How are local anesthetic agents categorized?

Updated: Jan 09, 2019
  • Author: Raffi Kapitanyan, MD; Chief Editor: David Vearrier, MD, MPH  more...
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Answer

Local anesthetics can be divided into 2 groups: the esters and the amides. See Table 2, below.

Table 2. Local Anesthetic Agents Used Commonly for Infiltrative Injection (Open Table in a new window)

Agent

Duration of Action

Maximum Dosage Guidelines (Total Cumulative Infiltrative Injection Dose per Procedure*)

Esters

Procaine (Novocaine)

Short (15-60 min)

7 mg/kg; not to exceed 350-600 mg

Chloroprocaine (Nesacaine)

Short (15-30 min)

Without epinephrine: 11 mg/kg; not to exceed 800 mg total dose

With epinephrine: 14 mg/kg; not to exceed 1000 mg

Amides

Lidocaine (Xylocaine)

Medium (30-60 min)

Without epinephrine: 4.5 mg/kg; not to exceed 300 mg

Lidocaine with epinephrine

Long (120-360 min)

With epinephrine: 7 mg/kg

Mepivacaine (Polocaine, Carbocaine)

Medium (45-90 min) Long (120-360 min with epinephrine)

7 mg/kg; not to exceed 400 mg

Bupivacaine (Marcaine)

Long (120-240 min)

Without epinephrine: 2.5 mg/kg; not to exceed 175 mg total dose

Bupivacaine with epinephrine

Long (180-420 min)

With epinephrine: Not to exceed 225 mg total dose

Etidocaine (Duranest)

No longer available in United States

Long (120-180 min)

Without epinephrine: 0.4 mg/kg; not to exceed 300 mg total dose

With epinephrine: 8 mg/kg

Prilocaine (Citanest)

Medium (30-90 min)

Body weight < 70 kg: 8 mg/kg; not to exceed 500 mg

Body weight >70 kg: 600 mg

Ropivacaine (Naropin)

Long (120-360 min)

5 mg; not to exceed 200 mg for minor nerve block

*Nondental use, administer by small incremental doses; administer the smallest dose and concentration required to achieve desired effect; avoid rapid injection.


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