Lidocaine Hydrochloride: Brands, Price & Uses in Bangladesh

Lidocaine Hydrochloride is an amide-type local anesthetic agent with the following approved and evidence-supported uses:

Established / FDA-approved uses

• Local infiltration anesthesia for minor surgical and dental procedures.
• Peripheral nerve blocks (e.g. brachial plexus, intercostal, pudendal blocks) for regional anesthesia.
• Sympathetic nerve blocks.
• Epidural and caudal anesthesia for surgical and obstetric procedures.
• Retrobulbar and other regional ophthalmic blocks (by trained specialists).
• Topical/surface anesthesia of accessible mucous membranes and skin (e.g. before minor procedures, to relieve pain from minor skin conditions or mucosal irritation), using appropriate topical formulations.
• Intravenous Lidocaine Hydrochloride is indicated for the acute management of life-threatening ventricular arrhythmias, such as those occurring during acute myocardial infarction, cardiac surgery, or cardiac catheterization.

Guideline-supported / adjunct use

• Use as part of Advanced Cardiac Life Support (ACLS) protocols as an alternative antiarrhythmic for shock-refractory ventricular fibrillation/pulseless ventricular tachycardia when amiodarone is unavailable or ineffective.

The specific formulation, strength, and route of Lidocaine Hydrochloride used depend on the indication and must be selected by a qualified physician or dentist.

The dose and route of Lidocaine Hydrochloride must be individualized by a qualified physician or dentist based on the procedure, site of administration, patient's age, weight, and physical status. The lowest effective dose should always be used.

Local infiltration / peripheral nerve block anesthesia (Adults)

Topical/surface anesthesia (Adults)

Applied as gel, ointment, spray, or viscous solution to the affected mucous membrane or skin area, in the minimum amount needed, generally not more often than every 3 hours and not exceeding the maximum recommended dose stated on the product label.

Intravenous use for acute ventricular arrhythmias (Adults)

Pediatric dosing

Doses must be reduced according to age, weight, and physical condition, and should not exceed the calculated maximum safe dose (mg/kg) for local anesthesia. For IV antiarrhythmic use in pediatric emergency care (e.g. per ACLS/PALS protocols), an initial bolus of approximately 1 mg/kg IV may be used under direct physician supervision.

Renal/hepatic impairment

No dose adjustment is generally required for local anesthetic use in mild-to-moderate renal impairment. For intravenous antiarrhythmic use, dose reduction and close monitoring are required in patients with hepatic impairment or reduced hepatic blood flow (e.g. heart failure, shock), since Lidocaine Hydrochloride is cleared primarily by the liver.

Side effects of Lidocaine Hydrochloride depend on the dose, route of administration, and whether absorption is local or systemic.

Local reactions

• Pain, burning, or stinging at the injection/application site.
• Localized edema or, rarely, true allergic contact reaction.

Systemic reactions (more likely with high dose, intravenous use, or inadvertent intravascular injection)

• Central nervous system: Lightheadedness, dizziness, perioral/tongue numbness, tinnitus, blurred vision, tremors, drowsiness, confusion, and, at high levels, seizures.
• Cardiovascular: Hypotension, bradycardia, arrhythmias, myocardial depression, and, at toxic levels, cardiovascular collapse or cardiac arrest.
• Rare: Methemoglobinemia (more common in infants and with high or repeated topical doses), true allergic/anaphylactic reactions.

These systemic effects represent local anesthetic systemic toxicity (LAST) and require immediate medical attention (see Overdose Effects).