Generic Name: lidocaine anesthetic

Brand Names: Xylocaine, Zingo

Drug Class: Local Anesthetics, Dental; Local Anesthetics, Parenteral

What is lidocaine anesthetic, and what is it used for?

Lidocaine anesthetic is a local anesthetic injection administered before painful medical procedures to numb specific body regions. Lidocaine anesthetic prevents pain by blocking the nerves in the treatment area from sending pain signals to the brain. Lidocaine stabilizes the membrane of nerve cells (neurons) and inhibits the flux of sodium ions, preventing the conduction of nerve impulses to the brain.

Lidocaine anesthetic administration may include:

  • Injections into the skin (percutaneous) to numb the treatment area
  • Injections into a vein (intravenous) to numb a region of the body (only for upper and lower extremities, Bier block)
  • Injections into areas around specific peripheral nerves (peripheral nerve blocks) including:
    • Dental
    • Shoulder and arm (brachial)
    • Ribs (intercostal)
    • Space adjacent to the vertebrae (paravertebral)
    • Perineum and lower vagina (pudendal)
    • Lower uterus, cervix and upper vagina (paracervical)
  • Sympathetic nerve blocks including:
    • Neck, head upper arm and upper chest (cervical - stellate ganglion)
    • Mid to low back (lumbar)
  • Injections into the space around the spinal canal (epidural/central nerve blocks) including:
    • Upper back (thoracic)
    • Lumbar
    • Tailbone area (caudal)

Warnings

  • Do not use lidocaine anesthetic in patients with known hypersensitivity to amide type of local anesthetics, or to any of the components in lidocaine anesthetic
  • Some lidocaine anesthetic formulations may contain sulfites; do not use on patients with sulfite allergy
  • Do not use lidocaine anesthetic solutions containing epinephrine in extremities such as ear, nose, fingers and toes; epinephrine constricts blood vessels, and reduced blood flow can cause tissue damage
  • Patients with severe liver disease are at greater risk for increased blood concentration of lidocaine, because the drug is metabolized by the liver; use with caution
  • Patients with bleeding or platelet disorders are at higher risk for superficial bleeding from the skin
  • Use with caution in patients with history of malignant hyperthermia, a severe reaction to certain commonly used anesthetic drugs
  • Significant systemic absorption may occur if injected into mucous membranes or open wounds
  • Lidocaine anesthetic for nerve blocks and infiltration must be administered only by clinicians who are well versed and equipped to diagnose and manage dose-related toxicity and other acute emergencies that might arise
  • While administering nerve blocks, care must be taken to avoid injecting into a blood vessel (except in Bier block for extremities)
  • Infusion of lidocaine anesthetic into joints after arthroscopy or other surgical procedures is an unapproved use; cartilage loss (chondrolysis) can occur
  • Cases of methemoglobinemia have been reported in association with lidocaine anesthetic use. Patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are at higher risk for developing methemoglobinemia; monitor closely

SLIDESHOW

Rheumatoid Arthritis Exercises: Joint-Friendly Workouts See Slideshow

What are the side effects of lidocaine anesthetic?

Side effects of lidocaine anesthetic include:

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

What are the dosages of lidocaine anesthetic?

Injectable Solution

  • 0.4%
  • 0.5%
  • 0.8%
  • 1%
  • 1.5%
  • 2%
  • 4%
  • 5%

Adult

Infiltration Anesthesia

  • Percutaneous: 1-60 mL of 0.5-1% solution (5-300 mg total dose)
  • IV regional: 10-60 mL of 0.5% solution (50-300 mg total dose)

Peripheral Nerve Blocks

  • Brachial: 15-20 mL of 1.5% solution (225-300 mg total dose)
  • Dental: 1-5 mL of 2% solution (20-100 mg total dose)
  • Intercostal: 3 mL of 1% solution (30 mg total dose)
  • Paravertebral: 3-5 mL of 1% solution (30-50 mg total dose)
  • Pudendal (each side): 10 mL of 1% solution (100 mg total dose)
  • Paracervical obstetrical analgesia (each side): 10 mL of 1% solution (100 mg total dose)

Sympathetic Nerve Blocks

  • Cervical (stellate ganglion): 5 mL of 1% solution (50 mg total dose)
  • Lumbar: 5-10 mL of 1% solution (50-100 mg total dose)
  • Central Neural Blocks/Epidural
  • General: 2-3 mL/dermatome for anesthesia
  • Thoracic: 20-30 mL of 1% solution (200-300 mg total dose)
  • Lumbar analgesia: 25-30 mL of 1% solution (250-300 mg total dose)
  • Lumbar anesthesia: 15-20 mL of 1.5% solution (225-300 mg), or 10-15 mL of 2% solution (200-300 mg total dose)

Dosing Considerations

  • Use preservative-free preparations for spinal or epidural anesthesia
  • May be buffered 9:1 with sodium bicarbonate, to reduce pain on injection (e.g. remove 2 mL of 1% lidocaine from 20 mL vial, and add 2 mL of sodium bicarbonate solution to vial)
  • Maximum dose: 4.5 mg/kg, up to 300 mg lidocaine without epinephrine; or 7 mg/kg, up to 500 mg lidocaine with epinephrine 

Pediatric

Infiltration

  • Percutaneous: 4-4.5 mg/kg maximum  
  • IV regional: 3 mg/kg

QUESTION

Medically speaking, the term "myalgia" refers to what type of pain? See Answer

Overdose

  • The patient’s vital signs should be constantly monitored after administration of every local anesthetic injection to prevent overdose.
  • Oxygen should be administered at the first sign of change in vital signs.
  • Overdose of lidocaine can cause convulsions and cardiovascular depression and appropriate supportive and symptomatic treatment should be immediately instituted.

 

What drugs interact with lidocaine anesthetic?

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

Use of local anesthetics increases the risk of developing methemoglobinemia, a blood disorder, when concurrently exposed to certain drugs. Examples of drugs associated with methemoglobinemia include:

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

Pregnancy and breastfeeding

  • Lidocaine anesthetic may be acceptable for use in pregnancy.
  • Lidocaine anesthetic is indicated for pain relief during labor and delivery, however, potential for toxicity exists. Local anesthetics cross the placenta when administered as epidural, pudendal, paracervical or caudal blocks; administer with caution and monitor mother, fetus and newborn closely for adverse effects.
  • Lidocaine is excreted in breast milk and must be used with caution in nursing women.

Subscribe to MedicineNet's General Health Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

Summary

Lidocaine anesthetic is a local anesthetic injection administered to numb specific parts of the body before painful medical procedures. Side effects of lidocaine anesthetic include irregular heart rhythms (arrhythmias), slow heartbeat (bradycardia), cardiovascular collapse, low blood pressure (hypotension), heart block, swelling (edema), shortness of breath (dyspnea), respiratory depression, respiratory arrest, anxiety, agitation, confusion, euphoria, and others. Lidocaine is safe to use in pregnancy, and in labor and delivery. Consult your doctor if you are breastfeeding.

Treatment & Diagnosis

Medications & Supplements

Prevention & Wellness

Health Solutions From Our Sponsors

FDA Logo

Report Problems to the Food and Drug Administration

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Medically Reviewed on 3/18/2022
References
https://reference.medscape.com/drug/xylocaine-zingo-lidocaine-anesthetic-343363#0

https://www.rxlist.com/zingo-drug.htm#clinpharm

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022114s001lbl.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/006488s097lbl.pdf

https://www.uptodate.com/contents/pudendal-and-paracervical-block

https://my.clevelandclinic.org/health/treatments/17507-stellate-ganglion-block

https://www.nysora.com/techniques/intravenous-regional-anesthesia/intravenous-regional-block-upper-lower-extremity-surgery/