ACTIONS AND USES: Lidocaine, the most frequently used injectable local anesthetic, acts by blocking neuronal pain impulses. It may be injected as a nerve block for spinal and epidural anesthesia. It acts by blocking sodium channels located within the membranes of neurons. Sodium channels
ROUTES OF ADMINISTRATION: Lidocaine may be given IV, IM, or subcutaneously to treat dysrhythmias. A topical form is also available.
ADMINISTRATION ALERTS: 1) Solutions of lidocaine containing preservatives or epinephrine are intended for local anesthesia only and must never be given parenterally for dysrhythmias.
2) Do not apply topical lidocaine to large skin areas or to broken or abraded areas, because significant absorption may occur.
3) Do not allow it to come into contact with the eyes.
4) For spinal or epidural block, use only preparations specifically labeled for IV use.
ADVERSE EFFECTS: When lidocaine is used for anesthesia, side effects are uncommon. An early symptom of toxicity is CNS excitement, leading to irritability and confusion. Serious adverse effects include convulsions, respiratory depression, and cardiac arrest. Until the effect of the anesthetic diminishes, patients may injure themselves by biting or chewing areas of the mouth that have no sensation following a dental procedure.
CONTRAINDICATIONS: Lidocaine should be avoided in cases of sensitivity to amide-type local anesthetics. Application or injection of lidocaine anesthetic is also contraindicated in the presence of severe trauma or sepsis, blood dyscrasias, dysrhythmias, sinus bradycardia, and severe degrees of heart block.
INTERACTIONS: Drug–Drug: Barbiturates may decrease the activity of lidocaine. Increased effects of lidocaine occur if taken concurrently with cimetidine, quinidine, and beta blockers. If lidocaine is used on a regular basis, its effectiveness may diminish when used with other medications.
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