In children, it is important to consider the maximum doses of local anesthetics when performing a laceration repair or painful procedure like abscess drainage. If there are multiple lacerations, or large lacerations, it may be possible to exceed those doses if one is not careful.
Max doses of common anesthetics
Lidocaine WITHOUT epinephrine – 4 mg/kg (0.4 mL/kg of 1% lidocaine)
Lidocaine WITH epinephrine – 7 mg/kg (0.7 mL/kg of 1% lidocaine)
Bupivicaine WITHOUT epinephrine – 2 mg/kg (0.8 mL/kg of 0.25% bupivicaine)
Bupivicaine WITH epinephrine – 3 mg/kg (1.2 mL/kg of 0.25% bupivicaine)
For example, in a 20 kg child (an average 5-6 year old), the maximum doses would be:
Lidocaine 1% - 8 ml
Lidocaine 1% with epi – 14 ml
Lidocaine 2% - 4 ml
Bupivicaine 0.25% - 16 ml
Bupivicaine 0.25% with epi - 24 ml
Pearls:
For added safety, some advocate not exceeding 80% of the max dose in children < 8 years of age
Higher concentration of lidocaine beyond 1% does not improve the time of onset or duration of action and may increases the risk of toxicity
The addition of epinephrine increases the maximum dose and duration of action, but may be more painful during infiltration
If the repair requires large amount of local anesthetic, consider doing an regional block
