lidocaine hydrochloride Nursing Considerations & Management

 Drug Name

Generic Name :  lidocaine hydrochloride ,lidocaine HCl in 5% dextrose , lidocaine HCl without preservatives

Brand Name:

  • Antiarrhythmic preparations: Xylocaine HCl IV for Cardiac Arrhythmias
  • Local anesthetic preparations: Octocaine, Xylocaine HCl (injectable)
  • Topical for mucous membranes: Anestacon, Burn-O-Jel, Dentipatch, DermaFlex, ELA-Max, Xylocaine, Zilactin-L
  • Topical dermatologic: Lidoderm, Numby Stuff, Xylocaine

Classification: Antiarrhythmic, Local anesthetic

Pregnancy Category B

Dosage & Route


  • Arrhythmia: Use only the 10% solution for IM injection. 300 mg in deltoid or thigh muscle. Switch to IV lidocaine or oral antiarrhythmic as soon as possible.

IV bolus

  • Arrhythmia: Use only lidocaine injection labeled for IV use and without preservatives or catecholamines. Monitor ECG constantly. Give 50–100 mg at rate of 25–50 mg/min. One-third to one-half the initial dose may be given after 5 min if needed. Do not exceed 200–300 mg in 1 hr.

IV, continuous infusion

  • Arrhythmia: Give 1–4 mg/min (or 20–50 mcg/kg/min). Titrate the dose down as soon as the cardiac rhythm stabilizes. Use lower doses in patients with CHF, liver disease, and in patients > 70 yr.

Topical, intratissue, epidural

  • Local anesthesia: Preparations containing preservatives should not be used for spinal or epidural anesthesia. Drug concentration and diluent should be appropriate to particular local anesthetic use: 5% solution with glucose is used for spinal anesthesia, 1.5% solution with dextrose for low spinal or “saddle block”; anesthesia. Dosage varies with the area to be anesthetized and the reason for the anesthesia; use the lowest dose possible to achieve results.


  • Arrhythmia: Safety and efficacy have not been established. American Heart Association recommends bolus of 0.5–1 mg/kg IV, followed by 30 mcg/kg/min with caution. The IM auto-injector device is not recommended.

Topical, intratissue, epidural

  • Local anesthesia: See adult dosage discussion. Use lower concentrations.
  • Use lower concentrations in these patients.
Therapeutic actions
  • Lidocaine is an amide type local anesthetic. It stabilizes the neuronal membrane and inhibits sodium ion movements, which are necessary for conduction of impulses. In the heart, lidocaine reduces phase 4 depolarization and automaticity. Duration of action potential and effective refractory period are also reduced.
  • As antiarrhythmic: Management of acute ventricular arrhythmias during cardiac surgery and MI (IV use). Use IM when IV administration is not possible or when ECG monitoring is not available and the danger of ventricular arrhythmias is great (single-dose IM use, for example, by paramedics in a mobile coronary care unit)
  • As anesthetic: Infiltration anesthesia, peripheral and sympathetic nerve blocks, central nerve blocks, spinal and caudal anesthesia, retrobulbar and transtracheal injection; topical anesthetic for skin disorders and accessible mucous membranes
Adverse effects
  • Dizziness, paresthesia, drowsiness, confusion, respiratory depression and convulsions.
  • Potentially Fatal: Hypotension and bradycardia leading to cardiac arrest; anaphylaxis
  • Hypovolemia; heart block or other conduction disturbances.
Nursing considerations
  • History: Allergy to lidocaine or amide-type local anesthetics, CHF, cardiogenic shock, second- or third-degree heart block, Wolff-Parkinson-White syndrome, Stokes-Adams syndrome, hepatic or renal disease, inflammation or sepsis in region of injection, lactation, pregnancy
  • Physical: T; skin color, rashes, lesions; orientation, speech, reflexes, sensation and movement (local anesthetic); P, BP, auscultation, continuous ECG monitoring during use as antiarrhythmic; edema; R, adventitious sounds; bowel sounds, liver evaluation; urine output; serum electrolytes, LFTs, renal function tests
  • WARNING: Check drug concentration carefully; many concentrations are available.
  • Reduce dosage with hepatic or renal failure.
  • Continuously monitor response when used as antiarrhythmic or injected as local anesthetic.
  • WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.
  • WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.
  • WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.
  • WARNING: Establish safety precautions if CNS changes occur; have IV diazepam or short-acting barbiturate (thiopental, thiamylal) readily available in case of seizures.
  • WARNING: Monitor for malignant hyperthermia (jaw muscle spasm, rigidity); have life-support equipment and IV dantrolene readily available.
  • Titrate dose to minimum needed for cardiac stability, when using lidocaine as antiarrhythmic.
  • Reduce dosage when treating arrhythmias in CHF, digitalis toxicity with AV block, and geriatric patients.
  • Monitor fluid load carefully; more concentrated solutions can be used to treat arrhythmias in patients on fluid restrictions.
  • Have patients who have received lidocaine as a spinal anesthetic remain lying flat for 6–12 hr afterward, and ensure that they are adequately hydrated to minimize risk of headache.
  • WARNING: Check lidocaine preparation carefully; epinephrine is added to solutions of lidocaine to retard the absorption of the local anesthetic from the injection site. Be sure that such solutions are used only to produce local anesthesia. These solutions should be injected cautiously in body areas supplied by end arteries and used cautiously in patients with peripheral vascular disease, hypertension, thyrotoxicosis, or diabetes.
  • Use caution to prevent choking. Patient may have difficulty swallowing following use of oral topical anesthetic. Do not give food or drink for 1 hr after use of oral anesthetic.
  • Apply lidocaine ointments or creams to a gauze or bandage before applying to the skin.
  • WARNING: Monitor for safe and effective serum drug concentrations (antiarrhythmic use: 1–5 mcg/mL). Doses > 6–10 mcg/mL are usually toxic.
Teaching points
  • Dosage is changed frequently in response to cardiac rhythm on monitor.
  • Oral lidocaine can cause numbness of the tongue, cheeks, and throat. Do not eat or drink for 1 hour after using oral lidocaine to prevent biting the inside of your mouth or tongue and choking.
  • You may experience these side effects: Drowsiness, dizziness, numbness, double vision; nausea, vomiting; stinging, burning, local irritation (local anesthetic).
  • Report difficulty speaking, thick tongue, numbness, tingling, difficulty breathing, pain or numbness at IV site, swelling, or pain at site of local anesthetic use.