Prilocaine Injection

What is Prilocaine Injection?
Prilocaine Hydrochloride is an amide-type local anesthetic with an intermediate duration of action. It is chemically similar to Lidocaine but is characterized by a lower profile of central nervous system toxicity. One of its most distinctive features is its ability to produce significant anesthesia with relatively low vasodilator activity, which often makes the addition of epinephrine unnecessary. In clinical practice, it is widely used in dentistry and for brief surgical procedures.
Uses of Prilocaine Injection
Dental Anesthesia: Often used in 4% concentrations for local infiltration or nerve blocks in dental procedures.
Intravenous Regional Anesthesia (Bier Block): Frequently the drug of choice for this technique in hand and forearm surgery due to its low systemic toxicity.
Epidural Anesthesia: Used for procedures where a medium-duration block is required.
Peripheral Nerve Blocks: Providing anesthesia for specific nerve groups in the limbs.
Surface Anesthesia: Often combined with Lidocaine (as EMLA cream) for topical numbing before needle insertions or minor skin surgeries.
How Does Prilocaine Injection Work?
Prilocaine works by stabilizing the neuronal membrane, preventing the initiation and conduction of nerve impulses. It binds to voltage-gated sodium channels on the internal surface of the nerve cell membrane. This binding blocks the influx of sodium ions into the cell, which is necessary for the cell to "fire" an electrical signal. As a result, the pain signal is halted before it can reach the brain.
FAQs on Prilocaine Injection
1. How does Prilocaine compare to Lidocaine? Prilocaine is slightly less potent than Lidocaine but has a lower risk of CNS toxicity. It also causes less vasodilation, meaning the numbing effect lasts reasonably long even without the addition of adrenaline (epinephrine), which is beneficial for patients sensitive to stimulants.
2. What is the risk of "Methemoglobinemia"? A unique side effect of Prilocaine is that its metabolite (o-toluidine) can cause methemoglobinemia—a condition where the blood's ability to carry oxygen is reduced. This is generally dose-dependent and rare at standard clinical doses, but it is the reason Prilocaine is used with caution in infants and patients with pre-existing anemia or respiratory distress.
3. What is the antidote for Prilocaine-induced methemoglobinemia? If a patient develops cyanosis (bluish skin) or low oxygen levels following high doses of Prilocaine, Methylene Blue is administered intravenously as a rapid and effective reversal agent.
Therapeutic Category
Anesthetics (Local/Regional Anesthetic - Amide type)
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