Intraosseous Lidocaine Administration
The evidence provided addresses intravenous lidocaine administration, not intraosseous (IO) lidocaine—these are fundamentally different routes with distinct pharmacokinetics, indications, and safety profiles. While IO access can deliver medications during resuscitation when IV access fails, the specific guidelines for lidocaine dosing via the IO route follow emergency resuscitation protocols, not the perioperative pain management protocols described in the available evidence.
IO Route for Lidocaine in Emergency Settings
For cardiopulmonary resuscitation, lidocaine can be administered via the IO route using standard resuscitation dosing protocols. 1, 2
Dosing for IO Administration During Resuscitation
Adult dosing: 50-100 mg administered as initial bolus, with repeat dosing after 5 minutes if needed 1
Pediatric dosing: 1 mg/kg bolus dose per American Heart Association guidelines 1
- Followed by continuous infusion at 30 mcg/kg/min if needed 1
IO Access Characteristics
- Success rate: Approximately 80% with trained providers achieving placement within 1-2 minutes 2
- Drug delivery: Rapid systemic circulation via highly vascularized bone marrow 2
- All resuscitation drugs can be given by the IO route, though lidocaine specifically demonstrates reliable pharmacokinetics 2
Critical Safety Considerations for IO Lidocaine
Complications Specific to IO Route
- Extravasation: Most common adverse effect, occurring in 12% of patients 2
- Rare but serious complications: Compartment syndrome, osteomyelitis, tibial fracture 2
- Systemic toxicity monitoring: Watch for perioral numbness, tinnitus, metallic taste, visual disturbances, confusion, seizures, cardiovascular collapse 3
Contraindications and Precautions
The IO route should be avoided in:
- Fractures at the insertion site 2
- Infection or burns at the insertion site 2
- Previous IO attempts in the same bone 2
Important Distinction: IV vs IO Lidocaine
The extensive guidelines provided 4 specifically address intravenous lidocaine for perioperative pain management, NOT intraosseous administration. These IV protocols include:
- Loading doses of 1.5 mg/kg over 10 minutes 4
- Continuous infusions at 1.5 mg/kg/h 4
- Extensive monitoring requirements in HDU settings 4
- Duration limits of 24 hours 4
These IV perioperative protocols should NOT be applied to IO administration, which is reserved for emergency vascular access during resuscitation when IV access cannot be rapidly obtained 2.
Clinical Pitfall
Do not confuse IO lidocaine administration (emergency resuscitation route) with IV lidocaine infusions (perioperative pain management). The IO route is a rescue vascular access method for delivering resuscitation drugs when IV access fails, not a planned route for analgesic therapy 2. The dosing, monitoring, and indications are completely different between these two routes.