Lidocaine Nursing Responsibilities
Brand Name: (Parenteral) LidoPen, Xylocaine (Local Anesthetic) Dilocane, Lidoject, Nervocaine, Octocaine, Xylovaine (Mucosal) Anestacon, Xylocaine Viscous (Lidocaine Patch) Lidoderm, (Topical) DermaFlex, ELA-Max, Solarcaine, Aloe Extra Burn Relief, Xylocaine, Zilactin-L
Classification: Anesthetic – topical or local, Antiarrythmics
- Intravenous – ventricular arrhythmias
- Intramuscular – self-injected or when IV is unavailable during transport to local facilities
- Local – infiltration or mucosal or topical anesthetic
- Patch – used when pain is present due to post-herpetic neuralgia
Mechanism of action
When administered intramuscularly or intravenously, Lidocaine suppresses the automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across the cell membrane with little or no effect on the heart. Locally, it produces local anesthesia effect by inhibiting the transport of ions across the neural membranes. Thus, initiation and conduction of normal nerve impulses is prevented.
- Advanced AV block
Used cautiously in patients with:
- Liver diseases
- Congenital heart failure
- Patient weighing less than 50 kilograms
- Geriatric patients
- Respiratory depression
- Heart block
- Pregnancy and lactation
- (mucosal use) decreased or absent gag reflex
- Burning sensation
Signs and symptoms of toxicity and overdose of Lidocaine:
- Blurred or double vision
- Nausea and vomiting
- Ringing in the ears
- Difficulty breathing
- Severe dizziness and fainting
- Unusually low heart rate
- When Lidocaine is administered as an antiarrhythmic the nurse should monitor the ECG continuously. Blood pressure and respiratory status should be monitored frequently during the drug administration.
- When administered as an anesthetic, the numbness of the affected part should be assessed.
- Serum Lidocaine levels should be monitored frequently during prolonged use. Therapeutic serum lidocaine levels range from 1.5 to 5 mcg/ml.
- If signs of overdose occur (listed above), stop the infusion immediately and monitor the patient closely.
- For throat sprays, make sure that the patient’s gag reflex is intact before allowing the patient to eat or drink.
- When IM injections are used, the medication should be administered in the deltoid muscle only while frequently aspirating to prevent IV injection.
- For direct IV injection only 1% and 2% solutions are used.
- Undiluted IV loading dose of Lidocaine is administered at 1 mg/kg at a rate of 25 to 50 mg over 1 minute. The dose may be repeated after 5 minutes.