Approach Considerations
The evaluation in patients with possible toxicity from a local anesthetic should be guided by the clinical presentation. Blood levels of the anesthetic may be measured, although blood levels may not correlate with toxicity and results are not obtained in a clinically useful time.
Imaging studies are determined by the overall clinical picture. For example, if the patient has a seizure and the etiology of the seizure is not apparent, consider a head computed tomography scan.
Obtain adequate intravenous access. Airway control may require intubation.
Tables
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. |
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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 |
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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. |
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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 |
