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Lidocaine and Epinephrine
Pronunciation
U.S. Brand Names
Generic Available
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Administration
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(LYE doe kane & ep i NEF rin)

U.S. Brand Names
Octocaine® Injection; Xylocaine® With Epinephrine

Generic Available

Yes


Synonyms
Epinephrine and Lidocaine

Pharmacological Index

Local Anesthetic


Use

Dental: Amide-type anesthetic used for local infiltration anesthesia; injection near nerve trunks to produce nerve block

Medical: Local infiltration anesthesia; AVS for nerve block


Pregnancy Risk Factor

B


Contraindications

Hypersensitivity to local anesthetics of the amide type, myasthenia gravis, shock, or cardiac conduction disease


Warnings/Precautions

Do not use solutions in distal portions of the body (digits, nose, ears, penis); use with caution in endocrine, heart, hepatic, or thyroid disease


Adverse Reactions

Refer to Lidocaine monograph


Overdosage/Toxicology

Refer to Lidocaine monograph


Drug Interactions

Due to epinephrine component, use with tricyclic antidepressants or MAO inhibitors could result in increased pressor response; use with nonselective beta-blockers (ie, propranolol) could result in serious hypertension and reflex bradycardia


Stability

Solutions with epinephrine should be protected from light


Mechanism of Action

Lidocaine blocks both the initiation and conduction of nerve impulses via decreased permeability of sodium ions; epinephrine increases the duration of action of lidocaine by causing vasoconstriction (via alpha effects) which slows the vascular absorption of lidocaine


Pharmacodynamics/Kinetics

Peak effect: Within 5 minutes

Duration: ~2 hours, dependent on dose and anesthetic procedure


Usual Dosage

Children: Use lidocaine concentrations of 0.5% to 1% (or even more diluted) to decrease possibility of toxicity; lidocaine dose should not exceed 7 mg/kg/dose; do not repeat within 2 hours

Adults: Dosage varies with the anesthetic procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required, and physical condition of patient


Dietary Considerations

No data reported


Administration

Before injecting, withdraw syringe plunger to ensure injection is not into vein or artery


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

See individual agents


Nursing Implications

Before injecting, withdraw syringe plunger to ensure injection is not into vein or artery


Dosage Forms

Injection with epinephrine:

1:100,000: Lidocaine hydrochloride 1% [10 mg/mL] (20 mL, 50 mL); 2% [20 mg/mL] (1.8 mL, 20 mL, 50 mL)

1:50,000: Lidocaine hydrochloride 2% [20 mg/mL] (1.8 mL)


References

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

MacKenzie TA and Young ER, "Local Anesthetic Update," Anesth Prog, 1993, 40(2):29-34.

Wynn RL, "Epinephrine Interactions With Beta-Blockers," Gen Dent, 1994, 42(1):16, 18.

Wynn RL, "Recent Research on Mechanisms of Local Anesthetics," Gen Dent, 1995, 43(4):316-8.

Yagiela JA, "Local Anesthetics," Anesth Prog, 1991, 38(4-5):128-41.


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