Making Lidocaine for Injection, by R.J.. lidocaine hydrochloride (HCL)

Important Introductory Disclaimer: I am not a licensed health practitioner. This article suggests knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available. As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals. No medication, including those available over the counter, should be taken without consulting a physician. Preparation of sterile medications by non-professionals should only be attempted in extreme emergencies where there is absolutely no access to commercially-prepared medicines.  Information shared here is for educational and entertainment purposes only. It is not medical advice nor a substitute for licensed medical care. 

Lidocaine, as known as lignocaine, is one of those substances that will make TEOTWAWKI a little more bearable. A local anesthetic, it is on the WHO List of Essential Medications. It is available over-the-counter in the form of pain patches, such as those often applied to relieve muscle strains and over-exertion. Topical anesthetic creams with lidocaine are used to alleviate the irritation of contact dermatitis due to poison oak and poison ivy, bug bites and stings, and sunburns. Tattoo creams contain up to 5% lidocaine, the strongest available without a prescription.

Lidocaine also comes in an injectable form in 1 and 2% solutions. It is often, but not always, combined with epinephrine for better anesthesia and to control bleeding. It is an anesthetic used in epidurals, dental procedures, and minor surgery where local and regional anesthetics are appropriate. It is often used to numb the skin around abrasions that need to be cleaned out and lacerations that need to be stitched. The numbing effect generally lasts only about thirty minutes, usually long enough to manage smaller injuries. Lidocaine injections are also used to manage heart arrhythmias and seizures and insert catheters.

Unfortunately, unless you are a physician, you cannot purchase lidocaine for injections. It is not a controlled substance, nor is it illegal to possess. However, the only way you are likely to obtain a vial or two is through a prescription from your physician. [JWR Adds: And doing so must be “within the normal scope of practice” of that particular physician.  So that means that if your doctor is a Wilderness Medicine or Remote Care doctor, then he might be willing to do so, but only if you live in a remote location, of have activities in very remote locales.]  Even if you can get it from him/her, it isn’t going to last forever. So we’re left with the DIY option. Here is one way to do so.

Start With The Powder

First off, purchase lidocaine hydrochloride (HCL) [in powder form] from a reputable distributor. I have used MedicalNumbingAgents.com twice now. As lidocaine is not a controlled substance, you do not need a prescription. Determine how much you want. The physician teaching a grid-down medicine course I attended recommended 500 grams for a family of seven. (I am hoping that he was overly cautious and that we never use anything close to that much lidocaine.) At the moment, it’s running $110 for that quantity. If you go to the site and leave it open for a bit, you’ll get a pop-up offering a coupon to save you $11.

While waiting for your lidocaine to arrive, obtain the other necessary items. Sterile saline labeled for injection is what you want, but it’s another item that’s hard to come by. If you can get it from a doctor, great. Do it. ShopMedVet.com has sterile saline for injection, but they require a medical license to purchase it.

If you can’t get sterile saline for injection, use the following TEOTWAWKI work-around.

Amazon sells small vials of sterile saline in three sizes—5, 10, and 15 ml.  Here is a typical one that you can order.

You want the 15 ml size (one tablespoon equals 15 ml). Current Amazon reviews indicate they have about an 18-month shelf-life when shipped. Most people use these for contact lenses when traveling. However, for us, they make a lovely addition to the medical kit. In addition to using these vials to make injectable lidocaine, they are ideal for small medical bags. They are useful in irrigating minor wounds. The squeeze bottle allows you to create gentle pressure for irrigating the wound and washing out dirt and debris. These bottles are also great for flushing a foreign object out of the eyes. While the cap is easily removed, it cannot be replaced. So once you open it, that’s it. Use it and then toss it.

With a short shelf-life, you won’t be able to rely on these little vials of sterile saline for a years-long collapse. But they will work until you can get a sterile laboratory established. And in all likelihood, they will still be good beyond the use-by date, as long as the solution isn’t cloudy and there are no particulates. An added benefit of using these little vials is that mixing in these bottles minimizes opportunities for contamination from other containers.

How Sterile is “Sterile”?

However, it is imperative to note that these sterile saline vials are not labeled for injection. Sterile saline that is for injection must be tested to show that it is pyrogen-free, meaning that there are no bacteria whatsoever that could cause infection. These vials have not been tested, and using them for injection has risks. Just like living in a collapsed society has risks.

Next, you need a scale that can accurately measure milligrams. Amazon has several options in digital scales with high reviews that start at around $20. Obviously, these are not EMP-proof, and they are battery-dependent. Non-electronic scales begin at about $30. If you have a re-loader in your family, and his scale is accurate, that may also be used, assuming that it can be disinfected.

And finally, the last item that you might not yet have on hand is a tiny metal funnel. It needs to be metal so that it can be sterilized. Here’s one option on Amazon: TecUnite 10 Pack Small Metal Funnels with 2 Pack Mini Pipette.

Other instruments that you need and probably already have are metal scissors, a surgical clamp of some sort, an accurate candy thermometer, alcohol wipes, and sterile gloves.

After gathering all your supplies, and before actually making your injectable lidocaine, you need to create a sterile environment. Work in a sterilized room if possible. Sterilize all your tools, including the clamp, scissors, and funnel, in an autoclave, pressure canner (15 psi for 30 minutes), or oven (325 degrees Fahrenheit for 2 hours, or 400 degrees Fahrenheit for 30 minutes). While those items are being sterilized, disinfect the scale thoroughly, especially the pan that will hold the lidocaine. Rubbing alcohol (70%, not 50% and not 91%) is an acceptable disinfectant, as is Dakin’s solution. Then wash and scrub your hands—a thorough medical scrub with soap and running water that takes at least two minutes—and then put on sterile gloves.

The Procedure

Now you’re ready to begin making the injectable lidocaine

To make a 1% lidocaine HCL solution:

1. Weigh 150 mg of lidocaine HCL on the scale.
2. Cut off the top of a 15 ml sterile saline vial about halfway down the neck.
3. Insert the funnel securely into the neck of the vial.
4. Pour the lidocaine into the funnel. (If the powder sticks to the funnel, squeeze the vial gently to move some saline into the funnel. Then release so that the saline drains back into the vial, taking the lidocaine with it. You may have to repeat this procedure a few times to get all the lidocaine into the vial.)
5. Remove the funnel.
6. Close the neck of the vial using your surgical clamp.

To make a 2% lidocaine HCL solution:

1. Weigh 300 mg of lidocaine HCL on the scale.
2. Follow steps 2-6 above.

For both 1% and 2% lidocaine solutions:

1. Create a double boiler with a small canning jar almost filled with water placed in a pan of water on the stove. You just need clean tap water; it doesn’t need to be sterile or distilled.
2. Place the vial in the canning jar, but be especially careful not to submerge it near the openings. Do not let any tap water enter the vial, which would contaminate the solution.
3. Heat the water past 176 degrees Fahrenheit. (Lidocaine dissolves in water, but it doesn’t melt until it reaches 176 degrees F. Melting ensures even distribution.)
4. Remove the vial from the jar. Do not remove the clamp.
5. Let the Lidocaine vial cool.
6. You now have a 1% or 2% solution of Lidocaine HCL.
7. This solution should be used within 24 hours and discarded thereafter.

To use this solution, with the clamp still in place, clean the top of the vial with an alcohol pad. Invert the vial, insert the needle through the top of the vial, and draw out the desired amount of lidocaine into the syringe. A physician will provide clear directions on usage and dosage. The dosage should never exceed 4.5 mg/kg or a total of 300 mg for an adult. The dosage depends on the procedure, the depth of anesthesia, the duration, blood flow, and the condition of the patient.

Making injectable lidocaine is not at all complicated, but it is essential to be careful and very precise. It is easy to overdose or kill a patient with lidocaine. You want to avoid that.

Contraindications: Lidocaine should not be used in people taking beta-blockers or heart medications. Common drugs that may increase lidocaine levels in the body because they slow lidocaine metabolism are erythromycin, ciprofloxacin, and omeprazole. Lidocaine crosses the placenta, so it should be used with caution in pregnant women. It is also excreted in breast milk, and thus its use should be avoided in nursing mothers.

Closing Disclaimer: This article provides the directions for making injectable lidocaine in a true TEOTWAWKI situation, wherein there is no hospital. There is no hope for one. You are only making this injectable lidocaine under the direct supervision of a licensed physician who will then use it to treat a patient. Everything about making injectable lidocaine should only be done by a licensed physician or pharmacist or under their direction and supervision.

For Further Reading:

https://modernsurvivalonline.com/guest-post-how-to-make-injectable-lidocaine-hcl/

https://griddownmed.blog/2015/04/25/from-modern-survival-online-make-your-own-lidocaine-topical-anesthetic/

https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=C7A7D3D2-7638-4570-9EB8-A5E2BEC82B5D

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433813/

https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/inspection-technical-guides/pyrogens-still-danger

https://www.medicinenet.com/lidocaine-injection/article.htm#what_is_the_dosage_for_lidocaine_injection