Interpretation
| Result | Meaning |
|---|---|
| Lidocaine | 5 mg/kg (≤350 mg); with epi 7 mg/kg (≤500 mg) |
| Bupivacaine | 2 mg/kg (≤175 mg); with epi 3 mg/kg (≤225 mg) |
| Levobupivacaine | 2 mg/kg (≤200 mg); with epi 3 mg/kg (≤225 mg) |
| Ropivacaine | 3 mg/kg (≤200 mg); with epi 3 mg/kg (≤250 mg) |
| Mepivacaine | 5 mg/kg (≤350 mg); with epi 7 mg/kg (≤500 mg) |
| Prilocaine | 6 mg/kg (≤400 mg); with epi 8 mg/kg (≤600 mg) |
| Chloroprocaine | 11 mg/kg (≤800 mg); with epi 14 mg/kg (≤1000 mg) |
Formula
Max dose (mg) = min(mg/kg limit × weight, absolute cap). Volume (mL) = mg ÷ (% × 10), since a 1% solution contains 10 mg/mL.
Clinical pearls
- Use lean or ideal body weight in obesity; doses of different local anesthetics given together are additive.
- Reduce doses in the elderly, in heart failure, hepatic or renal impairment, pregnancy and infants, and for highly vascular sites (intercostal, caudal, airway).
- Published limits vary between sources; these are the Berde & Strichartz (Miller's Anesthesia) values summarised by El-Boghdadly 2018, plus chloroprocaine from its FDA label. Have 20% lipid emulsion available for LAST.
Examples
max lidocaine dose 70 kg 1%how much 0.25% bupivacaine with epinephrine can I give a 60 kg womanropivacaine max dose 80kg 0.5%local anesthetic max dose lidocaine with epi 20 kg child 2%
FAQ
What is the maximum dose of lidocaine?
5 mg/kg up to 350 mg without epinephrine, and 7 mg/kg up to 500 mg with epinephrine (Berde & Strichartz). Some references quote 4.5 mg/kg and 300 mg plain.
How many mL of 1% lidocaine can I give?
A 1% solution is 10 mg/mL, so divide the maximum mg by 10: for a 70 kg adult, 350 mg plain lidocaine is 35 mL of 1%.