The Medicines and Medical Devices Committee (MMDC) has taken advice on things podiatrists need to consider for patients who have had the COVID-19 vaccine
At present, there is no evidence to suggest that local anaesthetic agents should not be given in patients due to receive, or having recently received, the COVID-19 vaccine. On a daily basis around the United Kingdom, surgery is being undertaken utilising local anaesthetics on patients who have recently been immunised. As far as we are aware, local anaesthetics are not contraindicated in this instance (nor has any such advice been given during vaccine training to members of the MMDC).
One might consider it reasonable to delay the use of local anaesthetics for a seven-day period, but there is no evidence or formal advice given to that effect. In terms of a risk-benefit ratio, if the patient needs both a procedure involving the administration of local anaesthetic, and is receiving a COVID-19 vaccination in close proximity, then there is no clear advice or evidence indicating that this should be avoided.
The advice in the guidance to healthcare professionals on the COVID-19 vaccination programme indicates that the scheduling of COVID-19 vaccine and other vaccines should ideally be separated by an interval of at least seven days to avoid incorrect attribution of potential adverse events.
Equally, recent Arthritis and Musculoskeletal Alliance (ARMA) advice on the use of steroid injections in patients in receipt of the vaccine, or shortly before receiving it, only points to the following:
“It is safe to have the COVID-19 vaccine alongside steroid exposure, but the patient may not mount such a good immune response.
- Do not delay vaccination for someone who is taking, has received or is soon to receive steroids in any form.
- If additional steroids are required to control inflammatory disease, that may take priority, as a flare can also worsen the risk from COVID-19
- It may be appropriate to delay a non-essential steroid injection, as part of a shared decision, so that the response to the vaccine is more effective. For a patient who is on an elective waiting list for a steroid injection of up to 80mg methylprednisolone or 80mg triamcinolone, the administration of the COVID-19 vaccine is the priority if the vaccine has been offered to the patient and the prevalence of COVID-19 is high. In this scenario, the steroid injection should be deferred by 2 weeks after the vaccine, to enable the patient to mount the best response to the COVID-19 vaccine.”
See ARMA: Principles for COVID-19 Vaccination in Musculoskeletal and Rheumatology for Clinicians
Our information is based on current practice and we appreciate that new vaccines constitute uncharted territory, so we would recommend you refer to the two documents below from GOV.UK:
- COVID-19 vaccination: information for healthcare practitioners
- COVID-19: the green book, chapter 14a
The latter document provides no evidence of any interaction or contra indication regarding local anaesthetics . Indeed, the Green Book simply states:
“Although no data for co-administration of COVID-19 vaccine with other vaccines exists, in the absence of such data first principles would suggest that interference between inactivated vaccines with different antigenic content is likely to be limited (see Chapter 11). Based on experience with other vaccines any potential interference is most likely to result in a slightly attenuated immune response to one of the vaccines. There is no evidence of any safety concerns, although it may make the attribution of any adverse events more difficult. Because of the absence of data on co-administration with COVID-19 vaccines, it should not be routine to offer appointments to give this vaccine at the same time as other vaccines. Based on current information about the first COVID-19 vaccines being deployed, scheduling should ideally be separated by an interval of at least seven days to avoid incorrect attribution of potential adverse events. As both of the early COVID-19 vaccines are considered inactivated (including the nonreplicating adenovirus vaccine), where individuals in an eligible cohort present having received another inactivated or live vaccine, COVID-19 vaccination should still be considered. The same applies for other live and inactivated vaccines where COVID-19 vaccination has been received first or where a patient presents requiring two vaccines. In most cases, vaccination should proceed to avoid any further delay in protection and to avoid the risk of the patient not returning for a later appointment. In such circumstances, patients should be informed about the likely timing of potential adverse events relating to each vaccine”
Thus, the seven day interval specifically relates to vaccine administration, and not other parenterally administered agents such as local anaesthetics.