Lidocaine Administration Protocol

Dosing Guidelines

The recommended protocol for lidocaine injection includes using ideal body weight for dose calculation, not exceeding 1.5 mg/kg for loading doses given over 10 minutes, and maintaining proper monitoring throughout administration 1, 2
Calculate dosage using ideal body weight (IBW), which can be determined by: Men: IBW = height in cm - 100 3, Women: IBW = height in cm - 105 1, 4
Do not use lidocaine in patients weighing less than 40 kg 1, 3
Maximum recommended dosing parameters: Loading dose: No more than 1.5 mg/kg given as an infusion over 10 minutes 1, Maximum hourly dose: 120 mg/hour regardless of weight 1, 3

Deliver through a separate, dedicated cannula with proper labeling of the infusion line 1
Initial infusion should be monitored with continuous ECG and pulse oximetry, and checked with regular blood pressure measurements (every 5 minutes during initial infusion and first 15 minutes thereafter) 1

Avoid concurrent use with other local anesthetics: Do not start lidocaine within 4 hours of any nerve or fascial plane block 1, Do not perform nerve blocks until 4 hours after completing lidocaine infusion 1, Remove topical lidocaine plasters before starting infusion 1, 5
Be vigilant for signs of local anesthetic toxicity: Early signs: tingling of tongue/lips, light-headedness, tinnitus, slurred speech 3, Progressive signs: muscle twitching, loss of consciousness, respiratory arrest 3, Severe toxicity: myocardial depression, cardiac arrhythmias, ventricular arrest 4
Relative contraindications include: Electrolyte disorders 4, Seizure disorders 4, Renal or hepatic impairment 4, Pregnancy/breastfeeding 4, Neurological disorders 4

Single-shot spinal blockade can be used concurrently with lidocaine due to the small dose of local anesthetic used 1