From the Guidelines
The maximum dose of lidocaine is 120 mg/h for intravenous infusion, with a loading dose of no more than 1.5 mg/kg and a maintenance infusion of no more than 1.5 mg/kg/h for no longer than 24 hours 1.
Key Considerations
- The dose should be calculated based on ideal body weight, and intravenous lidocaine should not be used in patients weighing less than 40 kg 1.
- For local anesthetic injections, the maximum dose of lidocaine with adrenaline is 7 mg/kg 1.
- The use of intravenous lidocaine should be ratified and approved by the local hospital and medication governance committee, and patients should be managed in a monitored bedspace in a high dependency unit (level 2 care) 1.
- Clinicians should be aware of the possibility of toxicity and have lipid emulsion 20% readily available 1.
Dosage Recommendations
- A bolus dose of 1-2 mg/kg followed by a continuous infusion of 1-2 mg/kg/h may be used for postoperative pain management in adults undergoing major surgery 1.
- However, the maximum dose of 120 mg/h for intravenous infusion should not be exceeded 1.
From the FDA Drug Label
The maximum recommended dose of 4% Lidocaine Hydrochloride Injection, USP should be such that the dose of lidocaine HCl is kept below 300 mg and in any case should not exceed 4. 5 mg/kg (2 mg/lb) body weight.
- Maximum dose: The maximum recommended dose of lidocaine is 300 mg or 4.5 mg/kg (2 mg/lb) body weight, whichever is lower 2.
- Key consideration: The dose should be adjusted based on the patient's weight, with a maximum dose of 4.5 mg/kg (2 mg/lb) body weight.
From the Research
Maximum Dose of Lidocaine
The maximum dose of lidocaine varies depending on the technique of administration and the presence of adrenaline.
- For subcutaneous injection, the maximum dose is 400 mg (500 mg with adrenaline) 3
- For injection in regions of high absorption, the maximum dose is 200 mg 3
- For single injection (perineural, e.g. plexus), the maximum dose is 400 mg (500 mg with adrenaline) 3
- For protracted injection (catheter, combined techniques), the maximum dose is 500 mg 3
- For injection into vasoactive regions (near to the spinal cord, spinal, epidural, sympathetic), the maximum dose is 1-25 ml 3
Tumescent Anaesthesia
In the case of tumescent anaesthesia, the maximum safe dose of lidocaine with epinephrine is:
- Probably between 35 and 55 mg/kg for liposuction 4
- No more than 28 mg/kg without liposuction 4
- Preliminary estimates for maximum safe dosages of tumescent lidocaine are 28 mg/kg without liposuction and 45 mg/kg with liposuction 5
General Guidelines
General guidelines for the maximum amounts of locally injected lidocaine exist, but there is a paucity of data in certain literature, such as Mohs micrographic surgery 6