Xylocaine

1. See Also
   1. Local Skin Anesthesia
   2. Digital Block
   3. Lidocaine-Epinephrine-Tetracaine (LET Anesthesia)
   4. EMLA cream
2. Preparations
   1. Lidocaine 0.5%, 1%, 2%
3. 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
   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. Dosing
   1. Intradermal Lidocaine
      1. See maximum dosing above
   2. Lidocaine Patch (indicated in Postherpetic Neuralgia)
      1. Apply to affected area every 4 to 12 hours as needed
5. Contraindications to Local Lidocaine use
   1. History of allergy to Local Anesthesia
   2. See Local Anesthetic for alternatives if allergy
6. Contraindications to combination with local Epinephrine
   1. Digital Block
   2. Poor vascular supply to an avulsed area
   3. Dirty wound (risk of infection)
   4. Distal organs
      1. Fingers
      2. Nose
      3. Penis
      4. Toes
      5. Earlobes
7. Additive: 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
8. 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