Adrenaline + Lidocaine Hydrochloride

Lidocaine is an amide-type local anesthetic that decreases sodium ion permeability in nerve cell membranes, blocking the induction and conduction of nerve impulses . Adrenaline (epinephrine) is a vasoconstrictor that causes local vasoconstriction, slowing the systemic absorption of lidocaine and prolonging its local anesthetic effect . This combination is used for infiltration anesthesia, nerve blocks, epidural, and caudal anesthesia . It also helps minimize bleeding at the injection site.

Adult: Per ml prep contains lidocaine HCl 20 mg and epinephrine 5 mcg. Dosage depends on several factors such as route, type and extent of surgical procedure, duration of anaesthesia and patient's condition and age. Max dose of lidocaine given with epinephrine: 7 mg/kg and not >500 mg.

Amide-type local anesthetic + Vasoconstrictor

Lidocaine blocks voltage-gated sodium channels in neuronal membranes, preventing nerve impulse initiation and conduction . Adrenaline activates α-adrenergic receptors causing local vasoconstriction, which slows lidocaine absorption, prolongs its effect, and reduces systemic toxicity . Onset of action is 1-5 minutes and duration is 1-2 hours (up to 3 hours with adrenaline) . It is metabolized in the liver via CYP1A2 and CYP3A4 and excreted renally .

Lidocaine binds to sodium channels in nerve cells, blocking sodium ion influx. This prevents depolarization and nerve impulse conduction . Adrenaline causes local vasoconstriction, reducing lidocaine's vascular absorption, prolonging local effects, and reducing the risk of systemic side effects .

Adult Dose: Epilepsy, impaired cardiac conduction, CHF, DM, closed angle glaucoma, impaired liver function (if site of admin is likely to result in high blood levels), severe renal dysfunction. Local anaesthetic effect may be reduced if injected into an inflamed or infected area. Cerebrovascular insufficiency, hyperthyroidism. Neonates, elderly, patients in poor general condition (optimise patient's condition before major block), pregnancy. Renal Dose: Lidocaine is a local anaesthetic which decreases permeability of sodium ions, blocking induction and conduction of nerve impulses. Combination with epinephrine restricts systemic spread of lidocaine, vascular absorption and its duration of local anaesthetic effect.

Halogenated inhalation anaesthetics; alpha- or beta-blocking agents; methyldopa, guanethidine; drugs with vasoconstrictor and pressor effects; antihypertensives; adrenergic neuron blockers; potassium-depleting drugs; cardiac glycosides; ephedra, yohimbe. TCAs may induce hypertension and arrhythmia.

This medicine is administered by a healthcare professional during the procedure; therefore, a missed dose is not applicable.

Common Side Effects: • Application-site reactions (irritation, redness, itching) • Mild redness, burning, or numbness • Dizziness • Nausea • Muscle spasms • Headache • Palpitations • Local necrosis • Bradycardia • Anxiety Serious Side Effects (Rare – Consult a Doctor): • CNS toxicity (due to improper IV administration) • Medullary depression with tonic and clonic seizures • Ventricular fibrillation • Severe hypertension (including cerebral hemorrhage and pulmonary edema) • Loss of consciousness • Respiratory arrest • Sodium metabisulfite may cause anaphylactic symptoms and potentially life-threatening asthma episodes in susceptible patients.

Local anesthesia, regional anesthesia, nerve blocks, epidural and caudal anaesthesia

Child: 3 mth-12 yr: Per ml prep contains lidocaine HCl 20 mg and epinephrine 5 mcg. Dosage depends on several factors such as route, type and extent of surgical procedure, duration of anaesthesia and patient's condition and age. Max dose 3 mg/kg. Ideal body weight should be used in children with high body weight.

Tachycardia, hypertension, cerebral arteriosclerosis, ischaemic heart disease, IV admin, anaesthetise digits or appendages, myasthenia gravis.

Severity of adverse effects in CNS and CVS are directly related to blood levels of lidocaine; the effects are more likely to occur after systemic administration rather than infiltration; dizziness; muscle twitching; local anaesthetic of mouth/throat impairs swallowing and increases the risk of aspiration (patients cautioned against eating or drinking for 3-4 hr after anaesthesia); transient effect on auditory system of neonate; erythema; pigmentation; pain; headache; palpitations; local necrosis; pulmonary oedema; hyperglycaemia; bradycardia; reduced cardiac output; anxiety. Epidural may cause hypotension, bradycardia, nausea and vomiting. Intraoral inj may cause stress reactions such as diaphoresis, palpitation, hyperventilation, generalised pallor and faintness. Topically: papules, burns, rash, skin irritation, burning sensation and blanching. Potentially Fatal: Severity of adverse effects in CNS and CVS related to blood levels of lidocaine; effects more likely to occur after systemic administration rather than infiltration. CNS toxicity (due to inadvertent IV admin), medullary depression with tonic & clonic convulsions; ventricular fibrillation; severe hypertension with cerebral haemorrhage and pulmonary oedema; unconsciousness; possibly respiratory arrest. Allergic reactions including anaphylactic symptoms and possibly life threatening asthmatic episodes in susceptible patients may occur due to sodium metabisulphate constituent. Central nerve blocks may cause CV depression (especially in hypovolaemia). Retrobulbar inj may reach subarachnoid space causing CV collapse, apnoea, convulsions, temporary blindness. Paracervical block may cause foetal bradycardia/tachycardia (careful monitoring of foetal heart rate is necessary).

Lidocaine is a local anaesthetic which decreases permeability of sodium ions, blocking induction and conduction of nerve impulses. Combination with epinephrine restricts systemic spread of lidocaine, vascular absorption and its duration of local anaesthetic effect.