Table 1.
Summary of local anaesthetic availability and licensing for intrathecal use in the UK and the USA
| Drug | Chemical structure | Medicines and Healthcare products Regulatory Agency (MHRA) licence, UK | FDA approval, USA | Licensed indication | Notes |
|---|---|---|---|---|---|
| Lidocaine | Amide | No | No | Not applicable | High incidence of transient neurologic symptoms.2 Not recommended. |
| Bupivacaine | Amide | Marcain Spinal 0.5% Heavy: Hyperbaric bupivavaine 0.5% (AstraZeneca) Hyperbaric bupivacaine 0.5% (Mercury Pharma) |
Marcaine Spinal: Hyperbaric bupivacaine 0.75% (Hospira) |
UK: ‘urological and lower limb surgery lasting 2–3 hours, abdominal surgery lasting 45–60 minutes’ USA: not specified |
Plain bupivacaine is not licensed for intrathecal use in the UK or USA. |
| Levobupivacaine | Amide | Chirocaine; Levobupivacaine 0.25/0.5/0.75% (Abbvie) Levobupivacaine 0.25/0.5/0.75% (Fresenius Kabi) |
No | UK: ‘surgical anaesthesia’ USA: not applicable |
No licensed hyperbaric levobupivacaine preparation. |
| Ropivacaine | Amide | No | No | Not applicable | No commercial preparation of hyperbaric ropivacaine. Plain ropivacaine used off-label in USA. |
| Mepivacaine | Amide | No | No | Not applicable | May have high incidence of transient neurologic symptoms.2 Used off-label in USA. |
| Articaine | Amide | No | No | Not applicable | No preservative-free preparation. Experimental only. |
| Procaine | Ester | No | No | Not applicable | Concerns about neurotoxicity.14, 15 Experimental only. |
| Prilocaine | Amide | Prilotekal: Hyperbaric prilocaine 2% (Sintetica) |
No | UK: ‘short term surgical procedures’ USA: not applicable |
Appropriate for procedures up to 90 min duration. |
| 2-Chloroprocaine | Ester | Ampres: Plain 2-chloroprocaine 1% (Sintetica) |
Clorotekal: Plain 2-chloroprocaine 1% (B. Braun) |
UK: ‘planned surgical procedure should not exceed 40 minutes’ USA: ‘those suitable for Clorotekal's short duration of action’ |
50 mg may be effective for up to 60 min for lower limb procedures. 60 mg may last up to 90 min; but, doses exceeding 50mg are not approved by MHRA or FDA.17 |