Ultrakain - instructions for use, reviews, analogs and forms of release (injections in ampoules for injection 1%, adrenaline D, D-C, including forte) medications for anesthesia and anesthesia in obstetrics and dentistry in adults, children and pregnancy

In this article, you can read the instructions for using the drug Ultracaine. Comments of visitors to the site - consumers of this medication, as well as opinions of specialists on the use of Ultracaine in their practice are presented. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Ultracaine in the presence of existing structural analogues.Use for anesthesia and anesthesia in obstetrics and dentistry in adults, children, as well as during pregnancy and lactation.

Ultracaine - local anesthetic drug. The amide structure of articaine is similar to the structure of other local anesthetics, but its molecule contains one additional ester group, which in the human body is rapidly hydrolyzed by esterases.

Articaine blocks the sodium channels of the neuron membrane, which leads to a decrease in the conduction of impulses along the nerve fiber, thus providing a local anesthetic effect. Local anesthetics cause a reversible loss of sensitivity due to the cessation or decrease in the conductivity of sensory nerve impulses directly at the injection site and around it. They have a membrane-stabilizing effect by reducing the permeability of nerve cell membranes for sodium ions.

Ultracaine D does not contain epinephrine (adrenaline), it is used when the addition of epinephrine to the local anesthetic is not necessary or the use of epinephrine is contraindicated. The effect of the drug begins quickly (the latent period is 1-3 minutes).The duration of anesthesia is approximately 20 minutes. Rapid destruction of articaine to an inactive metabolite - articaine acid - is the cause of its very low systemic toxicity, which allows the drug to be injected repeatedly.

Composition

Articaine hydrochloride + excipients (Ultracaine D).

Articaine hydrochloride + Epinephrine hydrochloride (adrenaline) + excipients (Ultracaine D-C and Forte form).

Pharmacokinetics

The binding of articaine to plasma proteins is approximately 95%. Artikain penetrates the placental barrier, practically does not excrete with breast milk. Articaine (as well as other amine type local anesthetics) is metabolized by microsomal enzymes of the liver. Besides this, articaine is also inactivated by nonspecific plasma esterases in tissues and blood by hydrolyzing the ester bond in the carboxyl group. Because hydrolysis occurs very rapidly and begins immediately after administration, about 90% of articaine is inactivated by this method. The resulting main metabolite, articaine, articaine acid, does not have local anesthetic activity and has no systemic toxicity.Articaine is excreted mainly by the kidneys in the form of articaine acid (64.2 ± 14.4%), arkainic acid glucuronide (13.4 ± 5%) and unchanged articaine (1.45 ± 0.77%).

Indications

Infiltration and conductive anesthesia in dental operations:

• uncomplicated removal of one or more teeth;
• treatment of carious cavities of the tooth;
• teeth grinding before prosthetics.

Ultrakain D-C Fort

Infiltration and conductive anesthesia in dental operations on the mucosa or bones, when it is necessary to create conditions for more severe ischemia:

• operations on the tooth pulp (amputation or extirpation);
• removal of a broken tooth (osteotomy);
• removal of the tooth affected by apical periodontitis;
• prolonged surgical interventions (eg, Caldwell-Luc surgery);
• percutaneous osteosynthesis;
• excision of cysts;
• interference on the gingival mucosa;
• resection of the apex of the tooth root;
• Treatment of cavities and grinding before prosthetics of highly sensitive teeth.

Forms of release

Solution for injection 1% (injections in ampoules).

Instructions for use and how to use them

Ultracaine

For adults, the maximum dose is 4-6 mg / kg body weight. The total dose is not more than 400 mg.

In infiltrative anesthesia, in the absence of inflammation, 1.7 ml of Ultrakain D solution per tooth or two adjacent teeth are usually administered.

With conductor anesthesia of the inferior alveolar nerve, approximately 1 1.7 ml of the drug solution is required.

Before the introduction of the drug, it is recommended to always perform an aspirate test in order to avoid unintentional intravascular injection of the drug. Injection pressure during the administration of the drug should be adjusted depending on the tissue sensitivity.

The introduction of the drug into the inflamed parts of the mucosa is not recommended.

Ultrakain DS (including Forte)

The drug is intended for use in the oral cavity, the introduction can be made only in non-inflamed tissues. Do not inject into inflamed tissues.

The drug is not intended for intravenous administration.

For anesthesia with uncomplicated removal of the upper jaw teeth in the absence of inflammation, it is usually sufficient to create a depot of the drug UltraCain D-C (Ultracaine D-C Fort) in the region of the transitional fold by inserting it into the submucosa from the vestibular side - 1.7 ml of the drug per tooth.In rare cases, an additional injection of 1 ml to 1.7 ml may be required to achieve complete anesthesia. In most cases this allows you not to carry a painful palatine injection. When several adjacent teeth are removed, the number of injections is usually limited.

For anesthesia with incisions and sutures in the palate with the goal of creating a palatine depot, about 0.1 ml of the drug for each injection is needed.

In the case of removal of premolars of the lower jaw in the absence of inflammation, you can do without mandibular anesthesia. An infiltration anesthesia provided by injecting 1.7 ml of the drug per tooth is usually sufficient. If this method fails to achieve the desired effect, an additional injection of 1-1.7 ml of the drug into the submucosa should be performed in the region of the transitional fold of the lower jaw from the vestibular side. If, however, in this case, it was not possible to achieve complete anesthesia, it is necessary to conduct a conductive blockade of the mandibular nerve.

When treating cavities and grinding teeth for crowns, with the exception of the lower molars, depending on the volume and duration of treatment, the administration of the drug Ultracaine D-C witha lower content of epinephrine in the region of the transitional fold from the vestibular side at a dose of 0.5-1.7 ml per tooth.

In surgical interventions, the dose of Ultrakain D-S Fort depends on the severity and duration of the intervention individually.

When performing one treatment procedure, adults can be administered articaine in a dose of up to 7 mg per 1 kg of body weight. It was noted that patients well tolerated doses up to 500 mg (corresponding to 12.5 ml of solution for injection).

In children older than 4 years, the dose is selected depending on the age and body weight of the child; The dose should not exceed 5 mg of articaine per 1 kg of body weight.

In elderly patients and patients with severe renal and hepatic insufficiency, it is possible to create elevated plasma concentrations of articaine. In these patients, the drug should be used at the minimum dose necessary to achieve sufficient depth of anesthesia.

In order to avoid accidental intravascular injection of the drug, always before it is administered, an aspiration test should be performed.

The injection pressure should correspond to the sensitivity of the tissues.

Side effect

• stupor, sometimes progressing to loss of consciousness;
• respiratory disorders, sometimes progressing to stopping breathing;
• muscular tremor;
• Muscular jerking sometimes progressing to generalized seizures;
• dizziness;
• paresthesia;
• hypoesthesia;
• transient visual disorders (blurred vision, blindness, double vision) that occur during or shortly after injection of the local anesthetic into the head region;
• damage to the facial nerve, which can lead to paralysis of the facial nerve;
• nausea, vomiting;
• a decrease in blood pressure;
• bradycardia;
• heart failure;
• shock;
• hyperemia of the skin;
• conjunctivitis;
• rhinitis;
• angioedema;
• hives;
• difficulty breathing;
• anaphylactic shock;
• puffiness or inflammation of the mucosa at the injection site.

Contraindications

• severe dysfunction of the sinus node or severe conduction disorders (such as severe bradycardia, AV blockade of 2-3 degrees);
• acute decompensated heart failure;
• severe arterial hypotension;
• anemia (including B12-deficiency anemia);
• methemoglobinemia;
• hypoxia;
• children under 4 years of age (lack of clinical experience);
• hypersensitivity to the components of the drug;
• hypersensitivity to other amine type local anesthetics, except in cases when hypersensitivity to these agents allergy to articaine has been excluded through appropriate studies conducted in compliance with all necessary rules and requirements.

Application in pregnancy and lactation

Ultracaine penetrates the placental barrier.

In view of the lack of clinical data, the decision to prescribe the drug by a dentist can be made only if the potential benefit of using it justifies the potential risk to the fetus.

During lactation, there is no need to interrupt breastfeeding, because in breast milk there are no clinically significant concentrations of articaine, but for the sake of precaution, breastfeeding should be discontinued for 4 hours after the last dose of articaine.

Use in children

Contraindicated in children under 4 years.

special instructions

To avoid intravascular injection, an aspiration test should always be performed.

To prevent the introduction of infections (including viral hepatitis), care must be taken to ensure that new sterile syringes and needles are always used when taking a solution from ampoules. Open cartridges can not be used again for other patients. Do not use a damaged cartridge for injections.

Patients are required to monitor the condition of the cardiovascular system, respiratory system, CNS.

Take food can only after the termination of the local anesthesia (restoration of sensitivity).

Impact on the ability to drive vehicles and manage mechanisms

The decision on when a patient after dental surgery can return to driving vehicles and engage in potentially dangerous activities that require increased concentration and speed of psychomotor reactions should be taken by a doctor.

Drug Interactions

Use with MAO inhibitors increases the risk of lowering blood pressure; It is necessary to abolish MAO inhibitors 10 days before the injection of anesthetic.

Local anesthetics enhance the effect of drugs that depress the central nervous system.Opioid analgesics increase the effect of local anesthetics and increase the risk of respiratory depression.

When injecting Ultrakain, patients who receive Heparin or Acetylsalicylic acid may develop bleeding at the injection site.

Ultrakain causes an increase and lengthening of the action of muscle relaxants.

Ultracaine shows antagonism with respect to the effect on skeletal muscle with drugs for the treatment of myasthenia gravis, therefore, when it is used, especially in high doses, an additional correction of the treatment of myasthenia is required.

Ultracaine causes a slowing of the metabolism of local anesthetics.

The local anesthetic effect of articaine is enhanced and lengthened by vasoconstrictive drugs.

Analogues of the drug Ultracaine

Structural analogs for the active substance:

• Articaine;
• Ultrakain D;
• Ultracaine D-C;
• Ultrakain Д-С forte.

Analogues for the pharmacological group (local anesthetics):

• Alkaine;
• Alfacaine;
• Amprovisol;
• Anecaine;
• Anestezine;
• Anestesol;
• Articaine;
• Artifrin;
• Aurobin;
• Benoxi;
• Block C;
• Bupikain;
• Versatis;
• Helicaine;
• Dentinox;
• Dentispray;
• Dicaine;
• Dinexan;
• Drill;
• Inokain;
• Kamistad;
• Xylocaine;
• Leocaine;
• Lidocaine;
• Lidochlor;
• Luan;
• Markain;
• Menovazine;
• Mepivastesin;
• Naropin;
• Novocaine;
• Pramoxin;
• Procaine hydrochloride;
• Risaxyl;
• Scandinibs;
• Scandinavian;
• Trimecaine;
• Ubistezin;
• Fastin 1;
• Folikap;
• Cytokartin;
• Emla.

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