LIDOCAINE, TOPICAL
(Xylocaine, Xylocaine Viscous, Maxilene 5, Lidodan)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)
Dosages
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
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
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.
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).
Mechanism of Action
Topical anesthetic
Forms Supplied
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
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
Comments
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.
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.
References
4, 44, 67
Last Edited
2022-07-05 21:09:11