Lidocaine Drip Dosing for Analgesia
For analgesia, lidocaine drips should be administered as a bolus of 1-2 mg/kg followed by a continuous infusion of 1-2 mg/kg/h, with a maximum of 100 mg/hour. 1
Recommended Dosing Protocol
Initial Loading Dose
- Administer 1.5 mg/kg as an infusion over 10 minutes (not to exceed 1.5 mg/kg) 1
- Too rapid administration increases toxicity risk
- Initial dose should be given with an anesthesiologist present
- Complete loading dose before skin incision when used perioperatively
Maintenance Infusion
- Continue at 1.5 mg/kg/h (not exceeding 100 mg/hour) 1
- Use ideal body weight for dose calculations 2
- For patients >70 kg: maximum 120 mg/hour 3
- For patients ≤70 kg: 60 mg/hour 3
Duration and Monitoring
- Duration should generally not exceed 24 hours 1
- If extending beyond 24 hours, reduce rate by 50% 1
- Continuous ECG, pulse oximetry, and regular blood pressure monitoring required 1
- Monitor for signs of toxicity (circumoral numbness, facial tingling, light-headedness, tinnitus) 2
Specific Clinical Indications
Postoperative Pain
- Most effective for major abdominal, pelvic, or spinal surgeries 1
- Consider when regional analgesia techniques are contraindicated or not feasible 1
- Particularly useful for reducing opioid consumption and improving intestinal motility 4
Cancer Pain
- Especially effective for opioid-refractory cancer pain 1
- May be particularly useful for neuropathic cancer pain 1
- Can be administered as bolus of 1-3 mg/kg over 20-30 minutes, followed by continuous infusion if effective 1
Status Migraine
- Initial bolus of approximately 3 mg/kg followed by infusion of 1.3-1.6 mg/kg/hr 5
- May take 16-19 hours for significant pain reduction 5
Administration Considerations
Delivery Method
- Use a dedicated infusion device that is lockable and tamper-proof 1
- Deliver through a separate, dedicated cannula 1
- Maintain minimum flow of sodium chloride 0.9% at 10 ml/h to flush the lidocaine and reduce vein irritation 1
- Use a one-way valve to prevent retrograde flow into simultaneous infusions 1
Safety Precautions
- Do not use concurrently with other local anesthetic interventions 1, 2
- Wait at least 4 hours after nerve blocks, fascial plane blocks, or port site infiltration before starting lidocaine infusion 1
- Do not perform nerve or fascial plane blocks until 4 hours after completion of lidocaine infusion 1
- Have 20% lipid emulsion readily available for potential toxicity treatment 2
Contraindications and Cautions
- Cardiac disease, electrolyte disorders, seizure disorders 2
- Renal or hepatic impairment 2
- Pregnancy/breastfeeding 2
- Neurological disorders 2
Lidocaine infusions provide effective analgesia through multiple mechanisms, including sodium channel blockade and anti-inflammatory properties. When properly administered and monitored, they can significantly reduce pain and opioid requirements while improving recovery outcomes.