From the Guidelines
For a 15kg child, the maximum safe dose of 2% lidocaine with adrenaline is 5.25ml, calculated based on the maximum recommended dose of 7mg/kg for lidocaine with adrenaline, which equals 105mg total for this child (15kg × 7mg/kg), and since 2% lidocaine contains 20mg/ml, dividing the total allowable dose (105mg) by the concentration (20mg/ml) gives 5.25ml 1.
Calculation Details
- Maximum recommended dose of lidocaine with adrenaline: 7mg/kg
- Child's weight: 15kg
- Total allowable dose: 15kg × 7mg/kg = 105mg
- Concentration of 2% lidocaine: 20mg/ml
- Maximum safe dose: 105mg ÷ 20mg/ml = 5.25ml
Important Considerations
- Always aspirate before injection to avoid intravascular administration
- Inject slowly
- Monitor the child for any signs of toxicity, such as:
- Confusion
- Ringing in ears
- Metallic taste
- Cardiac irregularities
Local Anesthetic Agents
- All local anesthetic agents are cardiac depressants and may cause central nervous system excitation or depression
- Particular weight-based attention should be paid to cumulative dosage in all children
- Lower doses should be used in very vascular areas
- Enhanced sedative effects may occur when used in combination with other sedatives or opioids 1
From the FDA Drug Label
The products accompanying this insert do not contain epinephrine. Pediatric Patients It is difficult to recommend a maximum dose of any drug for pediatric patients, since this varies as a function of age and weight For children over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child’s age and weight. For example, in a child of 5 years weighing 50 lbs the dose of lidocaine HCl should not exceed 75 to 100 mg (1. 5 to 2 mg/lb).
The FDA drug label does not answer the question.
From the Research
Maximum Dose of 2% Lidocaine with Adrenaline for a 15kg Child
- The maximum safe dose of lidocaine is not explicitly stated in the provided studies for a 15kg child.
- However, a study on tumescent lidocaine anesthesia 2 suggests that the maximum safe dosage of lidocaine is approximately 28 mg/kg without liposuction and 45 mg/kg with liposuction.
- For a 15kg child, the maximum safe dose would be:
- Without liposuction: 15kg x 28 mg/kg = 420mg
- With liposuction: 15kg x 45 mg/kg = 675mg
- Another study on pediatric airway topicalisation 3 suggests that a dose of 5 mg/kg lidocaine is considered appropriate for pediatric airway topicalisation.
- For a 15kg child, the dose would be: 15kg x 5 mg/kg = 75mg
- It is essential to note that these studies have different contexts and applications, and the maximum safe dose may vary depending on the specific procedure and individual patient factors.
Considerations for Administration
- The presence of epinephrine can slow the systemic absorption of lidocaine 4.
- The maximum safe dose of lidocaine may be lower for younger children or those with lower body weights 3.
- It is crucial to monitor plasma lidocaine levels and watch for signs of toxicity, such as ECG changes or seizures, when administering lidocaine to children 3.