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Table 1. Epinephrine Content Examples

Solution Volume	1:100,000 (1 mg/100 mL)	1:200,000 (1 mg/200 mL)
1 mL	0.01 mg	0.005 mg
5 mL	0.05 mg	0.025 mg
10 mL	0.1 mg	0.05 mg
20 mL	0.2 mg	0.1 mg
Example: 50 mL of 1% lidocaine with epinephrine 1:100,000 contains lidocaine 500 mg and epinephrine 0.5 mg.

Table 2. Local Anesthetic Agents Used Commonly for Infiltrative Injection

Agent	Duration of Action	*Maximum Dosage Guidelines (Total Cumulative Infiltrative Injection Dose per Procedure)**
Esters
Procaine (Novocaine)	Short (15-60 min)	7 mg/kg; not to exceed 350-600 mg
Chloroprocaine (Nesacaine)	Short (15-30 min)	Without epinephrine: 11 mg/kg; not to exceed 800 mg total dose With epinephrine: 14 mg/kg; not to exceed 1000 mg
Amides
Lidocaine (Xylocaine)	Medium (30-60 min)	Without epinephrine: 4.5 mg/kg; not to exceed 300 mg
Lidocaine with epinephrine	Long (120-360 min)	With epinephrine: 7 mg/kg
Mepivacaine (Polocaine, Carbocaine)	Medium (45-90 min) Long (120-360 min with epinephrine)	7 mg/kg; not to exceed 400 mg
Bupivacaine (Marcaine)	Long (120-240 min)	Without epinephrine: 2.5 mg/kg; not to exceed 175 mg total dose
Bupivacaine with epinephrine	Long (180-420 min)	With epinephrine: Not to exceed 225 mg total dose
Etidocaine (Duranest) No longer available in United States	Long (120-180 min)	Without epinephrine: 0.4 mg/kg; not to exceed 300 mg total dose With epinephrine: 8 mg/kg
Prilocaine (Citanest)	Medium (30-90 min)	Body weight < 70 kg: 8 mg/kg; not to exceed 500 mg Body weight >70 kg: 600 mg
Ropivacaine (Naropin)	Long (120-360 min)	5 mg; not to exceed 200 mg for minor nerve block
*Nondental use, administer by small incremental doses; administer the smallest dose and concentration required to achieve desired effect; avoid rapid injection.

Table 3. Minimum Intravenous Toxic Dose of Local Anesthetic in Humans ^[8]

Agent	Minimum Toxic Dose (mg/kg)
Procaine	19.2
Tetracaine	2.5
Chloroprocaine	22.8
Lidocaine	6.4
Mepivacaine	9.8
Bupivacaine	1.6
Etidocaine	3.4

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Author

Raffi Kapitanyan, MD Assistant Professor of Emergency Medicine, Rutgers Robert Wood Johnson Medical School

Raffi Kapitanyan, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mark Su, MD, MPH, FACEP, FACMT Consulting Staff and Director of Fellowship in Medical Toxicology, Department of Emergency Medicine, North Shore University Hospital

Mark Su, MD, MPH, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David Vearrier, MD, MPH Professor of Emergency Medicine, Department of Emergency Medicine, University of Mississippi Medical Center

David Vearrier, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Acknowledgements

John G Benitez, MD, MPH Associate Professor, Department of Medicine, Medical Toxicology, Vanderbilt University Medical Center; Managing Director, Tennessee Poison Center

John G Benitez, MD, MPH is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Medical Toxicology, American College of Preventive Medicine, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, and Wilderness Medical Society