What is the maximum dose of 2% lidocaine with epinephrine in milliliters that can be administered to a 15kg child?

From the Guidelines

For a 15kg child, the maximum safe dose of 2% lidocaine with epinephrine is 5.25ml, calculated based on the maximum recommended dose of 7mg/kg for lidocaine with epinephrine, as per the guidelines outlined in the study 1. To determine this dose, we consider the maximum recommended dose of 7mg/kg for lidocaine with epinephrine. Given that 2% lidocaine contains 20mg/ml, we calculate the dose as follows: (15kg × 7mg/kg) ÷ 20mg/ml = 105mg ÷ 20mg/ml = 5.25ml.

Key Considerations:

• The addition of epinephrine allows for a higher dose compared to plain lidocaine because the vasoconstriction slows systemic absorption, reducing toxicity risk 1.
• It is crucial to aspirate before injecting to avoid intravascular administration and to administer the anesthetic slowly to monitor for any adverse reactions.
• The guidelines also recommend considering the patient's age and the site of administration, as these factors can affect the duration of action and the risk of toxicity 1.

Administration Guidelines:

• Always use the lowest effective dose to minimize the risk of adverse effects.
• Monitor the patient closely during and after administration for signs of toxicity or other adverse reactions.
• Be prepared to manage any potential complications, including respiratory depression or cardiac arrhythmias, with appropriate emergency equipment and personnel trained in pediatric life support 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 Epinephrine

To determine the maximum dose of 2% lidocaine with epinephrine that can be administered to a 15kg child, we need to consider the recommended dosage limits and the factors that influence them.

• The study 2 suggests that a dose of 5 mg/kg lidocaine is considered appropriate for pediatric airway topicalisation.
• Since the child weighs 15kg, the maximum dose would be 5 mg/kg x 15 kg = 75 mg of lidocaine.
• Given that the concentration of lidocaine is 2%, the maximum volume of lidocaine that can be administered would be 75 mg / 20 mg/mL (2% solution) = 3.75 mL.

Considerations for Administration

When administering 2% lidocaine with epinephrine to a child, it is essential to consider the following factors:

• Age: Younger children are more susceptible to toxic lidocaine plasma levels and achieve this at a faster rate 2.
• Body weight: Lower body weights trend towards higher peak lidocaine plasma concentrations 2.
• Total dose volume: Higher peak plasma lidocaine levels occur with total dose volumes between 2 and 3 mL of 2% lidocaine local anesthetic 2.

Safety Precautions

It is crucial to follow safety precautions when administering local anesthetics to children, including:

• Using the minimum dose necessary to achieve the desired effect 3, 4.
• Monitoring for signs of lidocaine toxicity, such as ECG changes or seizures 2.
• Being aware of the potential for local anesthetic systemic toxicity (LAST) and having a plan in place for treatment 5, 6.