Lidocaine Dosage Guidelines for Adults

Introduction to Lidocaine Dosage

The American Academy of Dermatology recommends a maximum safe dose of lidocaine for adults as 4.5 mg/kg without epinephrine and 7.0 mg/kg with epinephrine, not exceeding 300 mg in the first case or 500 mg in the second 1

For local infiltration and topical anesthesia without epinephrine, the maximum dose is 4.5 mg/kg of body weight, not exceeding 300 mg total 1
For local infiltration and topical anesthesia with epinephrine, the maximum dose increases to 7.0 mg/kg of body weight, not exceeding 500 mg total 1, 2

For awake tracheal intubation and airway topicalization, do not exceed 9 mg/kg of lean body weight 3

In Mohs surgery, it has been shown to be safe with total doses of 500 mg of 1% lidocaine administered in multiple increments over an average of 8 hours without reaching toxic levels 1

For liposuction with tumescent anesthesia, doses up to 45 mg/kg have been found safe 4

Loading dose: 1.5 mg/kg administered as an infusion over 10 minutes 5
Maintenance infusion: 1.5 mg/kg/hour intraoperatively, reducing to 1.33 mg/kg/hour postoperatively 5
Maximum dose per hour: 120 mg/hour regardless of weight 5

Critical warning: Consider the total dose of all local anesthetics administered, regardless of route (regional infiltration, surgical, topical, or nerve blocks) 3, 4
Do not administer lidocaine within 4 hours of other local anesthetic interventions to prevent cumulative toxicity 4, 5

Early signs of toxicity include tinnitus (ringing in the ears) 4 and changes in hearing 3
Progressive toxicity signs include muscle contractions 5, convulsions 5, and respiratory arrest 3
Severe toxicity signs include myocardial depression 5 and ventricular arrest 3

The American Society of Anesthesiologists recommends that topical lidocaine should not be used within 4 hours of any other local anesthetic intervention, and the total dose of all local anesthetics from any route must be counted toward the maximum safe dose, to avoid cumulative toxicity in patients 6
The American Society of Anesthesiologists advises that lidocaine patches should be removed before any intravenous lidocaine administration to prevent increased systemic absorption and potential toxicity in patients 6

Early warning signs of lidocaine toxicity, as recommended by the American Heart Association, include circumoral numbness or facial tingling, tinnitus, slurred speech, lightheadedness or dizziness, and metallic taste or tongue tingling, which require immediate discontinuation of lidocaine use 6
Progressive toxicity requiring emergency care, as identified by the American College of Medical Toxicology, includes muscle twitching or contractions, loss of consciousness, seizures or convulsions, respiratory arrest, cardiac arrhythmias or myocardial depression, and ventricular arrest, which can be potentially fatal 6