Adult Dosing

Ventricular arrhythmias

Lidopen

• 300 mg of 10% soln IM into the anterolateral aspect of the thigh or deltoid region of the arm

Lidocaine hydrochloride

• 1-1.5 mg/kg Rapid IV bolus; may repeat doses of 0.5-0.75 mg/kg q5-10 minutes up to a total dose of 3 mg/kg
• May start continuous infusion of 1-4 mg/min
• Max: 200-300 mg in 1 hr period

VF/Pulse less VT, ACLS

• 0.5-0.75 mg/kg IV x 1, may repeat q5-10 minutes PRN. Max: 3 mg/kg

Anesthesia

Lidocaine hydrochloride, Xylocaine, Xylocaine-MPF

• Infiltration
• Percutaneous: 5 mg-300 mg of 0.5% or 1% (1-60 ml)
• Intravenous regional: 50 mg-300 mg of 0.5%

• Peripheral nerve blocks
• Brachial: 225 mg-300 mg of 1.5% (15-20 ml)
• Dental: 20 mg-100 mg of 2% (1-5 ml)
• Intercostal: 30 mg of 1% (3 ml)
• Paravertebral: 30 mg-50 mg of 1% (3-5 ml)
• Pudendal (each side): 100 mg of 1% (10 ml)

• Paracervical
• Obstetrical analgesia (each side): 100 mg of 1% (10 ml)

• Sympathetic nerve blocks
• Cervical (stellate ganglion): 50 mg of 1% (5 ml)
• Lumbar: 50-100 mg of 1%

• Central neural blocks
• Thoracic: 200-300 mg of 1% (20-30 ml)
• Analgesia: 250-300 mg of 1%
• Anesthesia: 225-300 mg of 1.5%; alt 200-300 mg of 2%
• Obstetrical analgesia: 200-300 mg of 1% (20-30 ml)
• Surgical anesthesia: 225-300 mg of 1.5%

• Maximum individual dose: 4.5 mg/kg (2 mg/lb) of body weight; maximum total dose: 300 mg
• For continuous epidural or caudal anesthesia, the maximum dosage should not be administered at intervals of <90 minutes
• When using continuous lumbar or caudal epidural anesthesia for non-obstetrical procedures, if required administer more drug to produce adequate anesthesia
• Max dose for 90 minute period of lidocaine hydrochloride for paracervical block in obstetrical and non-obstetrical patients: Total 200 mg
• For IV regional anesthesia: Not more than 4 mg/kg in adults

Anesthesia of the mucous membranes of the respiratory tract or the genito-urinary tract

• Retrobulbar injection: 120-200 mg of 4% lidocaine HCl; ie, 1.7-3 mg/kg or 0.9-1.5 mg/lb body weight
• Transtracheal injection: 2-3 mL of 4% lidocaine HCl
• Topical application: For laryngoscopy, bronchoscopy and endotracheal intubation 40-200 mg of lidocaine HCl), ie, 0.6-3 mg/kg or 0.3-1.5 mg/lb body weight

Obstetrical low spinal or saddle block anesthesia

• Normal vaginal delivery: 50 mg of 5% lidocaine
• For Caesarean section and deliveries requiring intrauterine manipulations: 75 mg of 5% lidocaine
• Surgical anesthesia: 75 mg-100 mg of 5% lidocaine

Pediatric Dosing

Ventricular arrhythmias

Lidocaine hydrochloride

• 0.5-1 mg/kg slow IV. May repeat q5-10 minutes. Max: 3-5 mg/kg
• Maintenance IV infusion: 10-50 mcg/kg/min

Lidopen

• Avoid use in children <50 kg (110 lbs)

VF/Pulse less VT, PALS

Lidocaine hydrochloride

• 1 mg/kg bolus (not to exceed 100 mg), followed by 20-50 mcg/kg/min continuous infusion
• May administer second bolus of 0.5-1 mg/kg if delay between bolus and continuous infusion

Anesthesia

Xylocaine, Xylocaine-MPF

• 5 yrs,50 lbs: 75-100 mg (1.5 to 2 mg/lb); use more dilute solutions (ie, 0.25 to 0.5%) and total dosages not to exceed 3 mg/kg (1.4 mg/lb) for induction of IV regional anesthesia in children
• Note: For children >3 yrs of age having a normal lean body mass and normal body development, determine the maximum dose by the child’s age and weight

Xylocaine 4%

• Below 300 mg and not to exceed 4.5 mg/kg (2 mg/lb) of body weight

Obstetrical low spinal or saddle block anesthesia

• 16 yrs
• Normal vaginal delivery: 50 mg of 5% lidocaine
• For Caesarean section and deliveries requiring intrauterine manipulations: 75 mg of 5% lidocaine
• Surgical anesthesia: 75 mg-100 mg of 5% lidocaine

[Outline]

• Adult Dosing
• Pediatric Dosing

• Production of local or regional anesthesia by infiltration techniques such as percutaneous injection and IV regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks (Lidocaine hydrochloride, Xylocaine, Xylocaine-MPF)
• Acute management of ventricular arrhythmias occurring during cardiac manipulations, such as cardiac surgery and fatal arrhythmias ventricular in origin occurring during acute myocardial infarction (Lidocaine hydrochloride, lidopen)
• Production of topical anesthesia of the mucous membranes of the respiratory tract or the genito-urinary tract (Xylocaine 4% and lidocaine 4% )
• Production of spinal anesthesia (lidocaine 5%)

• Hypersensitivity to any of the ingredients of the product

5% lidocaine

• Hypersensitivity to the local anesthetic agent
• Severe hemorrhage
• Shock
• Heart block
• Local infection at the site of proposed puncture
• Septicemia

Xylocaine, Xylocaine-MPF, Lidopen

• Adams-Stokes syndrome
• Wolff-parkinson-white syndrome
• Heart block without pacemaker
• Intra-articular continuous infusion

Lidocaine, 4% lidocaine

• Hypersensitivity to local anesthetics of the amide type

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments; increases risk of CNS toxicity in severe renal disease

Hepatic Dose Adjustment

• Hepatic impairment: Increased levels of lidocaine in severe hepatic disease; for ventricular arrhythmias, give half the bolus dose and slow infusion rate; dose adjustments not defined

• Only clinicians having expertise in diagnosis and management of dose-related toxicity and other acute emergencies arising from the block should employ these injections for infiltration and nerve block. Ensure the immediate availability of oxygen, other resuscitative drugs, cardiopulmonary equipment and the personnel needed for proper management of toxic reactions and related emergencies. Acidosis, cardiac arrest and even death have occurred on delaying proper management of dose-related toxicity, under ventilation from any cause and/or altered sensitivity
• Use of intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures is unapproved. Chondrolysis involving the shoulder joint have been reported on post-marketing surveillance in such patients. Cases of gleno-humeral chondrolysis have occurred in pediatric and adult patients following intra-articular infusions of local anesthetics. Time of onset of symptoms, such as joint pain, stiffness and loss of motion has occurred as early as the 2nd month after surgery but onset can be variable. Effective treatment for chondrolysis is unavailable; provide chondrolysis patients with additional diagnostic and therapeutic procedures and some may even require arthroplasty or shoulder replacement
• Perform aspiration before administration of local anesthetic solution to avoid intravascular injection
• Avoid using local anesthetic solutions containing antimicrobial preservatives (e.g., methylparaben) for epidural or spinal anesthesia as the safety of these agents has not been established with regard to intrathecal injection, either intentional or accidental
• The safety and efficacy of lidocaine HCl depends on proper dosage, correct technique, adequate precautions, and readiness for emergencies
• Use the lowest effective dose to avoid high plasma levels and serious adverse effects
• Perform syringe aspirations before and during each supplemental injection while using indwelling catheter techniques
• Initially administer test dose and monitor patient for CNS toxicity and CV toxicity, as well as for signs of unintended intrathecal administration, before proceeding for epidural anesthesia
• Significant increase in blood levels may occur on repeated doses because of slow accumulation of the drug or its metabolites. Tolerance due to elevated blood levels varies according to status of the patient
• Administer lower doses in debilitated, elderly patients, acutely ill patients, and children commiserating with their age and physical condition
• Exercise caution in administering local anesthetic solutions containing a vasoconstrictor and use in carefully circumscribed quantities in areas of the body supplied by end arteries or having compromised blood supply
• Exaggerated vasoconstrictor responses have occurred in patients with peripheral vascular disease and those with hypertensive vascular disease. Ischemic injury or necrosis have occurred
• Cautiously use preparations containing a vasoconstrictor in patients during or following the administration of potent general anesthetic agents, as cardiac arrhythmias may occur
• Monitor CV and respiratory (adequacy of ventilation) vital signs and the patient’s state of consciousness after each local anesthetic injection
• Consider restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness as early warning signs of CNS toxicity
• Patients with severe hepatic disease are at greater risk of developing toxic plasma concentrations
• Prolongation of A-V conduction is produced by this drugs; patients having impaired CV function are less able to compensate for this functional changes
• Familial malignant hyperthermia may occur. Maintain standard procedures for the management of malignant hyperthermia. Temperature elevation is preceded by unexplained signs of tachycardia, tachypnea, labile blood pressure and metabolic acidosis
• Follow proper tourniquet technique for performance of IV regional anesthesia
• Injection of small doses of local anesthetics into the head and neck area, including retrobulbar, dental and stellate ganglion blocks, may produces adverse reactions similar to systemic toxicity
• Confusion, convulsions, respiratory depression and/or respiratory arrest, and CV stimulation or depression have occurred
• Avoid exceeding dosage recommendations

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Heart Block
• CHF
• Bradycardia
• Impaired cardiac function
• Severe respiratory depression
• Neurological disease
• Spinal deformities
• Septicemia
• Severe hypertension
• Hypovolemia
• Severe shock
• Hypoxia
• Geriatrics
• MAOI drugs
• Tricyclic Antidepressants

Pregnancy Category:B

Breastfeeding: Concentrations of lidocaine in milk during continuous IV infusion, epidural administration and in high doses as a local anesthetic are low and the lidocaine is poorly absorbed by the infant. Unexpected to cause any adverse effects in breastfed infants. Special precautions are not required. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 11 February 2011. Manufacturer advises to exercise caution when lidocaine HCl is administered to a nursing woman.

• CNS: Seizures, hallucinations, lightheadedness, nervousness, apprehension, coma, tremor, confusion, anxiety, dizziness, euphoria, drowsiness, lethargy, agitation, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness
• RESP: Respiratory arrest, status asthmaticus
• CV: Arrhythmias, heart block, bradycardia, hypotension, cardiovascular collapse
• LOCAL: Injection site pain, edema
• EENT: Blurred vision, tinnitus
• DERM: Cutaneous lesions, urticaria
• MISC: Anaphylactoid reactions
• HEMA: Methemoglobinemia

• Antiarrhythmic (class IB), anesthetic; stabilizes the neuronal membrane, inhibits the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.
• Rapid onset of action when used as an anesthetic
• Duration of action of 60-90 minutes when used as an anesthetic
• Well absorbed
• Extensively metabolized by liver; CYP450: CYP1A2 (primary), CYP3A4 substrate
• Renally excreted: 10% unchanged
• Half-life: 1.5-2 hrs

US Trade Name(s)

• Lidopen
• Xylocaine
• Xylocaine-MPF

US Availability

lidocaine (generic)

• INJ: 0.5% (50 mL vial)
• INJ: 1% (2, 5, 20 mL amp and 30 mL vial)
• INJ: 1.5% (20 mL amp)
• INJ: 2% (2, 10 mL amp and 20, 50 mL vial)
• INJ: 4% (5 mL amp)
• INJ: 5% (2 mL amp)
• INJ: 20% (10 mL vial)
• INJ: 200 mg/100 mL
• INJ: 400 mg/100 mL
• INJ: 800 mg/100 mL

Lidopen

• INJ: 10%

Xylocaine

• INJ: 0.5% (50 mL vial)
• INJ: 1% (10, 20, 50 mL vial)
• INJ: 2% (10, 20, 50 mL vial)
• INJ: 10%
• INJ: 20%

Xylocaine-MPF

• INJ: 0.5% (50 mL vial)
• INJ: 1% (2, 5, 30 mL amp, vial and 10 mL polyamp and )
• INJ: 1.5% (10, 20 mL polyamp and 5 mL vial)
• INJ: 2% (2 mL amp and 10 mL polyamp and 2, 5 mL vial)
• INJ: 4% (5 mL amp)
• INJ: 10%
• INJ: 20%

Canadian Trade Name(s)

• Xylocard
• Xylocaine

Canadian Availability

lidocaine (generic)

• INJ (with 5% dextrose): 0.2% (plastic bags of 500 mL)
• INJ (with 5% dextrose): 0.4% (plastic bags of 250 mL)
• INJ (with 5% dextrose): 0.8% (8 mg/mL)
• INJ: 2% (for local anesthesia)
• INJ: 1% (2, 5 mL amp and 20, 50 mL vial)
• INJ: 2% (20, 50 mL vial)
• INJ: 200 mg/100 mL
• INJ: 400 mg/100 mL
• INJ: 800 mg/100 mL

Xylocard

• INJ: 20 mg/ mL (5 mL amp)

Xylocaine

• INJ: 0.5% (50 mL vial)
• INJ: 1% (2, 5, 10 mL amp and 20, 50 mL vial)
• INJ: 1.5%
• INJ: 2% (2, 5, 10 mL amp and 20 mL vial)

UK Trade Name(s)

• Minijet lignocaine

UK Availability

lidocaine (generic)

• INJ: 0.1% (500 mL)
• INJ: 0.2% (500 mL)
• INJ: 2% (2, 5, 10, 20 mL amp)
• INJ: 0.5% (10 mL amp)
• INJ: 1% (2, 5, 10 mL amp)
• INJ: 1% (10 mL prefilled syringe)
• INJ: 1% (20, 50 mL vials)
• INJ: 2% (20, 50 mL vials)
• INJ: 2% (2, 5 mL amp)

Minijet lignocaine

• INJ: 1% (10 mL syringes)
• INJ: 1% (10 mL vials)
• INJ: 2% (5 mL syringes)
• INJ: 2% (5 mL vials)

Australian Trade Name(s)

• MIN-I-Jet lignocaine hydrochloride injection
• Xylocaine
• Xylocard

Australian Availability

Lignocaine

• INJ: 1% (5, 20 mL)
• INJ: 2% (5, 20 mL)

MIN-I-Jet lignocaine hydrochloride injection

• INJ: 2% (5 mL prefilled syringes)

Xylocaine

• INJ: 0.5% (5 mL)
• INJ: 1% (2, 5, 20 mL)
• INJ: 2% (2, 5, 20 mL)
• INJ: 2% (for local anesthesia) (2.2 mL)

Xylocard

• INJ: 500 mg/5 mL

[Outline]

Anesthesia

Local Anesthetics; Injectable

Cardiovascular

Antidysrhythmics