Jasocaine-A2%+0.0005%

Jasocaine-A injection is indicated for the production of local or regional anesthesia by infiltration, peripheral nerve block, and other techniques where a prolonged duration of anesthesia with reduced bleeding at the site is desirable.

Established / approved uses

• Local infiltration anesthesia for minor surgical and dermatologic procedures
• Dental anesthesia (infiltration and nerve block) prior to dental extractions and restorative procedures
• Peripheral nerve block anesthesia for minor limb and soft-tissue procedures

Adjunct use

• The adrenaline (epinephrine) component is added as a vasoconstrictor adjunct to lidocaine to prolong anesthetic duration, reduce systemic absorption, and provide local hemostasis; it is not used as a stand-alone anesthetic.

Jasocaine-A is not indicated for spinal or intravenous regional anesthesia (Bier block) or for injection into end-arterial areas.

Each mL of Lidocaine + Adrenaline injection typically contains Lidocaine Hydrochloride 10 mg, 20 mg, or 50 mg (equivalent to 1%, 2%, or 5% w/v) combined with Adrenaline (Epinephrine) as tartrate or bitartrate, commonly at a concentration of 5 mcg/mL (1:200,000) or 10 mcg/mL (1:100,000). A sodium metabisulfite antioxidant is usually included to stabilize the adrenaline component. Exact strengths vary by manufacturer and formulation; refer to the specific product label for the strength dispensed.

Jasocaine-A is a fixed-dose injectable combination of an amide-type local anesthetic (lidocaine) and a sympathomimetic vasoconstrictor (adrenaline/epinephrine). Lidocaine produces reversible loss of sensation in a localized area by blocking nerve conduction, while adrenaline constricts local blood vessels, which slows systemic absorption of lidocaine, prolongs the duration of anesthesia, and reduces bleeding at the injection site. It is administered only by, or under the direct supervision of, a qualified healthcare professional trained in local/regional anesthetic techniques and in the management of anesthesia-related emergencies.

Jasocaine-A belongs to the therapeutic class of local anesthetics (amide type) formulated in combination with a vasoconstrictor (sympathomimetic/alpha-adrenergic agonist) to enhance and prolong local anesthetic effect.

Lidocaine + Adrenaline combines two pharmacologically distinct actions:

• Lidocaine is an amide-type local anesthetic that stabilizes the neuronal membrane by blocking voltage-gated sodium channels, inhibiting the initiation and conduction of nerve impulses, and thereby producing reversible local anesthesia.
• Adrenaline (epinephrine) is a direct-acting sympathomimetic that acts predominantly on alpha-1 adrenergic receptors in local vasculature, producing vasoconstriction. This reduces local blood flow, which slows systemic absorption of lidocaine, prolongs the duration and intensity of anesthesia, and reduces bleeding at the injection or surgical site.

Onset of action of Lidocaine + Adrenaline is typically within 2-5 minutes of infiltration, with a duration of anesthesia of approximately 1-2 hours or longer, substantially prolonged compared with plain lidocaine.

Jasocaine-A is for infiltration or peripheral nerve block injection only, administered by or under the direct supervision of a qualified healthcare professional. It must not be given intravenously.

• Aspirate (pull back on the syringe plunger) before injecting at each site to reduce the risk of inadvertent intravascular injection.
• Inject slowly, using the lowest effective volume.
• Resuscitation equipment and drugs must be immediately available whenever a local anesthetic is administered.
• Do not use if the solution is discolored, cloudy, or contains particulate matter.

Jasocaine-A has the following clinically significant drug interactions:

• MAO inhibitors and tricyclic antidepressants: may potentiate the pressor (blood-pressure-raising) effect of the adrenaline component, risking severe, sustained hypertension.
• Non-selective beta-blockers (e.g., propranolol): may lead to unopposed alpha-adrenergic effects of adrenaline, causing significant hypertension and reflex bradycardia.
• Volatile halogenated general anesthetics (e.g., halothane): sensitize the myocardium to circulating catecholamines, increasing the risk of ventricular arrhythmias when used with the adrenaline component.
• Other local anesthetics or antiarrhythmic drugs with local anesthetic activity (e.g., mexiletine): additive systemic toxicity with the lidocaine component.
• Phenothiazines and butyrophenones: may reduce or reverse the pressor effect of adrenaline.
• CYP3A4/CYP1A2 inhibitors (e.g., certain antifungals, macrolides): may reduce clearance of lidocaine, increasing systemic exposure.

Inform the treating clinician of all current medicines before receiving Jasocaine-A.

Side effects of Jasocaine-A may be local (related to the injection) or systemic (related to absorption of either component).

Local effects

• Injection site pain, transient blanching of the skin, prolonged numbness, or bruising

Systemic effects - lidocaine component

• Common: dizziness, drowsiness, perioral numbness or tingling, tinnitus, blurred vision
• Serious (with excessive dose or inadvertent intravascular injection): tremor, muscle twitching, seizures, hypotension, bradycardia, cardiac arrhythmia, and, rarely, cardiac arrest (local anesthetic systemic toxicity, LAST)

Systemic effects - adrenaline component

• Transient palpitations, tachycardia, anxiety, tremor, headache, and elevated blood pressure, particularly with inadvertent intravascular injection

Jasocaine-A should be used during pregnancy only if clearly needed and if the potential benefit justifies the potential risk to the fetus; a physician should be consulted before use. Local anesthetics with adrenaline are commonly used for necessary dental and minor procedures during pregnancy when the benefit outweighs the risk, but routine or elective use should be avoided unless required.

Lidocaine is excreted in small amounts in breast milk. Jasocaine-A should be used in breastfeeding women only under medical advice, weighing the benefit of the procedure against any potential exposure to the infant.

Jasocaine-A should be used with caution in the following situations:

• Cardiovascular disease: the adrenaline component can cause tachycardia and hypertension, particularly with inadvertent intravascular injection; use the lowest effective dose and aspirate before injecting.
• Hyperthyroidism: patients may have increased sensitivity to the effects of adrenaline.
• Hepatic impairment: lidocaine is metabolized by the liver; patients with severe hepatic disease are at higher risk of systemic toxicity and may require reduced doses.
• Sulfite sensitivity/asthma: some formulations contain sulfite preservatives that may cause allergic-type reactions, including anaphylactic symptoms, in susceptible individuals.
• Resuscitation equipment and trained personnel must be immediately available whenever Jasocaine-A is administered, given the risk of local anesthetic systemic toxicity (LAST) with excessive dose or inadvertent intravascular injection.
• Never inject into end-arterial areas (see Contraindications).

Overdose or inadvertent intravascular injection of Jasocaine-A can cause serious, potentially life-threatening local anesthetic systemic toxicity (LAST), with central nervous system effects (agitation, tremor, seizures) progressing to cardiovascular effects (arrhythmia, hypotension, cardiac arrest), as well as exaggerated adrenaline effects (severe hypertension, tachyarrhythmia).

Suspected overdose is a medical emergency. Seek immediate medical attention or contact emergency services. Management must be carried out in a setting with resuscitation capability and may include airway support, oxygen, seizure control, and, in severe cases, lipid emulsion therapy administered by trained medical personnel as a specific antidote. Do not attempt home treatment.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children. Do not use if the solution is discolored or contains particles. Discard any unused portion from opened ampoules/vials; do not use multi-dose preparations beyond the manufacturer's stated in-use period.

• Elderly: use the lower end of the dosing range; elderly and debilitated patients may be more sensitive to systemic effects of both components.
• Hepatic impairment: reduced clearance of lidocaine may increase the risk of systemic toxicity; dose reduction is generally recommended.
• Renal impairment: use with caution; while lidocaine itself is primarily hepatically cleared, active metabolites may accumulate with repeated or high dosing in severe renal impairment.
• Cardiovascular disease: see Precautions and Warnings; the adrenaline component requires particular caution.
• Pediatric patients: dosing must be calculated by body weight; see Pediatric Uses.

Jasocaine-A is intended for single-procedure administration to provide anesthesia for the duration of the planned procedure; it is not intended for chronic or repeated daily use. Repeat dosing within the same session should only be given by the treating clinician within the maximum total dose limits.

Lidocaine + Adrenaline is classified as a local anesthetic (amide type) in fixed combination with a vasoconstrictor (sympathomimetic, alpha-adrenergic agonist).

The lidocaine component of Lidocaine + Adrenaline blocks voltage-gated sodium channels on neuronal membranes, preventing depolarization and blocking the generation and conduction of nerve impulses, which produces reversible local anesthesia. The adrenaline component acts on alpha-1 adrenergic receptors to constrict local blood vessels, reducing local blood flow. This slows systemic absorption of lidocaine, prolongs its anesthetic effect at the injection site, and reduces intraoperative bleeding.

C

Jasocaine-A may be used in children for dental and minor procedural local anesthesia, with dosing strictly calculated on a mg/kg body-weight basis according to the child's age, weight, and the procedure being performed. Safety and efficacy in neonates and very young infants have not been well established for this combination, and use in this age group should be limited to clinicians experienced in pediatric anesthesia. Maximum dose limits are lower in children than in adults on a per-kg basis in many protocols, and extra caution is required to avoid inadvertent intravascular injection.