What is the recommended dose of lidocaine (local anesthetic) for a dental block prior to lip filler?

Lidocaine Dosage for Dental Block Prior to Lip Filler

For a dental block prior to lip filler procedures, the maximum recommended dose of lidocaine without epinephrine should not exceed 4.5 mg/kg of body weight with a general maximum total dose of 300 mg. 1

Dosage Guidelines

• For adults, the FDA-approved maximum dose of lidocaine without epinephrine is 4.5 mg/kg (not to exceed 300 mg total) 1
• With epinephrine, the maximum safe dose increases to 7.0 mg/kg 2
• For dental blocks specifically:
  • 1% lidocaine with 1:100,000 epinephrine is effective for inferior alveolar, lingual, and buccal nerve blocks 3
  • 2% lidocaine with 1:100,000 epinephrine is also commonly used but may cause more injection pain 3

Administration Technique

For dental blocks prior to lip filler:

1. Inferior alveolar nerve block:

   • Typically 1.8-3.6 mL of 2% lidocaine with 1:100,000 epinephrine
   • Alternatively, 3.6-7.2 mL of 1% lidocaine with 1:100,000 epinephrine

2. Mental nerve block (if targeting only the lower lip):

   • 0.9-1.8 mL of 2% lidocaine with 1:100,000 epinephrine per side

3. Infraorbital nerve block (for upper lip):

   • 0.9-1.8 mL of 2% lidocaine with 1:100,000 epinephrine per side

Safety Considerations

• Use the lowest effective dose to minimize risk of systemic toxicity 2
• Aspirate before injection to avoid intravascular administration 2
• Administer incrementally rather than as a single bolus 2
• Monitor for early signs of toxicity: circumoral numbness, facial tingling, light-headedness, and tinnitus 2

Alternative Approaches

For patients concerned about injection pain or those requiring less extensive anesthesia:

• 5% lidocaine cream applied simultaneously to the skin, vermilion, and mucosa of the lips for 20-30 minutes can provide profound anesthesia without injections 4
• This "anesthetic cream block" is easier to perform and better tolerated than injectable anesthetics 4

Timing Considerations

• Maximum hypoalgesia from topical lidocaine spray occurs 4-5 minutes after application 5
• Optimal time window for procedures after topical application is 3-8 minutes 5
• Injectable dental blocks typically provide anesthesia within 1-5 minutes, with 1% lidocaine solutions showing faster onset (52-63 seconds) compared to 2% solutions (259-335 seconds) 3

Important Cautions

• Contraindications include active infections at the injection site, true lidocaine allergy, uncontrolled diabetes, severe hypertension, heart failure, and certain neurological disorders 2
• Patients weighing less than 40 kg require adjusted dosing 2
• The duration of anesthesia is longer with 2% lidocaine (average 61 minutes longer) compared to 1% lidocaine 3
• Avoid exceeding recommended doses, as toxicity occurs in a dose-dependent manner 2