From the Guidelines
Lidocaine injection should be administered with caution, using the lowest effective dose, and with careful monitoring for signs of toxicity, as recommended by the most recent guidelines 1. When administering lidocaine injection for a medical procedure, it is essential to follow proper protocols to minimize the risk of local anesthetic systemic toxicity.
- The maximum safe dose of lidocaine is 4.5 mg/kg without epinephrine or 7 mg/kg with epinephrine, as stated in the guidelines 1.
- Aspirating the needle before injection is crucial to avoid introducing the drug directly into a vessel, as recommended by the guidelines 1.
- Incremental injections of anesthetic and continual assessment of the patient for signs of early toxicity are also vital, as emphasized in the guidelines 1.
- The use of intravenous lidocaine for acute pain should be ratified and approved by the local hospital and medication governance committee, or equivalent, and patients should be informed of the possible benefits and risks, as stated in the consensus statement 1.
- Ideal body weight should be used for dose calculation, and intravenous lidocaine should not be used in patients weighing < 40 kg, as recommended by the consensus statement 1.
- A loading dose of no more than 1.5 mg.kg-1, given as an infusion over 10 min, is recommended, followed by an infusion of no more than 1.5 mg.kg-1.h-1, for no longer than 24 h, as stated in the consensus statement 1.
- Patients receiving intravenous lidocaine should be managed in a monitored bedspace in a high dependency unit (level 2 care), with particular vigilance in patients with existing comorbidity, as recommended by the consensus statement 1.
- Lipid emulsion 20% should be readily available wherever intravenous lidocaine is used, and staff should know where it is kept, in case of toxicity, as emphasized in the consensus statement 1.
From the FDA Drug Label
Lidocaine HCl Injections are indicated for production of local anesthesia by infiltration techniques such as percutaneous injection by peripheral nerve block techniques such as brachial plexus and intercostal, when the accepted procedures for these techniques as described in standard textbooks are observed. The protocol for administering lidocaine injection is by:
- Infiltration techniques: such as percutaneous injection
- Peripheral nerve block techniques: such as brachial plexus and intercostal It is essential to follow the accepted procedures as described in standard textbooks for these techniques 2.
From the Research
Protocol for Administering Lidocaine Injection
The protocol for administering lidocaine injection for a medical procedure involves several key considerations, including:
- Using a small needle (27- to 30-gauge) to deliver anesthesia to the entry sites 3
- Delivering anesthetic along the advancement pathway of the device and marked targets using a 20-gauge spinal needle 3
- Administering a limited volume of dilute lidocaine anesthesia, with a mean delivered anesthesia volume of 357.2 ml (range, 250-525 ml) or 18.7 mg/kg (range, 11.1-28.4 mg/kg) 3
- Monitoring for adverse events and signs of toxicity, with no signs of toxicity reported in study patients 3
Key Considerations
Some key considerations when administering lidocaine injection include:
- The use of lidocaine alone as an excellent anesthetic for most patients, with the option to use less painful injectable agents, topical anesthetics, and oral sedation for frightened or pain-intolerant patients 4
- The comparison of lidocaine with other local anesthetics, such as bupivacaine, which has a prolonged duration of anesthesia 5, 6
- The use of lidocaine in various routes of administration, including neuraxial, perineural, intravenous, infiltrative approaches, topical, and transdermal 7
Administration Techniques
Different administration techniques have been studied, including:
- Limited dilute lidocaine infiltration, which facilitates a comfortable procedure and rapid recovery process 3
- Mixing solutions, such as a 50/50 mixture of lidocaine and bupivacaine, which has been shown to have no significant difference in onset and duration of anesthesia compared to using the solutions independently 5