Avoiding toxicity from too much local anesthesia can be a challenge when suturing large lacerations or multiple lacerations. For large lacerations, try using 0.25% bupivacaine(Drug information on bupivacaine), the maximum dose of which (because of its lower concentration) is 2 mg/kg, or about 70 mL. The maximum dose of 1% lidocaine(Drug information on lidocaine) is 4.5 mg/kg, or about 30 mL; and the maximum dose of 1% lidocaine plus epinephrine(Drug information on epinephrine) is 7 mg/kg, or about 50 mL. Consider repairing multiple lacerations one at a time; this allows the anesthetic from the first laceration to wear off before a second dose is given.
|D. Brady Pregerson, MD|