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 Formulary Chapter 15: Anaesthesia - Full Chapter
15.01  General anaesthesia
15.01  Anaesthesia, sedation and resuscitation in dental practice
15.01  Gas cylinders
15.01.01  Intravenous anaesthetics
15.01.01  Barbiturates to top
Thiopental
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Thiopental should only be used when the patient is under the supervision of an Anaesthetist.
 
15.01.01  Other intravenous anaesthetics
Etomidate
(Etomidate-Lipuro)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Etomidate (Hypnomidate)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Ketamine injection
(Anaesthetic)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Lidocaine injection
(Anaesthesia)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • The use of lidocaine (lignocaine) 2% cartridge, bupivacaine 0.0625% infusion andropivacaine is restricted to theatres only.
 
Propofol
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.02  Inhalational anaesthetics
15.01.02  Volatile liquid anaesthetics
Desflurane
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Isoflurane
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Sevoflurane
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.02  Nitrous oxide
Nitrous oxide
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Procedure for the Administration of Entonox for Pain Relief
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.03  Antimuscarinic drugs to top
Atropine injection
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Atropine Minijet injection
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Glycopyrronium injection
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Hyoscine Hydrobromide
(injection)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.04  Sedative and analgesic peri-operative drugs
15.01.04.01  Benzodiazepines
Diazepam
(Pre-medication)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Lorazepam
(Pre-medication)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Midazolam
(Pre-medication)
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NOTE: There is more than one monograph for Midazolam, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • For paediatric sedation before procedures (including but not limited to MRI and pre-operatively). 
    • UnlicensedUnlicensed - Midazolam 2.5 mg/mL oral solution is an unlicensed product
  • UCLH:
  • WH:
    • No restriction stated
 
Temazepam
(Pre-medication)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.04.01  Benzodiazepines
15.01.04.02  Non-opioid analgesics
Ketorolac
(Post-operative pain)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Restricted to anaesthetics
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Ketorolac tablets are not available
 
Parecoxib
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
15.01.04.03  Opioid analgesics to top
Alfentanil
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Restricted to Anaesthetics and Palliative Care only 
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Fentanyl
(Injection)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Restricted Only on the recommendation of the Pain Team for patients intolerant to or with contraindications to morphine and oxycodone
  • UCLH:
  • WH:
    • No restriction stated
 
Remifentanil
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Provider notes

  • NMUH:
    • For use in ICU (Intensive Care Unit) ONLY
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • CD = Controlled drug. The Misuse of Drug Regulations apply. For further details see. Prescribing Guidelines. Ideally, remifentanil should be administered as an infusion, either with a standard syringe driver or as a Target Controlled Infusion using the Minto pharmacokinetic model (with the Alaris PK pump). Remifentanil should be diluted before administration, typically to a concentration of 20 to 40 mcg/ml, though higher concentrations can be used. A recommended induction infusion rate is 0.5 mcg/kg/min or8 ng/ml target for a ventilated patient and the rate halved for maintenance and titrated to clinical need (considerably higher or lower rates may be required). Beware the elderly or those with significant comorbidity when initial rates should be reduced. A dedicated cannula or antireflux valve should be used if an IV cannula is shared with fluids or other drugs. The cannula and giving set should be flushed at the end of use to avoid boluses of remifentanil accidentally being administered postop. Boluses of remifentanil should be administered carefully, by slow injection over a period of 30 to 60seconds.
 
15.01.04.04  Other drugs for sedation
Dexmedetomidine injection
(Sedation in ITU)
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Approved for light sedation (RASS 0 to -3) in mechanically ventilated adult patients with CAM ICU positive agitated delirium where agitation precludes weaning and extubation only after standard sedative agents (including propofol, clonidine or a benzodiazepine) had been trialled for 48 hours. (JFC January 2019).

Provider notes

  • NMUH:
    • As per indication above
  • RFL:
    • see above indication
    • Refer to local protocol for use
  • RNOH: As per indication above
  • UCLH:
  • WH:
    • As above.
 
15.01.05  Neuromuscular blocking drugs
15.01.05  Non-depolarising muscle relaxants
Atracurium besilate
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Store in refrigerator 
  • UCLH:
  • WH:
    • No restriction stated
 
Cisatracurium
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • The use of cisatracurium is restricted to theatres only.
 
Mivacurium
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • The use of mivacurium is restricted to theatres only
 
Pancuronium
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Rocuronium bromide
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Store in a refrigerator
  • UCLH:
  • WH:
    • The use of rocuronium is restricted to theatres only
 
Vecuronium Bromide
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.05  Depolarising muscle relaxants
Suxamethonium chloride
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Store in a refrigerator
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.06  Drugs for reversal of neuromuscular blockade to top
15.01.06  Anticholinesterases
Neostigmine metilsulfate + Glycopyrronium bromide
(Reversal of neuromuscular blockade)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Neostigmine metisulfate
(Reversal of neuromuscular blockade)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.01.06  Other drugs for reversal of neuromuscular blockade
Sugammadex
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Provider notes

  • NMUH:
    • Restricted to consultant anaesthetists only. 
  • RFL:
    • Restricted to Anaesthetics & Critical Care according to local guidelines
  • RNOH:
    • Restricted for the emergency reversal of rocuronium 
  • UCLH:
  • WH:
    • For theatres use only
 
15.01.07  Antagonists for central and respiratory depression
Doxapram
(Anaesthesia)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Flumazenil
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Flumazenil is used to reverse the sedative effects of benzodiazepines in anaesthetic, intensive care and diagnostic procedures. It should not be used for routine benzodiazepine reversal. It has a shorter half-life than diazepam and midazolam and care is required to avoid the risk of resedation.
 
Naloxone
(Central and respiratory depression)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Use in accordance with the RNOH guidelines, see link below
  • UCLH:
  • WH:
    • No restriction stated
 
Link  RNOH: Naloxone Use and Administration in Opioid Toxicity
15.01.08  Drugs for malignant hyperthermia
Dantrolene sodium injection
(Malignant hyperthermia)
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Provider notes

  • NMUH:
    • Check MHRA Drug Safety Update
  • RFL:
    • Stock kept in theatres on Malignant Hyperthermia trolley
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Dantrolene Injection is kept in the following locations: Main Theatres, Obstetrics Theatre
 
15.02  Local anaesthesia to top
15.02  Articaine
15.02  Bupivacaine
Bupivacaine
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Approved for post-operative pain management following limb amputation for peripheral arterial disease to reduce post-operative opioid requirement (0.125% infusion via perineural stump catheter) (JFC September 2019). 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Ampules: No restriction stated
    • Heavy: Spinal anaesthesia only
    • Surgical Wound Infiltration:
      • RFH: Restricted to use in donor nephrectomy patients and in plastic surgery (DIEP flap breast reconstruction only)
      • BFH: Not available
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Inj 0.25% (25mg/10mL); 0.5% (50mg/10mL) only
 
Bupivacaine + Adrenaline
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Bupivacaine + Fentanyl epidural
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Provider notes

  • NMUH:
    • A ready-mixed bag of Fentanyl + Bupivicaine is available from Pharmacy
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Bupivacaine + Glucose
(Marcain Heavy)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
15.02  Levobupivacaine
Levobupivacaine
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • BCF: Restricted to obstetrics, theatres and critical care
    • RFH: Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Levobupivacaine + Fentanyl epidural
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • BCF: 100ml Restricted to Obstetrics, 500ml Restricted to Theatres Acute Pain Team only
    • RFH: Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
15.02  Lidocaine
Lidocaine + Adrenaline injection
(Xylocaine)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • For emergency caesarean section
 
Lidocaine 10% spray
(Xylocaine)
(Surface anaesthesia)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Lidocaine 2% + Chlorhexidine 0.25% gel
(Instillagel)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Lidocaine 2.5% + Prilocaine 2.5% cream
(EMLA)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Lidocaine 4% cream
(LMX4)
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Approved for topical anaesthetic of first-choice prior to venous cannulation or venepuncture for paediatrics (JFC July 2013)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Lidocaine 4% solution
(Laryngojet)
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Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Non-formulary
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • Non-formulary
 
Lidocaine 5% + Phenylephrine 0.5% topical solution
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Provider notes

  • NMUH:
    • Formulary for ENT use only
  • RFL:
    • For ENT use only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Lidocaine 5% ointment
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
LAT gel (Lidocaine 4% + Adrenaline 0.1% + Tetracaine 0.5%)
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Unlicensed Drug Unlicensed
GP - Red
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Approved for second-line management of pain in children requiring sutures/debridement (JFC February 2018)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • For A&E use only
  • RNOH:
    • Non-formulary
  • UCLH:
    • No restriction stated
  • WH:
    • Non-formulary
 
15.02  Mepivacaine to top
15.02  Prilocaine
Prilocaine 1% injection
(Citanest)
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Approved for short-acting nerve block (JFC July 2020).

Provider notes

  • NMUH:
    • Approved for short-acting nerve block (JFC July 2020)
  • RFL:
    • No restriction stated
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • No restriction stated
 
Prilocaine 3% + Felypressin injection
(Citanest with Octapressin)
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • BCF use only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • No restriction stated
 
Prilocaine hydrochloride 2% hyperbaric solution
(Prilotekal)
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Restricted Drug Restricted
GP - Red
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Approved for short duration spinal anaesthesia restricted to use in day surgery setting only (JFC February 2018).

Provider notes

  • NMUH:
    • As above
  • RFL:
    • As above
  • RNOH:
    • No restriction stated
  • UCLH:
  • WH:
    • For Day Surgery use only
 
15.02  Chloroprocaine
Chloroprocaine
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GP - Red
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • For day surgery spinal anaesthesia in adults where the planned surgical procedure is suitable for spinal anaesthesia and is of short duration not exceeding 40 minutes.
 
Procaine hydrochloride
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
15.02  Ropivacaine
Ropivacaine
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GP - Red
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Approved for:

  • Infiltration anaesthesia; restricted to RFH for knee surgery only (JFC January 2013)
  • Single dose in an off-label manner as a local infiltration during total hip replacement (THR) and total knee replacement (TKR) (JFC January 2017)
  • Surgical wound infiltration via Painbuster; for post-operative management of patients undergoing live-donor nephrectomy and patients undergoing Deep Inferior Epigastric Perforators (DIEP) flap breast reconstruction (JFC July 2015)
  • Ropivacaine continuous surgical wound infiltration via Painbuster; for colorectal surgery and incisional hernia (JFC May 2016)

Provider notes

  • NMUH:
    • No restriction stated
  • RFL:
    • Local infiltration during total hip replacement (THR) and total knee replacement (TKR).
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • The use of Lidocaine (lignocaine) 2% cartridge, bupivacaine 0.0625% infusion and ropivacaine is restricted to theatres only.
 
15.02  Tetracaine
Tetracaine 4% gel
(Ametop)
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • The use of tetracaine (Ametop) gel is restricted to Paediatrics DSU and A&E only.
 
15.02  Other local anaesthetics to top
Articaine hydrochloride + Adrenaline injection
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Formulary
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • For dental use at BCF only
  • RNOH:
    • Non-formulary
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Cocaine oromucosal solution
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Restricted Drug Restricted
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Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • 5% and 10% mouthwash available
  • RNOH:
    • Restricted - 10% available
  • UCLH:
    • Non-formulary
  • WH:
    • Non-formulary
 
Ethyl Chloride
(Cryogesic Spray)
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Formulary
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econdary care notes

  • NMUH:
    • Non-formulary
  • RFL:
    • No restriction stated
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Mepivacaine injection
(Scandonest Plain)
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Formulary
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econdary care notes

  • NMUH:
    • Non-formulary
  • RFL:
    • BCF only
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
 ....
 Non Formulary Items
Benzocaine 3% cream
(Local anaesthesia)

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Non Formulary
Cocaine + Adrenaline

View adult BNF View SPC online View childrens BNF
Non Formulary
Dermogesic spray

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Non Formulary
Dexmedetomidine injection
(Opthalmic surgery)

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Non Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Not approved for conscious sedation in Opthalmic surgery (May 2014)

Lidocaine + Tetracaine cream
(Pliaglis)

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Non Formulary
Lidocaine 5% patch

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Non Formulary
Black

Not approved for neuropathic pain (November 2012)

Link  NCL JFC: Position Statement - Lidocaine patch
Mepivacaine + Adrenaline injection
(Scandonest 2% Special)

View adult BNF View SPC online View childrens BNF
Non Formulary
Naloxone pre-filled syringes
(Prenoxad)

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Non Formulary
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

netFormulary