DRUG SUPPLIED DOSE COMMENTS
LIDOCAINE, TOPICAL (Paeds)
(Xylocaine, Xylocaine Viscous, Maxilene 5, Lidodan)

Mechanism of action:

Topical anesthetic



Ref: 4, 44, 67


Last update: 2022-07-05		 jelly:  2%
jelly:  2% urological syringe
ointment:  5%
cream: 5%
viscous:  2% (20 mg/mL)
topical solution: 4% (40 mg/mL)
endotracheal spray: 10% each metered dose spray delivers 10 mg
Lidocaine 2% Jelly:
For surface anesthesia and lubrication (e.g. urethral catheter insertion). Current studies show no analgesic benefit in children less than 2 years

Lidocaine 5% Ointment:
For temporary topical analgesia:  Apply up to TID.

Lidocaine 5% Cream:
For sensory analgesia to manage anticipated procedural pain (eg. IV insertion, lumbar puncture): Apply
at least 30 minutes prior to procedure. Remove within 4 hours

Lidocaine 2% Viscous:
For temporary topical oropharyngeal anesthesia:  
Children < 3 years old:  Apply up to 1.2 mL to affected area with a cotton swab up to Q3H PRN.  Do not swallow
Children > 3 years old:  Swish and spit up to 0.2 mL/kg up to Q3H PRN.  Maximum dose: 15 mL.

Lidocaine endotracheal spray:
Attach nozzle and prime pump with 5-10 sprays before initial use.  Discard nozzle and unused portion of canister after use.
Children >2 years:  Max dose:
Laryngotracheal: 3 mg/kg (max: 200 mg for procedure <1 min, or 400 mg for procedure >5 min)
Nasal/oropharyngeal: 4-5 mg/kg (max: 500 mg for procedure <1 min or 600 mg for procedure > 5 min).

 Topical anesthesia in the mouth may impair swallowing and enhance aspiration risk; do not eat for 60 min. following use.

Lidocaine 5% cream may be used for treatment of localized neuropathic pain under the guidance of Pain Service teams (data extrapolated from use of lidocaine patches).

Lidocaine 2% viscous is not indicated for teething pain.

Health Canada safety review concluded there is a link between viscous lidocaine 2% and severe adverse effects in children 5 months to 4 years.

Significant systemic absorption does not occur with normal topical use, but increases with use on increased surface area and/or with increased frequency of application. Caution with application to broken skin as systemic absorption will occur.

Refer to Local Anesthetic Cream Application policy.



Standard Prescription:

lidocaine 2% jelly: apply to___(frequency) (prn)

lidocaine 5% ointment: apply to___(frequency) (prn)

lidocaine 2% viscous: __mL swish and spit Q    H (PRN) (__mL/kg/dose)

lidocaine 2% viscous: __mL apply to mouth with cotton swab Q    H (PRN) (__mL/kg/dose)