Homeade Lidocane HCL?

[dtwn92]

Found this on my blog searches, wanted to get some other opinions and thoughts on this:

http://modernsurvivalonline.com/guest-p ... caine-hcl/" onclick="window.open(this.href);return false;

What you’ll need:

Lidocaine Hydrochloride (HCL) powder (roughly $1 per gram in small quantities)
Sterile saline, or distilled water (varies, $10 for 24 of the single-use saline vials I chose)
Thermometer, accurate up to 200 degrees F or so ($10 and up)
Scale, accurate down to 1mg or less. ($25 and up)
Funnel, small
Surgical clamp
Scissors
A clean work area with a stove or other way to heat water

I guess in a pinch it would "have to do" but I'm not sure I'd want to inject lidocaine in me if I didn't absolutely need it. I'm sure it could do more harm than good, and I think you could cause a MI if you inject into a vein (not certain at such small quantities).

Thoughts?

[VXMerlinXV]

Well, that is definitely thinking outside of the box. I am curious about the saline, we use those at work and they are never used for injection. Could it work in a pinch? Maybe, but I can't imagine injection grade saline isn't available someplace. Maybe fishtank saline or South American saline. I don't know, I don't really go overboard with my medication storage so I don't know where you would get such a thing.

I think this falls into the category of "If society has degraded to the point where people are mixing their own lido, then the patient will most likely not survive the procedure due to lack of follow up care and general living conditions." I'd love to get on board with this, but I've seen too many adverse reactions and complications stemming from homemade injectables over the past few years.

[abelru]

Meh...
Not really homemade as much as it is home-reconstituted, but I digress...

I say no-go.
If you can go to all the trouble to gather the listed components, and have ready access to "lidocaine powder", it begs the question; why don't you just buy standard lidocaine to begin with?

Also, what is the shelf life of the reconstituted solution? How would you store it? How to you store the constituent components? Without sterile controls or the meticulous manufacturing processes which the multi-BAH-ziollion mega huge pharma companies have in place, you really run the risk of doing way more harm than good.

Remember the compounding pharmacy that fucked up a batch of steroids a while back?

http://www.cdc.gov/hai/outbreaks/meningitis.html" onclick="window.open(this.href);return false;

http://www.cbsnews.com/8301-204_162-575 ... infection/" onclick="window.open(this.href);return false;

...and that's what those folks did professionally in a lab.

[IANMCDEVITT]

Why?.......I mean, why do you need it? I relocate shoulders at least once every three weeks, have for six years. I just do it as quickly as possible post injury and have real good history's by the patient's. I don't do fingers, except my own that is, I do knee caps occasionally...I don't block anything, never have. I wouldn't use it in a cardiac situation without a monitor available. I just cut out a spider bite with the guy biting a gauze covered stick, squeezed out a poison plug the size of my thumb nail.....I mean, what's the big deal about Lido ?.............AND............. the real thing is not even that difficult to get !

[okiebill]

I'm gonna have to agree that Lido (non epi) is not that hard to get, it will take a little digging but you can get it...

There are some very strong non Rx products for topical application that would work just fine for stitches and the like. Take a look at some of the better Tattooing numbing creams and combine them with " concentrated application".

Here is a conversation about this topic recently: http://www.zombiehunters.org/forum/view ... 3&t=105321

[CrossCut]

Might have some merit for the prepper/survivalist, you want something that can sit on the shelf or at the bottom of your bag unused for years, and still work. My BOL inside temps (unheated, when not there) varies from about -20 to 80F, the ingredients would last a lot longer than the Rx, and reconstitute it if needed. Buried caches too?

Not at the top of my list of must haves, but I'd prefer having some if the Mrs was coming at me with a dental extractor in her hands

[IANMCDEVITT]

....and I don't really suture. I could if I had to, but it's not one of my go-to skills (most definitely)...... In wilderness medicine I didn't suture either. Certainly in both the jungle or the African bush I do not suture. Not a good practice. Won't get into that discussion again. Now, if you told me you could make ASA, aspirin in your basement with some friggin tree bark......THAT has some uses.

[Veritas]

Lidocaine is great...home-reconsituted lidocaine is silly. Just buy the real stuff, I didn't even know lidocaine powder existed.

Lidocaine is nice for regional nerve blocks, when you would normally require some sort of procedural sedation but don't have the staff or don't have the skill to manage an airway, or don't want the risk. Situations like big abscesses (pilonidal cysts are tough even with lido, there's no good nerve to block), shoulders that have been out longer than an hour or so, complicated lacs that need primary closure, dirty wounds that need to be explored...or think of the PAW when dental care is crap, a regional nerve block can give a lot of relief (albeit temporary) and may even allow you to pull the tooth. Pain is bad, I've seen people vagal down while starting an iv, during a lumbar puncture, both of which involve very small needles. People recover better if they're not in pain. If the only people you plan on taking care of are hardened and trained military or paramilitary people, then maybe you can try the "bite a stick" method, but for most people I see, they can't handle much. In fact, the guy crying the most is usually the big burly cop or the guy covered in tattoos and piercings.

[IANMCDEVITT]

Easy with the tattoo and piercing bashing.........but, your right about the pain and healing AND the big guys cry a lot crack....yea, a blocked nerve for dental would be great in the PAW, BUT, I'm living proof oral surgeons screw that up on a regular basis........I have an Inferior Alveolar Neurectomy to prove it.......Back to the subject, I don't see the need in making it right now.....but each of us reading this are in different situations.

[Slugg]

Meh...
Not really homemade as much as it is home-reconstituted, but I digress...

I say no-go.
If you can go to all the trouble to gather the listed components, and have ready access to "lidocaine powder", it begs the question; why don't you just buy standard lidocaine to begin with?

Also, what is the shelf life of the reconstituted solution? How would you store it? How to you store the constituent components? Without sterile controls or the meticulous manufacturing processes which the multi-BAH-ziollion mega huge pharma companies have in place, you really run the risk of doing way more harm than good.

Remember the compounding pharmacy that fucked up a batch of steroids a while back?

http://www.cdc.gov/hai/outbreaks/meningitis.html" onclick="window.open(this.href);return false;

http://www.cbsnews.com/8301-204_162-575 ... infection/" onclick="window.open(this.href);return false;

...and that's what those folks did professionally in a lab.

I actually knew a guy who got those shots in his back. Gave him horrible meningitis and he was out of work for a few months. He was a gym teacher though, so I'm sure he got paid time off and such. Still, it almost killed him, so that makes me say no thank you to home brew lidocaine. I think I'd prefer homemade ETOH instead for my sutures thank you

[MacWa77ace]

Not a doctor but I play one on TV.

When the title is How to make 'X' and the first ingredient you'll need is 'X' I tend to lose interest.

ETA: There are many powdered drugs you can make injectable. They come in powder form in a glass tincture, you break the top off, use a syringe to inject some saline or purified water into the tincture then draw out the injection. The premise is that the powder would last a long time where the liquid form would not stay fresh or need to be refrigerated etc. So, you're not actually making the drug you're just making it injectable.

[ineffableone]

Also, what is the shelf life of the reconstituted solution? How would you store it? How to you store the constituent components?

In closing, I think it’s safe to assume that the solution should be used within 24 hours and any leftover discarded since it doesn’t contain any preservatives or antibacterials. With practice and the materials handy it only takes about 20 minutes to make more. I created a small kit with all the supplies, including pre-weighed lidocaine packets in tiny zip-loc bags that are clearly marked, in case I need to make it in a hurry. Hope no one ever needs to.

Lidocaine Hydrochloride (HCL) powder is available in lab grades from online distributors if you can’t obtain it in USP grade. You want “Lidocaine HCL” which is water soluble, not the straight “Lidocaine powder” or “Lidocaine base” which isn’t. It should be stored at room temperature according to its Material Safety Data Sheet, and has no predetermined shelf life or expiration date if stored in an airtight container – or at least none that I’ve been able to determine anyway.

It helps to read the source material. It might answer your questions.

While I am not planning to try this, I have to give the author some props for thinking outside the box, and testing it on himself. The recipe sounds plausible, and the concept reasonable.

Might have some merit for the prepper/survivalist, you want something that can sit on the shelf or at the bottom of your bag unused for years, and still work. My BOL inside temps (unheated, when not there) varies from about -20 to 80F, the ingredients would last a lot longer than the Rx, and reconstitute it if needed. Buried caches too?

Not at the top of my list of must haves, but I'd prefer having some if the Mrs was coming at me with a dental extractor in her hands

This is my general thoughts too. For someone with training and other medical equipment this might be a reasonable concept. Could be useful but not top priority for me as I do not have the medical training to consider this kind of effort. However...

I think this falls into the category of "If society has degraded to the point where people are mixing their own lido, then the patient will most likely not survive the procedure due to lack of follow up care and general living conditions." I'd love to get on board with this, but I've seen too many adverse reactions and complications stemming from homemade injectables over the past few years.

I have to agree with this comment also, when things get this serious, do you really have the medical facilities and knowledge to give after care?

I think a lot of folks have been influenced by popular media. The ever so common scene of folks pulling a bullet out of a shoulder (in a motel/woods/cave/basement) and just bandaging it up and living on to continue fighting the bad guys is way over done. This is not reality though. Sure it makes for exciting TV or movie moments but the reality is very very different.

While I could see something like this benefiting someone who actually has training, for the lay person with no or minimal training, it is likely not going to really cut it.

One of the things I loved from the book Earth Abides was how the author explained how a lot of the deaths were not from the specific event but secondary deaths. Death due to lack of medical knowledge and ability to treat, from depression and lack of will to go on, from all sort of things we can deal with now but in PAW it decreases your chances drastically. Simple medical issues we take for granted these days will be life threatening in PAW. Medium medical issues will be a death sentence, and the big medical issues well obvious if simple and medium are trouble the big ones are worse.

What I can see something like this recipe used for. Easing the pain of someone while you wait for them to die. Sadly but seriously that is what it is most likely going to come down to. Easing pain for someone who you don't have the ability to save. And the harsh reality, shutting them up. In PAW you don't want an injured or sick person screaming in pain keeping every one awake or worse bringing the zombie horde down on your little group. If you have a pain killer, then you use it on the person you expect to die to ease their pain and to keep the rest of your group able to go on. I know it sounds harsh, but that is the reality of PAW, it is harsh.

[IANMCDEVITT]

You aren't going to be able to ease the pain of someone with that recipe.......nice thought and I've done it, only with a heavier opiate (30-50mg MS IVP) Morphine Sulfate IV push.....or a benzo like "Euthozol" which we use on dogs (God bless them)..........You MAY be able to knock out someone's ventricles with about 300mg's. Depends on patient weight. If you do, they will go into a short tach, then fib, down to a fine V-Fib, then asystole no doubt........I don't really know if I'd call that peaceful, but, I agree with your extrapulations about what medicine will degrade too though.............your right on target.

[dtwn92]

As and FYI I didn't just post and run away, I've been reading some very good info.

I don't like or trust meds you would have to do this way, however in a pinch it could work. But until recently we didn't "numb" injuries we poured whiskey on them and went to town...lol

[LowKey]

I think he meant to relieve their pain through local anesthesia at the injury site rather than classic pain management, nerve blocking for example a limb with compartment syndrome.

[abelru]

Also, what is the shelf life of the reconstituted solution? How would you store it? How to you store the constituent components?

In closing, I think it’s safe to assume that the solution should be used within 24 hours and any leftover discarded since it doesn’t contain any preservatives or antibacterials. With practice and the materials handy it only takes about 20 minutes to make more. I created a small kit with all the supplies, including pre-weighed lidocaine packets in tiny zip-loc bags that are clearly marked, in case I need to make it in a hurry. Hope no one ever needs to.

Lidocaine Hydrochloride (HCL) powder is available in lab grades from online distributors if you can’t obtain it in USP grade. You want “Lidocaine HCL” which is water soluble, not the straight “Lidocaine powder” or “Lidocaine base” which isn’t. It should be stored at room temperature according to its Material Safety Data Sheet, and has no predetermined shelf life or expiration date if stored in an airtight container – or at least none that I’ve been able to determine anyway.

It helps to read the source material. It might answer your questions.

I did read the article.
My questions were rhetorical really.
Point being, what controls will be in place to ensure a product free of contaminants or adulterants? The authors method of stove-top med mixing is more akin to cooking meth than producing medical grade pharmaceuticals. Even by his own admission, the author finds fault with this method...

(1) Most sources of Lidocaine HCL that I found listed it as “Reagent ACS” grade, which is not for any medical use.  But that grade does require certification by the American Chemical Society, who tests batches from a production run and provides a Certificate of Analysis (COA) to the manufacturer as part of their certification.  A description of the different chemical grades is available here: http://www.reagents.com/products/reagents/grades.html" onclick="window.open(this.href);return false;.  Many sellers will provide this COA on request, but who can say what contamination may have occurred while the seller was repackaging the product into smaller quantities for retail sale?  Or even that the COA is from the same batch they sold you?   If that concerns you then it might help to consider that  thousands, if not millions, of people are snorting this same Reagent ACS grade lidocaine daily, as it’s a common dilutant added to street cocaine.  It’s also a fair question to ask if lab grade chemicals today are less pure than medical grade chemicals used 50-100 years ago.  But then again, what if your seller confused your lidocaine order with someone else’s strychnine order (both being white crystalline powders)?   Just trying to give both sides as I see them – and make a plea that you choose carefully and test cautiously if you decide to try this.  One bit of good news is that you’ll probably only ever need to test a single batch, since one $50 order would be a lifetime supply.

I've taken care of plenty of folks who are Coke fans who have rather unique and difficult to treat infections...

And as far as the saline is concerned...

There might be other factors I missed that separates “for injection” versus “not for injection” sterile saline.  For infrequent use and in the amount discussed here, the risk seems minimal.   I’d think that factory sealed “not for injection” sterile saline is still a safer option than using distilled water, but I’m not a doctor

It probably works, but you just might wind up with a shooters abscess. Just sayin'

YMMV

[Slugg]

I think he meant to relieve their pain through local anesthesia at the injury site rather than classic pain management, nerve blocking for example a limb with compartment syndrome.

This is what I was taking it as. Maybe close a simple through and through bullet hole or fix an impalement.

[JIM]

Just mix some benadryl with saline. Works just as well as a local anesthetic, but not as long as the lidocaïne

[CowDoc]

While I was reading this I was thinking I should weigh in since I might be one of the few people on the forum that have actually used reconstituted lidocaine powder regularly in a medical situation, albeit on animals.

In one of the large dairy practices I worked in it was standard operating procedure to use reconstituted lidocaine (as a local cornual nerve block) to augment sedation for dehorning. Lidocaine HCL powder was measured into a 500 ml bottle of sterile water and the bottle was connected by IV tubing to a adjustable, multi-dose barrel vaccine syringe for local infiltration. In practice we would sedate perhaps two to three dozen calves, perform the nerve block and “process” the calves, including brucellosis vaccination and tattoo, castration, dehorning, removal for supernumerary teats, etc, etc.

There were all sorts of warnings that I thought should be made, most of which have already been mentioned. As I re-read the article however it occurred to me the author had done a commendable job addressing most of my concerns, although I’m not sure there was appropriate emphasis given to the dangers.

Perhaps my biggest concern was that lack of attention paid to preventing overdose, in this case lidocaine toxicity. For humans the maximum safe dose (for infiltration) is approximately 4 mg/kg of body weight, so a 70 kg or 150 pound adult (human) shouldn’t receive more than approximately 300 mg or 30 ml of a 1% solution or 15 mls of a 2% solution. To the authors credit, as I re-read the article I found a sentence to exactly that effect.

The most significant criticism I would probably make of the article would be the relatively small emphasis the author places on preventing over-dose. With children (or small animals) I suspect it would be relatively easy for the inexperienced person to overdose in the heat of the moment. Also I don’t think adequate attention in the article was given to preventing inadvertent intravenous injection, meaning what qualifies as good infiltration technique.

As an aside, I should mention in the way of background, that the safe dose of lidocaine increases slightly with the addition of epinephrine to about 7 mg/kg or about 25 mls of a 2% solution. I’m also obligated to mention that some species are more sensitive to local anesthetics than others, so a one-size-fits-all for all god’s creatures is problematic. I have routinely used more the 180 lidocaine for bovine cesarean sections but goats & cats are reported to be particularly more sensitive to lidocaine.

As has already been mentioned by numerous posters here, there is also real danger associated with microbial contamination, particularly if the reconstituted product sits for any period of time. The infection risks range from routine staph or strep infections, to pseudomonas or fungal infections to Clostridium infections including but not limited to botulism.

Once again the author does promote a practice were you would only mix what you needed and points out that this is a last ditch end-of-the-world practice. I would argue however that he doesn’t sufficiently warn homesteaders or other do-it-yourselfers that injection of non-commercially sterile compounds is a very bad idea.

All in all, I was impressed with the article. The author considered and addressed sourcing the product, sanitary mixing, dosage and even performed a trial with a negative control. All of this is far more professional than most post-apocalyptic web pages.

That said, I would caution people having little or no experience administering local anesthesia to trying this out at home. For me personally, I’ll be sticking to commercially available, medical grade lidocaine known to be sterile. Besides, I can get it with epinephrine which extends the duration of local anesthesia.

Just my 2 cents.

[okiebill]

CowDoc,

If I have my choice I will forgo Lidocane with Epi as the added time to the numbing / added dosage does not offset the disadvantages associated with the vasoconstricting properties of the Epi. ( Lidocaine with Epi should not be used on fingers / toes, nose, ears ect...)

I mention this for the folks that are not aware of Lidocane w/ Epi's limitations.

[abelru]

CowDoc,

If I have my choice I will forgo Lidocane with Epi as the added time to the numbing / added dosage does not offset the disadvantages associated with the vasoconstricting properties of the Epi. ( Lidocaine with Epi should not be used on fingers / toes, nose, ears ect...)

I mention this for the folks that are not aware of Lidocane w/ Epi's limitations.

This came up the other day when I was consulted to evaluate a digital artery laceration with possible flexor tendon involvement in the ED. As a matter of customary practice, virtually everyone I have worked with would have either employed electrocautery or a Tourni-cot. I would venture to go out a limb and say that this is standard practice at most centers. However, the resident had locally infiltrated the laceration with about 3mL's of lido/epi.

Needless to say, when I heard this I had visions of of someone who would only be able to count to nine in a matter of days. I hold the "ears, nose, penis, fingers, toes" rule as gospel.
But after a fairly rushed lit search on epi use in the digits, I was quite surprised to find that there is a plethora of literature that debunks the myth that digital infiltration of epinepherine is inherently bad. In fact, the data actually support its use in many papers...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526033/" onclick="window.open(this.href);return false;

http://www.ncbi.nlm.nih.gov/pubmed/17255681" onclick="window.open(this.href);return false;

http://www.cjem-online.ca/v5/n4/p245" onclick="window.open(this.href);return false;

And coincidentally, this paper was recently published in the JAAOS describing the routine use of epi into the digits to provide effective anesthesia during minor hand procedures and tendon repairs. It seems our neighbors to the North have been using this method with great success and no reports of tissue necrosis to date have been noted by the author.

https://www.jaaos.org/content/21/8/443.abstract" onclick="window.open(this.href);return false;


Admittedly, it will likely be some time before I become comfortable enough with this technique to actually employ it in practice. Interesting none the less.

ETA: my search focussed only on epinepherines use in the hand. I will look in the coming days if epinepherine use has been similarly evaluated and established as safe for use in toes/lobes/penis'

[okiebill]

CowDoc,

If I have my choice I will forgo Lidocane with Epi as the added time to the numbing / added dosage does not offset the disadvantages associated with the vasoconstricting properties of the Epi. ( Lidocaine with Epi should not be used on fingers / toes, nose, ears ect...)

I mention this for the folks that are not aware of Lidocane w/ Epi's limitations.

This came up the other day when I was consulted to evaluate a digital artery laceration with possible flexor tendon involvement in the ED. As a matter of customary practice, virtually everyone I have worked with would have either employed electrocautery or a Tourni-cot. I would venture to go out a limb and say that this is standard practice at most centers. However, the resident had locally infiltrated the laceration with about 3mL's of lido/epi.

Needless to say, when I heard this I had visions of of someone who would only be able to count to nine in a matter of days. I hold the "ears, nose, penis, fingers, toes" rule as gospel.
But after a fairly rushed lit search on epi use in the digits, I was quite surprised to find that there is a plethora of literature that debunks the myth that digital infiltration of epinepherine is inherently bad. In fact, the data actually support its use in many papers...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526033/" onclick="window.open(this.href);return false;

http://www.ncbi.nlm.nih.gov/pubmed/17255681" onclick="window.open(this.href);return false;

http://www.cjem-online.ca/v5/n4/p245" onclick="window.open(this.href);return false;

And coincidentally, this paper was recently published in the JAAOS describing the routine use of epi into the digits to provide effective anesthesia during minor hand procedures and tendon repairs. It seems our neighbors to the North have been using this method with great success and no reports of tissue necrosis to date have been noted by the author.

https://www.jaaos.org/content/21/8/443.abstract" onclick="window.open(this.href);return false;


Admittedly, it will likely be some time before I become comfortable enough with this technique to actually employ it in practice. Interesting none the less.

ETA: my search focussed only on epinepherines use in the hand. I will look in the coming days if epinepherine use has been similarly evaluated and established as safe for use in toes/lobes/penis'

Abelru, Thanks for the great info and I agree it is an interesting concept but a long way from being accepted as standard practice.

[Veritas]

Gonna have to agree with abelru. Case reports of epi pens being injected into thumbs show no evidence of permanent damage. Like so many other theoretical risks, it has not proved up to science.

Epi is nice in lido. Helps analgesia last longer, gives you less blood in the field for a better view. I don't use it on crush wounds, skin flaps with a small base, or in patients with bad vascular disease and diabetes.

Regional blocks are the way to go. Every single thing in medicine has complications, so of course a dental block can go wrong. Every thing can go wrong. But it's a great option when you don't have much else to use, or when opiates aren't a good solution.

And I have tattoos. No piercings though. Guess that's why I don't cry when I get a blood draw. Like all the tattooed and pierced tough guys. Until they get that one drug...what's it called doc? Starts with a d...duh...duh...

[royalflush]

Lidocaine is great...home-reconsituted lidocaine is silly. Just buy the real stuff, I didn't even know lidocaine powder existed.

Lidocaine is nice for regional nerve blocks, when you would normally require some sort of procedural sedation but don't have the staff or don't have the skill to manage an airway, or don't want the risk. Situations like big abscesses (pilonidal cysts are tough even with lido, there's no good nerve to block), shoulders that have been out longer than an hour or so, complicated lacs that need primary closure, dirty wounds that need to be explored...or think of the PAW when dental care is crap, a regional nerve block can give a lot of relief (albeit temporary) and may even allow you to pull the tooth. Pain is bad, I've seen people vagal down while starting an iv, during a lumbar puncture, both of which involve very small needles. People recover better if they're not in pain. If the only people you plan on taking care of are hardened and trained military or paramilitary people, then maybe you can try the "bite a stick" method, but for most people I see, they can't handle much. In fact, the guy crying the most is usually the big burly cop or the guy covered in tattoos and piercings.

I think that most people who are considering home made lidocaine won't be doing regional nerve blocks- thus use in deep tissue treatment is off the table here for the vast majority, unless they have an aptitude for self teaching, anatomy, and physiology. IF someone with knowledge has it, i think it'd be of great help. you could nearly do a cesarian if you had to w/ lidocaine. but knowledge is power
pain: little bit is good- helps people realize they are injured and to rest instead of increase inflammation. pain's association w/ healing comes more from "central wind up", and is prevented much better by systemic opiods and NSAIDs. I could be wrong- but i'm not sure if lidocaine helps to prevent that or not. You are certainly right about the big ol fella's response to pain! Dental care- couldn't agree more! although the other Na channel blockers would be better, lido would work just fine.

1ML vials aren't hard to get of hcl prep, so kinda a silly conversation anyway, and you sink a few grams into a BV inadvertently and you could wind up in arrhythmia city. ask your dentist, it's a controlled drug, but it's class 3, but he can prescribe it to be mixed w/ sucralfate or pepto to be used on mouth ulcers. Not sure how many dentists will do this, but my brother used to have terrible mouth ulcers and we had several vials at the house.


someone mentioned use of non-injection grade saline- I would think that as long as it's a sealed sterile bottle and you aren't injecting IV you should be fine- but that's just my thought. not too much different than using the same saline to flush a wound.