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Lidocaine/Epinephrine

    Brands

    DEA Class;  Rx

    Common Brand Names; Xylocaine Dental with Epinephrine, Xylocaine MPF with Epinephrine, Xylocaine with Epinephrine

    • Local Anesthetics in Combination with Vasoconstrictors
      Miscellaneous Topical Agents for Local Pain

    Parenteral combination of an amide local anesthetic and vasoconstrictor
    Used for the production of local or regional anesthesia or analgesia for surgery, dental and oral surgery procedures, and for obstetrical procedures
    Addition of epinephrine slows local anesthetic absorption and prolongs maintenance of an active tissue concentration

    For local anesthesia, including infiltration anesthesia.

    For regional anesthesia, including caudal anesthesia, epidural anesthesia, or obstetric anesthesia such as paracervical block.
    For nerve block anesthesia, including peripheral nerve block such as brachial plexus block, intercostal nerve block, paravertebral block, and pudendal nerve block.
    For sympathetic nerve block, including cervical nerve block and lumbar sympathetic block.
    For dental anesthesia, including local infiltration and mandibular nerve block and maxillary nerve block.
    For the treatment of epistaxis.

    Lidocaine; epinephrine use requires an experienced clinician who is well versed in the diagnosis and management of dose-related toxicity and other acute emergencies that might arise from lidocaine exposure. Lidocaine; epinephrine use also requires a specialized care setting; use lidocaine; epinephrine only if the following are immediately available: oxygen, other resuscitative drugs, cardiopulmonary resuscitative equipment, and the personnel resources needed for proper management of toxic reactions and related emergencies. Delay in proper management of dose-related toxicity, underventilation from any cause, and/or altered sensitivity may lead to the development of acidosis, cardiac arrest, and, possibly, death.  

    Avoid intravenous administration, intraarterial administration, or intrathecal administration of lidocaine; epinephrine. Unintended intravascular or intrathecal injection may be associated with systemic toxicities, including central nervous system or cardiorespiratory depression. 

    • methemoglobinemia
    • malignant hyperthermia
    • chondrolysis 
    • respiratory arrest
    • seizures 
    • ventricular tachycardia 
    • cardiac arrest
    • bradycardia
    • arrhythmia exacerbation
    • AV block
    • ventricular fibrillation
    • anaphylactoid reactions
    • neonatal depression

    Small doses of lidocaine; epinephrine used for local head and neck anesthesia (e.g., retrobulbar and dental blocks) may produce systemic toxicity similar to that seen with unintentional intravascular injections of larger doses. 

    Give lidocaine; epinephrine in reduced doses in patients with impaired cardiovascular function (e.g., hypotension, AV block, shock); these patients are less able to compensate for functional changes associated with lidocaine; epinephrine-related prolongation of AV conduction. 

    Use lidocaine; epinephrine with caution in a breast-feeding woman. Lidocaine is excreted in breast milk with a milk to plasma ratio of 0.4. Previous American Academy of Pediatric recommendations considered lidocaine as usually compatible with breast-feeding. When it is used for dental or short-term, limited local anesthesia, the healthy term infant can generally safely nurse as soon as the mother is awake and alert. 

    Adults

    Lidocaine 7 mg/kg up to a total dose of lidocaine 500 mg by infiltration, epidurally, intracaudally, or perineurally.

    Geriatric

    Lidocaine 7 mg/kg up to a total dose of lidocaine 500 mg by infiltration, epidurally, intracaudally, or perineurally.

    Adolescents

    Lidocaine 7 mg/kg up to a total dose of lidocaine 500 mg by infiltration, epidurally, intracaudally, or perineurally.

    Children

    Lidocaine 7 mg/kg by infiltration, epidurally, intracaudally, or perineurally.

    Infants

    Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Lidocaine hydrochloride/Epinephrine

    • Epidural Inj Sol
    • Intracaudal Inj Sol
    •  Infiltration Inj Sol
    • Dental Inj Sol