Dicaine

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.

Dicain (Dicainum): description, recipe, instructions

Self-medication may be harmful to your health. You should consult your doctor and also read the instructions before use.

Eye drops, 0.5%, 15 ml

Dicaine is available in the form of ophthalmic films (0.75 mg) and powder substance (1 g) in dispensing cases of 30 pieces or in dark glass jars.

The active ingredient of the drug is tetracaine.

Dicaine is produced in the form of 0.3% eye drops in dropper bottles of 5 ml and 10 ml.

Based on the active substance (tetracaine), an analogue of the drug is produced - Eye films with Dicaine. In some cases, it is possible to use analogues of Dicaine with a similar therapeutic effect in the form of eye drops: Inocaine, Alcaine, Lidocaine, Benoxy, Leocaine.

Dicain eye drops consist of:

1. Leocaine.
2. Sodium chloride.
3. Purified water.

Produced in the form of drops of 5 and 10 ml

The drug Dicain is produced in several pharmaceutical forms:

• In the form of eye drops 0.3%, clear or slightly opalescent solution, colorless or slightly colored.

Active ingredients: tetracaine.

Auxiliary components: sodium chloride, leocaine, purified water.

In a cardboard package - 1 bottle with a dropper of 10 ml or 5 ml.

• In powder form, as a base for preparing solutions.

There are 30 packets in dispensing cases.

In a dark glass jar – 0.5 kg, 1 kg of powder.

• In the form of ophthalmic films with dicaine.

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Dispenser cases contain 30 films.

• In the form of an ointment.
• In the form of tablets.

Pharmacological action of the drug

A strong local anesthetic agent, used exclusively for terminal anesthesia. Tetracaine, being an active component, actively blocks directly voltage-dependent sodium channels, which prevents the generation of impulses in sensitive nerve endings and stops the conduction of impulses along nerve fibers.

Dicain is absorbed relatively easily directly at the site of application and after 30-90 seconds from the moment of applying the application to the surface of the CO, anesthesia occurs, lasting 15-20 minutes.

Analogues of the drug Dicaine are: Intercaine, Ametocaine, Felicaine, Foncaine, Tetracaine hydrochloride, Pantocaine, Medicaine, Decicaine, Anetaine, Rexocaine, Intercaine.

Dicaine is a local anesthetic drug used for terminal anesthesia. By blocking voltage-gated sodium channels, the active substance Dicaine (tetracaine) prevents the generation of impulses in the endings of sensory nerves and their subsequent conduction along the nerve fibers.

The effect of the medicine occurs 0.5-1.5 minutes after its application to the surface of the mucous membrane, the duration is up to 15-20 minutes. Tetracaine is completely absorbed through the mucous membranes and hydrolyzed within 1-2 hours.

Docaine is used only for local anesthesia.

Dicaine is a local anesthetic drug used for superficial anesthesia.

The substance blocks sodium channels, preventing the occurrence of impulses in sensitive nerve endings and their conduction in nerve tissues.

The drug begins to act 30–90 seconds after application to the mucous membranes. The duration of action is 20 minutes.

Dicain solution is quickly and almost completely absorbed through the mucous membranes. The rate of absorption is determined by the dosage of the drug. The degree of its binding to plasma proteins is quite high. The substance is completely hydrolyzed in plasma with the participation of cholinesterase over 1.5 hours, forming PABA-containing compounds.

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.

Directions for use and dosage

The drug is used primarily for terminal anesthesia, rarely for epidural anesthesia. The substance is very toxic, so the solution is practically unsuitable for conduction and infiltration anesthesia. The highest dose for topical application is 0.1 grams.

In accordance with the instructions, in ophthalmic practice, Dicain is used in 2-3 drops. A strong analgesic effect develops within 1-2 minutes.

To achieve the required anesthetic effect during eye surgery, as a rule, a 0.5% solution is sufficient. To prolong the action and enhance the effectiveness of the drug, add a 0.1% solution of epinephrine to Dicaine (at the rate of 3-5 drops per 10 ml of tetracaine).

For pain relief, measuring intraocular pressure is usually limited to a 0.1% solution.

In otolaryngology, in most cases a solution of 0.25-0.5% is sufficient. For adult patients, up to 3 ml of a 1% solution can be prescribed at the discretion of the doctor. 2 and 3% solutions are used only when absolutely necessary. Spraying or lubricating the larynx and pharynx is done gradually, maintaining intervals and monitoring the patient's condition. To reduce the overall reaction to the drug, the patient is given 0.1 grams of barbamyl 30-60 minutes before pain relief.

In the absence of contraindications to the use of vasoconstrictors, epinephrine hydrochloride is added to Dicaine (1 drop of 0.1% solution for every 1-2 ml of tetracaine). A tampon is soaked in the solution and the surface of the mucous membrane is treated. You should not leave the tampon in the nasal cavity for a long time.

The use of Dicaine for epidural anesthesia requires precautions. The preparation of a 0.25-0.3% solution is carried out under aseptic conditions by mixing Dicain with sterile water for injection and an isotonic solution of sodium chloride, a stabilized solution of hydrochloric acid. Before use, the drug is sterilized by boiling for half an hour, after which a 0.1% solution of epinephrine hydrochloride is added to it at the rate of 1 drop. per 5 ml of anesthesia solution. The product is administered in stages - 15-20 ml. The interval between injections is 5 minutes.

For anesthesia of the urinary tract, up to 10 ml of 0.1% Dicaine solution is used.

Dicain Latin name: Dicainum Pharmacological groups:
Local anesthetics
Nosological classification (ICD-10):
Z100 CLASS XXII Surgical practice Pharmacological action

Active ingredient (INN) Tetracaine (Tetracaine)
Application:
Local (superficial and spinal) anesthesia.

Contraindications:

Hypersensitivity (including to other local anesthetics of the ester group or PABA and its derivatives), severe somatic diseases, children (up to 10 years).

Use during pregnancy and breastfeeding:

Possible in exceptional cases, if the expected effect of therapy exceeds the potential risk to the fetus and newborn.

Side effects:

When applied topically: allergic contact dermatitis, burning sensation, swelling and pain in the area of ​​application; with long-term use - keratitis, persistent clouding of the cornea, scarring on the cornea with loss of visual acuity, slower epithelization. With injection: central nervous system stimulation, depression, nervousness, dizziness, blurred vision, drowsiness, tremor, convulsions, loss of consciousness, cardiovascular failure, changes in blood pressure (usually hypotension), cardiac arrest, respiratory disorders, nausea, vomiting, chills, constriction pupils, tinnitus, idiosyncrasy or decreased tolerance, urticaria, anaphylactic shock.

Interaction:

Reduces the antibacterial activity of sulfonamide drugs. Vasoconstrictors prolong the effect and reduce toxicity.

Overdose:
Symptoms:
dizziness, general weakness, cyanosis, agitation, anxiety, muscle tremors, convulsions, respiratory failure, collapse, methemoglobinemia, nausea, vomiting, coma, AV block.
Treatment:
removal from the skin and mucous membranes, gastric lavage (through a tube) with activated carbon, administration of saline laxatives; for respiratory depression - mechanical ventilation and oxygen therapy, collapse - intravenous administration of blood substitutes (saline solutions, hemodez, polyglucin), use of vasoconstrictors (preferably stimulating myocardium), convulsions - diazepam or short-acting barbiturates (iv), methemoglobinemia - 1– 2 mg/kg methylene blue (IV) or 100–200 mg ascorbic acid orally.

Directions for use and dosage:

For superficial anesthesia - 0.05–1% (if necessary 2–3%) solution; in children over 10 years old - no more than 1-2 ml of 0.5-1% solution, in adults - up to 3 ml of 1% solution. The highest dose for adults is 3 ml of a 3% solution. For epidural anesthesia - 5 ml of 0.3% solution 3-4 times at intervals of 5 minutes.

Precautionary measures:

Should not be applied to large areas of damaged skin (risk of absorption and systemic toxicity). In ophthalmology, it is not recommended to use for a long time or frequently (possible damage to the cornea). Use with caution in patients with reduced levels of cholinesterase in the blood plasma, heart rhythm disturbances, AV blockades, and shock. Spinal anesthesia requires blood pressure monitoring.

Special instructions:

Instruments and syringes that come into contact with tetracaine should not contain residual alkali (forms an insoluble base).

Side effects

With topical use of Dicain, mild allergic reactions, burning sensation, and swelling after instillation are possible.

Dicaine is very toxic (10 times more toxic than novocaine, and 2-5 times more toxic than cocaine). Intoxication with the drug is manifested by anxiety, agitation, convulsions, cardiovascular failure, respiratory distress, nausea, vomiting, and hypotension. In case of overdose, the mucous membrane at the application site should be washed (for this, an isotonic NaCl solution is used) and caffeine and/or another analeptic drug should be administered subcutaneously.

special instructions

If possible, novocaine should be used instead of Dicaine, since it is less toxic.

It is important to remember that solutions containing more than 2% tetracaine can lead to damage to the epithelium of the cornea and significant dilation of conjunctival vessels.

Dicaine may weaken the effect of sulfonamide drugs.

Since the drug is very quickly absorbed by the mucous membranes of the respiratory tract, it is necessary to exercise extreme caution when using it in ENT practice and carefully monitor the patient’s condition.

It is prohibited to administer the solution subarachnoidally.

Medical instruments that come into contact with Dicaine should not contain alkali residues, since tetracaine precipitates under the influence of alkali.

When performing spinal anesthesia with the use of Dicaine, blood pressure monitoring is necessary.

Drug interactions of Dicaine

To avoid the formation of an insoluble base, it is necessary to avoid contact of instruments and syringes with alkali residues.

Also, when using Dicain, it should be taken into account that:

• Vasoconstrictor medications prolong the effect of drops and reduce their toxicity;
• Dicaine reduces the antimicrobial activity of sulfonamides;
• Cholinesterase-inhibiting medications (antimyasthenic drugs, demecaria bromide, cyclophosphamide, insecticides, ecothiopathy chloride, thiotepa) help reduce the metabolism of tetracaine and increase its toxicity;
• Anticoagulants (enoxaparin sodium, sodium, warfarin, heparin) increase the risk of bleeding;
• Beta blockers slow down the metabolism of Dicaine, increasing its toxicity;
• Sleeping pills and sedative medications can enhance their inhibitory effect on the central nervous system;
• MAO inhibitors (procarbazine, furazolidone, selegiline) increase the risk of low blood pressure;
• The effect of muscle relaxant drugs is enhanced and prolonged.