Lidocaïne/Adrenaline Aguettant (Epinephrine, Lidocaine Hydrochloride)

Lidocaine/epinephrine is used in the local anesthetic pathway to provide targeted numbness for various procedures.

• Surgical procedures: provides localized anesthesia to facilitate incision and manipulation without pain.
• Nerve block anesthesia: enables temporary interruption of nerve signal transmission for regional anesthesia.
• Epidural analgesia: delivers analgesic effect for labor or postoperative pain management while limiting systemic exposure.

• Lidocaine blocks voltage‑gated sodium channels on neuronal membranes, preventing the initiation and propagation of nerve impulses. Epinephrine activates alpha‑ and beta‑adrenergic receptors, causing vasoconstriction at the injection site, which slows systemic absorption of lidocaine, prolongs its anesthetic duration, and reduces peak plasma concentrations.

Adverse reactions may occur following administration of lidocaine/epinephrine solution.

Common Side Effects

• Transient pain or burning at the injection site.
• Mild tachycardia or palpitations.
• Light‑headedness or dizziness.
• Nausea or mild vomiting.
• Metallic taste in the mouth.

Serious or Rare Side Effects

• Severe allergic reaction (anaphylaxis) with rash, swelling, or airway compromise.
• Cardiac arrhythmias or myocardial ischemia due to excessive epinephrine effect.
• Central nervous system toxicity such as seizures or profound confusion.
• Prolonged hypotension or cardiovascular collapse.
• Systemic lidocaine toxicity manifesting as tinnitus, visual disturbances, or loss of consciousness.

When using lidocaine/epinephrine, clinicians should observe several safety measures.

• Assess cardiovascular status: avoid in patients with uncontrolled hypertension or significant arrhythmias.
• Check for allergy: do not use in individuals with known hypersensitivity to lidocaine or epinephrine.
• Use caution with MAO inhibitors: risk of hypertensive crisis.
• Limit total dose: adhere to recommended maximum to prevent systemic toxicity.
• Avoid intravascular injection: aspirate before administration to ensure correct placement.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Lidocaine/epinephrine may interact with other medicines; awareness of key interactions helps prevent adverse events.

Major Interactions (Avoid)

• Beta‑blockers: may enhance epinephrine‑induced hypertension and bradycardia.
• Monoamine oxidase inhibitors: risk of severe hypertensive crisis.
• Non‑selective alpha antagonists (e.g., phentolamine): may diminish vasoconstriction, increasing systemic absorption.

Moderate Interactions (Monitor Closely)

• Diuretics: can alter lidocaine plasma levels, requiring observation.
• Calcium channel blockers: may increase lidocaine concentration and cardiac effects.