Lignocaine
Synonyms :
Lidocaine, Xylocaine
Mechanism :
Lignocaine is a member of the amino amide class of local anesthetics. Local anesthetics block the generation and the conduction of nerve impulses by increasing the threshold for electrical excitation in the nerve, by slowing propagation of the nerve impulse, and by reducing the rate of rise of the action potential.
Indication :
- Ventricular arrhythmia
- Local anaesthetic
- Anaesthetic lubricant when used as topical agent
Contraindications :
Contraindicated in patients with a known hypersensitivity to lignocaine or to any local anesthetic agent of the amide type, intravenous regional anaesthesia, severe hypotension, hypovolemia, paracervical block in obstetrics. Use with caution in liver disease, epilepsy, impaired cardiovascular function, respiratory impairment
Dosing :
Antiarrhythmic:
Start with bolus of 0.5-1 mg/kg IV/ET; Max: 100 mg. Continuous infusion: 20-50 mcg/kg/min IV. Monitor ECG simultaneously.
Ventricular fibrillation or pulseless tachycardia: IV
<12 years: 1 mg/kg repeat every 5 min to max of 3 mg/kg and 12-18 years: 50-100 mg.
Local anaesthetic-Local infiltration:
<12 years: 3 mg/kg and 12-18 years upto 200 mg, not more frequently than once in 4 hours.
Anaesthetic lubricant:
Available as 2% and 4% cream, spray, lotion, ointment, gel
Apply moderate amount of 2% jelly for endotracheal intubation, urinary catheterization, endoscopy (Do not exceed 4.5 mg/kg/12 hours in children <10 years and 600 mg/12 hours in older children). For skin cuts and sunburns, apply topically 3-4 times a day.
Adverse Effect :
Euphoria, nervousness, light-headedness, confusion, dizziness, sensations of heat, drowsiness, tinnitus, apprehension, vomiting, blurred or double vision, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression, urticaria, edema, cutaneous lesions, anaphylactoid reactions, hypotension, bradycardia, and cardiovascular collapse, which may lead to cardiac arrest.
Interaction :
Local anesthetics containing epinephrine/norepinephrine, monoamine oxidase inhibitors or tricyclic antidepressants: May produce severe, prolonged hypertension.
Vasopressor drugs and of Ergot-Type Oxytocic drugs: Cause severe, persistent hypertension or cerebrovascular accidents.
Phenothiazines and Butyrophenones: May reduce or reverse the pressor effect of epinephrine.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
Use with caution; reduce dose. Monitor lidocaine concentrations closely and adjust infusion rate as necessary; consider alternative therapy. Maximum rate of continuous IV infusion: 20 mcg/kg/minute.