Lignocaine/Lidocaine SC

Amide Anaesthetic·Analgesia - Topicals & Local

Local infiltration anaesthesia, regional nerve blocks, refractory ventricular tachycardia/fibrillation

INJECTABLEXylocaine, Xylocaine with AdrenalineAmpoules/Vials (1%, 2%) for…S4TGA

Max Dose

3 mg/kg (Plain)

Max w/ Adren.

7 mg/kg

Onset

1-2 mins

LAST Risk

SEIZURES

Rapid Summary

Overview

The universal, rapid-acting, short-duration amide local anaesthetic. Used for suturing, minor procedures, and IV cannulation.

Maximum Dose

Max 3 mg/kg (Plain solution) or 7 mg/kg (Mixed with Adrenaline).

Clinical Focus

Exceeding the maximum weight-based dose will trigger Local Anaesthetic Systemic Toxicity (LAST), presenting as tinnitus and seizures.

Bottom Line

Lignocaine/Lidocaine SC is the standard local anaesthetic for subcutaneous infiltration and minor procedures, but systemic toxicity (CNS then cardiac) occurs rapidly if maximum doses are exceeded or inadvertent IV injection occurs.

Formulation & Access

Brand Names

Xylocaine, Xylocaine with Adrenaline

Parenteral

Ampoules/Vials (1%, 2%) for SC, IM, or IV use.

Prescribing & PBS

Hospital/Clinic supply. S4.

Indications & Use

Primary

TGA

Local infiltration anaesthesia, regional nerve blocks, refractory ventricular tachycardia/fibrillation.

Clinical Place

The most commonly used local anaesthetic worldwide due to its near-instant onset and excellent safety profile at correct doses.

Quick reference

Class & Role

Amide Anaesthetic — The universal, rapid-acting, short-duration amide local anaesthetic.

Route / Formulation

Ampoules/Vials (1%, 2%) for SC, IM, or IV use. (Xylocaine, Xylocaine with Adrenaline)

Usual Dose & Max

SC / ID 1% or 2% solution. Calculate safe volume based on patient weight. (e.g., for a 70kg adult, max plain 1% lidocaine is 21 mL).

Key Indication Doses

Local Infiltration: SC / ID 1% or 2% solution. Calculate safe volume based on patient weight. (e.g., for a 70kg adult, max plain 1% lidocaine is 21 mL). IV Regional Anaesthesia (Bier Block): IV 0.5% solution into a tourniquet-isolated limb. Antiarrhythmic (VT/VF): IV 1-1.5 mg/kg bolus (Acts as a Class Ib antiarrhythmic).

Best Uses

Avoid / Cautions

Heart block (2nd/3rd degree) for IV use. Severe hepatic failure (drug accumulates). Pregnancy Category A.

Key Risks

Neurological: LAST (Local Anaesthetic Systemic Toxicity). Begins with perioral numbness, ringing in the ears, and visual disturbances. Progresses rapidly to violent tonic-clonic seizures and coma. Cardiovascular: Hypotension, bradycardia, arrhythmias (usually only seen after the CNS seizure phase, unlike bupivacaine which hits the heart first). Immunological: True IgE allergy to amide anaesthetics is exceptionally rare (allergies were common with old 'ester' anaesthetics like procaine).

Key Interactions

Beta-blockers and Amiodarone increase the risk of bradycardia and toxicity if lidocaine is used systemically.

Monitoring

Always draw back (aspirate) the syringe plunger before injecting to ensure the needle is not inside a blood vessel. Ask the patient to report ringing in their ears or a metallic taste immediately.

Clinical Pearl

A 1% solution contains 10 mg of drug per 1 mL. A 2% solution contains 20 mg per 1 mL. For a 70kg patient, Max plain dose is 210mg (which is 21 mL of 1% solution, or just 10.5 mL of 2% solution). Always calculate before drawing up.

Access

Xylocaine, Xylocaine with Adrenaline

Brand: Xylocaine, Xylocaine with Adrenaline

Lignocaine/Lidocaine SC

Amide Anaesthetic·Analgesia - Topicals & Local

Local infiltration anaesthesia, regional nerve blocks, refractory ventricular tachycardia/fibrillation

INJECTABLEXylocaine, Xylocaine with AdrenalineAmpoules/Vials (1%, 2%) for…S4TGA

Max Dose

3 mg/kg (Plain)

Max w/ Adren.

7 mg/kg

Onset

1-2 mins

LAST Risk

SEIZURES

Rapid Summary

Overview

The universal, rapid-acting, short-duration amide local anaesthetic. Used for suturing, minor procedures, and IV cannulation.

Maximum Dose

Max 3 mg/kg (Plain solution) or 7 mg/kg (Mixed with Adrenaline).

Clinical Focus

Exceeding the maximum weight-based dose will trigger Local Anaesthetic Systemic Toxicity (LAST), presenting as tinnitus and seizures.

Bottom Line

Formulation & Access

Brand Names

Xylocaine, Xylocaine with Adrenaline

Parenteral

Ampoules/Vials (1%, 2%) for SC, IM, or IV use.

Prescribing & PBS

Hospital/Clinic supply. S4.

Indications & Use

Primary

TGA

Local infiltration anaesthesia, regional nerve blocks, refractory ventricular tachycardia/fibrillation.

Clinical Place

The most commonly used local anaesthetic worldwide due to its near-instant onset and excellent safety profile at correct doses.

Quick reference

Class & Role

Amide Anaesthetic — The universal, rapid-acting, short-duration amide local anaesthetic.

Route / Formulation

Ampoules/Vials (1%, 2%) for SC, IM, or IV use. (Xylocaine, Xylocaine with Adrenaline)

Usual Dose & Max

SC / ID 1% or 2% solution. Calculate safe volume based on patient weight. (e.g., for a 70kg adult, max plain 1% lidocaine is 21 mL).

Key Indication Doses

Best Uses

Avoid / Cautions

Heart block (2nd/3rd degree) for IV use. Severe hepatic failure (drug accumulates). Pregnancy Category A.

Key Risks

Key Interactions

Beta-blockers and Amiodarone increase the risk of bradycardia and toxicity if lidocaine is used systemically.

Monitoring

Always draw back (aspirate) the syringe plunger before injecting to ensure the needle is not inside a blood vessel. Ask the patient to report ringing in their ears or a metallic taste immediately.

Clinical Pearl

Access

Xylocaine, Xylocaine with Adrenaline

Brand: Xylocaine, Xylocaine with Adrenaline