Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 0.4%
- 0.5%
- 0.8%
- 1%
- 1.5%
- 2%
- 4%
- 5%
Infiltration Anesthesia
Percutaneous: 1-60 mL of 0.5-1% solution (5-300 mg total dose)
IV regional: 10-60 mL of 0.5% solution (50-300 mg total dose)
Peripheral Nerve Blocks
Brachial: 15-20 mL of 1.5% solution (225-300 mg total dose)
Dental: 1-5 mL of 2% solution (20-100 mg total dose)
Intercostal: 3 mL of 1% solution (30 mg total dose)
Paravertebral: 3-5 mL of 1% solution (30-50 mg total dose)
Pudendeal (each side): 10 mL of 1% solution (100 mg total dose)
Paracervical obstetrical analgesia (each side): 10 mL of 1% solution (100 mg total dose)
Sympathetic Nerve Blocks
Cervical (stellate ganglion): 5 mL of 1% solution (50 mg total dose)
Lumbar: 5-10 mL of 1% solution (50-100 mg total dose)
Central Neural Blocks/Epidural
General: 2-3 mL/dermatome for anesthesia
Thoracic: 20-30 mL of 1% solution (200-300 mg total dose)
Lumbar analgesia: 25-30 mL of 1% solution (250-300 mg total dose)
Lumbar anesthesia: 15-20 mL of 1.5% solution (225-300 mg), or 10-15 mL of 2% solution (200-300 mg total dose)
Dosing Considerations
Use preservative-free preparations for spinal or epidural anesthesia
May be buffered 9:1 with sodium bicarbonate, to reduce pain on injection (e.g. remove 2 mL of 1% lidocaine from 20 mL vial, and add 2 mL of sodium bicarbonate solution to vial)
Maximum dose: 4.5 mg/kg, up to 300 mg lidocaine without epinephrine; or 7 mg/kg, up to 500 mg lidocaine with epinephrine
Adverse Effects
Frequency Not Defined
Arrhythmias
Bradycardia
Cardiovascular collapse
Edema
Hypotension
Heart block
Apprehension
Agitation
Coma
Confusion
Drowsiness
Dizziness
Disorientation
Euphoria
Lightheadedness
Nervousness
Paresthesia
Psychosis
Sensations of heat, cold, or numbness
Slurred speech
Seizures
Tinnitus
Tremulousness
Unconsciousness
Visual disturbances including blurred or double vision
Skin lesions
Urticaria
Anaphylactoid reactions
Difficulty swallowing
Nausea
Vomiting
Muscle twitching/ tremors
Dyspnea
Respiratory depression/arrest
Administration Effects
- pain IM injection site
- IM injection increases serum creatine kinase
Warnings
Contraindications
Hypersensitivity to drug or amide type anesthetic
Cautions
Some formulations may contain sulfites
History of malignant hyperthermia
DO NOT use solutions containing epinephrine in distal areas of body (eg, digit, nose, ear) because of vasoconstrictive effects; addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action
Significant systemic absorption reported when administered to mucosal surfaces and open wounds
Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)
Use with caution in hepatic impairment (ability to metabolize diminishes)
Pregnancy & Lactation
Pregnancy Category: B
Lactation: Excreted in breast milk; use caution
Pregnancy Categories
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Pharmacology
Mechanism of Action
Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction
Pharmacokinetics
Half-life: 7-30 min (initial); 1.5-2 hr (terminal)
Vd: 0.7-2.7 L/kg (patch)
Peak plasma concentration: 1-5 mcg/mL
Protein Bound: 60-80%
Metabolism: Liver
Metabolites: Monoethylglycinexylidide (MEGX), glycinexylidide (GX)
Excretion: Urine (primarily)
Administration
IV Incompatibilities
Additive: amphotericin B, dacarbazine, methohexital, phenytoin
Syringe: cefazolin
Y-site: amphotericin B cholesteryl SO4, thiopental
IV Preparation
Standard diluent: 2 g/250 mL D5W
IV Administration
Use microdrip (60 drops/mL) or infusion pump to administer an accurate dose
Local thrombophlebitis may occur in pts receiving prolonged IV infusions
Add 1 g of drug (using 25mLl of 4% or 5 mL of 20 % inj) to 1 L of D5W inj to provide a solution containing 1 mg/mL
Storage
Injection is stable at room temperature
Images
Patient Handout
Formulary
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