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Local Anaesthetic (Amide) Pregnancy: Compatible for procedural use at standard doses

Lidocaine (Intranasal/Topical ENT)

Brand names: Xylocaine 10% Spray

Adult dose

Dose: Nasal topical: 1–2 sprays (10 mg/spray) to nasal mucosa. Maximum 3 sprays per session. Throat spray: 1–4 sprays (max 40 mg) to posterior pharynx.
Route: Topical spray
Frequency: As needed for procedure
Max: 40–60 mg per session (4–6 sprays)
For ENT procedures (nasoendoscopy, nasogastric tube insertion, bronchoscopy preparation). Risk of aspiration of food/drink with numb gag reflex — advise nil by mouth for 1 hour after throat spray.

Paediatric dose

Route: Topical
Frequency: As needed
Max: 3 mg/kg maximum total topical dose
Concentration: 100 mg/mL = 10 mg/spray mg/ml
Maximum topical dose: 3 mg/kg. Care in children — systemic absorption from mucosa; risk of LAST (local anaesthetic systemic toxicity) if excessive.

Dose adjustments

Renal

N/A (topical use)

Hepatic

Caution in significant hepatic disease — reduced clearance of any absorbed drug

Clinical pearls

  • Aspiration risk: advise patient nil by mouth for 1 hour after throat spray — gag reflex suppressed
  • Lidocaine spray in ENT: 10 mg/spray — easy to exceed safe dose (total max 200–300 mg adult); count sprays
  • LAST treatment: 20% Intralipid emulsion available wherever local anaesthetics used
  • Cocaine 10% topical: used in nasal surgery for vasoconstriction + anaesthesia (controlled drug)

Contraindications

  • Lidocaine allergy
  • Concurrent topical cocaine or other mucosal anaesthetics (additive toxicity)

Side effects

  • Systemic toxicity if excessive dose absorbed (CNS/cardiac)
  • Methemoglobinaemia (rare with mucous membrane application)
  • Gag reflex suppression — aspiration risk if eating/drinking within 1h

Interactions

  • Other local anaesthetics — additive toxicity risk

Monitoring

  • Count sprays given
  • CNS symptoms during procedure
  • Aspiration precautions post-procedure

Reference: BNFc; BNF; AAGBI LAST Guidelines; ENT-UK Procedural Guidance. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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