sthetic required for most routine procedures. The actual volumes
and concentrations to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia and
degree of muscular relaxation required, duration of anesthesia required, and the physical condition of the patient. In all cases the
lowest concentration and smallest dose that will produce the desired result should be given. Dosages should be reduced for children
and for the elderly and debilitated patients and patients with cardiac and/or liver disease.
The onset of anesthesia, the duration of anesthesia and the degree of muscular relaxation are proportional to the volume and
concentration (ie, total dose) of local anesthetic used. Thus, an increase in volume and concentration of Xylocaine Injection will
decrease the onset of anesthesia, prolong the duration of anesthesia, provide a greater degree of muscular relaxation and increase
the segmental spread of anesthesia. However, increasing the volume and concentration of Xylocaine Injection may result in a more
profound fall in blood pressure when used in epidural anesthesia. Although the incidence of side effects with lidocaine HCl is quite
low, caution should be exercised when employing large volumes and concentrations, since the incidence of side effects is directly
proportional to the total dose of local anesthetic agent injected.
For intravenous regional anesthesia, only the 50 mL single dose vial containing Xylocaine (lidocaine HCl) 0.5% Injection should be
used.
Epidural Anesthesia
For epidural anesthesia, only the following dosage forms Xylocaine Injection are recommended:
1% without epinephrine 10 mL Polyamp DuoFit™
1% without epinephrine 30 mL single dose solutions
1% with epinephrine 30 mL single dose solutions
1:200,000
1.5% without epinephrine 10 mL Polyamp DuoFit™
1.5% without epinephrine 20 mL Polyamp DuoFit™
1.5% with epinephrine 30 mL ampules, 30 mL single dose solutions
1:200,000
2% without epinephrine 10 mL Polyamp DuoFit™
2% with epinephrine 20 mL ampules, 20 mL single dose solutions
1:200,000
Although these solutions are intended specifically for epidural anesthesia, they may also be used for infiltration and peripheral nerve
block, provided they are employed as single dose units. These solutions contain no bacteriostatic agent.
In epidural anesthesia, the dosage varies with the number of dermatomes to be anesthetized (generally 2 to 3 mL of the indicated
concentration per dermatome).
Caudal and Lumbar Epidural Block
As a precaution against the adverse experience sometimes observed following unintentional penetration of the subarachnoid space,
a test dose such as 2 to 3 mL of 1.5% lidocaine HCl should be administered at least 5 minutes prior to injecting the total volume
required for a lumbar or caudal epidural block. The test dose should be repeated if the patient is moved in a manner that may have
displaced the catheter. Epinephrine, if contained in the test dose (10 to 15 mcg have been suggested), may serve as a warning of
unintentional intravascular injection. If injected into a blood vessel, this amount of epinephrine is likely to produce a transient
page 7 of 27
“epinephrine response” within 45 seconds, consisting of an increase in heart rate and systolic blood pressure, circumoral pallor,
palpitations and nervousness in the unsedate |
