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Local anaesthetic + vasoconstrictor

Lidocaine with adrenaline

Brand names: Xylocaine with Adrenaline

Adult dose

Dose: Lidocaine max with adrenaline 1:200,000 = 7 mg/kg (max 500mg). Without: max 3 mg/kg (max 200mg)
Route: Infiltration / nerve block
Frequency: per procedure

Clinical pearls

  • Adrenaline reduces bleeding and prolongs LA action; raises max safe lidocaine dose
  • Calculate weight-based max dose every time — overdose easy with multiple sites

Contraindications

  • Hypersensitivity to amide LAs
  • End-arterial sites (digit/penis/tip-of-nose) — historical concern (current evidence permits low-dose use, but caution)
  • Severe cardiac conduction abnormalities

Side effects

  • LA toxicity (CNS / cardiac)
  • Tachycardia / hypertension (adrenaline)
  • Methaemoglobinaemia (rare)
  • Anaphylaxis

Interactions

  • β-blockers (severe hypertension)
  • TCAs/MAOIs
  • Class I antiarrhythmics

Monitoring

  • HR
  • BP
  • CNS symptoms (tinnitus, perioral tingling)

Reference: BNF; AAGBI LA toxicity guideline; https://bnf.nice.org.uk/drugs/lidocaine-with-adrenaline/. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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