Xylogel 2%

Ventricular arrhythmias, Haemorrhoids, Sympathetic nerve block, Peripheral nerve block, Perianal pain and itching, Ventricular fibrillation or ventricular tachycardia, Epidural anaesthesia, Spinal anaesthesia, Regional anaesthesia, Surface anaesthesia, Pupil dilatation

IV Preparation Add 1-2 g of lidocaine hydrochloride to 1 L of D5W making 1-2 mg/mL solution; use (using 5-10 mL of 20% inj soln); may also use 400 mg/100 mL in D5W or 800 mg/100 mL in D5W 8 mg/mL concentrations have been recommended for fluid-restricted pts

Intravenous Ventricular Arrhythmias 1-1.5 mg/kg slow IV bolus over 2-3 minutes May repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to 3 mg/kg total Continuous infusion: 1-4 mg/min IV Regional Anesthesia (IV) 4 mg/kg Parenteral Sympathetic nerve block Adult: As 1% soln: 50 mg for cervical block or 50-100 mg for lumbar block. Epidural Epidural anaesthesia Adult: 2-3 mL administered for each dermatome to be anaesthesised. Recommended doses are: Lumbar epidural 250-300 mg (as 1% soln) for analgesia and 225-300 mg (as 1.5% soln) or 200-300 mg (as 2% soln) for anaesth; for thoracic epidural: 200-300 mg (as 1% soln). For obstetric caudal analgesia: 200-300 mg (as 1% soln); for surgical caudal anaesth: 225-300 mg (as 1.5% soln). For continuous epidural or caudal anaesth, not to repeat max doses more frequently than 1.5 hrly. Peripheral nerve block Adult: As 1.5% soln: For brachial plexus block: 225-300 mg. As 2% soln: For dental nerve block: 20-100 mg. As 1% soln: For intercostal nerve block: 30 mg; for paracervical block: 100 mg on each side, repeated not more frequently than every 90 min; for paravertebral block: 30-50 mg; for pudendal block: 100 mg on each side. As 4% soln: For retrobulbar block: 120-200 mg. Intraspinal Spinal anaesthesia Adult: As hyperbaric soln of 1.5% or 5% lidocaine in 7.5% glucose soln. Normal vaginal delivery: Up to 50 mg (as 5% soln) or 9-15 mg (as 1.5% soln). Caesarian operation: Up to 75 mg (as 5% soln). Other surgical procedures: 75-100 mg. Hepatic impairment: Dosage reduction may be needed.

Ventricular Arrhythmias Bolus: 0.5-1 mg/kg IV/IO/ET, not to exceed 100 mg; follow with continuous infusion; if delay between bolus and start of infusion is >15 minutes, administer a second bolus q5-10min to 5 mg/kg, THEN Continuous infusion: 20-50 mcg/kg/min IV

Hypovolaemia; heart block or other conduction disturbances.

Lidocaine is an amide type local anaesth. It stabilises the neuronal membrane and inhibits Na ion movements, which are necessary for conduction of impulses. In the heart, lidocaine reduces depolarisation of the ventricles during diastole and automaticity in the His-Purkinje system. Duration of action potential and effective refractory period are also reduced.

Hepatic or renal impairment; CHF and following cardiac surgery; bradycardia; respiratory depression; porphyria; elderly or debilitated patients; pregnancy. Lactation: crosses into breast milk, use caution

Common Cardiovascular: Hypotension Dermatologic: Edema, erythema at injection site, petechiae, skin irritation Gastrointestinal: Constipation, Nausea, vomiting Neurologic: Confusion, dizziness, headache, paresthesia, somnolence, tremor Other: Irritation symptom, Topical products; ie, erythema, edema Serious Cardiovascular: Cardiac arrest, cardiac dysrhythmia Hematologic: Methemoglobinemia Neurologic: Seizure Anaphylactoid reactions Malignant hyperthermia Potentially Fatal: Hypotension and bradycardia leading to cardiac arrest; anaphylaxis.

May increase serum levels w/ cimetidine and propranolol. Increased risk of cardiac depression w/ ?-blockers and other antiarrhythmics. Additive cardiac effects w/ IV phenytoin. Hypokalaemia caused by acetazolamide, loop diuretics and thiazides may antagonise effect of lidocaine. Dose requirements may be increased w/ long-term use of phenytoin and other enzyme-inducers.