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. This calculation is based on the most recent and highest quality study available, which is the 2019 guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures 1. The key points to consider when administering local anesthetics to pediatric patients include:
- Maximum recommended doses and durations of action, which are dependent on the concentration, total dose, and site of administration, as well as the patient’s age and the use of epinephrine 1.
- The importance of calculating the maximum allowable safe dosage before administration to avoid excessive doses, especially when using local anesthetic drugs in combination with other sedatives or opioids 1.
- The need to aspirate frequently to minimize the likelihood of injecting the needle into a blood vessel and to use lower doses when injecting into vascular tissues 1.
- The consideration of using a smaller dose if clinically appropriate and the careful drawing up of the medication to avoid errors 1. It's also important to note that the addition of adrenaline (epinephrine) to lidocaine allows for a higher maximum dose compared to plain lidocaine, due to its vasoconstrictive effects, which slow systemic absorption and reduce toxicity risk while prolonging the anesthetic effect 1. Always consider the patient's individual needs and medical history when determining the appropriate dose of local anesthetic, and consult the most recent guidelines and recommendations for pediatric patients 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, especially in pediatric patients 3.