lidocaine anesthetic (Xylocaine, Zingo)

Dosing and uses of Xylocaine, Zingo (lidocaine anesthetic)

• Adult
• Pediatric

 

Adult dosage forms and strengths

injectable solution

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

 

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)

Pudendeal (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 dosage forms and strengths

injectable solution

• 0.5%
• 1%
• 1.5%
• 2%
• 4%
• 5%

 

Infiltration

Percutaneous: 4-4.5 mg/kg maximum

IV regional: 3 mg/kg

 

Xylocaine, Zingo (lidocaine anesthetic) adverse (side) effects

Frequency not defined

Arrhythmias

Bradycardia

Cardiovascular collapse

Edema

Hypotension

Heart block

Apprehension

Agitation

Coma

Confusion

Drowsiness

Dizziness

Disorientation

Euphoria

Lightheadedness

Nervousness

Paresthesia

Psychosis

Sensations of heat, cold, or numbness

Slurred speech

Seizures

Tinnitus

Tremulousness

Unconsciousness

Visual disturbances including blurred or double vision

Skin lesions

Urticaria

Anaphylactoid reactions

Difficulty swallowing

Nausea

Vomiting

Muscle twitching/ tremors

Dyspnea

Respiratory depression/arrest

Administration Effects

• pain IM injection site
• IM injection increases serum creatine kinase

 

Warnings

Contraindications

Hypersensitivity to drug or amide type anesthetic

 

Cautions

Some formulations may contain sulfites

History of malignant hyperthermia

DO NOT use solutions containing epinephrine in distal areas of body (eg, digit, nose, ear) because of vasoconstrictive effects; addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action

Significant systemic absorption reported when administered to mucosal surfaces and open wounds

Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)

Use with caution in hepatic impairment (ability to metabolize diminishes)

 

Pregnancy and lactation

Pregnancy category: B

Lactation: Excreted in breast milk; use caution

 

Pregnancy categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

 

Pharmacology of Xylocaine, Zingo (lidocaine anesthetic)

Mechanism of action

Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability and increasing action potential threshold; inhibits depolarization, which results in blockade of conduction

 

Pharmacokinetics

Half-life: 7-30 min (initial); 1.5-2 hr (terminal)

Vd: 0.7-2.7 L/kg (patch)

Peak plasma concentration: 1-5 mcg/mL

Protein Bound: 60-80%

Metabolism: Liver

Metabolites: Monoethylglycinexylidide (MEGX), glycinexylidide (GX)

Excretion: Urine (primarily)

 

Administration

IV Incompatibilities

Additive: amphotericin B, dacarbazine, methohexital, phenytoin

Syringe: cefazolin

Y-site: amphotericin B cholesteryl SO4, thiopentaL

 

IV Preparation

Standard diluent: 2 g/250 mL D5W

 

IV Administration

Use microdrip (60 drops/mL) or infusion pump to administer an accurate dose

Local thrombophlebitis may occur in pts receiving prolonged IV infusions

Add 1 g of drug (using 25mLl of 4% or 5 mL of 20 % inj) to 1 L of D5W inj to provide a solution containing 1 mg/mL

 

Storage

Injection is stable at room temperature