Directions for use and dosage
In ophthalmology, the drug is used in the form of a 0.1% transparent, colorless or slightly colored solution. The dose of Dicaine depends on the type of procedure performed. So, when measuring intraocular pressure, 1 drop is prescribed twice with an interval of several minutes. Anesthesia develops 1-2 minutes after instillation.
For surgical interventions and removal of foreign bodies, 0.25%, 0.5%, 1% or 2% Dicaine solution is used. The dose of the drug is 2-3 drops. Severe anesthesia develops within 1-2 minutes.
As a rule, in ophthalmology, a 0.5% solution is sufficient for pain relief during surgical interventions. To enhance and prolong the effect of anesthesia, add 3-5 drops of a 0.1% adrenaline solution to 10 ml of Dicaine. If long-term pain relief is necessary, eye films are used.
In otorhinolaryngological practice, Dicain is used for some surgical interventions, for example, puncture of the maxillary sinus, cronchotomy, middle ear surgery and removal of polyps. Since the drug is absorbed quite quickly by the mucous membranes of the respiratory system, caution should be exercised when using it and the patient’s condition should be carefully monitored.
In children over 10 years of age, the dose of Dicaine, according to the instructions, is no more than 1-2 ml, and the concentration of the solution is from 0.5 to 1%. The dosage for adults should not exceed 3 ml of a 1% solution. The use of Dicain 2% or 3% is possible only for serious indications and in cases of extreme necessity. The maximum permissible dose of the drug for anesthesia of the upper respiratory tract for adults is 0.09 g once (which corresponds to 3 ml of a solution of 3% concentration).
Dicaine
Name: Dicain (Dicainum) Pharmacological action: 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).
Directions for use: 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 - 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 effects: 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: Powder and ophthalmic films with dicaine, 30 pieces in dispensing cases.
Storage conditions: List A. In a well-closed container.
Synonyms: Tetracaine hydrochloride, Ametocaine, Anetain, Decicaine, Felicaine, Foncaine, Intercaine, Medicaine, Pantocaine, Rexocaine.
Attention! The description of the drug " Dicain " on this page is a simplified and expanded version of the official instructions for use. Before purchasing or using the drug, you should consult your doctor and read the instructions approved by the manufacturer. Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
Side effects
Local side effects of Dicain include:
- Allergic contact dermatitis;
- Pain and swelling at the application site;
- Burning sensation;
- Irritation of mucous membranes.
With long-term use of Dicain in ophthalmology, persistent clouding of the cornea, keratitis, slower epithelization and scar formation on the cornea of the eye with subsequent loss of visual acuity are possible.
Systemic side effects include blurred vision, cyanosis, arrhythmia, central nervous system excitation and anaphylactic shock.
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.
special instructions
Frequent and long-term use of the drug is not recommended.
Solutions with a concentration of 2% or more can cause damage to the corneal epithelium and significant dilation of the vessels of the outer shell of the eye.
Dicaine is prescribed with caution to patients with AV block, heart rhythm disturbances, shock, and reduced levels of cholinesterase in the blood. When performing local spinal anesthesia, it is necessary to monitor blood pressure.
Syringes and instruments in contact with the drug should not contain alkaline residues, as this will form an insoluble base.
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.
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:
- Esters: novocaine, procaine, tetracaine;
- 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:
- 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;
- 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:
- Careful collection of allergy history (hereditary history, presence of allergic diseases and reactions to medications);
- Examination of the patient;
- 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.
References
- 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.
- 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.
- 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.
