Skip to content
ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Local anaesthetic + vasoconstrictor Pregnancy: Section 4.6, verbatim: 'Although there is no evidence from animal studies of harm to the foetus, as with all drugs, lidocaine should not be given during early pregnancy unless the benefits are considered to outweigh the risks. The addition of adrenaline may potentially decrease uterine blood flow and contractility, especially after inadvertent injection into maternal blood vessels. Foetal adverse effects due to local anaesthetics, such as foetal bradycardia, seem to be most apparent in paracervical block anaesthesia. Such effects may be due to high concentrations of anaesthetic reaching the foetus.' Breast-feeding: 'Lidocaine may enter the mother's milk, but in such small amounts that there is generally no risk of this affecting the neonate. It is not known whether adrenaline enters breast milk or not, but it is unlikely to affect the breast-fed child.'

Lidocaine with adrenaline

Brand names: Xylocaine with Adrenaline

Used in: Epistaxis (Nosebleed)

Lidocaine with adrenaline is a combined local anaesthetic preparation used for infiltration and nerve-block anaesthesia, in which the added adrenaline prolongs and intensifies the block and reduces local bleeding.

Adult dose

Dose: Adults and children above 12 years of age. 'The dosage is adjusted according to the response of the patient and the site of administration. The lowest concentration and smallest dose producing the required effect should be given.' SPC dose table (concentration, volume, mass, indication), verbatim: FIELD BLOCK - infiltration, 1%, up to 15 ml, up to 150 mg, for surgical operations; intercostal per nerve, 1%, 2-5 ml (max. 15 ml), 20-50 mg (max. 150 mg), for surgical operations, postoperative pain and fractured ribs; pudendal, 1%, 10 ml, 100 mg, for instrumental delivery. MAJOR NERVE BLOCK - paracervical (each side), 1%, 10 ml, 100 mg, for surgical operations, dilatation of cervix and obstetric pain relief; sciatic, 2%, 15 ml, 300 mg, for surgical operations. 'The figures reflect the expected average dose range needed. Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.'
Route: Infiltration and nerve block - 'For local anaesthesia only.' 'Lidocaine with adrenaline should not be given intravenously.' 'Preservative containing solutions should not be used intracisternally, epidurally, intrathecally or by any route giving access to the cerebrospinal fluid, or intra- or retro-bulbary.'
Frequency: Per procedure. 'The main dose, should be injected slowly, at a rate of 100-200 mg/min, or in incremental doses, while keeping in constant verbal contact with the patient. If toxic symptoms occur, the injection should be stopped immediately.'
Max: Maximum single dose of lidocaine when given with adrenaline is 500 mg (section 4.2, verbatim: 'The maximum single dose of lidocaine when given with adrenaline is 500 mg.'). The SPC adds a separate volume limit: 'The volume to be injected in a single dose should not exceed 15 ml, unless otherwise justified.'
In this SPC the 500 mg figure is the stated adult maximum single dose, but 7 mg/kg appears ONLY in the paediatric paragraph for patients 1 to 12 years of age ('up to 0.7 ml (7 mg/kg)'). No weight-based adult maximum is given anywhere in section 4.2, and the plain-lidocaine figures the page also quotes ('Without: max 3 mg/kg (max 200mg)') are not in this SPC at all - they belong to a plain lidocaine product and are not re-sourced by this bundle. ELDERLY AND DEBILITATED: 'Elderly or debilitated patients require smaller doses, commensurate with age and physical status.' TECHNIQUE: 'In general, surgical anaesthesia requires the use of higher concentrations and doses. When a less intense block is required, the use of a lower concentration is indicated. The volume of drug used will affect the extent and spread of anaesthesia. Care should be taken to prevent acute toxic reactions by avoiding intravascular injection. Careful aspiration before and during the injection is recommended. An accidental intravascular injection may be recognised by a temporary increase in heart rate.' 'The clinician's experience and knowledge of the patient's physical status are of importance in calculating the required dose.' ADRENALINE-SPECIFIC CAUTION (section 4.4): 'Solutions containing adrenaline should be used with caution in patients with hypertension, cardiac disease, cerebrovascular insufficiency hyperthyroidism, advanced diabetes and any other pathological condition that may be aggravated by the effects of adrenaline.' SETTING: 'Regional anaesthetic procedures should always be performed in a properly equipped and staffed area. Equipment and drugs necessary for monitoring and emergency resuscitation should be immediately available. When performing major blocks, or using large doses, an IV cannula should be inserted before the local anaesthetic is injected.' 'The effect of local anaesthetics may be reduced if an injection is made into an inflamed or infected area.'

Paediatric dose

Dose: 7 mg/kg
Route: Infiltration and nerve block with lidocaine 1% with adrenaline 1:200,000 - 'For local anaesthesia only'
Frequency: Single dose per procedure. THIS FIGURE IS THE SPC'S UPPER GUIDELINE, NOT A ROUTINE STARTING DOSE - verbatim: 'Weight-based doses in ml/kg, up to 0.7 ml (7 mg/kg) should be regarded as guidelines for use in paediatric patients.'
Max: The volume to be injected in a single dose should not exceed 15 ml, unless otherwise justified (section 4.2) - the SPC's own dose table equates 15 ml of the 1% solution with 150 mg of lidocaine.
Concentration: 10 mg/ml
Applies to paediatric patients 1 to 12 years of age with lidocaine 1% with adrenaline; adults and children above 12 years of age use the adult section. The SPC expresses the figure primarily as a volume, 'up to 0.7 ml' per kg of the 1% solution, and gives 7 mg/kg as its own mass equivalent - it is a ceiling for a single dose, so the calculator output should be read as the maximum, not as the dose to give. 'Consider both age and weight for calculation of dosages. In children with a high body weight a gradual reduction of the dosage is often necessary and should be based on the ideal body weight.' 'Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.' The 500 mg adult maximum single dose is stated under the heading 'Adults and children above 12 years of age' and is NOT offered as a paediatric ceiling. No dose is given for children below 1 year of age in this SPC. Concentration 10 mg/ml is lidocaine 1%, pinned by the product name and confirmed by the SPC table (15 ml = 150 mg at 1%). Verify all paediatric dosing against a children's formulary before prescribing.

Dose adjustments

Renal

No numeric adjustment is given. Section 4.4 lists 'Patients with advanced liver disease or severe renal dysfunction' among the groups who 'require special attention in order to reduce the risk of dangerous side effects'.

Hepatic

No numeric adjustment is given. Section 4.4 lists 'Patients with advanced liver disease or severe renal dysfunction' among the groups who 'require special attention in order to reduce the risk of dangerous side effects'.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Applies to paediatric patients 1 to 12 years of age with lidocaine 1% with adrenaline; adults and children above 12 years of age use the adult section. The SPC expresses the figure primarily as a volume, 'up to 0.7 ml' per kg of the 1% solution, and gives 7 mg/kg as its own mass equivalent - it is a ceiling for a single dose, so the calculator output should be read as the maximum, not as the dose to give. 'Consider both age and weight for calculation of dosages. In children with a high body weight a gradual reduction of the dosage is often necessary and should be based on the ideal body weight.' 'Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.' The 500 mg adult maximum single dose is stated under the heading 'Adults and children above 12 years of age' and is NOT offered as a paediatric ceiling. No dose is given for children below 1 year of age in this SPC. Concentration 10 mg/ml is lidocaine 1%, pinned by the product name and confirmed by the SPC table (15 ml = 150 mg at 1%). Verify all paediatric dosing against a children's formulary before prescribing.

Verify in a children's formulary

Contraindications

  • Hypersensitivity to the active substance, to any of the excipients listed in section 6.1 or to local anaesthetics of the amide type (section 4.3)
  • Hypersensitivity to methyl and/or propyl parahydroxybenzoate (methyl-/propyl paraben), or to their metabolite para amino benzoic acid (PABA); 'Formulations of lidocaine containing parabens should be avoided in patients allergic to ester local anaesthetics or their metabolite PABA' (section 4.3)
  • 'The use of a vasoconstrictor is contraindicated for anaesthesia of fingers, toes, tip of nose, ears and penis.'
  • Not to be given intravenously - 'Lidocaine with adrenaline should not be given intravenously.' (section 4.4)
  • Preservative containing solutions must not be used intracisternally, epidurally, intrathecally or by any route giving access to the cerebrospinal fluid, or intra- or retro-bulbary (section 4.2)

Side effects

  • Paraesthesia and dizziness - common
  • Bradycardia - common
  • Hypotension and hypertension - common
  • Nausea and vomiting - common
  • Signs and symptoms of CNS toxicity (convulsions, numbness of tongue and circumoral paraesthesia, tinnitus, tremor, dysarthria, hyperacusis, visual disturbances, CNS depression) - uncommon
  • Allergic reactions, anaphylactic reaction - rare
  • Neuropathy, peripheral nerve injury, arachnoiditis - rare
  • Diplopia - rare
  • Cardiac arrest, cardiac arrhythmias - rare
  • Respiratory depression - rare
  • Acute systemic toxicity: 'Such reactions are caused by high blood concentrations of a local anaesthetic, which may appear due to (accidental) intravascular injection, overdose or exceptionally rapid absorption from highly vascularised areas.' CNS signs generally precede cardiovascular toxicity unless the patient is anaesthetised or heavily sedated

Monitoring

  • 'Careful aspiration before and during the injection is recommended. An accidental intravascular injection may be recognised by a temporary increase in heart rate.' (section 4.2)
  • Keep 'constant verbal contact with the patient' while the main dose is injected; 'If toxic symptoms occur, the injection should be stopped immediately.' (section 4.2)
  • Watch for the early CNS toxicity sequence: 'The first symptoms are usually, circumoral paraesthesia, numbness of the tongue, light-headedness, hyperacusis, tinnitus and visual disturbances. Dysarthria, muscular twitching or tremors are more serious and precede the onset of generalised' convulsions (section 4.8.1)
  • 'Equipment and drugs necessary for monitoring and emergency resuscitation should be immediately available. When performing major blocks, or using large doses, an IV cannula should be inserted before the local anaesthetic is injected.' (section 4.4)
  • Patients treated with class III antiarrhythmic drugs (e.g. amiodarone) 'should be under close surveillance and ECG monitoring considered, since cardiac effects may be additive' (section 4.4)
  • 'Paracervical block can sometimes cause foetal bradycardia/tachycardia, and careful monitoring of the foetal heart rate is necessary.' (section 4.4)
  • Extra caution in patients with epilepsy, impaired respiratory function, partial or complete heart conduction block, advanced liver disease or severe renal dysfunction, acute porphyria, and in older people or those in poor general condition (section 4.4)

Clinical monograph

How it works

Lidocaine blocks neuronal sodium channels to prevent nerve conduction, while adrenaline causes local vasoconstriction that slows systemic absorption, prolonging anaesthesia and limiting bleeding.

Prescribing in practice

  • Because of the adrenaline-induced vasoconstriction, it must not be used in or around end-arterial sites such as digits, the nose tip, ears, penis and skin flaps, where ischaemic necrosis can result.
  • Always aspirate before injection and use the lowest effective dose, as inadvertent intravascular injection can cause local anaesthetic systemic toxicity.
  • Use caution where systemic adrenaline absorption is hazardous, such as severe cardiovascular disease, and with drugs that potentiate adrenaline.

Monitoring

Monitor for local anaesthetic systemic toxicity (perioral tingling, dizziness, arrhythmias, seizures) and assess perfusion of the anaesthetised area.

Counselling the patient

  • This injection numbs the area and the added adrenaline makes it last longer with less bleeding.
  • Tell us immediately if you feel dizzy, develop ringing in the ears or a metallic taste, or notice palpitations.
  • Numbness will wear off gradually; protect the area from injury until sensation returns.

Evidence & guidelines

Avoidance of adrenaline-containing local anaesthetic in end-arterial sites is long-established safe-practice guidance.

Reference: AAGBI LA toxicity guideline; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs
Pathways