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Lidocaine (Lignocaine)

Details

Presentation:

50 mg in 5 mL amp (1% solution)

Route:

IM (when used to reconstitute Ceftriaxone only)
Local tissue infiltration (for chest decompression)
IO – infuse slowly over 120 seconds and allow to dwell for 60 seconds. Flush IO catheter with normal saline (5 – 10mL for adults, 2 – 5 mL for paediatrics)

Onset of action:

1 – 5 minutes (infiltration); 5 – 15 minutes (other routes)

Duration:

1 – 1.5 hours

Mode of action

Sodium channel blocker – interrupts impulse conduction in peripheral nerves and stabilises excitable cell membranes

  • Local anaesthetic to reduce pain associated with:
    • Intramuscular administration of Ceftriaxone
    • Chest decompression in patients with GCS > 10 (MICA only)
    • Intraosseous administration of medication or fluid in a conscious patient (MICA only)
  • Known hypersensitivity to lidocaine or related local anaesthetics (bupivacaine, levobupivacaine, prilocaine, ropivacaine)
  • IM and local infiltration – inadvertent intravascular administration may result in systemic toxicity (see below)
  • IO – impaired CV function (e.g. hypotension, bradycardia, poor perfusion, heart block, heart failure)
  • Allergic reactions are rare and may present as localised oedema, urticaria, bronchospasm and anaphylaxis
  • Signs of systemic toxicity include:
    • CNS: tinnitus, blurred vision, sudden change in conscious state, agitation, convulsions
    • CV: hypotension, bradycardia, arrhythmias (e.g. conduction blocks, ventricular tachyarrhythmias), cardiac arrest
Significant interactions
  • Nil
Pregnancy
  • Safe to use
Breastfeeding
  • Safe to use
Notes
  • Lidocaine and lignocaine are the same medication, but lidocaine is the preferred name internationally. Both names will be in use in Australia until 2023.
Infusion
  • None

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