Lidocaína
Lidocaine
Lidocaine hydrochloride
También conocido como: Xylocaine MPF · EMLA · Intubeaze · Lignadrin · Lignol · Locovetic · Lidoderm · lidocaini hydrochloridum · lignocaine hydrochloride · Lidocainum
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Evidencia posológica v13 auditada
Evidencia estructurada para el cálculoRegional anesthesia (extra-label) — CRI via peritoneal wound catheter
Requiere verificación veterinaria
NA
Contexto clínico obligatorio (5)
- 1. Lidocaine formulation concentration, administration volume, site of administration, administration technique (eg, aspiration prior to injection), and underlying patient condition(s) are important interrelated factors that determine lidocaine’s safe and effective use.
- 2. All dosages below use 2% lidocaine (20 mg/mL) unless otherwise specified.
- Infiltration: dilute to 0.5% concentration (for each 1 mL of lidocaine 2% solution, dilute with 3 mL sterile water)
- Regional anesthesia (extra-label):
- Lidocaine should be stored at room temperature, at 15°C to 30°C (59°F-86°F).
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
La lidocaína es un anestésico local de tipo amida versátil y un agente antiarrítmico de Clase IB. En medicina veterinaria, se utiliza ampliamente no solo para anestesia local/regional, sino también por vía sistémica para el manejo de arritmias ventriculares, dolor neuropático y trastornos de la motilidad gastrointestinal.
Las aplicaciones clínicas clave incluyen:
- Terapia antiarrítmica: El fármaco de elección para la taquicardia ventricular (TV) aguda y potencialmente mortal y los complejos ventriculares prematuros (CVP) en perros.
- Analgesia sistémica: Se administra como infusión a velocidad constante (CRI), a menudo en combinación con opioides y ketamina (p. ej., MLK CRI), para proporcionar una analgesia adyuvante profunda, reducir la CAM (concentración alveolar mínima) de los anestésicos inhalados y mitigar el dolor neuropático o la hiperalgesia.
- Efectos procinéticos y antiinflamatorios: En caballos, la lidocaína sistémica se utiliza frecuentemente para tratar o prevenir el íleo posoperatorio y para eliminar especies reactivas de oxígeno (ROS), reduciendo así la lesión por reperfusión.
Perla clínica: Los gatos son significativamente más sensibles a los efectos tóxicos cardiodepresores y del sistema nervioso central (SNC) de la lidocaína. Su uso sistémico en felinos sigue siendo controvertido y requiere extrema precaución y una dosificación precisa.
Mecanismo de acción
Lidocaine exerts its effects through multiple mechanisms depending on the target tissue:
- Antiarrhythmic Action (Class IB): Lidocaine binds to and blocks fast voltage-gated sodium channels (Nav1.5) in the myocardium. It exhibits use-dependent and state-dependent blockade, meaning it preferentially binds to sodium channels in their inactive state (which occurs during depolarization). This action → attenuates phase 4 diastolic depolarization → decreases automaticity → suppresses ectopic ventricular pacemakers without significantly affecting the SA or AV nodes at therapeutic levels.
- Local Anesthetic/Analgesic Action: Blocks neuronal voltage-gated sodium channels, preventing the influx of sodium required for the initiation and conduction of action potentials in peripheral nerves. Systemically, it reduces ectopic firing from damaged afferent neurons, providing relief from neuropathic pain.
- Prokinetic & Cytoprotective Action: The exact mechanism for enhancing intestinal motility (especially in equine ileus) is multifactorial, likely involving suppression of sympathetic inhibitory reflexes, direct anti-inflammatory effects, and acting as a scavenger of reactive oxygen species (ROS) to prevent lipid peroxidation and reperfusion injury.
Seguridad y advertencias
Contraindicaciones
- Known hypersensitivity to amide-class local anesthetics
- Severe SA, AV, or intraventricular heart block (unless artificially paced)
- Adams-Stokes syndrome
- Intravenous use of lidocaine products containing epinephrine
- Continuous rate infusion (CRI) in cats during the perioperative period (due to negative haemodynamic effects)
- Intravenous administration of lidocaine solutions containing adrenaline
- Use of adrenaline-containing solutions for complete ring block of an extremity (danger of ischaemic necrosis)
Efectos adversos
- CNS toxicity (dose-related): drowsiness, depression, ataxia, nystagmus, muscle tremors, seizures
- Gastrointestinal: nausea and vomiting (usually transient)
- Cardiovascular: hypotension (especially with rapid IV bolus), bradycardia, PR and QRS interval prolongation, circulatory collapse at toxic doses
- Cats: heightened risk of severe cardiodepression and CNS signs
- Muscle fasciculations
- Laryngeal oedema (in cats, associated with CFC propellants in unlicensed aerosols)
Precauciones
Use with extreme caution in cats due to heightened sensitivity to CNS and cardiodepressant effects. Use cautiously in patients with liver disease, congestive heart failure, shock, hypovolemia, severe respiratory depression, or marked hypoxia. Patients susceptible to malignant hyperthermia require intensified monitoring. NEVER administer lidocaine containing epinephrine intravenously.
Interacciones farmacológicas
Lidocaine infusions reduce MAC requirements. Additive cardiodepression may occur, especially in cats.
May cause additive or antagonistic cardiac effects; enhanced risk of toxicity.
May decrease lidocaine clearance, increasing lidocaine levels and effects.
Diuretic-induced hypokalemia may reduce the antiarrhythmic efficacy of lidocaine.
May induce hepatic enzymes, increasing lidocaine metabolism and decreasing its serum levels.
May decrease hepatic blood flow and lidocaine clearance, increasing lidocaine levels.
Large doses of lidocaine may prolong succinylcholine-induced apnea.
May cause increased myocardial depression
Monitorización
- Continuous ECG monitoring (especially during IV bolus or CRI)
- Signs of CNS toxicity (ataxia, tremors, seizures)
- Blood pressure (monitor for hypotension)
- Serum lidocaine levels if available (Therapeutic range: 1-6 micrograms/mL)
- ECG (especially during IV therapy for arrhythmias)
- Heart rate
- CNS signs (monitor for fasciculations or seizures)
Farmacocinética
Vida media
Absorción
High first-pass effect makes it ineffective orally. Following a therapeutic IV bolus, onset of action is generally within 2 minutes with a duration of 10-20 minutes.
Distribución
Rapidly redistributed from plasma into highly perfused organs (kidney, liver, lungs, heart), then widely throughout body tissues. High affinity for fat and adipose tissue. Bound to plasma proteins (primarily alpha1-acid glycoprotein). Vd is approximately 4.5 L/kg in dogs.
Metabolismo
Rapidly metabolized in the liver to active metabolites (MEGX and GX).
Eliminación
Less than 10% of a parenteral dose is excreted unchanged in the urine.
Sobredosis
In dogs, toxicity may result if serum levels exceed 8 micrograms/mL.
- Clinical Signs: Ataxia, nystagmus, depression, seizures, bradycardia, hypotension, and at very high levels, circulatory collapse.
- Management: Because lidocaine is rapidly metabolized, simply stopping the infusion or reducing the rate (with close monitoring) is often sufficient for minor signs.
- Seizure Control: Treat seizures or excitement with diazepam or a short/ultrashort-acting barbiturate. > Warning: Longer-acting barbiturates (e.g., pentobarbital) should be avoided.
- Cardiovascular Support: Treat circulatory depression with IV fluids, pressor agents, and initiate CPR if necessary.
Productos disponibles
Formulaciones
- Injection: 0.5%, 1%, 1.5%, 2%, 4% solutions
- Premixed IV infusion solutions (with D5W)
- Topical: patches, ointments, creams, lotions, gels, sprays, and jellies
- Injectable: 1% solution
- Injectable: 2% solution (some contain adrenaline)
- Topical: 2% solution
- Topical: 4% solution
- Topical: 2.5% cream (with prilocaine)
- Transdermal: 5% patches
Veterinario
- Lidocaine HCl for Injection: 2% (20 mg/mL) in 100 mL & 250 mL multi-use vials
- Intubeaze 2% topical solution
- Lignadrin injectable
- Lignol injectable
- Locaine injectable
- Locovetic injectable
Etiquetado para humanos
- Lidocaine Hydrochloride Injection: 0.5%, 1%, 1.5%, 2% & 4% in various vials, ampules, and syringes
- Lidocaine Hydrochloride with Dextrose Injection: 1.5% or 5% with 7.5% dextrose
- Premixed IV infusions in D5W (2 mg/mL, 4 mg/mL, 5 mg/mL)
- Topical liquids, patches, ointments, creams, lotions, gels, sprays, and jellies
- EMLA 2.5% cream (with prilocaine)
- Xylocaine 4% topical solution
- Lidoderm 5% transdermal patch
Estado regulador
POM-V classification
POM-V classification
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Store at temperatures less than 40°C, preferably between 15-30°C. Avoid freezing.
Información para el cliente
La lidocaína es un medicamento potente utilizado principalmente en el entorno hospitalario por profesionales veterinarios.
- Propósito: Se utiliza para corregir ritmos cardíacos anormales (arritmias) que ponen en peligro la vida o para proporcionar alivio continuo del dolor (a menudo mezclado con otros analgésicos) después de una cirugía mayor o un traumatismo.
- Monitoreo: Debido a que el fármaco se administra directamente en el torrente sanguíneo, su mascota será monitoreada de cerca (generalmente con un ECG y controles de presión arterial) para garantizar que la dosis sea segura y efectiva.
- Efectos secundarios: Si ocurren efectos secundarios, generalmente son leves y se resuelven rápidamente una vez que se ajusta la velocidad de administración del medicamento. Los signos a observar (si su mascota está despierta) incluyen somnolencia, temblores musculares o náuseas.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.