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Lignocaine

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lidocaine prescribing information FDA indications warnings dosage

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https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set…

Lignocaine, also called lidocaine, is an amide local anaesthetic and a class Ib antiarrhythmic.

Main uses

  • Local infiltration and nerve blocks for minor surgery, suturing, dental procedures
  • Topical anaesthesia of skin or mucosa
  • Regional anaesthesia in selected settings
  • Intravenous treatment of some ventricular arrhythmias, especially ventricular tachycardia or refractory ventricular fibrillation in resuscitation contexts

How it works

It blocks voltage-gated sodium channels in nerves. This prevents generation and conduction of pain impulses. In the heart, it suppresses ventricular automaticity and ectopic activity.

Common preparations

  • 1% = 10 mg/mL
  • 2% = 20 mg/mL
  • May be combined with adrenaline/epinephrine, which slows systemic absorption, prolongs local action, and reduces bleeding.

Dose safety

For plain lidocaine injection, US labeling gives a usual adult maximum of 4.5 mg/kg, with a maximum total of 300 mg. Dose limits differ by formulation, site, technique, and whether adrenaline is used, so clinicians calculate the total milligrams, not just volume. The textbook reference also emphasizes reducing the dose for low body weight, older age, debility, liver disease, renal impairment, epilepsy, or heart block. Pye's Surgical-Handicraft, p. 103.

Adverse effects and toxicity

Early systemic toxicity can cause:
  • Metallic taste, numbness around the mouth
  • Tinnitus, dizziness, drowsiness, agitation
  • Tremor or seizures
Severe toxicity can cause:
  • Hypotension, bradycardia, widened QRS complexes
  • Ventricular arrhythmia, cardiac depression, cardiac arrest
Most dangerous reactions arise from excess dose or unintended intravascular injection, not true allergy. Pye's Surgical-Handicraft, p. 103. Injection should be administered by trained clinicians with monitoring and resuscitation capability.

Important precautions

Avoid or use specialist guidance with:
  • Known allergy to amide local anaesthetics
  • Significant liver dysfunction
  • Severe conduction disease or major cardiac impairment
  • Concomitant medicines that increase lidocaine levels or cardiac effects
For authoritative formulation-specific dose limits and warnings, see the DailyMed prescribing information.
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