What type of lidocaine is commonly used for abscess incision and drainage (I and D)?

From the Guidelines

For abscess incision and drainage (I&D), 1% lidocaine without epinephrine is commonly used for local anesthesia. This approach is based on general medical knowledge and guidelines for local anesthesia in minor surgical procedures. When using lidocaine for abscess I&D, it is essential to follow proper techniques to minimize complications and ensure effective anesthesia.

• The typical approach involves infiltrating the skin and surrounding tissues with 5-10 mL of 1% lidocaine using a 25-27 gauge needle.
• It's crucial to avoid injecting directly into the abscess cavity as this can be painful and may spread infection.
• Instead, create a field block by injecting in a ring around the abscess.
• Allow 2-5 minutes for the anesthetic to take effect before proceeding with the procedure.
• Buffering the lidocaine with sodium bicarbonate (9:1 ratio of lidocaine to sodium bicarbonate) can reduce the pain of injection by neutralizing the acidic pH.
• Lidocaine without epinephrine is preferred because vasoconstriction from epinephrine could potentially impair wound healing and because abscesses often occur in areas with end-arteries (like fingers, toes, nose, ears) where vasoconstriction should be avoided. The study on intravenous lidocaine for postoperative pain and recovery 1 provides guidelines for the safe use of lidocaine, but it is not directly applicable to abscess I&D. However, it emphasizes the importance of careful dose calculation and monitoring for toxicity, which is also relevant for local anesthesia in minor surgical procedures. The maximum safe dose of lidocaine is 4.5 mg/kg (or approximately 30 mL of 1% solution for a 70 kg adult) to prevent systemic toxicity.

From the FDA Drug Label

Lidocaine Hydrochloride Injection, USP is a sterile, nonpyrogenic, aqueous, isotonic solution that contains a local anesthetic agent and is administered parenterally by injection. Each mL of the 1% solution contains lidocaine hydrochloride 10 mg, sodium chloride 7 mg and 1 mg methylparaben as antiseptic preservative. Each mL of the 2% solution contains lidocaine hydrochloride 20 mg, sodium chloride 6 mg and 1 mg methylparaben as antiseptic preservative. LIDOCAINE HCI INJECTION, USP is supplied in the following dosage forms NDC 51662-1384-1 LIDOCAINE HCI INJECTION, USP 2% 1000 mg/50 mL (20 mg/mL) 50 mL VIAL Lidocaine Hydrochloride Injection, USP is preserved with 0. 1% methylparaben and is available in the following concentrations: 1% (10 mg/mL) 2 mL Multiple Dose Vials packaged in 25s (NDC 0143-9579-25) 30 mL Multiple Dose Vials packaged in 10s (NDC 0143-9578-10) 50 mL Multiple Dose Vials packaged in 10s (NDC 0143-9577-10) 2% (20 mg/mL) 2 mL Multiple Dose Vials packaged in 25s (NDC 0143-9576-25) 50 mL Multiple Dose Vials packaged in 10s (NDC 0143-9575-10)

The 2% lidocaine solution is commonly used for abscess I and D, as it is available in various concentrations, including 1% and 2% solutions, and is administered parenterally by injection 2 2.

• Key concentrations: 1% (10 mg/mL) and 2% (20 mg/mL)
• Administration: parenteral injection
• Common use: local anesthetic agent for procedures such as abscess I and D.

From the Research

Lidocaine for Abscess Incision and Drainage

• Lidocaine is a commonly used local anesthetic for incision and drainage (I&D) of skin abscesses 3, 4.
• A study published in The Journal of Emergency Medicine found that injectable 1% lidocaine provided similar analgesia compared to a transdermal lidocaine/tetracaine patch for I&D of skin abscesses 3.
• Another study published in the Journal of Endodontics found that buffered 2% lidocaine with 1:100,000 epinephrine did not result in significantly decreased pain of infiltrations or incision and drainage procedure compared to non-buffered 2% lidocaine with 1:100,000 epinephrine 4.
• The choice of lidocaine formulation and administration method may depend on the specific clinical situation and patient factors 3, 4, 5, 6.

Administration of Lidocaine

• Lidocaine can be administered via injection or topical application 3, 6.
• When administering lidocaine, it is essential to follow proper techniques and precautions to ensure patient safety and minimize potential complications 6.
• The use of lidocaine for I&D of skin abscesses is a common practice in emergency medicine and primary care settings 3, 7, 5.