What are the uses of Lidocaine (Lignocaine)?

From the Guidelines

Lignocaine is primarily used as a local anesthetic and antiarrhythmic medication, with its most recent and highest quality use supported by the 2021 international consensus statement on efficacy and safety for postoperative pain and recovery 1.

Key Uses of Lignocaine

• As a local anesthetic, lignocaine blocks sodium channels in nerve cell membranes, preventing the initiation and conduction of nerve impulses and resulting in temporary numbness and pain relief.
• It's commonly used in dental procedures, minor surgeries, skin procedures, and for infiltration anesthesia.
• Lignocaine is also available in topical forms for skin and mucous membrane anesthesia, including creams, gels, and sprays typically in 2-5% concentrations.

Antiarrhythmic Use

• As an antiarrhythmic agent, lignocaine is administered intravenously at 1-1.5 mg/kg for ventricular arrhythmias, particularly after myocardial infarction, as supported by earlier guidelines 1.
• The recommended dosing for intravenous lignocaine in the setting of acute myocardial infarction or for ventricular arrhythmias is an initial bolus of 1.0 to 1.5 mg/kg, with additional boluses as needed, followed by a maintenance infusion 1.

Other Uses and Considerations

• Lignocaine serves as a treatment for neuropathic pain conditions like postherpetic neuralgia and can help manage symptoms of irritable bowel syndrome when used as a rectal gel.
• The medication typically works within minutes when used as an anesthetic, with effects lasting 1-2 hours, though this varies by formulation and administration route.
• Side effects may include dizziness, drowsiness, and at higher doses, cardiovascular and central nervous system complications.
• Recent consensus statements emphasize the importance of careful patient selection, monitoring, and dosing to minimize the risk of toxicity, particularly when using intravenous lignocaine for postoperative pain management 1.

From the FDA Drug Label

The safety and effectiveness of lidocaine depend on proper dosage, correct technique, adequate precautions, and readiness for emergencies. Lidocaine should also be used with caution in patients with severe shock or heart block Use in Ophthalmic Surgery: When local anesthetic solutions are employed for retrobulbar block, lack of corneal sensation should not be relied upon to determine whether or not the patient is ready for surgery Use in the Head and Neck Area: Small doses of local anesthetics injected into the head and neck area, including retrobulbar, dental and stellate ganglion blocks, may produce adverse reactions

The main uses of lignocaine include:

• Local anesthesia: for procedures such as retrobulbar block, dental block, and stellate ganglion block
• Ophthalmic surgery: for retrobulbar block
• Head and neck area: for small doses of local anesthetics injected into the head and neck area 2 2

From the Research

Lignocaine Uses

• Lignocaine is widely used as a local anaesthetic and antiarrhythmic drug 3.
• It is commonly administered to patients with acute myocardial infarction as prophylaxis for ventricular fibrillation, although its efficacy in preventing primary ventricular fibrillation is still debated 3.
• Lignocaine is used for the treatment of ventricular arrhythmias, and it exhibits well-investigated anti-arrhythmic effects 4.
• It is also used as a local anaesthetic for peri-oral injections, with recommended dosages based on the circulating level of lignocaine rather than the amount of adrenaline contained in the injected volume 5.

Administration and Dosage

• The recommended usual upper limit for dosage for a healthy adult patient is four and a half 2 ml (or 2.2-ml) cartridges of lignocaine with adrenaline (180-198 mg lignocaine or 2.57-2.82 mg/kg) body weight, if carefully given 5.
• For some medically compromised patients, minimal doses only of lignocaine and adrenaline (about one cartridge) should be used, and especial caution is necessary in patients likely to react adversely to the exogenous adrenaline of the dual formulation 5.
• The doses injected should be the minimum that allow the treatment to proceed, and if necessary, the doses are better given at a series of appointments rather than as a large volume on one single occasion 5.

Toxicity and Side Effects

• Toxicity, sometimes with serious clinical consequence, is not uncommon and is usually related to overdosage 3.
• Lignocaine systemic toxicity is rare, but it may be life-threatening, and its early identification and management are of vital importance 6.
• Neurologic manifestations of lidocaine toxicity, including altered mental status and seizure, can occur, and prompt treatment with benzodiazepine and discontinuation of lidocaine is necessary 6.
• Lignocaine can cause hypotension, bradycardia, and ventricular arrhythmias, similar to what may be seen in humans after accidental intravenous injections of local anesthetics 7.