How to make injectable Lidocaine HCL

The following post was previously published here on MSO – it can be seen in its original format HERE.

 

by RalphP

Almost every other prepper / survivalist that I’ve met shares a similar “hope for the best, but prepare for the worst” philosophy about life.  If this pretty much describes you too, than you’ve probably considered a SHTF situation where, with no access to doctors or dentists, you might be forced to perform some type of minor surgery at home.  Draining an abscess or pulling a tooth maybe.  These are common minor surgeries, but with no anesthesia (or only over-the-counter varieties) they might be very painful.  You’ve probably also thought about how you might treat trauma, like lacerations, punctures, or burns – where suturing, debriding, or removing foreign objects from a wound might be necessary.  Painful enough for an adult, but worse for a child to have to endure.  And while no sane person really wants to think about the worst cases, like having to treat a gunshot, knife, or chainsaw injury to a loved one, you know that ignoring the possibility doesn’t make it any less likely to happen either.  Hope for the best, but prepare for the worst.  TEOTWAWKI might be a dangerous place to live.

 

Everyone also agrees on the need for First-Aid training and supplies; but in cases of more severe trauma, First-Aid is just that – the “first aid” provided to the victim to limit further harm while getting them to a hospital for professional care.  If the SHTF than the “hospital” is most likely going to be your home, and it’s there that the bandage will need to be removed, the damage accessed, and a decision made on how best to promote healing.  This may require invasive, and painful, examination and treatment.  Some might be able to ‘bite the bullet’, but others, particularly children and certainly animals, couldn’t.  Recoiling from pain is an involuntary response and one of the most primitive instincts.  The lack of an effective local anesthetic would not only limit what medical procedures could reasonably be performed, but also result in unnecessary pain in those that could be.  Now fantasies about an untrained medic performing vascular surgery, nerve or tendon repair, or a bowel resection aside – it is a fact that for some injuries the penalty for surgical failure isn’t going to be any worse than if you do nothing at all, so you may want to try.  Local anesthesia will be needed to help the patient to remain still, or if nothing else than to help ease their pain.

 

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

 

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. (see note 1)

 

The supplies and materials I used:

 

My beautiful picture

 

The isopropyl alcohol shown above isn’t part of the solution, it’s used for cleaning the equipment.  Before you begin, all the equipment and anything they might touch, including you, should be thoroughly cleaned with a disinfectant or antiseptic.  Boil any items that can be.  Scrub and glove your hands.

 

For the sterile saline, I chose a type packaged in 15ml plastic vials and marketed for nasal irrigation purposes.  Search on “ModuDose” and you’ll find it (see note 2).  Mine were dated as expiring in one year, I plan to use them beyond that date unless they turn cloudy or have particulates in them.  I like this particular kind as they’re the perfect size for creating single doses with minimal waste, and they lessen the chance of contamination by not having to mix and transfer the solution between multiple containers during the process.

 

My beautiful picture

 

To produce a 2% lidocaine HCL solution (weight/volume), weigh out 0.3 grams (300mg) of lidocaine HCL, snip the top of the 15ml saline vial about half way down the neck with scissors, insert the funnel securely into the neck of the vial, and pour the lidocaine HCL powder into the funnel.  The powder tends to stick to the funnel, so you’ll probably need to gently squeeze the vial to force the saline up into the funnel, then release to allow the saline to flow back down into the vial carrying the lidocaine HCL powder with it.  Repeat as necessary to get all the lidocaine into the vial. Remove the funnel, and seal the neck of the saline/lidocaine vial using a surgical clamp or needle holder.

 

With the 2% lidocaine/saline solution vial now sealed shut, place the vial into a small pan of normal tap water, being careful not to submerge it fully – we don’t want any tap water to enter the vial.  Heat the water past 176 degrees Fahrenheit (I found it easiest to place a small glass filled with tap water into the pan the water, like a double boiler) and allow it to remain slightly above that temperature for 2-3 minutes.  Lidocaine HCL melts at 176 degrees F (80C), and dissolves in water.  Allowing the lidocaine HCL to melt, not just dissolve, in the saline ensures even distribution with no chance of particulates.  If particulates do remain at this point, they’re not lidocaine HCL and the solution shouldn’t be used.

 

My beautiful picture

 

Remove the vial from the pan, and keeping it securely clamped closed, allow it to cool.  You now have 15ml of 2% lidocaine HCL ready for use, which is also about the maximum recommended safe dosage for an adult.

 

My beautiful picture

 

Use it the same as you would any other vial of Rx injectable solution:  With the vial still clamped shut, clean a section near the top of the vial with an alcohol pad, invert the vial, insert the needle through the plastic section just cleaned, and draw out the desired amount into the syringe.

 

For different amounts of solution, or to make it in different concentrations, the formula is:

[Weight of lidocaine in grams  /  Volume of saline in milliliters] x 100.  For example, 1 gram lidocaine / 100 milliliters of saline = .01 X 100 = 1% solution.

 

As my first real test, I used a 0.5ml insulin syringe with a 30G needle, and performed three injections for a total of 1.5ml of 2% lidocaine in a 1″ square area just above the knee.  In a real situation a 6-10ml syringe with a longer needle would probably be better, I just have a lot of insulin needles stored so I used them instead.  Surprisingly, there was no sting from the lidocaine solution over that of the saline alone (tested first as the control).  I had expected some mild stinging, as is normally reported with Rx lidocaine without any sodium bicarbonate solution added, but there was no noticable difference.

 

My beautiful picture

 

Anesthetic effect was good and as expected.  In other words, the area injected and the immediate vicinity around it was completely numb.  Hospital / Clinic / Prescription Strength numb.  It reached full effect in about 10 minutes, and lasted a little over 30 minutes total before wearing off rather quickly.  The lack of epinephrine and, I suspect, the lower viscosity of the saline used here than in the lidocaine solution available by Rx probably allows it to disperse, and wear off, faster.  In further testing, I’ve used up to 6ml of 2% lidocaine in a single application, and even had some success at performing digital (fairly easy) and radial (not so much) nerve blocks.

 

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.

 

Notes:

(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.  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.

 

(2) Most OTC sterile saline solutions are labeled “not for injection”, which I believe indicates they haven’t been tested as being pyrogen free, and which is one requirement to be USP certified “for injection” purposes.  More on pyrogens here: http://www.fda.gov/iceci/inspections/inspectionguides/inspectiontechnicalguides/ucm072906.htm   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.

Disclaimer

Note: the advice given in this article isn’t by any means meant to replace qualified professional advice. Neither the author nor the website owner shall be held liable for any secondary effects or injuries as a result of you putting into practice any of the advice given in this article.


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10 Comments

  1. Being a former Field Corpsman I can say that if you don’t have this recipe in your prepper references and the materials in your larder, you REALLY should. Having to cut or debride soft tissue without any anesthetic is excruciating. I have seen how our toughest warriors have reacted to it, and it is astonishing. This ‘recipe’ can turn what would be like torture become a surgical procedure. You can either have help with your procedure or you can use your support to hold down the patient. your choice, but for someone sworn to providing aid, I prefer to make my patient as comfortable as possible.

  2. I have a really stupid question…How do you know your knee was numb enough to work on it? How do you know if it is numb enough to cut into your knee more than say 0.25 to 0.5 inch, would you feel the pain? I am going to try this, but am curious as to how you know when you have enough anesthesia that is deep enough to do any kind of incision.

  3. @MarkOwen = You would not want to use the ointment since it will have other ingredients which would not be good to inject into your skin or subcutaneous tissue.

    @MI Patriot = you would use the same strength of Lidocaine for intradermal (just in the skin) as you would for subcutaneous (Under the skin layer). Lidocaine is a local anesthetic (it stays pretty much where you put it) so if you are going a little deeper, you need to inject it to that level and around the area you are going to perform the procedure on. I will say that you don’t want to be performing surgery on yourself if you can avoid it, because if you are the surgeon and you pass out, or have some other accident, you are in a bad spot.

    Remember that the biggest risk you take is infection, so in a “When there is no Doctor” situation, I would recommend having some anti-biotic on hand to use in the event of post operative complications. You would want to be sure you have as sterile environment as possible, and that you use a topical antibiotic gel on the wound topically afterwards. Normally I would say you want to let the wound air out, but in those situations, it is more important to avoid infection, that it is to have it heal without a scar.

    Just my humble opinion.

  4. If I’m not confident enough or don’t have the opportunity to do this, would it be worth applying Lidocaine topically to an area I have to cut?

  5. I will be sharing this post with a like minded friend, but am curious about reliable sources for said supplies? perhaps Rourke could either provide me, or field responses for me, if you don’t want to post them here…I know a couple, but not having done any business with them, i worry about quality…

  6. @Eric, I’ve tried making extra-strength topical lidocaine mixtures (up to 15% w/v) using petroleum
    jelly, glycerin, solarcaine (sunburn) jel, and a OTC triple antibiotic ointment containing
    Pramoxine and couldn’t get really any real numbing effect on unbroken skin with any of them. I was trying to make an EMLA-like cream, without success. I even tried applying the solutions under an occlusive dressing and leaving it in contact with the skin for up to an hour, but it didn’t provide much in the way of anesthesia when compared to an untreated area when using jabs from a toothpick as a test.

    @grammyprepper, this is what I’d consider the most reliable source I’ve found: http://www.sciencelab.com/page/S/PVAR/10419/SLL1060 It’s also the most expensive source unfortunately. And while it’s not positive proof, the lidocaine HCL powder should dissolve in the saline solution even without heating, but I’ve seen tiny clumps of it take awhile to do so. For certain, if there are any particulates floating in the mixture after heating and allowing it to cool, no idea what they might be, but they are NOT lidocaine HCL.

  7. You can find a wide variety of sources for the materials and to be honest without a medical license you would need to do your homework and find one you can trust. As for particulates in the compound Here (http://www.arlok.com/articles/Particulate%20Matter%20in%20Injections%20What%20is%20It%20and%20What%20are%20the%20Concerns.pdf) is a PDF which addresses what they are and what the risks are. If you have the resources to perform sterile filtering that would help remove most of the particulates. Just remember the more a compound is open to the air, the greater the risk of introducing bacteria and other less than desirable items to your mixture.

  8. you can also get a fliter needle…it is a regular looking needle that has a small folder in the lumen, it should filter out the particulates….just draw it up into the syringe using the filter needle, then change the needle to a regular one to use for injection….should work to get non particular dose

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