Xylocaine: Expert Local Anesthesia for Procedural Pain Control

Xylocaine

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Product dosage: 50 gm
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Synonyms Xylocaine Jelly 2% 50gm Easycainnie 2% Jelly 30gm Xylocaine Jelly 2% 30gm

Xylocaine (lidocaine hydrochloride) is a premier amide-type local anesthetic agent, representing a cornerstone in modern medical pain management. Its mechanism of action involves the reversible blockade of voltage-gated sodium channels on neuronal membranes, effectively inhibiting the initiation and conduction of nerve impulses to produce rapid, reliable, and predictable local anesthesia. Trusted for decades in diverse clinical environments—from emergency departments and operating theaters to dental clinics and outpatient procedure rooms—Xylocaine provides essential analgesia for a wide spectrum of interventions. Its well-characterized pharmacokinetic profile and established safety record make it a first-line choice for healthcare professionals requiring precise and controlled numbing.

Features

• Active Pharmaceutical Ingredient: Lidocaine Hydrochloride
• Available Formulations: Injectable solution (multiple concentrations: 0.5%, 1%, 1.5%, 2%), Jelly (2%), Ointment (5%), Topical Solution (4%), Cream (various), Patches (5%)
• Rapid Onset of Action: Typically provides effective anesthesia within 2-5 minutes for infiltration; slightly longer for nerve blocks dependent on concentration and site.
• Variable Duration of Effect: Effect duration is concentration and vasoconstrictor-dependent, ranging from 30 minutes to several hours (e.g., with epinephrine).
• Multiple Routes of Administration: Approved for infiltration, nerve block, epidural, spinal (hyperbaric specific formulations), topical, and transdermal use.
• Precise Dosage Calibration: Injectable solutions are clearly marked (e.g., 10 mg/mL for 1% solution), allowing for accurate calculation of total mg dosage.

Benefits

• Facilitates Pain-Free Procedures: Enables the performance of a vast array of surgical, dental, and diagnostic procedures without patient discomfort, improving compliance and outcomes.
• Rapid and Predictable Efficacy: Its quick onset allows for efficient workflow in clinical settings, minimizing wait times and increasing patient throughput.
• Versatile Clinical Application: A single agent can be utilized for everything from simple suturing and dental work to complex regional nerve blocks and neuraxial anesthesia.
• Enhanced Safety with Vasoconstrictors: Formulations containing epinephrine (e.g., 1:100,000 or 1:200,000) provide hemostasis and prolong anesthetic effect while reducing systemic absorption and potential toxicity.
• Well-Established Safety Profile: Decades of extensive clinical use and research have created a comprehensive understanding of its pharmacokinetics, dynamics, and management of adverse events.

Common use

Xylocaine is indicated for the production of local anesthesia by various application techniques. Its use is pervasive across medical specialties.

• Infiltration Anesthesia: Direct injection into tissue for minor surgical procedures, wound repair (suturing), and lesion removal (e.g., biopsies, cyst excisions).
• Peripheral Nerve Blocks: Injection near specific nerves or nerve plexuses to anesthetize a larger area (e.g., brachial plexus block for arm surgery, digital block for finger procedures).
• Central Neuraxial Blocks: Used in epidural anesthesia for labor pain management and surgical procedures, and in specific hyperbaric formulations for spinal anesthesia.
• Topical Anesthesia: Application to mucous membranes of the mouth, pharynx, larynx, trachea, urethra, and skin for surface analgesia prior to endoscopic examinations, intubations, catheterizations, or superficial dermatological procedures.
• Dental Procedures: Infiltration and nerve block for restorative work, extractions, and periodontal surgery.
• Cardiac Applications: Intravenous administration is used for the acute management of ventricular arrhythmias (though this is a systemic antiarrhythmic use, distinct from its local anesthetic role).

Dosage and direction

Dosage is highly individualized and depends on the procedure, tissue vascularity, area to be anesthetized, depth of anesthesia required, and patient’s physical status. THE SMALLEST DOSE AND VOLUME THAT PRODUCES THE DESIRED EFFECT SHOULD BE USED. Always aspirate before injecting to avoid intravascular administration.

• For Infiltration and Minor Nerve Blocks: Maximum recommended dose is 4.5 mg/kg (not to exceed 300 mg) of plain lidocaine. With epinephrine, the maximum dose is 7 mg/kg (not to exceed 500 mg). For a 1% solution (10 mg/mL), this equates to a maximum of 30 mL of plain or 50 mL of epinephrine-containing solution for a 70 kg patient.
• For Epidural Use: Dosing is complex and weight-based. A typical test dose is 2-3 mL of a solution containing epinephrine (to detect unintentional intravascular or intrathecal injection). Maintenance doses vary widely (e.g., 10-20 mL for lumbar epidural).
• Topical Use: Apply the smallest amount needed to cover the area. For 2% jelly, a single dose in adults should not exceed 30 mL (600 mg). For 5% ointment, apply a thin layer to the affected area.
• Direction: Administer sterile formulations using aseptic technique. For injections, proceed slowly with frequent aspiration. For topical forms, apply evenly to clean, intact mucosa or skin.

Precautions

• Vascularity of Area: Use extreme caution and reduced doses in highly vascular regions (e.g., head, neck, mucous membranes, inflamed or infected tissue) to avoid rapid systemic absorption and toxicity.
• Debilitated, Elderly, Acutely Ill Patients: These patients, and those with severe hepatic or renal impairment, may be more susceptible to the effects (both desired and toxic) of local anesthetics due to altered metabolism and protein binding. Dose reduction is imperative.
• Neurological or Cardiac Disease: Patients with pre-existing heart block, severe shock, or compromised neurological function require extreme caution.
• Methemoglobinemia: Be aware that large doses of lidocaine, particularly topical application to mucous membranes, have been associated with methemoglobinemia, especially in susceptible individuals (e.g., those with G6PD deficiency).
• Malignant Hyperthermia: Although lidocaine is not a known triggering agent, standard monitoring for this condition during procedures is always advised.
• Allergy: Although true IgE-mediated allergy to amide-type anesthetics is rare, inquire about previous reactions. Cross-sensitivity with other amides (e.g., bupivacaine, ropivacaine) may occur.

Contraindications

• Known Hypersensitivity: Absolute contraindication in patients with a documented allergy to lidocaine or any other amide-type local anesthetic, or to any component of the formulation (e.g., methylparaben, which is a preservative in some multi-dose vials).
• Severe Shock or Heart Block: Contraindicated in patients with Adams-Stokes syndrome, Wolff-Parkinson-White syndrome, or severe degrees of sinoatrial, atrioventricular, or intraventricular block in the absence of a pacemaker.
• Epidural/Spinal Anesthesia Specific: Contraindicated in patients with sepsis, infection at the injection site, severe bleeding diathesis, or increased intracranial pressure.
• Intravenous Regional Anesthesia (Bier Block): The use of formulations containing epinephrine is absolutely contraindicated for this technique due to the risk of severe prolonged vasoconstriction and ischemia.

Possible side effect

Adverse reactions are generally dose-related and result from high plasma levels (toxicity) or unintended effects on other systems.

• Central Nervous System: Nervousness, dizziness, blurred vision, tremors, drowsiness, circumoral paresthesia, tinnitus. At higher concentrations: seizures, respiratory depression, and coma.
• Cardiovascular System: Usually seen only after significant systemic exposure. Includes hypotension, bradycardia, arrhythmias, and cardiovascular collapse, which can be fatal.
• Allergic Reactions: Rare. May range from skin eruptions (urticaria, rash) to anaphylactoid reactions, including bronchospasm and edema.
• Local Effects: Pain, tenderness, or erythema at the injection site. Persistent paresthesia or nerve damage is a rare but serious complication.
• Methemoglobinemia: Characterized by cyanosis that does not respond to oxygen, dyspnea, fatigue, and headache.

Drug interaction

• Other Local Anesthetics: Concomitant use may have additive toxic effects.
• Antiarrhythmic Drugs: (e.g., procainamide, quinidine, amiodarone) may potentiate myocardial depression.
• Beta-Blockers: (e.g., propranolol) may reduce hepatic blood flow, decreasing the metabolism of lidocaine and potentiating its toxicity.
• CYP3A4 and CYP1A2 Inhibitors: (e.g., cimetidine, fluvoxamine, certain antifungals) can decrease lidocaine metabolism, increasing the risk of toxicity.
• Vasopressors: The addition of epinephrine to lidocaine can potentiate the effects of other exogenously administered sympathomimetics, leading to severe hypertension or tachyarrhythmias.
• MAO Inhibitors / Tricyclic Antidepressants: May potentiate the pressor effect of epinephrine-containing formulations.

Missed dose

The concept of a “missed dose” is not applicable to Xylocaine when used as an on-demand local anesthetic for procedures. It is administered as a single dose for a specific intervention. For its antiarrhythmic intravenous use (a separate indication), dosing is managed in a continuous clinical setting where missed doses are handled by medical professionals according to a strict protocol.

Overdose

Lidocaine overdose is a medical emergency. Management is primarily supportive.

• Symptoms: Initially CNS excitation (nervousness, dizziness, tremors, seizures) followed by CNS depression (drowsiness, coma, respiratory arrest). Cardiovascular effects include hypotension, bradycardia, arrhythmias, and cardiac arrest.
• Management:
  1. Airway, Breathing, Circulation: Secure the airway and provide 100% oxygen. Assist ventilation as needed. Establish IV access.
  2. Seizures: Treat with a benzodiazepine (e.g., diazepam, midazolam). If unavailable, a short-acting barbiturate may be used.
  3. Hypotension/Bradycardia: Treat with IV fluids and vasopressors (e.g., ephedrine, norepinephrine) as required. Atropine may be used for bradycardia.
  4. Cardiac Arrest: Initiate advanced cardiac life support (ACLS) protocols.
  5. Lipid Emulsion Therapy: Intravenous lipid emulsion (e.g., 20% Intralipid) is a recognized antidotal therapy for severe local anesthetic systemic toxicity (LAST). A bolus of 1.5 mL/kg followed by an infusion of 0.25 mL/kg/min is recommended.

Storage

• Store at controlled room temperature, 20°-25°C (68°-77°F). Protect from light and freezing.
• Keep all formulations in their original container, tightly closed.
• Sterile injectable solutions are for single use in a single patient. Discard any unused portion. Multi-dose vials contain preservatives but must be handled with strict aseptic technique.
• Keep out of reach of children and pets.

Disclaimer

This information is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, anesthesiologist, or other qualified health provider with any questions you may have regarding a medical condition or procedure. Never disregard professional medical advice or delay in seeking it because of something you have read here. The dosage, administration, and indications for Xylocaine must be determined by a qualified healthcare professional based on the individual patient’s needs and clinical context.

Reviews

• “The gold standard for rapid-onset local anesthesia. Its reliability and predictable duration make it my first choice for most office-based procedures. The availability of different concentrations with and without epinephrine provides excellent flexibility.” – General Surgeon
• “An indispensable tool in the ER. From laceration repair to reducing fractures with a hematoma block, its efficacy is unmatched. Understanding its toxicity profile is paramount for safe use.” – Emergency Medicine Physician
• “The 2% jelly is fantastic for urethral catheterization and transesophageal echocardiography probe placement. It significantly improves patient comfort and tolerance for these often-unpleasant procedures.” – Critical Care Nurse
• “While newer agents exist for longer procedures, lidocaine remains the workhorse for dental anesthesia due to its excellent safety margin and proven history. It’s what I trained with and what I trust.” – Dentist