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==Anesthetic==
''See [[critical care quick reference]] for drug doses by weight.''
===Precautions===
*For wounds, may use HCO3 (1cc to 10cc Lido) to decr pain
*inject through wound edges NOT intact skin


=== Theraputic Doses ===
==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 <ref>Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019</ref>


MAX DOSE (mg/kg)
==Adult Dosing==
===[[Local anesthetics|Local Anesthetic]]===
*Maximum without epinephrine: 5mg/kg (max 300mg)
*Maximum with epinepherine: 7mg/kg (max 500mg)


{| class="pbNotSortable" border="1" cellpadding="1" cellspacing="1" width="200"
===[[Arrythmia|Antiarrhythmic]]===
|-
*Loading dose = 2% 1-1.5mg/kg
| '''Agent'''
**Additional boluses of 0.5-0.75mg/kg q5-10min up to max of 3mg/kg
| '''With Epi'''
**If effective start infusion of 2mg/min
| '''Without Epi'''
*Indications
|-
**Treatment of ventricular arrhythmias and ectopy
| Lidocaine
***Considered 2nd-line to [[amiodarone]] for treatment of [[V-fib]] and [[pulseless v-tach]]
| 7
 
| 3-5
==Pediatric Dosing==
|-
===[[Local anesthetics|Local Anesthetic]]===
| Mevipicaine
*Without epinepherine: 5mg/kg (max 300mg)
| 8
*With epinepherine: 7mg/kg (max 500mg)
| 7
 
|-
===[[Arrythmia|Antiarrhythmic]]===
| Bupivicaine
''See [[critical care quick reference]] for drug doses by weight.''
| 3
| 1.5
|}


==Antiarrhythmic==
==Special Populations==
=== Adult Dosing ===
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: American B, Australia A
*Loading dose = 1-1.5 mg/kg
*Lactation: Not expected to cause any adverse effect <ref>https://www.ncbi.nlm.nih.gov/books/NBK501230/</ref>
**Additional boluses of 0.5-0.75 mg/kg q5-10min up to max of 3mg/kg
*Renal Dosing
**If effective start infusion of 2mg/min
**Adult: No adjustment provided in manufacturer's labelling but accumulation of metabolites may be increased in renal dysfunction<ref>Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019</ref>
**Pediatric: No adjustment provided in manufacturer's labelling <ref>Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019</ref>
*Hepatic Dosing
**Adult: Reduce maintenance infusion when used IV (0.75 mg/minute). Monitor concentration.<ref>Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019</ref>
**Pediatric: Use with caution. Reduce dose. <ref>Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019</ref>
 
==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


=== Contraindications ===
===Serious===
*High SA or AV block
*[[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


=== Indications ===
==Pharmacology==
*Treatment of ventricular arrhythmias and ectopy
*Pharmacokinetics
**Considered 2nd-line to amiodarone for tx of V-fib and pulseless v-tach
**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


=== Mechanism of Action ===
==Comments==
*Class Ib
*Mix lidocaine 1%/epinephrine with sodium bicarbonate 8.4% in 3:1 ratio results in significantly less painful injections. <ref>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/ </ref> <ref>SGEM#307: Buff up the lido for the local anesthetic http://thesgem.com/2020/10/sgem307-buff-up-the-lido-for-the-local-anesthetic/</ref>
**Binds to fast Na channels in inactive state thereby inhibiting recovery after repolarization
**Shorter shelf-life due to decreased stability (use within 2 hours in the Vent A study)
**Acts preferentially on ischemic tissue
*Warming local anesthetics also decreases pain of injection <ref>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.</ref>
***Elevates V-fib threshold
*Inject through wound edges whenever possible
***Suppresses ventricular ectopy
**Avoid injecting through intact skin when possible
*Little effect on vascular tone, contractility or cardiac output


=== Kinetics ===
*Onset of action = 45-90s
*Duration of action = 10-20min


== Toxicity==
==Indications by Condition==
===Diagnosis ===
''The following table is automatically generated from disease/condition pages across WikEM.''
Symptoms:
# CV
##(brady/arrest)
###Tx w/ epi per ACLS
#CNS
##lightheaded, ringing in ears
##Seizure
##Abrupt change in MS, drowsiness, confusion


See Also: [[Local Anesthetic Systemic Toxicity (LAST)]]
{{#ask:[[Has DrugName::Lidocaine]]
|?Has Indication=Indication
|?Has Dose=Dose
|?Has Context=Context
|?Has Route=Route
|?Has Population=Population
|format=table
|headers=plain
|mainlabel=-
|sort=Has Indication
|limit=50
}}


==See Also==
==See Also==
*[[Antiarrhythmics]]
*[[Local anesthetic systemic toxicity]]
*[[Incision and Drainage]]
*[[Critical care quick reference]]
 
==References==
<references/>


[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:Cards]]
[[Category:Cardiology]]
[[Category:Tox]]

Revisión actual - 21:56 20 mar 2026

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 epinephrine: 5mg/kg (max 300mg)
  • Maximum with epinepherine: 7mg/kg (max 500mg)

Antiarrhythmic

  • Loading dose = 2% 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: American B, Australia A
  • Lactation: Not expected to cause any adverse effect [2]
  • Renal Dosing
    • Adult: No adjustment provided in manufacturer's labelling but accumulation of metabolites may be increased in renal dysfunction[3]
    • Pediatric: No adjustment provided in manufacturer's labelling [4]
  • Hepatic Dosing
    • Adult: Reduce maintenance infusion when used IV (0.75 mg/minute). Monitor concentration.[5]
    • Pediatric: Use with caution. Reduce dose. [6]

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

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


Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

IndicationDoseContextRoutePopulation
Electrical storm1-1.5mg/kg IV bolus, then 1-4mg/min infusionAntiarrhythmic if actively ischemicIVAdult
Polymorphic ventricular tachycardia1-1.5mg/kg IV, then 1-4mg/min infusionNon-torsades PMVT, alternative agentIVAdult
Polymorphic ventricular tachycardia1mg/kg (max 100mg) IVNon-torsades PMVTIVPediatric
Pulseless arrest1-1.5 mg/kg, then 0.5-0.75 mg/kg q5-10 min2nd line antiarrhythmicIVAdult
Rapid sequence intubation1.5 mg/kgPremedicationIVAdult

See Also

References

  1. ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
  2. ↑ https://www.ncbi.nlm.nih.gov/books/NBK501230/
  3. ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
  4. ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
  5. ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
  6. ↑ Lidocaine. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed March 15, 2019
  7. ↑ 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/
  8. ↑ SGEM#307: Buff up the lido for the local anesthetic http://thesgem.com/2020/10/sgem307-buff-up-the-lido-for-the-local-anesthetic/
  9. ↑ 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.
Obtenido de «https://www.wikem.org/w/index.php?title=Lidocaine&oldid=387463»