리도카인
Lidocaine
Lidocaine hydrochloride
다른 이름: Xylocaine MPF · EMLA · Intubeaze · Lignadrin · Lignol · Locovetic · Lidoderm · lidocaini hydrochloridum · lignocaine hydrochloride · Lidocainum
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
구조화 용량 계산 근거Regional anesthesia (extra-label) — CRI via peritoneal wound catheter
인증된 수의사 확인 필요
NA
반드시 함께 고려할 임상 맥락 (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).
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
리도카인은 다목적으로 사용되는 아마이드계 국소 마취제이자 Class IB 항부정맥제입니다. 수의학에서는 국소/부위 마취뿐만 아니라 심실성 부정맥, 신경병증성 통증 및 위장관 운동 장애를 관리하기 위해 전신적으로도 널리 사용됩니다.
주요 임상 적용:
- 항부정맥 치료: 개에서 급성으로 생명을 위협하는 심실 빈맥(VT) 및 심실 조기 수축(VPC) 치료의 일차 선택약입니다.
- 전신 진통: 지속적 정맥 점적(CRI)으로 투여되며, 종종 오피오이드 및 케타민과 병용(예: MLK CRI)하여 강력한 보조 진통 효과를 제공하고, 흡입 마취제의 최소 폐포 농도(MAC)를 낮추며, 신경병증성 통증이나 통각 과민을 완화합니다.
- 위장관 운동 촉진 및 항염증 효과: 말에서는 수술 후 장폐색(ileus)을 치료하거나 예방하고, 활성 산소종(ROS)을 제거하여 재관류 손상을 줄이기 위해 전신적 리도카인이 자주 사용됩니다.
임상 팁: 고양이는 리도카인의 심장 억제 및 중추신경계(CNS) 독성 효과에 훨씬 더 민감합니다. 고양이에서의 전신적 사용은 여전히 논란의 여지가 있으며, 극도의 주의와 정확한 용량 조절이 필요합니다.
작용 기전
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.
안전성·주의사항
금기사항
- 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)
부작용
- 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)
주의
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.
약물 상호작용
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
모니터링
- 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)
약동학
반감기
흡수
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.
분포
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.
대사
Rapidly metabolized in the liver to active metabolites (MEGX and GX).
배설
Less than 10% of a parenteral dose is excreted unchanged in the urine.
과다투여
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.
제품
제형
- 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
동물용의약품
- 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
인용의약품
- 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
규제 현황
POM-V classification
POM-V classification
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store at temperatures less than 40°C, preferably between 15-30°C. Avoid freezing.
보호자 정보
리도카인은 강력한 약물로, 일반적으로 동물병원에서 수의학 전문가에 의해서만 사용됩니다.
- 목적: 생명을 위협하는 비정상적인 심장 박동(부정맥)을 교정하거나, 큰 수술이나 외상 후 지속적인 통증 완화(종종 다른 진통제와 혼합하여 사용)를 제공하기 위해 사용됩니다.
- 모니터링: 약물이 혈류로 직접 투여되기 때문에, 용량이 안전하고 효과적인지 확인하기 위해 반려동물은 면밀한 모니터링(일반적으로 심전도 및 혈압 측정 포함)을 받게 됩니다.
- 부작용: 부작용이 발생하더라도 대개 경미하며 약물 투여 속도를 조절하면 빠르게 사라집니다. 반려동물이 깨어 있는 경우 졸음, 근육 떨림 또는 메스꺼움 등의 징후가 있는지 관찰하십시오.
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