From the Guidelines
For a 15kg child, the maximum safe dose of 2% lidocaine with adrenaline is 5.25ml, as calculated based on the maximum recommended dose of 7mg/kg for lidocaine with adrenaline, to prevent lidocaine toxicity. This calculation is derived from the guidelines provided by the study 1, which outlines the maximum allowable safe dosage for local anesthetic agents, including lidocaine. According to the study, the maximum dose of lidocaine with epinephrine is 7mg/kg. Given that 2% lidocaine contains 20mg/ml, we can calculate the maximum volume as follows:
- First, calculate the maximum dose in milligrams: 15kg × 7mg/kg = 105mg
- Then, divide the maximum dose by the concentration of lidocaine: 105mg ÷ 20mg/ml = 5.25ml This limit is crucial to prevent lidocaine toxicity, which can cause serious complications such as seizures, cardiac arrhythmias, and central nervous system depression if exceeded, as noted in the study 1. It's essential to adhere to these guidelines to ensure the safety of pediatric patients undergoing procedures that require local anesthesia.
From the Research
Maximum Dose of 2% Lidocaine with Adrenaline for a 15kg Child
- The maximum dose of 2% lidocaine with adrenaline for a child is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, study 4 recommends a maximum dose of 670 mg of lignocaine with adrenaline for the infiltration technique of local analgesia, but this is for adults and not specifically for children.
- To estimate the maximum dose for a 15kg child, we can use the recommended dose per kilogram of body weight.
- Study 4 suggests that for dilute solutions such as 0.4% and 0.5% lignocaine, a dose of up to 500 mg or more can be used for plain lignocaine and 670 mg with adrenaline.
- Assuming a similar dose per kilogram of body weight for children, we can estimate the maximum dose for a 15kg child.
- However, it is essential to note that the studies provided do not give a clear recommendation for the maximum dose of 2% lidocaine with adrenaline for a 15kg child, and the estimation should be done with caution and considering the specific clinical context 2, 4.
- Study 6 provides information on the use of IV lidocaine in children and adolescents with status migraine, but it does not provide a clear recommendation for the maximum dose of 2% lidocaine with adrenaline for a 15kg child.
Considerations for Administration
- When administering local anesthetics to children, it is crucial to consider factors such as age, weight, and medical history 2, 3.
- The addition of adrenaline to the local anesthetic solution can help reduce the risk of toxicity and allow for higher doses to be used 3.
- However, the use of adrenaline is contraindicated in certain situations, such as in patients with severe cardiovascular disease or those taking certain medications 3.