Recommended Dosing of Intravenous Lidocaine 1% for Analgesia
For intravenous analgesia, the recommended dose of lidocaine 1% is a loading dose of 1.5 mg/kg given over 10 minutes, followed by an infusion of 1.5 mg/kg/hour for no longer than 24 hours, using ideal body weight for calculation. 1, 2
Dosing Guidelines
- Calculate the dose using ideal body weight rather than actual body weight, especially important in obese patients 1, 2
- Initial loading dose should not exceed 1.5 mg/kg, administered as an infusion over 10 minutes (not as a bolus) 1
- Maintenance infusion should not exceed 1.5 mg/kg/hour 1
- Maximum infusion duration should be limited to 24 hours 1
- For any patient, regardless of weight, do not exceed 120 mg/hour 1
- Do not use intravenous lidocaine in patients weighing less than 40 kg 1
Safety Considerations
- Intravenous lidocaine should be considered a "high-risk" medication requiring appropriate monitoring 1
- Continuous ECG monitoring, pulse oximetry, and regular blood pressure measurements are recommended during administration 1
- The initial loading dose should be administered with an anesthesiologist present 1
- Lidocaine infusion should be delivered through a separate, dedicated cannula 1
- Do not administer intravenous lidocaine within 4 hours of other local anesthetic interventions (e.g., nerve blocks) 1
- Do not perform nerve blocks until 4 hours after discontinuing an intravenous lidocaine infusion 1
- Lipid emulsion 20% should be readily available wherever intravenous lidocaine is used to treat potential toxicity 1
Clinical Applications
- Intravenous lidocaine has shown efficacy for opioid-refractory cancer pain 1
- It may be particularly useful for neuropathic pain conditions 1, 3
- Disorders manifesting as deafferentation or central neuralgias appear to respond favorably to intravenous lidocaine 3
- For postoperative pain management, intravenous lidocaine should be part of a multimodal approach 1
Monitoring and Precautions
- Patients receiving intravenous lidocaine outside the operating room/recovery area should ideally be managed in a monitored setting (high dependency unit) 1
- Be vigilant for signs of local anesthetic systemic toxicity, which can include perioral numbness, tinnitus, metallic taste, visual disturbances, confusion, seizures, and cardiovascular collapse 1
- Dose reduction is recommended in patients with hepatic dysfunction, cardiac impairment, or the elderly 2
- Hospital medication governance committee approval should be obtained before implementing intravenous lidocaine protocols 1
- Informed consent should be obtained from patients when possible 1
Important Distinctions from Other Routes of Administration
- The maximum dose for intravenous lidocaine is significantly lower than for peripheral nerve blocks (where up to 7 mg/kg with epinephrine may be used) 2, 4
- For intravenous regional anesthesia (Bier block), the maximum dose should be limited to 3-5 mg/kg 2
- When used without epinephrine for other routes, the maximum individual dose should not exceed 4.5 mg/kg of body weight, with a recommended maximum total dose of 300 mg 4