Lidocaine Hydrochloride / Epinephrine

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

Trade Names

Lidocaine Hydrochloride and Epinephrine
- Injection 2% with 1:50,000 epinephrine

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

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

Xylocaine Parenteral with Epinephrine (Canada)

Pharmacology

Lidocaine

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

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 and IV regional anesthesia, 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

Adults and Children

Dose determined by number of dermatomes to be anesthetized. 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.
• Consider administering a test dose prior to epidural anesthesia.
• 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 between 59° and 86°F. Protect from light. Do not use if the injection is pinkish or darker than slightly yellow or if it contains a precipitate.

Drug Interactions

Amiodarone

Excessive cardiac depression and seizures may occur.

Beta-blockers

May cause increased BP and bradycardia. Elevated lidocaine levels with toxicity may occur.

Cimetidine

Decreased lidocaine Cl.

COMT inhibitors (eg, entacapone)

Excessive sympathetic stimulation may result.

Ergot derivatives (ergotamine), vasopressors

May cause severe persistent hypertension or cerebrovascular accidents.

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

Severe prolonged hypertension may occur.

Mexiletine

May increase lidocaine concentrations.

Phenothiazines (eg, thioridazine), butyrophenones (droperidol)

May reduce or reverse the pressor effect of epinephrine.

Succinylcholine

May prolong neuromuscular blockade.

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%); CV 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 (3%).

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, severe shock, heart block, severe hypertension, impaired CV function, peripheral vascular disease, hypertensive vascular disease, hepatic disease, acute illness, and in elderly or debilitated patients.

Intra-articular infusions following surgical procedures

This is an unapproved use; postmarketing reports of chondrolysis have been received.

Peripheral or hypertensive vascular disease

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

Sulfite sensitivity

Use caution in sulfite-sensitive patients; some preparations contain sodium metabisulfite.

Toxic reactions

Resuscitative equipment, oxygen, and other resuscitative drugs should be available for immediate use.

Use in the head and neck area

Small doses of local anesthetics injected into the head and neck area may produce adverse reactions similar to systemic toxicity (eg, confusion, convulsions, respiratory depression, and/or respiratory arrest) seen with unintentional intravascular injections of larger doses.

Use of tourniquet

Solutions containing epinephrine should not be administered when a tourniquet is in place.

Patient Information

• 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.

Copyright © 2009 Wolters Kluwer Health.