III. Pharmacokinetics
- Store at room Temperature (not in refrigerator)
- Reduces risk of infection with multi-use bottles
- Kirschke (2003) Clin Infect Dis 36:1369-73 [PubMed]
-
Lidocaine alone (1%=10 mg/ml, 2%=20 mg/ml)
- Onset: 2 to 5 minutes
- Duration: 1.5 to 2 hours
- Max dose: 4 mg/kg to 280 mg (up to 14 ml 2%, 28 ml 1%)
-
Lidocaine with Epinephrine 1:100,000 or 1:200,000
- Onset: 2 minutes
- Duration: 2 to 6 hours
- Max dose: 7 mg/kg to 500 mg (up to 25 ml 2%, 50 ml 1%)
- Epinephrine increases Lidocaine's duration of action and maximal safe dose (decreases systemic absorption)
IV. Dosing
- Intradermal Lidocaine
- See maximum dosing above
V. Contraindications: Local Lidocaine use
- History of allergy to Local Anesthesia
- See Local Anesthetic for alternatives if allergy
VI. Contraindications: Combination with local Epinephrine use
- Digital Block
- Poor vascular supply to an avulsed area
- Dirty wound (risk of infection)
- Distal organs (relative contraindication)
- Previously absolutely contraindicated injection sites: Fingers, Nose, Penis, Toes, Earlobes
- More recent data suggests safety (approach as a relative contraindication)
VII. Preparations: Sodium Bicarbonate (Buffered Lidocaine)
- Indications
- Effective in reducing sting from Local Lidocaine
- Dilution 1:10 of 7.5% Sodium Bicarbonate in Xylocaine
- Preparation in Syringe (3.5 cc)
- Xylocaine: 3 cc
- Sodium Bicarbonate: 0.4 cc
- Precautions
- Shelf-life of Buffered Lidocaine reduced to 1 week
VIII. References
- Pfenninger (1994) Procedures, Mosby, p. 135-155
- Mortiere (1996) Wound Management, p. 27-39
- Achar (2002) Am Fam Physician 66(1):91-4 [PubMed]