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Local Anaesthetic (IV Systemic — Opioid-Sparing / Anti-inflammatory) Pregnancy: Intraoperative use acceptable; crosses placenta (used safely in regional anaesthesia)

Lidocaine (IV Infusion — Opioid-Sparing Analgesia)

Brand names: Lidocaine Hydrochloride (generic)

Adult dose

Dose: Loading: 1.5 mg/kg IV over 10–15 min at induction. Intraoperative infusion: 1.5–2 mg/kg/hr. Post-operative: 1–1.5 mg/kg/hr for up to 24h
Route: IV infusion
Frequency: Continuous intraoperative/post-operative infusion
Max: 3 mg/kg/hr (toxicity risk above this threshold)
Cochrane review supports IV lidocaine for laparoscopic and abdominal surgery: reduces pain scores, opioid consumption, time to first flatus, and PONV. Not licensed for this indication — used off-label. Requires cardiac monitoring during infusion. Stop if toxicity signs emerge.

Paediatric dose

Dose: 1.5 mg/kg
Route: IV infusion
Frequency: Loading then 1.5 mg/kg/hr
Max: 3 mg/kg/hr
Concentration: 10 mg/mL (1%) — dilute for infusion mg/ml
Limited paediatric data — use with caution; specialist anaesthetic guidance. Neonates: avoid IV lidocaine infusion.

Dose adjustments

Renal

Caution in renal impairment — metabolite accumulation

Hepatic

Reduce dose in hepatic impairment — lidocaine is hepatically metabolised

Paediatric weight-based calculator

Limited paediatric data — use with caution; specialist anaesthetic guidance. Neonates: avoid IV lidocaine infusion.

Clinical pearls

  • Early toxicity signs: perioral numbness, tinnitus, metallic taste — reduce or stop infusion immediately if these occur
  • Reduces post-operative ileus: IV lidocaine accelerates return of gut function after abdominal surgery — evidence-based component of ERAS protocols
  • ECG monitoring essential: run continuous ECG during lidocaine infusion — QRS widening or arrhythmias mandate immediate cessation
  • Intralipid rescue: for severe lidocaine toxicity (seizures, cardiac arrest) — 20% intralipid 1.5 mL/kg IV bolus (have immediately available)
  • Stop 30–60 min before discharge from monitored setting — do not continue on unmonitored general ward

Contraindications

  • Known lidocaine/amide local anaesthetic allergy
  • Severe cardiac conduction disorders (heart block)
  • Uncontrolled epilepsy
  • Severe hepatic impairment

Side effects

  • Perioral tingling/numbness (early toxicity)
  • Dizziness and tinnitus (early toxicity)
  • Sedation
  • Bradycardia and hypotension
  • Seizures (toxicity)
  • Cardiac arrhythmias (serious toxicity)

Interactions

  • Beta-blockers — additive cardiac depression
  • Antiarrhythmics — additive cardiac toxicity
  • CYP1A2/CYP3A4 inhibitors — increased lidocaine levels

Monitoring

  • Continuous ECG during infusion
  • Blood pressure and HR
  • Neurological symptoms (tingling, dizziness — early toxicity)
  • Plasma lidocaine levels if prolonged infusion (target <5 mcg/mL)

Reference: BNFc; BNF; Cochrane Review: IV Lidocaine Perioperative Analgesia (Weibel et al 2018); ERAS Society Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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