Lidocaine Hydrochloride

 

Brand Names:
Anestacon®; Band-Aid® Hurt-Free™ Antiseptic Wash [OTC]; Burnamycin [OTC]; Burn Jel [OTC]; Burn-O-Jel [OTC]; LidaMantle®; Lidoderm®; L-M-X™ 4 [OTC]; L-M-X™ 5 [OTC]; Premjact® [OTC]; Solarcaine® Aloe Extra Burn Relief [OTC]; Topicaine® [OTC]; Xylocaine®; Xylocaine® MPF; Xylocaine® Viscous; Zilactin-L® [OTC]

AVAILABLE FORMS:
Infusion (premixed): 0.2% (2 mg/ml), 0.4% (4 mg/ml), 0.8% (8 mg/ml)
Injection (for direct I.V use): 1% (10 mg/ml), 2% (20 mg/ml)
Injection (for I.M. use): 300 mg/3 ml automatic injection device

INDICATIONS:
 Ventricular arrhythmias caused by MI, cardiac manipulation, or cardiac glycosides.

ACTION:
A class IB antiarrhythmic that decreases the depolarization, automaticity and excitability in the ventricles during the diastolic phase by direct action on the tissues, especially the Purkinje network.


ADVERSE REACTIONS:

Cardiovascular: Bradycardia, hypotension, heart block, arrhythmia, cardiovascular collapse, sinus node supression, increase defibrillator threshold, vascular insufficiency (periarticular injections), arterial spasms
Central nervous system: Drowsiness after administration is usually a sign of a high blood level. Other effects may include lightheadedness, dizziness, tinnitus, blurred vision, vomiting, twitching, tremor, lethargy, coma, agitation, slurred speech, seizure, anxiety, euphoria, hallucinations, paresthesia, psychosis.
Dermatologic: Itching, rash, edema of the skin, contact dermatitis
Gastrointestinal: Nausea, vomiting, taste disorder
Local: Thrombophlebitis
Neuromuscular & skeletal: Transient radicular pain (subarachnoid administration; up to 1.9%)
Ocular: Blurred vision, diplopia
Respiratory: Dyspnea, respiratory depression or arrest, bronchospasm
Miscellaneous: Allergic reactions, urticaria, edema, anaphylactoid reaction

 

CONTRAINDICATIONS:

Hypersensitivity to lidocaine or any component of the formulation; hypersensitivity to another local anesthetic of the amide type; Adam-Stokes syndrome; severe degrees of SA, AV, or intraventricular heart block (except in patients with a functioning artificial pacemaker); premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn-related products

 

NURSING CONSIDERATIONS:
 

1.  Give I.M. injections in the deltoid muscle only.
2. Monitor levels. Therapeutic levels are 2 to 5 mcg/ml.
3. Monitor patient's response, especially blood pressure and electrolytes, BUN and creatinine levels. Notify prescriber promptly if abnormalities develop.
   
4. Stop infusion and notify prescriber if arrhythmias worsen or ECG changes, such as widening QRS complex or substantially prolonged PR interval, are evident.