LEBANON — A shortage of local anesthetics at Dartmouth Hitchcock Medical Center and Dartmouth Health clinics has become “critical” in recent weeks, spurring the Lebanon-based health system to change the way it distributes the drugs, according to a message DH’s central supply pharmacy manager sent to providers last week.
“Local anesthetic supply has been poor for the past few years due to supply interruption of raw ingredients and manufacturing delays,” Eric Hoynack said in the June 30 message to DH leaders, physicians, advance practice providers, residents, fellows and nurses. The “Pharmacy supply chain has been able to distribute supply based on availability, however, in the last few weeks supply has deteriorated to the point we can no longer continue distribution in our current manner.”
The products affected include all strengths and sizes of bupivacaine, lidocaine, mepivacain and ropivacaine, which are used in various clinical settings to numb areas for treatment.
In response to the shortages, the inpatient pharmacy at DHMC is centralizing the stock of all local anesthetics. Preservative-free products are being prioritized for operating rooms, pain clinics and procedural areas that require preservative-free preparations. Hoynack asked that providers consider using topical anesthetics for starting IVs. In outpatient settings, DH is prioritizing preservative-free products for ambulatory surgery and pain clinics.
In a response to a request to speak with Hoynack, DH spokeswoman Audra Burns said, “Our pharmacy team has been diligently working to maintain necessary local anesthetic supplies during the national shortage. We are actively triaging what we have onsite and continue to work with providers on alternatives when necessary to ensure there is no disruption to patient care.”
DH is not alone in the Upper Valley in experiencing challenges due to the shortages.
At Gifford Health Care in Randolph, providers have had to use different volumes and concentrations of bupivacaine and lidocaine. While Jane McConnell, Gifford’s pharmacy manager, said that drug shortages have become commonplace over the past 15 years or so, this one is different in that it affects almost all departments.
“This one might have raised to this level because it is really widespread,” McConnell said.
Lidocaine, for example, is commonly used in dental offices to numb a portion of patients’ mouths.
“That’s what all these drugs are doing; (they are) basically numbing agents,” McConnell said. “Temporarily blocking the pain pathway to (the) brain.”
They are “widely used throughout the facility,” she said of Gifford, including in podiatry, the pain clinic, operating rooms and the emergency room.
In contrast, when a chemotherapy drug or oxytocin, used in the birthing center, are on shortage, McConnell said the pharmacists “don’t alert the whole facility.”
The shortage of local anesthetics has been ongoing for about six months, McConnell said. She said it’s unclear what’s driving the shortage or how long it might last.
“A little more transparency on their end would be fantastic,” McConnell said of drug manufacturers. They’ve “got to tell us why you’re not doing something. If I knew that, I would know where it’s headed. I just know it’s not there.”
In general, she said, drug shortages are often driven by a manufacturing plant being shut down or a shortage of raw materials. She noted that there are often very few manufacturers of each drug, so that if one plant goes down it can have an impact.
In the meantime, McConnell and her staff are working to obtain what they can and inform providers of how to use the anesthetics in different volumes and concentrations than they’re used to.
“It’s an unfortunate situation,” she said. “When does it become dangerous?”
There’s a risk that if she gives a provider who is accustomed to using a concentration of 2% lidocaine, a concentration of 0.5%, they could use a dose that would be ineffective, causing the patient pain. Or, in the opposite, scenario there’s a risk of a provider using too much and numbing more of the body than is necessary.
To avoid those scenarios, McConnell said, “It’s just a lot of management.”
Dr. Joseph Perras, CEO of Mt. Ascutney Hospital and Health Center in Windsor, said last week that the shortage of anesthetics comes as health care providers are already navigating others.
“We are not feeling the clinical impact yet, but this newest shortage is unfortunately adding to an already long list of critical medications and supplies that health care providers are struggling to procure,” he said.
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.
