Local anesthetics

Background
  • Amides have two "i's" (prilocaine, lidocaine, etc)
  • Esters have one "i" (tetracaine, procaine, benzocaine, etc)
  • Ester local anesthetics more likely to cause allergic reaction due to metabolite PABA[1]
  • If pt allergic to amides and esters, consider local Diphenhydramine (Na blocker)

Maximum Doses of Anesthetic Agents
Agent Without Epinephrine With Epinephrine Duration Notes
Lidocaine5 mg/kg (max 300mg)7 mg/kg (max 500mg)30-90 min
  • 1% soln contains 10 mg/ml
  • 2% soln contains 20 mg/ml
Mepivicaine7 mg/kg8 mg/kg
Bupivicaine2.5 mg/kg (max 175mg)3 mg/kg (max 225mg)6-8 hr
  • 0.5% soln contains 5 mg/ml
  • May cause cardiac arrest if injected intravascularly
  • Do not buffer with bicarbonate
Ropivacaine3 mg/kg
Prilocaine6 mg/kg
Tetracaine1 mg/kg1.5 mg/kg3hrs (10hrs with epi)
Procaine7 mg/kg10 mg/kg30min (90min with epi)

Side Effects
  • CNS
    • Perioral numbness
    • Seizure
  • Cardiovascular
    • AV blocks
    • VT and VF
    • Asystole
  • Allergic reaction
  • Methemoglobinemia

See Also
  • Local Anesthetic Systemic Toxicity (LAST)

References
  1. GlobalRPH. Local Anesthetics (ester and amide-type). http://www.globalrph.com/local-anesthetics.htm.
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