{"id":21413,"date":"2020-05-18T06:51:23","date_gmt":"2020-05-18T03:51:23","guid":{"rendered":"https:\/\/freemedicalmcqs.com\/?p=21413"},"modified":"2022-04-25T02:52:39","modified_gmt":"2022-04-24T23:52:39","slug":"calculate-maximum-dose-of-local-anesthetic","status":"publish","type":"post","link":"https:\/\/freemedicalmcqs.com\/calculate-maximum-dose-of-local-anesthetic\/","title":{"rendered":"Calculate Maximum Dose of Local Anesthetic"},"content":{"rendered":"<h3 style=\"text-align: center;\"><a href=\"https:\/\/freemedicalmcqs.com\/courses\/local-anesthesia-quiz\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #ff0000;\"><strong>Before continuing this article, get our free Local Anesthesia Quiz<\/strong><\/span><\/a><\/h3>\n<p>Local anesthetics produce anesthesia by inhibiting excitation of nerve endings or by blocking conduction in peripheral nerves. Cocaine, a compound indigenous to the Andes Mountains, West Indies, and Java,\u00a0was the first anesthetic to be discovered and is the only naturally occurring local anesthetic; all others are synthetically derived. Cocaine was introduced into Europe in the 1800s following its isolation from coca beans. Sigmund Freud, the noted Austrian psychoanalyst, used cocaine on his patients and became addicted through self-experimentation.<\/p>\n<h2>Contents:<\/h2>\n<ul>\n<li>Brief overview of structure &amp; mode of action of local anesthetic<\/li>\n<li>Different types of local anesthetic<\/li>\n<li>Safe dosage calculations<\/li>\n<li>Complications of peripheral nerve blocks<\/li>\n<li>Treatment of toxicity<\/li>\n<li>Contraindications<\/li>\n<\/ul>\n<h2>How do local anesthetic work?<\/h2>\n<p>Modern local anesthetics are amides supplied in a water soluble weak acid solution<\/p>\n<p>The unionised base diffuses into nerve cells and causes reversible blockade of Na+ channels in excitable neural tissue, preventing action potential propagation<\/p>\n<p>They are less effective in infected tissue due to the relative acidity of the tissue<\/p>\n<figure id=\"attachment_21414\" aria-describedby=\"caption-attachment-21414\" style=\"width: 720px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-21414\" src=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetics.jpg\" alt=\"Local anesthetics types\" width=\"720\" height=\"220\" srcset=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetics.jpg 720w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetics-300x92.jpg 300w\" sizes=\"(max-width: 720px) 100vw, 720px\" \/><figcaption id=\"caption-attachment-21414\" class=\"wp-caption-text\">Local anesthetics types<\/figcaption><\/figure>\n<h2>Maximum safe dosages of local anesthetics<\/h2>\n<ul>\n<li>Depends on vascularity of injection site<\/li>\n<li>Depends on health of patient<\/li>\n<li>Cautiously increased in presence of adrenaline (vasoconstrictor)<\/li>\n<\/ul>\n<figure id=\"attachment_36922\" aria-describedby=\"caption-attachment-36922\" style=\"width: 844px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-36922\" src=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-Anesthetic-dose-table-2-844x1024.png\" alt=\"Local Anesthetic dose table 2\" width=\"844\" height=\"1024\" srcset=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-Anesthetic-dose-table-2-844x1024.png 844w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-Anesthetic-dose-table-2-247x300.png 247w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-Anesthetic-dose-table-2-768x932.png 768w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-Anesthetic-dose-table-2.png 1068w\" sizes=\"(max-width: 844px) 100vw, 844px\" \/><figcaption id=\"caption-attachment-36922\" class=\"wp-caption-text\">Local Anesthetic dose table 2<\/figcaption><\/figure>\n<p>\u00a0<\/p>\n<figure id=\"attachment_36923\" aria-describedby=\"caption-attachment-36923\" style=\"width: 1024px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-36923\" src=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetic-dose-table-1024x930.png\" alt=\"local anesthetic dose table\" width=\"1024\" height=\"930\" srcset=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetic-dose-table-1024x930.png 1024w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetic-dose-table-300x272.png 300w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetic-dose-table-768x697.png 768w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/local-anesthetic-dose-table.png 1064w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><figcaption id=\"caption-attachment-36923\" class=\"wp-caption-text\">local anesthetic dose table<\/figcaption><\/figure>\n<p style=\"text-align: right;\"><a href=\"https:\/\/freemedicalmcqs.com\/ecg-interpretation-how-to-read-ecg\/\">ECG Interpretation and How to Read ECG<\/a><\/p>\n<h2>Which local anesthetic is better to use?<\/h2>\n<ul>\n<li>Lignocaine (lidocaine)\n<ul>\n<li>Fast onset (&lt; 10 minutes)<\/li>\n<li>Duration of action 2 hours Max.<\/li>\n<li>Safe dose: 3 mg\/kg<\/li>\n<li>Cautious dose increase to 5 mg\/kg with vasoconstrictor<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Local anesthetic dosing for a 70 kg man<\/strong><\/p>\n<ul>\n<li>ALWAYS consult the anaesthetist before administration as they may have already performed a regional technique such as a femoral nerve block<\/li>\n<\/ul>\n<p>The following is a guide for appropriate maximum dosing for lignocaine and bupivacaine Maximum safe dosing<\/p>\n<ul>\n<li>Lignocaine \u2013\n<ul>\n<li>Max. safe dose = 3 mg\/kg \u2013 5 mg\/kg if combined with adrenaline<\/li>\n<li>Available in 1% or 2% solution<\/li>\n<\/ul>\n<\/li>\n<li>\u00a0Bupivacaine \u2013\n<ul>\n<li>Max. safe dose = 2mg\/kg<\/li>\n<li>Available in 0.25% or 0.5% solution<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Remember: a 1% solution = 10mg\/ml and sums are easy!<\/p>\n<h3><strong>Calculation of Maximum Recommended Dosage of local anesthetics:<\/strong><\/h3>\n<ol>\n<li>The\u00a0<em><strong>concentration<\/strong><\/em>\u00a0of the local anesthetic should\u00a0be known.\n<ul>\n<li>Percent concentration must be converted to concentration of drug\u00a0(mg\/mL) as follows (table modeled from\u00a0AAP, AAPD, CJ Cote, S Wilson, Work Group on Sedation)<\/li>\n<li>\n<table style=\"height: 232px;\" border=\"1\" width=\"111\" cellspacing=\"1\" cellpadding=\"1\">\n<thead>\n<tr>\n<th scope=\"col\"><strong>Concentration %<\/strong><\/th>\n<th scope=\"col\">mg\/mL<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>4<\/td>\n<td>40<\/td>\n<\/tr>\n<tr>\n<td>3<\/td>\n<td>30<\/td>\n<\/tr>\n<tr>\n<td>2.5<\/td>\n<td>25<\/td>\n<\/tr>\n<tr>\n<td>2<\/td>\n<td>20<\/td>\n<\/tr>\n<tr>\n<td>1<\/td>\n<td>10<\/td>\n<\/tr>\n<tr>\n<td>0.5<\/td>\n<td>5<\/td>\n<\/tr>\n<tr>\n<td>0.25<\/td>\n<td>2.5<\/td>\n<\/tr>\n<tr>\n<td>0.125<\/td>\n<td>1.25<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/li>\n<\/ul>\n<\/li>\n<li>The\u00a0<em><strong>weight<\/strong><\/em>\u00a0of the patient should\u00a0be known.<\/li>\n<\/ol>\n<p style=\"text-align: right;\"><a href=\"https:\/\/freemedicalmcqs.com\/how-to-read-chest-x-ray\/\">How to Read Chest X-Ray<\/a><\/p>\n<h2>Local Anesthetic Examples<\/h2>\n<h3>1% Lignocaine Example<\/h3>\n<p>How much 1% solution can I give to a 70kg man?<\/p>\n<ul>\n<li>Max. safe dose = 3mg\/kg = 210mg<\/li>\n<li>1% solution = 10mg\/ml so 210\/10 = 21ml<\/li>\n<li>With adrenaline = 5mg\/kg \u2013 350mg\/10 = 35ml<\/li>\n<\/ul>\n<h3>2% Lignocaine Example<\/h3>\n<p>How much 2% solution can I give to a 70kg man?<\/p>\n<ul>\n<li>Max. safe dose = 3mg\/kg = 210mg<\/li>\n<li>2% solution = 20mg\/ml so 210\/20 = 10.5ml<\/li>\n<li>With adrenaline = 5 mg\/kg \u2013 350mg\/20 = 17.5 ml<\/li>\n<\/ul>\n<h3>Bupivacaine<\/h3>\n<p>How much 0.5 % solution can I give to a 70kg man?<\/p>\n<ul>\n<li>Max. safe dose is 2mg\/kg = 140mg<\/li>\n<li>0.5% = 5mg\/ml \u2013 140mg\/5 = 28ml<\/li>\n<\/ul>\n<h3>Bupivacaine<\/h3>\n<p>How much 0.25 % solution can I give to a 70kg man?<\/p>\n<ul>\n<li>Max. safe dose is 2mg\/kg = 140mg<\/li>\n<li>0.25% = 2.5mg\/ml \u2013 140mg\/2.5 = 56ml<\/li>\n<\/ul>\n<p>More examples about dosage of local anesthetic (Lidocaine):<\/p>\n<ul>\n<li>Total dose of local anesthetic that can be used\n<ul>\n<li>Maximum dose of lidocaine (plain, without vasoconstrictor)\u00a0\u00a0is 4.5 mg\/kg\u00a0(not to exceed 300 mg)<\/li>\n<li>Example patient weight &#8211; 10 kg<\/li>\n<li><strong>Total dose that can be used for this patient\u00a0= 4.5 mg\/kg x 10 kg = 45 mg<\/strong><\/li>\n<\/ul>\n<\/li>\n<li>Maximum volume of lidocaine administered\n<ul>\n<li>Depends on concentration (see conversion table above)<\/li>\n<li>E.g. for 1% lidocaine: contains 10 mg of lidocaine per 1 mL<\/li>\n<li><strong>Max volume of 1% lidocaine\u00a0that can be administered to a 10 kg patient\u00a0 = 45 mg \/ 10mg\/mL = 4.5 mL<\/strong><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: right;\"><a href=\"https:\/\/freemedicalmcqs.com\/abg-interpretation-and-arterial-blood-gases-analysis\/\">ABG interpretation and arterial blood gases analysis<\/a><\/p>\n<h2>Complications of peripheral nerve block<\/h2>\n<h3>Technique<\/h3>\n<ul>\n<li>Neural damage<\/li>\n<li>Bleeding\/hematoma<\/li>\n<li>Intravascular injection of LA<\/li>\n<li>Infection<\/li>\n<li>Undesired effects e.g. temporary nerve palsy<\/li>\n<\/ul>\n<h3>Drug<\/h3>\n<ul>\n<li>Toxicity<\/li>\n<li>Anaphylactoid response (v.rare)<\/li>\n<li>Methaemaglobinaemia (prilocaine)<\/li>\n<\/ul>\n<h3>Toxicity of local anesthetics<\/h3>\n<figure id=\"attachment_21415\" aria-describedby=\"caption-attachment-21415\" style=\"width: 525px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-21415\" src=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-anesthetics-toxicity-1024x768.jpg\" alt=\"Local anesthetics toxicity\" width=\"525\" height=\"394\" srcset=\"https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-anesthetics-toxicity-1024x768.jpg 1024w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-anesthetics-toxicity-300x225.jpg 300w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-anesthetics-toxicity-768x576.jpg 768w, https:\/\/freemedicalmcqs.com\/wp-content\/uploads\/2020\/05\/Local-anesthetics-toxicity.jpg 1068w\" sizes=\"(max-width: 525px) 100vw, 525px\" \/><figcaption id=\"caption-attachment-21415\" class=\"wp-caption-text\">Local anesthetics toxicity<\/figcaption><\/figure>\n<ul>\n<li>Immediate: due to intravascular injection<\/li>\n<li>Delayed: due to absorption from vascular site, accumulation, repeated injection, relative overdose<\/li>\n<\/ul>\n<p>Systemic toxicity may occur from administration of local anesthetics and is related to the serum concentration of the drug as it is absorbed into the circulation. This serum concentration is influenced by the dose, site, and method of drug administration <em>(Berde &amp; Strichartz, Butterworth et eds, Catterall &amp; Mackie, Curtis et al, Rosenberg et al, Schwartz &amp; Kaufman).<\/em><\/p>\n<h2>What are the signs of Local Anesthetic toxicity?<\/h2>\n<ol>\n<li><strong>CNS<\/strong>:\n<ol>\n<li>Agitation<\/li>\n<li>Sleepiness<\/li>\n<li>Perioral numbness\/tingling<\/li>\n<li>Slurring of speech<\/li>\n<li>Fitting<\/li>\n<\/ol>\n<\/li>\n<li><span style=\"font-size: 1rem;\"><strong>CVS<\/strong>: <\/span>\n<ol>\n<li><span style=\"font-size: 1rem;\">\u2013 Hypotension<\/span><\/li>\n<li><span style=\"font-size: 1rem;\"> \u2013 Arrhythmias, often VT\/VF <\/span><\/li>\n<li><span style=\"font-size: 1rem;\">\u2013 Bradycardias (<\/span><span style=\"font-size: 1rem;\"> May be masked by addition of adrenaline to LA)<\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<h2><span style=\"font-size: 1rem;\">Management of LA Toxicity<\/span><\/h2>\n<ul>\n<li>Call for help<\/li>\n<li>STOP INJECTING<\/li>\n<li>Remember A B C<\/li>\n<li>Administer oxygen, support airway<\/li>\n<li>Ventilate with bag &amp; mask if necessary<\/li>\n<li>Ensure iv access, give fluids<\/li>\n<li>Begin CPR if necessary<\/li>\n<\/ul>\n<h3 style=\"text-align: center;\"><a href=\"https:\/\/freemedicalmcqs.com\/courses\/local-anesthesia-quiz\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #ff0000;\"><strong>Get our free Local Anesthesia Quiz<\/strong><\/span><\/a><\/h3>\n<p>The only books you need to read about local anesthesia:<\/p>\n<p><iframe style=\"width: 120px; height: 240px;\" src=\"\/\/ws-na.amazon-adsystem.com\/widgets\/q?ServiceVersion=20070822&amp;OneJS=1&amp;Operation=GetAdHtml&amp;MarketPlace=US&amp;source=ss&amp;ref=as_ss_li_til&amp;ad_type=product_link&amp;tracking_id=smeds-20&amp;language=en_US&amp;marketplace=amazon&amp;region=US&amp;placement=0323074138&amp;asins=0323074138&amp;linkId=9ea97efa2169191ab8546e091f5bcec9&amp;show_border=true&amp;link_opens_in_new_window=true\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\"><\/iframe>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/p>\n<p><iframe style=\"width: 120px; height: 240px;\" src=\"\/\/ws-na.amazon-adsystem.com\/widgets\/q?ServiceVersion=20070822&amp;OneJS=1&amp;Operation=GetAdHtml&amp;MarketPlace=US&amp;source=ss&amp;ref=as_ss_li_til&amp;ad_type=product_link&amp;tracking_id=smeds-20&amp;language=en_US&amp;marketplace=amazon&amp;region=US&amp;placement=0133077713&amp;asins=0133077713&amp;linkId=caf6423fd90d7cdb7c26d01ff895e60f&amp;show_border=true&amp;link_opens_in_new_window=true\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\"><\/iframe>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/p>\n<p><iframe style=\"width: 120px; height: 240px;\" src=\"\/\/ws-na.amazon-adsystem.com\/widgets\/q?ServiceVersion=20070822&amp;OneJS=1&amp;Operation=GetAdHtml&amp;MarketPlace=US&amp;source=ss&amp;ref=as_ss_li_til&amp;ad_type=product_link&amp;tracking_id=smeds-20&amp;language=en_US&amp;marketplace=amazon&amp;region=US&amp;placement=B07QP8FPZJ&amp;asins=B07QP8FPZJ&amp;linkId=11779b1366b4f3d87c04eb7d9f0ac264&amp;show_border=true&amp;link_opens_in_new_window=true\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\"><\/iframe><\/p>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Before continuing this article, get our free Local Anesthesia Quiz Local anesthetics produce anesthesia by inhibiting excitation of nerve endings [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":21418,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[145],"tags":[150],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Calculate Maximum Dose of Local Anesthetic - FreeMedicalMCQs.com<\/title>\n<meta name=\"description\" content=\"Using a very simple local anesthetics formula, you can easily calculate the maximum dose of each local anesthetic. 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