lidocaine can cause porphyria in animals, its use in persons with porphyria should be avoided.
When administered to inflamed or infected tissues, the effect of lidocaine may be reduced.
Before the initiation of intravenous lidocaine, hypokalemia, hypoxia and acid-base disruption must be eliminated.
Some local anesthetic procedures can lead to serious adverse reactions, regardless of the local anesthetic used.
Conducting anesthesia of the spinal nerves can lead to depression of the cardiovascular system, especially against the background of hypovolemia,Therefore, when conducting epidural anesthesia, patients with cardiovascular disorders should be careful.
Epidural anesthesia can lead to arterial hypotension and bradycardia. The risk can be reduced by the preliminary administration of crystalloid or colloidal solutions. It is necessary to immediately stop arterial hyiotension. In some cases, paracervical blockade in pregnancy can lead to bradycardia or tachycardia in the fetus, which requires careful monitoring of heart rate in the fetus (see section "Use during pregnancy and during breastfeeding").
Introduction to the head and neck can lead to unintentional entry into the artery with the development of cerebral symptoms even in low doses. Retrobulbar administration in rare cases can lead to entry into the subarachnoid space of the skull, leading to severe / severe reactions, including cardiovascular failure, apnea, convulsions and temporary blindness. Retro- and peribulbar injection of local anesthetics carries a low risk of persistent oculomotor dysfunction.The main reasons include trauma and (or) local toxic effect on muscles and (or) nerves.
The severity of such reactions depends on the degree of injury, the concentration of the local anesthetic and the duration of its exposure in tissues. In this regard, any local anesthetic should be used in the lowest effective concentration and dose. Solution for injection of lidocaine is not recommended for use in newborns. The optimal serum concentration of lidocaine, which avoids such toxicity as convulsions and arrhythmias, is not established in newborns. Avoid intravascular injection, if not directly indicated.
Use with caution:
- in patients with coagulopathy. Therapy with anticoagulants (eg, heparin), NSAIDs or plasma substitutes increases the tendency to bleeding. Accidental damage to blood vessels can lead to severe bleeding. If necessary, check bleeding time, activated partial thromboplastin time (APTT), and platelet count;
- patients with complete or incomplete blockade of intracardiac conduction, as local anesthetics can depress AV-hold-up;
- It is necessary to carefully monitor patients with convulsive disorders for symptomatology from the central nervous system. Low doses of lidocaine can also increase convulsive readiness. In patients with Melkersson-Rosenthal syndrome, allergic and toxic reactions from the nervous system in response to the administration of local anesthetics can develop more often;
- third trimester of pregnancy.
Lidocaine, a solution for injection, 20 mg / ml, is not allowed for intrathecal administration (subarachnoidal anesthesia).