| Formulary Chapter 15: Anaesthesia - Full Chapter
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| 15.02 |
Local anaesthesia |
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Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available. |
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| 15.02 |
Articaine |
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Articaine Hydrochloride with Adrenaline
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Formulary
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Injection 40mg/mL with 1 in 200,000 and 40mg/mL with 1 in 100,000
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| 15.02 |
Bupivacaine |
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The licensed doses stated may not be appropriate in some settings and expert advice should be sought. |
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Bupivacaine and Adrenaline
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Formulary
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Injection 0.25% / 1:200,000 10mL
Injection 0.5% / 1:200,000 10mL
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Bupivacaine Hydrochloride
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Formulary
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Injection 0.25%, 0.5% 10mL
Infusion 0.1%, 0.125% 250ml
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Bupivacaine Hydrochloride 0.5% with Glucose
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Formulary
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Injection bupivacaine 5mg/mL / glucose 80mg/mL 4mL
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Bupivacaine with Fentanyl
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Formulary
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Epidural infusion fentanyl 2micrograms/mL, bupivacaine 0.1% 500mL
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| 15.02 |
Levobupivacaine |
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The licensed doses stated may not be appropriate in some settings and expert advice should be sought. |
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Levobupivacaine
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Formulary
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Infusion 1.25mg/mL 100mL & 200ml
Injection, 2.5mg/mL, 5mg/mL and 7.5mg/mL
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Levobupivacaine with Fentanyl
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Formulary
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Epidural
 Unlicensed
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| 15.02 |
Lidocaine |
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The licensed doses stated may not be appropriate in some settings and expert advice should be sought. |
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Lidocaine injection
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Formulary
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Injection 0.5%, 1%, 2%
 for use in surgical procedures.
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Lidocaine ointment
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Formulary
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Ointment 5%
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Lidocaine plasters
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Formulary
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Plasters 5% (700mg/medicated plaster)
See chapter 4
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Lidocaine with Adrenaline
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Formulary
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Injection 1% / 1:200,000 20mL
Injection 2% / 1:200,000 20mL
Injection 2% / 1:80,000 2mL cartridge (for dental use)
for use in surgical procedures.
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Lidocaine with Phenylephrine
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Formulary
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Lidocaine 5%/Phenylephrine 0.5% nasal spray
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Lidocaine with Prilocaine (EMLA®)
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Formulary
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Lidocaine 25mg/1g, Prilocaine 25mg/1g cream
for licensed indications.
for specific indications within hospital Trusts, including:
MBHT - for use in theatres for grommet insertion (unlicensed use).
ELHT - to help with irritation caused by use of Aldara cream in women with Vulval intraepithelial neoplasia.
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Lidocaine2% with Chlorhexidine 0.25% (Instillagel®)
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Formulary
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Gel lidocaine 2% / chlorhexidine 0.25% 6ml & 11ml
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 MHRA: All medical devices and medicinal products containing chlorhexidine - Risk of anaphylactic reaction due to chlorhexidine allergy
MHRA: Chlorhexidine solutions: reminder of the risk of chemical burns in premature infants
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| 15.02 |
Mepivacaine |
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Mepivacaine hydrochloride injection
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Formulary
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Injection 30mg/1mL
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| 15.02 |
Prilocaine |
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Prilocaine Hydrochloride
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Formulary
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Prilocaine hydrochloride (Prilotekal®) in glucose injection 20mg/mL
Prilocaine Hydrochloride (Citanest®) injection 1%
Prilocaine Hydrochloride with Felypressin (Citanest with Octapressin®) 3% prilocaine
hydrochloride and 0.54 micrograms/mL felypressin
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| 15.02 |
Chloroprocaine |
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The licensed doses stated may not be appropriate in some settings and expert advice should be sought. |
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Chloroprocaine hydrochloride
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Formulary
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Injection 50mg/5mL
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| 15.02 |
Ropivacaine |
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Ropivacaine Hydrochloride
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Formulary
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Injection 2mg/mL, 7.5mg/mL, 10mg/mL Infusion 2mg/mL
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| 15.02 |
Tetracaine |
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Tetracaine (Ametop gel®)
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Formulary
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Gel 4% 1.5g tube
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| 15.02 |
Ethyl Chloride |
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Ethyl Chloride (Cryogesic® Spray)
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Formulary
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Spray
To provide a sensory cold sensation to check spinal and epidural anaesthesia blocks.
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine
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Cancer Drugs Fund
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Homecare |
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ICB commissioned |
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NHS England commissioned |
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Blueteq form needed |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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