ocal anesthetics following arthroscopic and other surgical procedures is an unapproved use, and there have
been post-marketing reports of chondrolysis in patients receiving such infusions. The majority of reported cases of chondrolysis have
involved the shoulder joint; cases of gleno-humeral chondrolysis have been described in pediatric and adult patients following intraarticular
infusions of local anesthetics with and without epinephrine for periods of 48 to 72 hours. There is insufficient information to
determine whether shorter infusion periods are not associated with these findings. The time of onset of symptoms, such as joint pain,
stiffness and loss of motion can be variable, but may begin as early as the 2nd month after surgery. Currently, there is no effective
treatment for chondrolysis; patients who experienced chondrolysis have required additional diagnostic and therapeutic procedures and
some required arthroplasty or shoulder replacement.
To avoid intravascular injection, aspiration should be performed before the local anesthetic solution is injected. The needle must be
repositioned until no return of blood can be elicited by aspiration. Note, however, that the absence of blood in the syringe does not
guarantee that intravascular injection has been avoided.
Local anesthetic solutions containing antimicrobial preservatives (eg, methylparaben) should not be used for epidural or spinal
anesthesia because the safety of these agents has not been established with regard to intrathecal injection, either intentional or
accidental.
Xylocaine with epinephrine solutions contain sodium metabisulfite, a sulfite that may cause allergic-type reactions including
anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall preva lence of
sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than
in non-asthmatic people.
PRECAUTIONS
General
The safety and effectiveness of lidocaine HCl depend on proper dosage, correct technique, adequate precautions, and readiness
for emergencies. Standard textbooks should be consulted for specific techniques and precautions for various regional anesthetic
procedures.
Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use (see WARNINGS and
ADVERSE REACTIONS). The lowest dosage that results in effective anesthesia should be used to avoid high plasma levels
and serious adverse effects. Syringe aspirations should also be performed before and during each supplemental injection when
using indwelling catheter techniques. During the administration of epidural anesthesia, it is recommended that a test dose be
administered initially and that the patient be monitored for central nervous system toxicity and cardiovascular toxicity, as well as
for signs of unintended intrathecal administration, before proceeding. When clinical conditions permit, consideration should be
given to employing local anesthetic solutions that contain epinephrine for the test dose because circulatory changes compatible with
epinephrine may also serve as a warning sign of unintended intravascular injection. An intravascular injection is still possible even if
aspirations for blood are negative. Repeated doses of lidocaine HCl may cause signif
