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Amide local anaesthetic / Class IB antiarrhythmic

Lidocaine hydrochloride

Brand names: Xylocaine, Versatis, EMLA (with prilocaine)

Adult dose

Dose: Local infiltration: max 3mg/kg plain, 7mg/kg with adrenaline; Antiarrhythmic: 1–1.5mg/kg IV bolus then 1–4mg/min infusion; Topical patch (Versatis) for postherpetic neuralgia: 1–3 patches/12h on/12h off
Route: SC infiltration / IV / Topical
Frequency: Per indication

Clinical pearls

  • AAGBI/Resuscitation Council UK Local Anaesthetic Toxicity guideline: Intralipid 20% rescue protocol
  • Maximum safe doses critical — calculate by body weight before each procedure
  • NICE NG193 neuropathic pain: lidocaine plasters for localised neuropathic pain (including postherpetic neuralgia)
  • Resuscitation Council ALS: lidocaine alternative to amiodarone for refractory VF/pVT

Contraindications

  • Hypersensitivity to amide LAs
  • Complete heart block (IV antiarrhythmic)
  • Adams-Stokes syndrome
  • Wolff-Parkinson-White (relative)
  • Apply to broken skin (topical patches)

Side effects

  • Local anaesthetic systemic toxicity (LAST — perioral numbness, tinnitus, seizures, cardiac arrest)
  • Hypotension
  • Bradycardia
  • Drowsiness
  • Allergy (rare for amide class)
  • Methaemoglobinaemia (high-dose, EMLA in infants)

Interactions

  • Class I/III antiarrhythmics (additive toxicity)
  • Beta-blockers (reduced clearance)
  • Cimetidine (reduced clearance)

Monitoring

  • Symptoms of LAST during/after infiltration
  • ECG (IV antiarrhythmic)
  • Plasma levels in prolonged infusions

Reference: BNF; AAGBI Local Anaesthetic Toxicity guideline; Resuscitation Council UK ALS; NICE NG193; https://bnf.nice.org.uk/drugs/lidocaine-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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