Ethyl Chloride (ethyl chloride)

Ethyl chloride is applied topically as a spray. The dosage of ethyl chloride varies with the procedure and the response of the patient. The smallest dose needed to produce the desired effect should be used. Ethyl chloride is commercially available in metal tubes with valve closures or in glass bottles with spring release closures. These containers have various size nozzle openings for regulation of spray. Usually, fine spray is used for local anesthesia. The container should be held in the hand prior to administration to increase the volatility of the liquid.

For use in local anesthesia, the container should be held about 3-9 inches from the area being treated and the spray directed downward to the target area for 3-7 seconds until the skin just begins to turn white but should not be frosted. Because the local anesthetic effect is very brief, incisions should be made promptly after swabbing with an antiseptic. To prevent pain of injection, the same ethyl chloride application technique should be followed; the needle for injection should then be introduced quickly with the skin taut after swabbing with an antiseptic.

When ethyl chloride is used as a counterirritant after the active irritated trigger point (a deep hypersensitive localized spot in a muscle) has been evaluated and identified, the container should be held about 12-18 inches from the skin and the pinpoint stream directed to meet the body at an acute angle to lessen the shock of impact. The spray should be applied in one direction only, starting at the trigger area and moving in parallel sweeps 1.5-2 cm apart slowly (10 cm/second) and evenly outward over the reference zone; sweeps should be repeated rhythmically until the area has been covered. The number of sweeps will depend on the size of the treated muscle. The skin should not be frosted because excessive cooling may increase muscle spasms and pain. With trigger points, the source of pain seldom is the site of pain. The affected muscle should be passively stretched during application, gradually increasing the force with successive sweeps. As the muscle relaxes, smoothly take up the slack by establishing a new stretch length. The full normal length of the muscle should be reached to completely inactivate the trigger point and relieve pain. The muscle should be rewarmed. Application may be repeated if necessary. Apply moist heat for 10-15 minutes after treatment. Eliminate factors that perpetuate the trigger mechanism.

No dosing information is available for this tab.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

Local Anesthetics/Long-Acting Bupivacaine

SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction.

MECHANISM OF ACTION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1)

CLINICAL EFFECTS: Concurrent or use of local anesthetics with 96 hours of use of long-acting bupivacaine may result in neurologic and cardiovascular toxicity. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also result in methemoglobinemia.(1,2) Non-liposomal bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally.(1)

PREDISPOSING FACTORS: Use of additional agents that are associated with methemoglobinemia may further increase the risk of methemoglobinemia.(1) Patients who are at increased risk of developing methemoglobinemia include those with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition. If local anesthetics must be used in these patients, close monitoring for symptoms and signs of methemoglobinemia is recommended.(1)

PATIENT MANAGEMENT: Avoid the use of other local anesthetics within 96 hours following the administration of long-acting bupivacaine. In patients for whom use is required, monitor for neurologic and cardiovascular effects. Also monitor for methemoglobinemia with use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine.(1,2) Non-liposomal bupivacaine may be administered in the same syringe as bupivacaine liposomal or injected immediately before bupivacaine liposomal as long as the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1)

DISCUSSION: Concurrent use of other local anesthetics or use of other local anesthetics within 96 hours following long-acting bupivacaine may result in additive neurologic and cardiovascular effects. Use of articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, and tetracaine may also increase the risk of methemoglobinemia.(1,2) Non-liposome bupivacaine may impact the pharmacokinetic and/or physicochemical properties of the liposomal formulation when administered in the same syringe or used simultaneously unless the ratio of mg of non-liposomal bupivacaine to mg of bupivacaine liposomal does not exceed 1:2.(1) Local anesthetics other than bupivacaine may trigger the immediate release of bupivacaine from the liposomal formulation when administered together locally. Lidocaine may be administered 20 minutes or more prior to bupivacaine. It is unknown if other local anesthetics may be used without compromising the release characteristic of bupivacaine liposomal.(1)

There are no moderate interactions for this drug.

There is no enhanced messaging for this drug.

• Cryoglobulinemia

There are no severe contraindications for this drug.

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

There are no severe adverse reactions for this drug.

Rare or Very Rare

• Dyschromia
• Skin irritation

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.

No enhanced messaging available.