Overview
Prilocaine is a local anesthetic of the amide type, used for infiltration anesthesia, nerve blocks, and epidural anesthesia. It has a rapid onset and intermediate duration of action, with lower systemic toxicity compared to some other local anesthetics due to its metabolism.
Mechanism of Action
Prilocaine blocks sodium ion channels in neuronal membranes, preventing depolarization and propagation of action potentials, thereby inhibiting nerve conduction and producing local anesthesia.
Indications
- Local anesthesia for dental procedures
- Infiltration anesthesia
- Peripheral nerve blocks
- Epidural anesthesia
- Intravenous regional anesthesia (Bier block)
Dosage
Dosage varies by procedure and patient factors. For dental anesthesia: typically 40-80 mg (2-4 mL of 2% solution). Maximum recommended dose: 400 mg (8 mg/kg) for adults. Always use the lowest effective dose.
Contraindications
- Hypersensitivity to prilocaine or other amide local anesthetics
- Methemoglobinemia or predisposition to methemoglobinemia
- Severe hepatic impairment
- Severe renal impairment
Side Effects
- Methemoglobinemia (dose-related)
- Hypotension
- Bradycardia
- Dizziness
- Nausea
- Headache
- Paresthesia
- Allergic reactions (rare)
Interactions
- Sulfonamides: increased risk of methemoglobinemia
- Other local anesthetics: additive toxicity
- MAO inhibitors, tricyclic antidepressants: may potentiate cardiovascular effects