“epinephrine response” within 45 seconds, consisting of an increase in heart rate and systolic blood pressure, circumoral pallor,
palpitations and nervousness in the unsedated patient. The sedated patient may exhibit only a pulse rate increase of 20 or more beats
per minute for 15 or more seconds. Patients on beta blockers may not manifest changes in heart rate, but blood pressure monitoring
can detect an evanescent rise in systolic blood pressure. Adequate time should be allowed for onset of anesthesia after administration
of each test dose. The rapid injection of a large volume of Xylocaine Injection through the catheter should be avoided, and, when
feasible, fractional doses should be administered.
In the event of the known injection of a large volume of local anesthetic solution into the subarachnoid space, after suitable
resuscitation and if the catheter is in place, consider attempting the recovery of drug by draining a moderate amount of cerebrospinal
fluid (such as 10 mL) through the epidural catheter.
MAXIMUM RECOMMENDED DOSAGES
Adults
For normal healthy adults, the individual maximum recommended dose of lidocaine HCl with epinephrine should not exceed 7 mg/kg
(3.5 mg/lb) of body weight, and in general it is recommended that the maximum total dose not exceed 500 mg. When used without
epinephrine the maximum individual dose should not exceed 4.5 mg/kg (2 mg/lb) of body weight, and in general it is recommended
that the maximum total dose does not exceed 300 mg. For continuous epidural or caudal anesthesia, the maximum recommended
dosage should not be administered at intervals of less than 90 minutes. When continuous lumbar or caudal epidural anesthesia is used
for non-obstetrical procedures, more drug may be administered if required to produce adequate anesthesia.
The maximum recommended dose per 90 minute period of lidocaine hydrochloride for paracervical block in obstetrical patients and
non-obstetrical patients is 200 mg total. One half of the total dose is usually administered to each side. Inject slowly, five minutes
between sides (see also discussion of paracervical block in PRECAUTIONS).
For intravenous regional anesthesia, the dose administered should not exceed 4 mg/kg in adults.
Children
It is difficult to recommend a maximum dose of any drug for children, since this varies as a function of age and weight. For children
over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the
child’s age and weight. For example, in a child of 5 years weighing 50 lbs the dose of lidocaine HCl should not exceed 75 to 100 mg
(1.5 to 2 mg/lb). The use of even more dilute solutions (ie, 0.25 to 0.5%) and total dosages not to exceed 3 mg/kg (1.4 mg/lb) are
recommended for induction of intravenous regional anesthesia in children.
In order to guard against systemic toxicity, the lowest effective concentration and lowest effective dose should be used at all times. In
some cases it will be necessary to dilute available concentrations with 0.9% sodium chloride injection in order to obtain the required
final concentration.
NOTE: