Lidocaine
See critical care quick reference for drug doses by weight.
General
- Also known internationally as lignocaine
- Type: Local anesthetics; Antiarrhythmics
- Dosage Forms: Local injection, transdermal, intravenous, inhaled, viscous
- Common Trade Names: Xylocaine, P-Care, ReadySharp Lidocaine, Xylocard [1]
Adult Dosing
Local Anesthetic
- Maximum without epinepherine: 5mg/kg (max 300mg)
- Maximum with epinepherine: 7mg/kg (max 500mg)
Antiarrhythmic
- Loading dose = 1-1.5mg/kg
- Additional boluses of 0.5-0.75mg/kg q5-10min up to max of 3mg/kg
- If effective start infusion of 2mg/min
- Indications
- Treatment of ventricular arrhythmias and ectopy
- Considered 2nd-line to amiodarone for treatment of V-fib and pulseless v-tach
- Treatment of ventricular arrhythmias and ectopy
Pediatric Dosing
Local Anesthetic
- Without epinepherine: 5mg/kg (max 300mg)
- With epinepherine: 7mg/kg (max 500mg)
Antiarrhythmic
See critical care quick reference for drug doses by weight.
Special Populations
- Pregnancy Rating: American B, Australia A
- Lactation: Not expected to cause any adverse effect [2]
- Renal Dosing
- Hepatic Dosing
Contraindications
- Allergy to amide anesthetics
- Note that these allergies are rare and are often caused by preservative, so a preservative-free formulation may be appropriate
- Note that allergy to amide anesthetics does not suggest allergy to ester anesthetics
- High SA or AV block (without pacemaker)
- Concurrent treatment with Class I anti-dysrhythmic agents
- Wolff-Parkinson-White syndrome
Adverse Reactions
Local
- Dermatologic
- Itching or irritation
- Depigmentation
- Rash/urticaria
- Edema
- Venous inflammation
Serious
- Local Anesthetic Systemic Toxicity (LAST)
- Rare during infiltration of local anesthetic
- CNS toxicity
- Metallic taste
- Tinnitus
- Tingling of lips
- Dizziness
- Anxiety
- Confusion
- Lethargy
- Loss of consciousness
- Seizures
- Nausea/vomiting
- Cardiovascular toxicity
- Bradycardia
- Decreased myocardial contractility
- Atrioventricular block
- Vasodilation
- Ventricular arrhythmias
- Cardiac arrest
- Bronchospasm
- Respiratory depression or arrest
- Methemoglobinemia
Pharmacology
- Pharmacokinetics
- Onset of action = 45-90s
- Duration of action = 10-20min (antiarrythmic IV); 30-90 min (subcutaneous)
- Half-life 90 - 120 minutes
- Prolonged in hepatic impairment or congestive heart failure
- Metabolism
- Primarily hepatic
- Excretion
- Urine
- Mechanism of Action
- Class Ib antiarrythmic
- Binds to fast Na channels in inactive state thereby raising the depolarization threshold
- Acts preferentially on ischemic tissue
- Elevates V-fib threshold
- Suppresses ventricular ectopy
- Little effect on vascular tone, contractility, or cardiac output
- Class Ib antiarrythmic
Comments
- Mix lidocaine 1%/epinephrine with sodium bicarbonate 8.4% in 3:1 ratio results in significantly less painful injections. [7] [8]
- Shorter shelf-life due to decreased stability (use within 2 hours in the Vent A study)
- Warming local anesthetics also decreases pain of injection [9]
- Inject through wound edges whenever possible
- Avoid injecting through intact skin when possible
See Also
References
- ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
- ↑ https://www.ncbi.nlm.nih.gov/books/NBK501230/
- ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
- ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
- ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
- ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
- ↑ Vent A et. al Buffered lidocaine 1%/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. J Am Acad Dermatol. 2020 Jul;83(1):159-165. doi: 10.1016/j.jaad.2019.09.088. https://pubmed.ncbi.nlm.nih.gov/31958526/
- ↑ SGEM#307: Buff up the lido for the local anesthetic http://thesgem.com/2020/10/sgem307-buff-up-the-lido-for-the-local-anesthetic/
- ↑ Hogan, M., vanderVaart, S., Perampaladas, K., Machado, M., Einarson, T. and Taddio, A., 2020. Systematic Review And Meta-Analysis Of The Effect Of Warming Local Anesthetics On Injection Pain.