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Local Anaesthetic / Antiarrhythmic (Class Ib)

Lidocaine (IV — Anaesthesia/ICU)

Brand names: Xylocard, Lignocaine

Intravenous lidocaine is an amide local anaesthetic used in anaesthesia and critical care as a class Ib antiarrhythmic and, increasingly, as a component of multimodal analgesia.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It blocks voltage-gated sodium channels, stabilising neuronal and cardiac cell membranes; in the heart it shortens the action potential and suppresses ventricular ectopy.

Prescribing in practice

  • It has a narrow therapeutic index — excessive plasma concentrations cause central nervous system toxicity (perioral numbness, seizures) and cardiovascular collapse, so infusions must be carefully controlled.
  • Clearance is reduced in hepatic impairment and low cardiac output states, increasing the risk of accumulation.
  • Doses should be reduced and care taken when other local anaesthetic has already been given.

Monitoring

Monitor ECG, blood pressure, and conscious level, and watch for early neurological signs of toxicity during infusion.

Counselling the patient

  • Tell the team straight away if you feel dizzy, develop tingling around the mouth, or notice ringing in the ears.
  • This medicine is given and monitored by the clinical team in a controlled setting.

Evidence & guidelines

Use reflects established antiarrhythmic and perioperative practice; consult current prescribing references and local protocols.

Reference: PROSPECT Guidelines (Lidocaine infusion); AAGBI LAST Guidelines 2023; ALS Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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