Avoiding toxicity from too much local anesthesia can be a challenge when suturing large lacerations or multiple lacerations. For large lacerations, try using 0.25% bupivacaine, the maximum dose of which (because of its lower concentration) is 2 mg/kg, or about 70 mL. The maximum dose of 1% lidocaine is 4.5 mg/kg, or about 30 mL; and the maximum dose of 1% lidocaine plus epinephrine is 7 mg/kg, or about 50 mL. Consider repairing multiple lacerations one at a time; this allows the anesthetic from the first laceration to wear off before a second dose is given.
|D. Brady Pregerson, MD