- Local: For peridural infiltration and regional anesthesia
- Antiarrhythmic: Treatment of ventricular tachycardia and runs of premature ventricular beats
- Anticonvulsant: For status epilepticus (last resort)
- Treatment of neuropathic or intractactable pain
- Stable at room temperature
- Solutions diluted in D5W stable for 14-120 days depending on concentration - use diluted solutions within 24 hours to prevent bacterial contamination
- Multiple concentrations and formulations exist therefore check vial carefully
- Solutions Compatible: dextrose up to D10W, 0.9% NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate
- Additives/Above Cassette Compatible: KCl (up to 40 mmol/L), glycopyrrolate, heparin, hydroxyzine
- Y-site Compatible: amiodarone, ciprofloxacin, morphine, dobutamine, dopamine, labetalol, nitroglycerin, nitroprusside sodium, TPN (amino acids/dextrose)
- Incompatible: phenytoin, thiopental
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES |
| IV Direct | YES Cardiac monitoring, continous BP monitoring Usual dilution: 10-20 mg/mL Infusion time: 2 minutes Infusion rate: Max: 0.7 mg/kg/minute or 50 mg/minute, whichever is less |
| IV Intermittent Infusion |
YES Cardiac monitoring, BP monitoring For intractable seizures Infusion Time: 30 minutes Usual Dilution: 8 mg/mL (for seizures, supplied as 250 mL bag for use on large volume pump)
|
| IV Continuous Infusion |
YES Cardiac monitoring, BP monitoring - Neuropathic or intractable pain - Continuous oxygen saturation and Cardio-Respiratory monitoring - Seizures Standard Drug Concentration: 8 mg/mL (supplied as 250 mL bag for use on large volume pump) |
| Intraosseous | YES |
| Endotracheal | YES Usual dilution: dilute dose in 1-2 mL NS |
| Local Infiltration | YES, for production for peridural infiltration and regional anesthesia |
NOTE: DO NOT administer lidocaine with preservative or epinephrine IV
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Local infiltration:
- Dosage varies with the anesthetic procedure, degree of anesthesia, vascularity of tissue, duration of anesthesia and physical condition of patient.
- Lidocaine with epinephrine: DO NOT exceed 7 mg/kg. Not to be administered at intervals of less than 2 hours
- Lidocaine without epinephrine: DO NOT exceed 4.5 mg/kg. For continuous caudal and epidural anaesthesia the maximum recommended dose should not be administered at intervals of less than 2 hrs.
Antiarrhythmic:
- PEDIATRIC:
- Loading dose: 1 mg/kg/dose by slow IV/IO/Endotracheal injection
- May repeat 0.5-1 mg/kg Q 10-15 minutes till desired effect or up to a total maximum
loading dose of 5 mg/kg. - Continuous IV Infusion: 10-50 mcg/kg/minute (supplied as 50 ml syringe for use on syringe pump)
- ADULT:
- Loading Dose: 1-1.5 mg/kg IV; may repeat doses of 0.5 - 0.75 mg/kg if refractory after 5-10 minutes
- Maximum total loading dose: 3 mg/kg - Continuous infusion: 1-4 mg/minute IV
N.B. - moderate to severe CHF may require ½ loading doses and lower infusion rates
Intractable Seizures:
- Loading dose: 2 mg/kg/dose IV over 30 minutes, then
- Continuous infusion: 2 to 6 mg/kg/hour IV (supplied as 250 mL bag for use on large volume pump)
Neuropathic or Intractable Pain:
- 1 - 2 mg/kg/hour - Maximum rate 200 mg/hour - Adjust rate every 8 - 10 hours PRN to allow for steady state concentration. Supplied as 50 mL syringe for use on syringe pump.
- Reassess after 72 hours
Intraosseous Line Infusion (to decrease pain associated with IO insertion):
- Preservative free lidocaine 2% (0.5 mg/kg/dose, MAX 40 mg) infused over 1 - 2 min into medullary space. Follow with NaCL 0.9% flush.
- CNS effects - apprehension, tremors, seizures, respiratory arrest, drowsiness, anxiety, agitation, euphoria
- With high doses: bradycardia, hypotension, heart block, cardiovascular collapse, arrhythmias
- Thrombophlebitis
- Paresthesias, blurred vision
- Monitor EKG and serum lidocaine concentrations with continuous infusion
- Therapeutic plasma levels = 6-21 micromol/L (1.5-5 mcg/mL)
- Solutions containing preservatives should not be used for spinal or epidural block
- Solutions containing epinephrine should not be used for the treatment of arrhythmias
- Contraindicated in Adams-Stokes syndrome, severe sinoatrial, atrioventricular and intraventricular heart block
- Cimetidine or beta-blockers (eg. propranolol) may interact and cause lidocaine toxicity
- Solution containing epinephrine should not be used in anesthesia of digits, ears, nose or penis
- For management of hemodynamic instability due to lidocaine toxicity: see Intralipid 20% (fat emulsion) monograph