LIDOCAINE

Generic Name:  lidocaine hydrochloride ,lidocaine HCl in 5% dextrose , lidocaine HCl without
preservatives
Brand Name:
 Antiarrhythmic preparations: Xylocaine HCl IV for Cardiac Arrhythmias
 Local anesthetic preparations: Octocaine, Xylocaine HCl (injectable)
 Topical for mucous membranes: Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max,
Xylocaine, Zilactin-L
 Topical dermatologic: Lidoderm, Numby Stuff, Xylocaine
Classification: Antiarrhythmic, Local anesthetic

Lidocaine, also known as lignocaine, is a medication used to numb tissue in a specific area (local
anesthetic). It is also used to treat ventricular tachycardia and to perform nerve blocks. 

Lidocaine mixed with a small amount of adrenaline (epinephrine) is available to allow larger doses for
numbing, to decrease bleeding, and to make the numbing effect last longer. When used as an injectable,
lidocaine typically begins working within four minutes and lasts for half an hour to three hours. Lidocaine
mixtures may also be applied directly to the skin or mucous membranes to numb the area.

Therapeutic actions
 Lidocaine is an amide type local anesthetic. It stabilizes the neuronal membrane and inhibits sodium
ion movements, which are necessary for conduction of impulses. In the heart, lidocaine reduces phase
4 depolarization and automaticity. Duration of action potential and effective refractory period are also
reduced.

Indications
 As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV
use). Use IM when IV administration is not possible or when ECG monitoring is not available and the
danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile
coronary care unit)
 As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks,
spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin
disorders and accessible mucous membranes

Adverse effects
 Dizziness, paresthesia, drowsiness, confusion, respiratory depression and convulsions.
 Potentially Fatal: Hypotension and bradycardia leading to cardiac arrest; anaphylaxis

Contraindications
 Hypovolemia; heart block or other conduction disturbances.

Nursing considerations
Assessment
 History: Allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or
third-degree heart block, Wolff-Parkinson-White syndrome, Stokes-Adams syndrome, hepatic or renal
disease, inflammation or sepsis in region of injection, lactation, pregnancy
  Physical: T; skin color, rashes, lesions; orientation, speech, reflexes, sensation and movement (local
anesthetic); P, BP, auscultation, continuous ECG monitoring during use as antiarrhythmic; edema; R,
adventitious sounds; bowel sounds, liver evaluation; urine output; serum electrolytes, LFTs, renal
function tests
Interventions
 WARNING: Check drug concentration carefully; many concentrations are available.
 Reduce dosage with hepatic or renal failure.
 Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.
 WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse
reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.
 WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting
barbiturate (thiopental, thiamylal) readily available in case of seizures.
 WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support
equipment and IV dantrolene readily available.
 WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting
barbiturate (thiopental, thiamylal) readily available in case of seizures.
 WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support
equipment and IV dantrolene readily available.
 Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.
 Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric
patients.
 Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in
patients on fluid restrictions.
 Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr
afterward, and ensure that they are adequately hydrated to minimize risk of headache.
 WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine
to retard the absorption of the local anesthetic from the injection site. Be sure that such solutions are
used only to produce local anesthesia. These solutions should be injected cautiously in body areas
supplied by end arteries and used cautiously in patients with peripheral vascular disease, hypertension,
thyrotoxicosis, or diabetes.
 Use caution to prevent choking. Patient may have difficulty swallowing following use of oral
topical anesthetic. Do not give food or drink for 1 hr after use of oral anesthetic.
 Apply lidocaine ointments or creams to a gauze or bandage before applying to the skin.
 WARNING: Monitor for safe and effective serum drug concentrations (antiarrhythmic use: 1–5
mcg/mL). Doses > 6–10 mcg/mL are usually toxic.