Lidocaine: Difference between revisions
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|maxdose=4.5 mg/kg with plain lidocaine<br>7 mg/kg with adrenaline<br><small>Note: Intercostal block safe dose is 10 times less.{{#pmid:24660158|golzari}}</small> | |maxdose=4.5 mg/kg with plain lidocaine<br>7 mg/kg with adrenaline<br><small>Note: Intercostal block safe dose is 10 times less.{{#pmid:24660158|golzari}}</small> | ||
|onset=2-5 | |onset=Infiltration and minor nerve: 1-2 mins.<br>Intra-articular: 5-10 mins<br>Major nerve blocks:15-30 mins<ref name="medsafe">https://www.medsafe.govt.nz/profs/Datasheet/l/lidocaineclarisinj.pdf</ref> | ||
|duration= | |duration=Infiltration and minor nerve: 1.5 - 2 hours<br>Intra-articular: 30-60 mins post washout<br>Major nerve blocks: 1.5 - 3 hours<br>Duration longer with adrenaline.<ref name="medsafe"/> | ||
|class=Amino amide local anaesthetic | |class=Amino amide local anaesthetic | ||
|metabolism= | |metabolism= | ||
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|side effects= | |side effects= | ||
|interactions= | |interactions= | ||
|chemical structure= | |chemical structure=2ā(diethylamino)āNā(2,6ā dimethylphenyl) acetamide hydrochloride monohydrate | ||
|drugbank ID= | |drugbank ID= | ||
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==Toxicity== | ==Toxicity== | ||
{{Main|Local Anaesthetic Toxicity}} | {{Main|Local Anaesthetic Toxicity}} | ||
The central nervous system is where the premonitory signs of toxicity occur. Early symptoms include circumoral numbness, tongue paraesthesia, and dizziness. Patients may complain of sensory disturbance such as tinnitus and blurred vision. There may be excitatory signs, such as restlessness, agitation, nervousness, or paranoia. These may progress to muscle twitching and seizures. With severe toxicity, CNS depression can occur with coma. Ā | The central nervous system is where the premonitory signs of toxicity occur, and it is a graded response. Early symptoms include circumoral numbness, tongue paraesthesia, and dizziness. Patients may complain of sensory disturbance such as tinnitus and blurred vision. There may be excitatory signs, such as restlessness, agitation, nervousness, or paranoia. These may progress to muscle twitching and seizures. With severe toxicity, CNS depression can occur with coma. Ā | ||
Cardiovascular effects with hypotension and bradycardia can occur as a result of a relative overdose with neuraxial blockage or nerve blocks nerve the CNS. Unintentional intravascular injection produces severe cardiotoxic reactions which include hypotension, atrioventicular heart block, idioventricular rhythms, ventricular tachycardia, and ventricular fibrillation. Even premonitory signs can progress to cardiotoxicity and so any reaction should be | Cardiovascular effects with hypotension and bradycardia can occur as a result of a relative overdose with neuraxial blockage or nerve blocks nerve the CNS. Unintentional intravascular injection produces severe cardiotoxic reactions which include hypotension, atrioventicular heart block, idioventricular rhythms, ventricular tachycardia, and ventricular fibrillation. Even premonitory signs can progress to cardiotoxicity and so any reaction should be treated promptly.<ref>{{#pmid:29494086}}</ref> | ||
==See Also== | ==See Also== |
Revision as of 07:37, 5 May 2021
Lidocaine | |
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Other names | Lignocaine, Xylocaine |
Drug class | Amino amide local anaesthetic |
Maximum dose | 4.5 mg/kg with plain lidocaine 7 mg/kg with adrenaline Note: Intercostal block safe dose is 10 times less.[1] |
Onset of action | Infiltration and minor nerve: 1-2 mins. Intra-articular: 5-10 mins Major nerve blocks:15-30 mins[2] |
Duration of action | Infiltration and minor nerve: 1.5 - 2 hours Intra-articular: 30-60 mins post washout Major nerve blocks: 1.5 - 3 hours Duration longer with adrenaline.[2] |
Chemical structure | 2ā(diethylamino)āNā(2,6ā dimethylphenyl) acetamide hydrochloride monohydrate |
Lidocaine was the first clinically used amide local anesthetic in 1948. It is widely used because of its potency; rapid onset; tissue penetration; and effectiveness in infiltration, peripheral nerve block, and both epidural and spinal blocks. In peripheral nerve blockage 1-1.5% is sufficient to produce a motor blockade, while for epidural and spinal blocks higher strengths are used.
Chemical Structure
Formulations
Lidocaine Cream
Lidocaine cream is not readily available in New Zealand and is not subsidised. It has to be ordered over the internet.
- Haim International for 10.56% lidocaine cream, apply twice daily
- 4% Lidocaine patches can be purchased from ebay, brand name is Salonpas. They last for 8 hours.
Toxicity
- Main article: Local Anaesthetic Toxicity
The central nervous system is where the premonitory signs of toxicity occur, and it is a graded response. Early symptoms include circumoral numbness, tongue paraesthesia, and dizziness. Patients may complain of sensory disturbance such as tinnitus and blurred vision. There may be excitatory signs, such as restlessness, agitation, nervousness, or paranoia. These may progress to muscle twitching and seizures. With severe toxicity, CNS depression can occur with coma.
Cardiovascular effects with hypotension and bradycardia can occur as a result of a relative overdose with neuraxial blockage or nerve blocks nerve the CNS. Unintentional intravascular injection produces severe cardiotoxic reactions which include hypotension, atrioventicular heart block, idioventricular rhythms, ventricular tachycardia, and ventricular fibrillation. Even premonitory signs can progress to cardiotoxicity and so any reaction should be treated promptly.[3]
See Also
References
- ā Golzari et al.. Lidocaine and pain management in the emergency department: a review article. Anesthesiology and pain medicine 2014. 4:e15444. PMID: 24660158. DOI. Full Text.
- ā 2.0 2.1 https://www.medsafe.govt.nz/profs/Datasheet/l/lidocaineclarisinj.pdf
- ā Torp et al.. Lidocaine Toxicity. 2021. . PMID: 29494086.
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,