What is the recommended dosing for lidocaine (local anesthetic) for local anesthesia?

From the Guidelines

For local anesthesia, lidocaine should be administered at a dose not exceeding 4.5 mg/kg for adults and 1.5-2.0 mg/kg for children, with a maximum total dose of 300 mg (or 500 mg if used with epinephrine) to minimize the risk of toxicity and ensure optimal outcomes in terms of morbidity, mortality, and quality of life. The recommended dosing for lidocaine is based on the most recent and highest quality study available, which provides guidelines for the use of local anesthesia in office-based dermatologic surgery 1.

Key Considerations for Lidocaine Administration

• The concentration of lidocaine used varies by procedure, with 0.5-1% typically used for infiltration anesthesia, 1-2% for nerve blocks, and 2% for topical applications.
• When epinephrine is added, it prolongs the duration of action and helps to reduce systemic absorption, but the maximum allowable dose should still be calculated before administration to avoid excessive dosing 1.
• Patients with liver disease, elderly patients, or those with cardiovascular conditions may require reduced doses, typically by 25-50%, to minimize the risk of adverse effects.
• The onset of action for lidocaine is usually within 2-5 minutes, and the duration of action depends on the concentration, total dose, and site of administration, as well as the use of epinephrine and the patient's age.

Important Safety Precautions

• Always aspirate before injecting lidocaine to avoid intravascular administration.
• Be aware of the potential for toxicity with excessive doses, which can manifest as CNS symptoms (dizziness, seizures) or cardiovascular effects (hypotension, arrhythmias).
• Monitor patients closely during and after the procedure to ensure prompt recognition and management of any adverse effects.

By following these guidelines and considering the individual patient's needs and medical history, healthcare providers can ensure the safe and effective use of lidocaine for local anesthesia, minimizing the risk of complications and optimizing outcomes in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: Table 1 (Recommended Dosages) summarizes the recommended volumes and concentrations of Lidocaine Hydrochloride Injection, USP for various types of anesthetic procedures. The dosages suggested in this table are for normal healthy adults and refer to the use of epinephrine-free solutions When larger volumes are required, only solutions containing epinephrine should be used except in those cases where vasopressor drugs may be contraindicated. In all cases the lowest concentration and smallest dose that will produce the desired result should be given Dosages should be reduced for children and for the elderly and debilitated patients and patients with cardiac and/or liver disease. For epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3ml of the indicated concentration per dermatome).

The recommended dosing for lidocaine (local anesthetic) for local anesthesia is as follows:

• The lowest concentration and smallest dose that will produce the desired result should be given.
• Dosages should be reduced for:
  • Children
  • Elderly patients
  • Debilitated patients
  • Patients with cardiac and/or liver disease
• For epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3ml of the indicated concentration per dermatome) 2.

From the Research

Recommended Dosing for Lidocaine

The recommended dosing for lidocaine (local anesthetic) for local anesthesia is as follows:

• The maximal recommended local anesthetic dose of lidocaine is 7 mg/kg 3
• Higher doses are used in tumescent liposuction 3
• For skin surgery, lidocaine 1% with epinephrine 1:200,000 (maximum dose 40mL) is the agent of choice 4
• In facelift procedures, a mean lidocaine dose of 21.6 +/- 3.6 mg/kg (range, 17.5-26.3 mg/kg) infiltrated subcutaneously over 20 minutes or less has been used without lidocaine-related adverse effects 3

Considerations for Administration

Some key considerations for the administration of lidocaine include:

• Epinephrine-induced vasoconstriction delays local anaesthetic clearance, thus prolonging its effect and enabling a higher maximum dose to be used 4
• Adding epinephrine introduces the possibility of a drug interaction with tricyclic antidepressants and nonselective beta-blockers 4
• Injection pain can be reduced by buffering the solution using sodium bicarbonate 4
• Plain lidocaine can be used without drug interactions, but injection pain is least with 0.5% solutions 4

Safety and Adverse Events

The safety and adverse event profile of lidocaine is as follows:

• Lidocaine toxicity is exceedingly rare to entirely absent 5
• Incidence of adverse events possibly anesthesia related is >0.15%, with most being mild cases of dizziness, drowsiness, or lightheadedness from epinephrine tachycardia 5
• No cases of lidocaine toxicity were reported, diagnosed, or treated in a study of dermatologic surgeons 5
• Volumes of lidocaine in skin cancer excision and repair are modest and within safe limits 5