Lidocaine

See critical care quick reference for drug doses by weight.

General

Adult Dosing

Local Anesthetic

  • Without epinepherine: 5mg/kg (max 300mg)
  • 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

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:
  • Lactation:
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug or agents with same chemical classification (amide/ester)
  • High SA or AV block

Adverse Reactions

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
    • Cardiovascular toxicity
      • Bradycardia, decreased myocardial contractility, atrioventricular block, vasodilation, ventricular arrhythmias, cardiac arrest

Pharmacology

  • Half-life:
    • Onset of action = 45-90s
    • Duration of action = 10-20min (antiarrythmic IV); 30-90 min (subcutaneous)
  • Metabolism:
  • Excretion:
  • Mechanism of Action:
    • Class Ib antiarrythmic
      • Binds to fast Na channels in inactive state thereby inhibiting recovery after repolarization
      • Acts preferentially on ischemic tissue
        • Elevates V-fib threshold
        • Suppresses ventricular ectopy
    • Little effect on vascular tone, contractility or cardiac output

Comments

  • For wounds, may use HCO3 (1cc to 10cc Lido) to decrease pain
  • Inject through wound edges NOT intact skin

See Also

References