Posology : מינונים

4.2. Posology and method of administration                           weight. Dosages may need adaptation as cardiac
Posology                                                             output and hepatic blood flow may decrease with Local and regional anaesthesia                                       advanced age indicating a decreased clearance of As a matter of principle the smallest possible dose that             lidocaine (see section 5.2).
produces adequate anaesthesia should be administered.
The dosage should be adjusted individually according to              Other special patient groups the particulars of each case.                                        Doses should be reduced in patients in poor general condition or in those with reduced protein binding capacity
Adults:                                                              (resulting e.g. from renal insufficiency, liver insufficiency, When injected into tissues with marked systemic                      cancer, pregnancy).
absorption, without combination with a vasoconstrictor, a            In patients with severe renal insufficiency the dose may single dose of lidocaine Hydrochloride monohydrate                   need to be adapted due to reduced clearance and should not exceed 4.5 mg/kg body weight (BW) (or 300                 increased half-life of lidocaine (see section 5.2).
mg). If combined with a vasoconstrictor, 7 mg/kg BW (or              Patients with liver diseases show reduced tolerance 500 mg) of lidocaine Hydrochloride monohydrate per                   towards amide-type local anaesthetics. This may be due single dose should not be exceeded.                                  to reduced hepatic metabolism and decreased protein synthesis resulting in a lower protein binding rate of the
For the clinical uses listed below, recommendations for              local anaesthetic. Dose reduction is advisable in such single doses and strengths of the injection solution to be           cases.
administered to adults with average body weight (70 kg)              The dose should be reduced in patients showing clinical are as follows:                                                      signs of cardiac insufficiency. Nevertheless, local or regional nerve blockage can be the anaesthetic method
Usual of choice in such patients.
Type of              Concentration                                    During pregnancy, the dose may need to be reduced volume    Maximum dose [mg] anaesthesia          [%]
[ml]                               depending on the type of anaesthesia. Regional 300                      anaesthetic blocks in which usually large doses are Infiltration         0.5-1
500 (with epinephrine)   required should be avoided during the first trimester.
Major nerve blocks   1-2            30-50    500 (with epinephrine)   For use in anaesthetic blocks in which smaller doses are Minor nerve blocks   1              5-20     200                      administered, the dosage may need to be reduced because of the altered anatomical and physiological
Epidural             1-2            15-30*   500 (with epinephrine) characteristics in late pregnancy.
1.5 or 5 in
Spinal                              1-2      100
7.5% glucose
Method of administration
Intravenous regional anaesthesia (IVRA) 0.5              40                                Local and regional anaesthesia - upper limb         0.25           50-100                            Intradermal, intramuscular, subcutaneous, or -lower limb                                                           submucosal use (infiltration), perineural (injection into *1.5 ml per segment in average                                     the surroundings of peripheral nerves), epidural or spinal use. Intravenous use regarding intravenous regional anaesthesia (Bier`s block).
Every local anaesthetic procedure should only be             4.5. Interaction with other medicinal products and carried out by personnel adequately skilled in the           other forms of interactions respective anaesthetic technique.                            Pharmacodynamic interactions • Vasoconstrictors