Making Lidocaine for Injection, by R.J.

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




22 Comments

  1. Well, desperate times, desperate measures. But please, NO USING this for neuraxial (epidural or spinal) anesthesia! This whole set up is likely not very pure, medically speaking, and likely to cause persistent neurological problems (cauda equine syndrome) prepared this way and used in spinal/epidural blocks. 35 years as physician this July.

    1. Butch, I’ve been buying syringes from my small local pharmacy for over 8 years, b/c I inject my prescription testosterone into my body. But a prescription is not required for syringes. When my pharmacy doubled the price of syringes, I went to a different pharmacy in our community, told them what sizes I wanted, & they sold them to me. I got the impression that they’ll sell them to anyone, except to anyone who goes in showing signs of drug abuse or an addict. In fact, I’ve purchased extra, without questions or monitoring by the pharmacy. Now, different states & countries may have different regulations on syringes.

      1. I purchase my syringes at the feed store. Syringes and needles are separate. I have to keep quite a few on hand for my babies in case of an infection or severe pain (my babies are my sheep and goats – all of whom were bottle babies). I also purchase antibiotics and pain meds for them and keep it on hand.

  2. Thank you for providing this back up plan and information for my personal physician who is licensed, it’s always a good learning experience to find new ideas for situations that might warrant alternatives with all of the safety caveats.

  3. Sounds like sepsis waiting to happen.

    I was an OR nurse and Labor and Delivery RN. I had a couple of college chemistry courses and there is no way I would attempt this.

    Having survived sepsis, I have a mortal fear of it.

    1. ICU transport nurse here. Mixing drugs is no problem as long as you maintain sterile technique. Also the likely hood of getting a bloodstream infection from a subcutaneous injection is slim. You’re more likely to get an infection from the actual procedure you’re numbing the spot for. Must have been out of practice for a while.

  4. HAPPY THANKSGIVING ALL! This article is a TEOTWAKI REALITY CHECK. The very subject should give us all great pause. Most people don’t even have basic First Aid knowledge or skills. Cross training should be in the planning of every person and community committed to disaster preparedness: teaching everything from safety and accident prevention to First Aid and emergency support and intervention skills. A related and critically important discussion would be the preparedness of hospitals (and the ability for trained medical personnel to create or recreate accessible, appropriately supplied satellite stations where medical services could be provided). Hospitals and service provisions continue to change driven by everything from emerging technologies to medical economics and government regulation. The culture of medicine as a profession is also changing, and not for the better in my view.

  5. It is frightening how often the failure of Plan A forces the promotion of Plan B. You better have one or you skip Plan C and move directly to Plan D…as in Dead.

    Medical training, medical supplies and then the will power to do what has to be done is imperative in a grid down situation. The Boy Scouts said it best: Be Prepared!

  6. i wonder if anyone has done this using a pressure cooker at 15psi for 20-30 minutes? That kills all bacteria. We used an autoclave when i worked in a medical lab to sterilize media plates after we had identified the bacteria. None survived to my knowledge. There is a indicator tape that shows that the product has been thru the autoclave. Ought to work for a pressure cooker too.

  7. DO NOT USE THIS PROCESS!!!! This is simply a terrible plan. You would be far better off just enduring the pain. There is a MUCH simpler way. I wouldn’t recommend making an injection under any circumstance, but if you felt you needed to this would be much better. Amazon has the items you would need. Look up Sterile, empty vials and syringe filters. Use sterile saline, for injection if possible but if not you could use what is described in the article.
    Dissolve the lidocaine (it dissolves easily at the strengths of 1 or 2%) in the saline. Pull up all of the solution in a syringe.
    Attach a syringe tip filter to the syringe, then a needle to the filter.
    inject the solution through the filter into the sterile vial.
    This is a much more closed system process and stands a much better chance of being sterile, as well as filtering out particulates almost guaranteed to be in the lidocaine powder. I am a compounding pharmacist who has been trained in sterile procedures. I do not recommend that anyone EVER uses this or any other process to make an injection. This is not intended to be used as medical advice.

  8. My two cents: If the area/wound being treated is small then the pain should be manageable. The patient might even be better off with some pain than simply numbness to remind him to avoid further injury to the area. If on the other hand the area/wound is large the pain would probably be correspondingly larger and I’m just not sure some “pirate” lidocaine is going to help you much. You seriously need real medical care. Yes I know the idea is “after the SHTF …” but in the case of a serious injury this looks like a prescription to death while believing you are doing something helpful.

  9. Good information for an end of the world scenario. Please limit the application to only that scenario. Perhaps store the powder to give to a physician or pharmacist if necessary.

    Keep in mind improper dosing can result in heart arrhythmias which can kill you. Non-sterile technique can result in sepsis which can kill you. Direct injection into a blood vessel can kill you.

    Many ways to die here if you are untrained and make a simple mistake. That seems to be the tenor from a number of medical professionals who are voicing caution. In the delivery of healthcare, sometimes what you don’t know can get you in big trouble. There’s a reason medical training takes many years.

  10. I would make my own sterile saline solution as needed by using a UV sterilizer. It would seem like using sterilized distilled water in the proper quantity with the appropriate amount of lidocaine hypo chloride just before using would fit the bill. Any wound that is open will already have bacteria swimming around and perhaps using the UV sterilizer on the wound itself might be of help. Any way this kitchen medicine has a better chance of success than slapping on a band aid.

  11. From my very limited education, I would not attempt to close a wound unless it were is only a few hours old, and very clean. The best advice is to clean it as best you can, and leave it open, or risk sepsis (blood poising). Odds are that oral antibiotics are not adequate to combat sepsis. The wound would heal slowly, and through a process called granulation, in that way. any infection is not trapped under tissue. I do not know when I would use lidocaine other than only as a last resort, even if it were medical grade. It is a good tool to have in the tool box, but sadly my skills are crude at best, yet if it aggressive measures are need to save a life that is in immediate danger, it could be an option, if the patient will not cooperate while a foreign object is removed, or an required incision made to combat a serious infection in progress was made.

    I have personally have to experience periods of time under extreme pain on numerous occasions. There are different kinds of pain, and it will not kill you, and it will be forgotten. However, I can imagine that if I could not restrain the patient, something, anything to calm the patient, who would otherwise and naturally interfere with the process, would be in order. I would do this only if the action was absolutely needed to save their life. They would thank you later, even if they had to endure severe pain.

    Having grown up with small and large animals, and nursed and doctored up many of them, even successfully performing CPR on a dog, this rudimentary experience does provide some insight. Do not be afraid of pain. It only hurts for awhile, or for a moment.

  12. Dr. M’s suggestion of storing supplies to be given to an appropriately trained medical professional in the event of a post-disaster emergency opens up an interesting idea, and subject of conversation. At least to some extent, this strategy (and the strength it draws from decentralization) may make possible the set-up of temporary hospital satellite facilities — staffed by appropriately trained personnel. Having plans in place for such a facility is a great idea — not a small endeavor to be sure, but worthwhile.

    A few words of caution as well — small amounts of knowledge are often fragmentary, and lacking a larger context and complete picture. Think “unintended, and potentially deadly, consequences”. Exercise extraordinary caution.

  13. You can make your own sterile water or saline with a pressure canner 15 pounds for 30 min. adding 8.46 grams of pure salt in one quart of water or 9 grams per liter, this will give you sterile saline solution.
    I am not sure at what temp Lidocaine becomes unstable or disintegrates , so pressure canning it may not work.
    Someone may know the answer to this.

  14. Do not put any home made medications in the eye. Infection risks. I’m a retired doctor. Outside the box article reminding us all about how thankful we should be to God for our breath and that we live in the USA.

    1. Yorie’s words of caution are important in our family experience. One of our adult children contracted an eye infection from an unknown source (could have come from anywhere — think shopping cart, door handle, hand shake, anywhere). The only symptom was insatiable itching. No eye matter. No fever. Even though only one eye was affected, the primary care provider thought it might have been allergies or some unusual form of “pink eye”, and started treatment with eye drops. Within hours there was no relief, and we moved to antibiotics. Within hours of that we were in the office of a specialist who was so concerned that he said he wouldn’t treat the infection and sent us back to the primary or the hospital. With a variety of considerations in mind, we went straight to the emergency room. Treatment included labs (no sepsis, THANK GOD), a 2nd oral antibiotic and an injection. Recovery followed. But… We were so concerned that we followed up with the ENT who explained exactly what had happened, and why the correct diagnosis seemed elusive. It turns out that this kind of infection is rarely seen (in the experience of our ENT) in a primary care office. Most people affected do not seek treatment until they have a fever of 104, and an infection that has reached the brain. The structures of the eye provide a pathway to the structures of the brain. Our loved one was spared because of quick, determined and undeterred action. God provided a series of clear signs, and conveyed a message of urgency. We share this story with other readers with the hope that what we learned will help someone else.

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