II. Preparations

  1. Lidocaine 0.5%, 1%, 2%

III. Pharmacokinetics

  1. Store at room Temperature (not in refrigerator)
    1. Reduces risk of infection with multi-use bottles
    2. Kirschke (2003) Clin Infect Dis 36:1369-73 [PubMed]
  2. Lidocaine alone (1%, 2%)
    1. Onset: 2 to 5 minutes
    2. Duration: 1.5 to 2 hours
    3. Max dose: 4 mg/kg to 280 mg (14 ml 2%, 28 ml 1%)
  3. Lidocaine with Epinephrine 1:100,000 or 1:200,000
    1. Onset: 2 minutes
    2. Duration: 2 to 6 hours
    3. Max dose: 7 mg/kg to 500 mg (25 ml 2%, 50 ml 1%)
    4. Epinephrine increases Lidocaine's duration of action and maximal safe dose (decreases systemic absorption)

IV. Dosing

  1. Intradermal Lidocaine
    1. See maximum dosing above

V. Contraindications: Local Lidocaine use

  1. History of allergy to Local Anesthesia
  2. See Local Anesthetic for alternatives if allergy

VI. Contraindications: Combination with local Epinephrine use

  1. Digital Block
  2. Poor vascular supply to an avulsed area
  3. Dirty wound (risk of infection)
  4. Distal organs (relative contraindication)
    1. Previously absolutely contraindicated injection sites: Fingers, Nose, Penis, Toes, Earlobes
    2. More recent data suggests safety (approach as a relative contraindication)
      1. Ilicki (2015) J Emerg Med 49(5):799-809 +PMID: 26254284 [PubMed]

VII. Preparations: Sodium Bicarbonate (Buffered Lidocaine)

  1. Indications
    1. Effective in reducing sting from Local Lidocaine
  2. Dilution 1:10 of 7.5% Sodium Bicarbonate in Xylocaine
  3. Preparation in Syringe (3.5 cc)
    1. Xylocaine: 3 cc
    2. Sodium Bicarbonate: 0.4 cc
  4. Precautions
    1. Shelf-life of Buffered Lidocaine reduced to 1 week

VIII. References

  1. Pfenninger (1994) Procedures, Mosby, p. 135-155
  2. Mortiere (1996) Wound Management, p. 27-39
  3. Achar (2002) Am Fam Physician 66(1):91-4 [PubMed]

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Ontology: Xylocaine (C0699094)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008012
English local anesthetics lidocaine base (Xylocaine), lidocaine base (Xylocaine), xylocaine, Astrazeneca Brand of Lidocaine, Xylocaine