**Local Anesthetic (LA) Admixtures**

Revised 20201111 – Rothschiller, MD

**Drug Dilutions for Local Anesthetic Injection**

#### To make 40 mL of **Lidocaine 0.25%** with 5 mcg/mL of epinephrine:

- Add 10 mL of Lidocaine HCl 1%, Preservative Free, 10 mg/mL
- Add 30 mL of Sterile Sodium Chloride 0.9%, Preservative Free
- Add 0.2 mL of Epinephrine 1mg/mL (1:1000) Solution

Maximum lidocaine single dose with epinephrine vasoconstrictor is 6-7 mg/kg (infiltration) – not to exceed a 500 mg total dose.

**For example,**Lidocaine 0.25% contains 2.5 mg of lidocaine per 1 mL. Therefore the maximum volume of 0.25% lidocaine with epinephrine that can be administered to a 10 kg patient = 70 mg / 2.5 mg/mL = 28 mL

To convert 1:200,000 to mcg/mL: Divide 1,000,000 by the second number = 1,000,000/200,000 = 5 mcg/mL

**10 mL Vial Local Anesthetic **

- 1:50,000 Epinephrine Admixture: Add 0.2 mL epinephrine (1:1,000) to 10 mL of LA
- 1:100,000 Epinephrine Admixture: Add 0.1 mL epinephrine (1:1,000) to 10 mL of LA
- 1:200,000 Epinephrine Admixture: Add 0.05 mL epinephrine (1:1,000) to 10 mL of LA

**20 mL Vial Local Anesthetic**

- 1:50,000 Epinephrine Admixture: Add 0.4 mL epinephrine (1:1,000) to 20 mL of LA
- 1:100,000 Epinephrine Admixture: Add 0.2 mL epinephrine (1:1,000) to 20 mL of LA
- 1:200,000 Epinephrine Admixture: Add 0.1 mL epinephrine (1:1,000) to 20 mL of LA

**Local Anesthetic Drug Nomenclature:**

**Lidocaine**Hydrochloride Injection (Xylocaine®, lignocaine)**Ropivacaine**Hydrochloride Injection (Naropin®)**Bupivacaine**Hydrochloride Injection (Marcaine®, Sensorcaine®)

Epinephrine is the generic name (recommended international non-proprietary name) which is the same as adrenaline (British approved name). The proprietary (brand or trade) name is the name given by a pharmaceutical manufacturer. It is capitalized and the ® is added.

**Concentration of Diluted Drugs**

- 1:100 is the same as
**1% Solution**or a 10 mg/mL or 10,000 mcg/mL - 1:1,000 is the same as
**0.1% Solution**or 1 mg/mL or 1,000 mcg/mL - 1:10,000 is the same a
**0.01% Solution**= 0.1 mg/mL or 100mcg/mL - 1:100,000 is the same as
**0.001 % solution**= 0.01 mg/mL or 10 mcg/mL - 1:200,000 is the same as
**0.0005% solution**= 0.005 mg/mL or 5 mcg/mL

**Convert 1:200,000 to mcg/mL: Divide 1,000,000 by the second number = 1,000,000/200,000 = 5 mcg/mL**

Regular normal saline NS (0.9 % sodium chloride) and bNS [0.9 % sodium chloride with benzyl alcohol, United States Pharmacopeia (USP)]. Bacteriostatic Sodium Chloride Injection, USP is a sterile, non-pyrogenic, isotonic solution of sodium chloride (0.9 %) in water for injection.