Abstract
Lidocaine (lignocaine) 1% with epinephrine (adrenaline) 1:200,000 (maximum dose 40mL) is the agent of choice in skin surgery. It can be used at all sites except the fingers, toes and penis, where epinephrine should be avoided. Epinephrine-induced vasoconstriction delays local anaesthetic clearance, thus prolonging its effect and, by reducing peak blood lidocaine concentrations, enables a higher maximum dose to be used. Adding epinephrine, however, introduces the possibility of a drug interaction with tricyclic antidepressants and nonselective beta-blockers. Also, injection pain is greater because of the acidic sodium metabisulphite that has to be added to prevent epinephrine oxidation. Injection pain can be reduced by buffering the solution using sodium bicarbonate. There are no drug interactions that prevent the use of plain lidocaine: injection pain is least with 0.5% solutions. Injection of large volumes of very dilute lidocaine solutions (tumescent anaesthesia) enables higher maximum doses of lidocaine to be tolerated and large areas to be anaesthetised by infiltration. Amethocaine gel is a faster acting and more effective topical anaesthetic compared with eutectic lidocaine-prilocaine cream, but is a topical sensitiser. In...Continue Reading
Citations
Feb 14, 1998·Dermatologic Clinics·E Dunlavey, B Leshin
Mar 9, 2012·Expert Opinion on Drug Safety·Suzanne BerkmanTina Alster
Dec 20, 2008·Clinics in Dermatology·Marcia S Driscoll, Jane M Grant-Kels
Nov 21, 2007·Journal of the American Academy of Dermatology·Marcia S Driscoll, Jane M Grant-Kels
May 9, 2006·Dermatologic Clinics·Susan M Sweeney, Mary E Maloney
Jul 27, 2007·The British Journal of Surgery·A J DixonJ B Dixon
Jun 22, 2012·International Journal of Dermatology·Firas Al-QarqazZiad Al Dabbagh
Apr 4, 2015·Journal of Plastic Surgery and Hand Surgery·Hristo ShipkovFabienne Braye
Sep 21, 2016·Journal of the American Academy of Dermatology·Amy Kalowitz BieberJennifer A Stein
Dec 8, 2016·Obstetrics and Gynecology·Amy Kalowitz BieberMiriam Keltz Pomeranz
Sep 19, 2001·The Journal of Hand Surgery : Journal of the British Society for Surgery of the Hand·I C Vossinakis
May 1, 2019·JCI Insight·Bahir H ChamseddinLu Q Le
Jun 24, 2015·Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [et Al.]·Monica StankiewiczSonya Osborne
Aug 24, 1999·Postgraduate Medicine·D W SmithS C DeBerard
Mar 20, 2021·International Journal of Dermatology·Frank WinsettRichard F Wagner