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Lidocaine and/or BUPivacaine with epiNEPHrine injection (various strengths)

November 09 , 2017

Issue:
There is an ongoing shortage of certain lidocaine and/or BUPivacaine injectable products containing epiNEPHrine. The availabilty of affected products is constantly changing and therefore stock levels will be variable at different sites across the province. Stock levels are very low and may not meet current demands. Inventory might be depleted prior to resolution of the backorders.

Action:

  • Reserve all lidocaine presevative free products for epidural use only.
  • For all other indications, if alternatives are not available, lidocaine and/or BUPivacaine with epiNEPHrine may need to be prepared at the point of care.
    • This is only an option during the drug shortage
    • Must be prepared immediately before use due to short stability.
    • To ensure safe preparation, refer to the following chart and instructions:
Final Prepared Product Base Medication Vial epiNEPHrine 1mg/mL volume to add to base medication vial
BUPivacaine 0.25% with epiNEPHrine 1:200 000 BUPivacaine 0.25% 2mL vial (preservative free) 0.1 mL
BUPivacaine 0.5% with epiNEPHrine 1:200 000 BUPivacaine 0.5% 2mL vial (preservative free) 0.1 mL
lidocaine 1% with epiNEPHrine 1:100 000 lidocaine 1% 20 mL vial (contains preservative) 0.2 mL
lidocaine 1% with epiNEPHrine 1:200 000 lidocaine 1% 20 mL vial (contains preservative) 0.1 mL
lidocaine 2% with epiNEPHrine 1:100 000 lidocaine 2% 20 mL vial (contains preservative) 0.2 mL
lidocaine 2% with epiNEPHrine 1:200 000 lidocaine 2% 20 mL vial (contains preservative) 0.1 mL

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Instructions:

  • Using a filter needle, draw up the specified volume of epiNEPHrine into a 1 mL syringe.
  • Change the needle.
  • Inject epiNEPHrine into the specified 20 mL base medication vial.
  • Mix gently.
  • Label appropriately with medication name and expiration date of 1 hour.

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