Lidocaïne / Adrenaline Aguettant (Epinephrine, Lidocaine Hydrochloride)

Lidocaine with epinephrine is used in local anesthetic procedures to provide temporary loss of sensation in targeted tissues.

• Local anesthesia for surgical procedures: provides analgesia for minor and major surgeries requiring regional numbness.
• Epidural anesthesia: enables pain control during childbirth or lower‑body surgeries by blocking nerve transmission in the epidural space.
• Infiltration anesthesia: allows localized numbness for superficial procedures such as skin suturing or dental work.
• Perineural (nerve block) anesthesia: delivers targeted nerve blockade for limb or extremity surgeries, extending analgesia duration.

• Lidocaine exerts its effect by binding to voltage‑gated sodium channels on neuronal membranes, stabilizing the inactive state and preventing depolarization, which blocks nerve impulse propagation. Epinephrine acts on α‑adrenergic receptors on vascular smooth muscle, causing vasoconstriction that reduces local blood flow. This vasoconstriction limits systemic absorption of lidocaine, prolonging the anesthetic duration and overall decreasing bleeding at the injection site.

Adverse reactions to the lidocaine‑epinephrine combination can range from mild, transient events to serious, potentially life‑threatening conditions.

Common Side Effects

• Burning or stinging at injection site: brief discomfort that resolves quickly.
• Tingling or numbness: expected sensory changes lasting until drug wears off.
• Light‑headedness or dizziness: transient due to systemic absorption.
• Mild tachycardia: increased heart rate from epinephrine.
• Nausea or vomiting: occasional gastrointestinal upset.

Serious or Rare Side Effects

• Severe allergic reaction: hives, swelling, bronchospasm, or anaphylaxis requiring emergency care.
• Cardiac arrhythmias: irregular heartbeat that may need monitoring.
• Seizures: central nervous system excitation from high lidocaine levels.
• Cardiovascular collapse: profound hypotension or shock in rare cases.
• Tissue necrosis: prolonged vasoconstriction causing local tissue damage.

When using lidocaine with epinephrine, clinicians should observe several safety measures to minimize risks.

• Allergy assessment: avoid in patients with known lidocaine or epinephrine hypersensitivity.
• Cardiovascular status: use cautiously in patients with uncontrolled hypertension or arrhythmias.
• Pregnancy: safety not established; weigh benefits vs risks.
• Pediatric use: dose must be calculated by qualified professional.
• Drug interactions: review concomitant medications that affect catecholamine levels.
• Store below 25°C: keep in original container, protect from light and moisture.

Lidocaine‑epinephrine may interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• MAO inhibitors: risk of hypertensive crisis when combined with epinephrine.
• Other local anesthetics: additive toxicity may increase systemic adverse effects.
• Tricyclic antidepressants: can potentiate lidocaine’s cardiotoxicity.

Moderate Interactions (Monitor Closely)

• Beta‑blockers: may blunt epinephrine‑induced tachycardia, masking signs of toxicity.
• Antihypertensive agents: epinephrine may counteract blood‑pressure‑lowering effects.
• Calcium channel blockers: possible enhanced cardiovascular effects when combined.