Lidocaine Hydrochloride/Epinephrine

Pronouncation: (LIE-doe-cane HIGH-droe-KLOR-ide/epp-ih-NEFF-rin)
Class: Local anesthetic, Vasopressor

Trade Names:
Xylocaine with Epinephrine
- Injection 0.5% with 1:200,000 epinephrine
- Injection 1% with 1:100,000 epinephrine
- Injection 2% with 1:50,000 epinephrine
- Injection 2% with 1:100,000 epinephrine

Trade Names:
Xylocaine MPF with Epinephrine
- Injection 1% with 1:200,000 epinephrine
- Injection 1.5% with 1:200,000 epinephrine
- Injection 2% with 1:200,000 epinephrine

Mechanism of Action

Pharmacology

Lidocaine

Stabilizes neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.

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Epinephrine

Stimulates both alpha- and beta-receptors within sympathetic nervous system; relaxes smooth muscle of bronchi and iris and is an antagonist of histamine.

Indications and Usage

Production of local or regional anesthesia by infiltration techniques such as percutaneous injection, by peripheral nerve block techniques such as brachial plexus and intercostals, and by central neural techniques such as lumbar and caudal epidural blocks.

Contraindications

History of hypersensitivity to local anesthetics of the amide type.

Dosage and Administration

Dose determined by number of dermatomes to be anesthetized (2 to 3 mL/dermatome). The dose of local anesthetic administered varies with the procedure, vascularity of the tissues, depth of anesthesia, degree of required muscle relaxation, duration of anesthesia desired, and the physical condition of the patient. Reduce dosages for children, the elderly, debilitated patients, and patients with cardiac or liver disease. Consult individual prescribing information for dosage recommendations.

General Advice

  • For local infiltration only. Not for intravascular administration.
  • Multiple concentrations are available. Ensure that the proper concentration is being used.
  • Do not administer if particulate matter, cloudiness, or discoloration noted.
  • To avoid intravascular administration, aspirate injection site before anesthetic solution is injected.
  • Do not use anesthetic solutions containing preservatives for epidural or spinal anesthesia.
  • Discard any unused solution when using single dose vial or ampule.

Storage/Stability

Store at 59° to 86°F.

Drug Interactions

Ergot derivatives (ergotamine), vasopressors

May cause severe persistent hypertension or cerebrovascular accidents.

MAOIs (eg, isocarboxazid), tricyclic antidepressants (eg, amitriptyline)

Severe prolonged hypertension may occur.

Phenothiazines (eg, thioridazine), butyrophenones (droperidol)

May reduce or reverse the pressor effect of epinephrine.

Laboratory Test Interactions

Lidocaine IM injection may increase creatine phosphokinase levels, which may compromise the diagnosis of acute MI.

Adverse Reactions

Cardiovascular

Bradycardia; hypotension (3%); cardiovascular collapse; cardiac arrest.

CNS

Excitation; depression; lightheadedness; nervousness; apprehension; euphoria; confusion; dizziness; drowsiness; sensations of heat, cold, or numbness; twitching; tremors, convulsions, unconsciousness; positional headache (3%); shivering (2%).

EENT

Tinnitus; blurred or double vision; permanent injury to extraocular muscles.

GI

Vomiting; loss of bowel control.

Genitourinary

Loss of bladder control; loss of sexual function.

Respiratory

Respiratory depression or arrest.

Miscellaneous

Allergy (eg, cutaneous lesions, urticaria, edema, anaphylactoid reactions); backache.

Precautions

Pregnancy

Category B .

Lactation

Undetermined.

Children

Reduce dose; commensurate with age, body weight, and physical condition.

Special Risk Patients

Use with caution in areas of the body supplied by end arteries or having compromised blood supply, patients with neurological disease, spinal deformities, septicemia and severe hypertension, impaired CV function, or hepatic disease.

Peripheral or hypertensive vascular disease

May exhibit exaggerated vasoconstrictor response and ischemic injury or necrosis may result.

Patient Information

  • Explain name, dose, action, and potential adverse reactions of drug.
  • Advise patient that medication will be prepared and administered by a health care provider in a medical setting.
  • Caution patient that temporary loss of sensation and motor activity may be experienced.
  • Instruct patient to inform health care provider if any of the following are experienced during or after the anesthetic injection: restlessness; anxiety; ringing in the ears; dizziness; blurred vision; drowsiness or change in mental status; rapid heart rate, rapid breathing or feeling of shortness of breath; hot or cold sensations.
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