Lidocaine

Pregnancy Pregnancy: Lidocaine may be administered during pregnancy and breastfeeding. Epidural anaesthesia with lidocaine is contraindicated in obstetrics in the event of haemorrhagic crisis or pre-existing haemorrhage. Breastfeeding Breastfeeding: Lidocaine may be administered during pregnancy and breastfeeding. Hepatic impairment Hepatic impairment: Avoid or reduce the dose in severe hepatic impairment. Driving Driving: Following injection of local anaesthetics, transient loss of sensation and/or motor block may occur. Until these effects have subsided, patients should not drive or operate machinery. Lidocaine should be administered by persons trained in resuscitation who have access to appropriate equipment. Resuscitation facilities and equipment must be available when local anaesthetics are administered. It should be used with caution in patients with myasthenia gravis, epilepsy, congestive heart failure, bradycardia, or respiratory depression, including situations in which agents known to interact with lidocaine—either by increasing its bioavailability or producing additive effects (e.g., phenytoin) or by prolonging its elimination (e.g., hepatic impairment or end-stage renal impairment where lidocaine metabolites may accumulate)—are being administered. Patients treated with class III antiarrhythmics (e.g., amiodarone) should be closely monitored and ECG monitoring should be considered, as cardiac effects may be additive. Cases of chondrolysis have been reported in patients receiving continuous intra-articular infusion of local anaesthetics postoperatively. The majority of reported cases of chondrolysis involved the shoulder joint. Due to the contribution of multiple factors and inconsistency in the scientific literature regarding the mechanism of action, a causal relationship has not been established. Continuous intra-articular infusion is not an approved indication for lidocaine. Intramuscular lidocaine may increase creatine phosphokinase concentrations, which may interfere with the diagnosis of acute myocardial infarction. Lidocaine has been shown to be porphyrinogenic in animals and should be avoided in persons suffering from porphyria. The effect of lidocaine may be reduced if injected into inflamed or infected areas. Hypokalaemia, hypoxia, and acid-base imbalance should be corrected before initiating treatment with intravenous lidocaine. Certain local anaesthesia procedures may be associated with serious adverse reactions, regardless of the local anaesthetic used. Central nerve block may cause cardiovascular depression, especially in the presence of hypovolaemia, and therefore epidural anaesthesia should be used with caution in patients with impaired cardiovascular function. Epidural anaesthesia may lead to hypotension and bradycardia. This risk may be reduced by prior administration of colloidal or crystalloid solutions into the circulation. Hypotension should be promptly treated. Paracervical block may occasionally cause foetal bradycardia or tachycardia, requiring careful monitoring of the foetal heart rate. Injections in the head and neck regions may inadvertently enter an artery, causing cerebral symptoms even at low doses. Retrobulbar injections may, although rarely, reach the subarachnoid cranial space, causing serious/severe reactions including cardiovascular collapse, apnoea, convulsions, and temporary blindness. Retrobulbar and peribulbar injections of local anaesthetics carry a low risk of persistent ocular motor dysfunction. Primary causes include trauma and/or local toxic effects on muscles and/or nerves. The severity of such tissue reactions is related to the degree of trauma, the concentration of the local anaesthetic, and the duration of tissue exposure to the local anaesthetic. For this reason, as with all local anaesthetics, the lowest effective concentration and dose of local anaesthetic should be used. The use of lidocaine solution for injection is not recommended in neonates. In this age group, the optimal serum concentration of lidocaine required to avoid toxicity, such as convulsions and cardiac arrhythmias, is not known. Intravascular injection is not indicated and should be avoided. Use with caution in: Patients with coagulopathy. Treatment with anticoagulants (e.g., heparin), NSAIDs, or plasma substitutes causes an increased tendency for bleeding. Accidental damage to blood vessels may lead to serious haemorrhage. If necessary, bleeding time, activated partial thromboplastin time (aPTT), and platelet count should be analysed. Patients with complete or incomplete cardiac conduction block—due to the fact that local anaesthetics may suppress atrioventricular conduction. Patients with seizures of cerebral origin should be strictly monitored for manifestations of central nervous system symptoms. Furthermore, low doses of lidocaine hydrochloride may also cause an increased propensity for convulsions. In patients with Melkersson-Rosenthal syndrome, toxic and allergic reactions of the nervous system to local anaesthetics may occur more frequently. Third trimester of pregnancy. The 10 mg/ml lidocaine solution for injection is not approved for intrathecal administration (subarachnoid anaesthesia).