Lidocaine
Also known as: Lidocaine, Lignocaine, Xylocaine, CAS 137-58-6
Overview
Lidocaine is a synthetic local anesthetic and antiarrhythmic drug widely used in various medical settings. It is not found naturally and is characterized by its ability to block sodium channels, thereby preventing the transmission of nerve signals. This mechanism makes it effective for local anesthesia, pain relief, and managing certain heart rhythm disorders. Lidocaine is available in several forms, including injectable solutions, topical gels, and patches, allowing for versatile application depending on the clinical need. Extensive research supports its use, with high-quality evidence from systematic reviews and meta-analyses, particularly in pain management and anesthesia. Its efficacy and safety profile have made it a staple in both acute and chronic pain management strategies.
Benefits
Lidocaine provides analgesic and anti-inflammatory benefits. Intraperitoneal lidocaine has demonstrated superior analgesic effects compared to intravenous administration in post-abdominal surgery patients, according to a meta-analysis. However, some studies suggest that intravenous lidocaine may not significantly reduce pain scores in acute pain scenarios compared to controls. Perioperative intravenous lidocaine infusion exhibits systemic anti-inflammatory effects, supported by systematic reviews. Additionally, lidocaine is used for managing burn pain, with potential benefits highlighted in systematic reviews. The effectiveness varies based on the administration route and specific application, with immediate onset for local anesthesia and potentially longer for systemic effects.
How it works
Lidocaine functions primarily by blocking sodium channels in nerve cells, which prevents the depolarization necessary for nerve signal transmission. This action inhibits the sensation of pain and other nerve impulses in the localized area. The drug interacts with the nervous system, specifically targeting sodium channels in neurons. When administered, lidocaine is rapidly absorbed intravenously, although bioavailability varies depending on the route of administration. By blocking sodium influx, lidocaine effectively stabilizes the neuronal membrane, preventing the initiation and conduction of action potentials, thus providing anesthesia and pain relief.
Side effects
Lidocaine is generally safe when used appropriately, but it can cause side effects. Common side effects (occurring in >5% of patients) include dizziness, nausea, and numbness at the injection site. Uncommon side effects (1-5%) may include headache, confusion, and allergic reactions. Rare but serious side effects (<1%) include seizures, respiratory depression, and cardiac arrhythmias. Lidocaine can interact with other local anesthetics and certain antiarrhythmic drugs, potentially increasing the risk of adverse effects. It is contraindicated in individuals with hypersensitivity to lidocaine or amide-type local anesthetics. Caution is advised in patients with liver or kidney dysfunction due to altered metabolism and excretion. Monitoring for signs of toxicity is crucial to ensure patient safety.
Dosage
Dosage varies depending on the application. For intravenous use, the typical dose is 1-2 mg/kg, while local anesthesia uses solutions ranging from 0.5% to 2%. The maximum safe intravenous dose is generally 4 mg/kg. Lidocaine is administered as needed for pain relief or before procedures. It is available in injectable solutions, gels, and patches, with absorption rates varying by administration route. No specific cofactors are required for its action. Proper dosing and administration are crucial to avoid systemic toxicity. Always follow healthcare provider instructions for appropriate use.
FAQs
How quickly does lidocaine work?
Lidocaine provides rapid onset of local anesthesia or pain relief, typically within a few minutes when applied topically or injected locally. Intravenous administration may have a slightly delayed onset for systemic effects.
What are the signs of lidocaine toxicity?
Signs of lidocaine toxicity include dizziness, numbness, confusion, seizures, respiratory depression, and cardiac arrhythmias. Monitor patients closely for these symptoms, especially during and after administration.
Can lidocaine be used for chronic pain?
Lidocaine can be used for chronic pain management in certain situations, such as neuropathic pain. However, it should be used under medical supervision as part of a comprehensive pain management plan.
Is lidocaine safe during pregnancy?
Lidocaine is generally considered safe during pregnancy when used appropriately under medical supervision. However, potential risks and benefits should be discussed with a healthcare provider.
How should lidocaine be administered?
Lidocaine administration depends on the formulation and indication. Injectable solutions are administered by healthcare professionals, while topical gels and patches can be applied by patients as directed. Always follow the prescribed instructions.
Research Sources
- https://pubmed.ncbi.nlm.nih.gov/38506678/ – A meta-analysis indicated that intraperitoneal lidocaine provides better analgesic effects than intravenous lidocaine in patients undergoing post-abdominal surgery. The study highlighted improved pain relief with intraperitoneal administration, though it noted variability in study designs. This suggests that the route of administration can significantly impact the effectiveness of lidocaine for postoperative pain management.
- https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2025/03000/effectiveness_of_intravenous_lidocaine_in.65.aspx – This study examined the effectiveness of intravenous lidocaine in treating burn pain through a systematic review and meta-analysis. The findings suggest potential benefits in managing burn pain, although the authors noted the limited number of studies specifically focused on burn pain. The research indicates that intravenous lidocaine could be a useful adjunct in burn pain management strategies.
- https://academic.oup.com/painmedicine/article-abstract/25/11/651/7698049 – A systematic review and meta-analysis supported the use of perioperative intravenous lidocaine for its anti-inflammatory effects. The study found that lidocaine infusion during the perioperative period has systemic anti-inflammatory effects, which can be beneficial in surgical patients. However, the authors acknowledged heterogeneity in study designs, suggesting the need for further research to confirm these findings.
- https://www.mdpi.com/2077-0383/12/11/3772 – This citation does not appear to be directly referenced in the provided research content. Therefore, a summary cannot be provided without additional context.
- https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.706844/full – This citation does not appear to be directly referenced in the provided research content. Therefore, a summary cannot be provided without additional context.
Supplements Containing Lidocaine
Lidocaine Patch 5%
novaplus™
Polysporin®
Polysporin®
Salonpas LIDOCAINE PLUS Pain Relieving Liquid
Hisamitsu
Aspercreme for LIDOCAINE PAIN RELIEF CREAM
Aspercreme
Bactine Max Pain Relieving Cleansing Spray
Bactine
Aspercreme Lidocaine Pain Relief Dry Spray
Aspercreme
RectiCare Anorectal Lidocaine 5% Cream
RectiCare (Ferndale Laboratories)
ANTROLIN Nifedipine 0.3% w/w and Lidocaine Hydrochloride
ANTROLIN
Salonpas Lidocaine 4% Pain Relieving Gel Patch - Odor Free
Salonpas