Xylocaine 2% Plain Injection Dosage/Direction for Use

MDV: Adults and children above 12 yrs of age: Xylocaine should only be used by physicians with experience of regional anaesthesia or under their supervision. The lowest possible dose for adequate anaesthesia should be used.
Maximum recommended doses: Xylocaine 20 mg/ml, 20 ml (400 mg lidocaine hydrochloride).
Table 1 Dosage Recommendations, is a guide to dosage for the more commonly used techniques in the average adult. The clinician's experience and knowledge of the patient's physical status are of importance in calculating the required dose. When prolonged blocks are used, e.g., by repeated administration, the risks of reaching a toxic plasma concentration or inducing a local neural injury must be considered. (See Table 1.)

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The doses given in the table are those considered to be necessary to produce successful blocks and should be regarded as a guide for use in adults. Individual variations in onset and duration occur. The figures reflect the expected average dose range needed. Standard textbooks should be consulted for factors affecting specific block techniques and for individual patient requirements.
Unnecessarily high doses of local anaesthetics are to be avoided. In general, surgical anaesthesia requires the use of the higher concentrations and doses. When blocking smaller nerves, or when a less intense block is required, the use of a lower concentration is indicated. The volume of drug used will affect the extent and spread of anaesthesia.
In order to avoid intravascular injection, aspiration should be repeated prior to and during administration of the main dose, which should be injected slowly or in incremental doses, at a rate of 100-200 mg/min, while closely observing the patient's vital functions and maintaining verbal contact. An inadvertent intravascular injection may be recognised by a temporary increase in heart rate and an accidental intrathecal injection by signs of a spinal block. If toxic symptoms occur, the injection should be stopped immediately.
The doses should be reduced for children and patients in reduced general condition.
Polyamp: The lowest dosage and volume that results in effective anaesthesia should be used and should be based on the status of the patient and the type of regional anaesthesia intended. XYLOCAINE solutions contain no antimicrobial agent and should be used only once and any residue discarded.
Lignocaine should be administered with great caution to patients with impaired cardiovascular function as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs.
Adult: RECOMMENDED DOSAGES FOR XYLOCAINE PLAIN SOLUTIONS FOR VARIOUS ANAESTHETIC PROCEDURES IN THE AVERAGE, HEALTHY, 70 KG ADULT PATIENT. (See Table 2.)

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Note: Recommended Doses: The previously suggested concentrations and volumes serve only as a guide. Toxic doses vary widely between patients and toxic effects may occur after any local anaesthetic procedure.
Careful observation of the patient must therefore be maintained. It is recommended that the dose of lignocaine at any one time should not exceed 3 mg/kg (plain solutions) However, the dose administered must be tailored to the individual patient and procedure, and the maximum doses here quoted should be used as a guide only.
Hypotension: During thoracic, lumbar and caudal epidural anaesthesia, a marked fall in blood pressure and/or intercostal paralysis may be seen, possibly due to the use of excessive doses, improper positioning of the patient or accidental disposition of the anaesthetic within the subarachnoid space. Hypotension and bradycardia may occur as a result of sympathetic blockade.
Test dose: For epidural anaesthesia, a 3 - 5 mL test dose of a local anaesthetic solution should be administered. Verbal contact and repeated monitoring of heart rate and blood pressure should be maintained for 5 minutes after the test dose after which, in the absence of signs of subarachnoid or intravascular injection, the main dose may be administered.
Prior to administration of the total dose, aspiration should be repeated. The main dose should be injected slowly, with continual assessment of the patient. If toxic symptoms or signs occur, the injection should be stopped immediately.
Use in Children: For children, a reduced dosage based on body weight or surface area should be used. The dosage should be calculated for each patient individually and modified in accordance with the physician's experience and knowledge of the patient.
In children, early signs of local anaesthetic toxicity may be difficult to detect in cases where the block is given during general anaesthesia.
Use in Elderly: A reduction in dosage may be necessary for elderly patients especially those with compromised cardiovascular and/or hepatic function.
In epidural anaesthesia, a smaller dose may provide adequate anaesthesia.
With impaired hepatic function: Although lignocaine is metabolised by the liver, dosage reduction for local anaesthesia is probably not warranted. However, caution should be exercised with repeated doses.
With impaired renal function: Impairment of renal function is unlikely to affect lignocaine clearance in the short term (24 hours). However, toxicity due to accumulation may develop with prolonged or repeated administration.