MDose · Veterinary drug reference
TIER2 TOPIC: LOCAL ANESTHETICS (LIDOCAINE / BUPIVACAINE ± MEPIVACAINE)
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Pending clinical review (PROPOSED)Rule-based (RULE_BASED)— applies to the facts and dose entries in this species selection; individual source records retain their own status.
Indications2
Local/regional anesthesia: infiltration, line/incisional blocks, nerve blocks (dental), epidurals; topical (EMLA for venipuncture/catheter placement); IV lidocaine CRI for perioperative/hyperalgesic analgesia; lidocaine systemic = ventricular antiarrhythmic (see pearls)
DogCatExtra-label (EXTRA_LABEL)2 source records · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Local/regional anesthesia: infiltration, line/incisional blocks, nerve blocks (dental), epidurals; topical (EMLA for venipuncture/catheter placement); IV lidocaine CRI for perioperative/hyperalgesic analgesia; lidocaine systemic = ventricular antiarrhythmic (see pearls) — Extra-label (human/LA products); approved injectable forms
- Cat · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Local/regional anesthesia: infiltration, line/incisional blocks, nerve blocks (dental), epidurals; topical (EMLA for venipuncture/catheter placement); IV lidocaine CRI for perioperative/hyperalgesic analgesia; lidocaine systemic = ventricular antiarrhythmic (see pearls) — Extra-label (human/LA products); approved injectable forms
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Dose regimens0
No dose regimens recorded for this species selection.
Adverse effects4
Systemic toxicity (intravascular injection/overdose): CNS excitation → seizures (lidocaine-type) vs CARDIAC collapse/arrest (bupivacaine-type) — The feared complication — calculate max dose BEFORE drawing up
CatNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Cat · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Methemoglobinemia (prilocaine/EMLA large-surface use) — Class effect
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Epidural: respiratory paralysis with high doses — Technique-dependent
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Cat CNS/cardiodepressant sensitivity (IV lidocaine) — Species caution — controversial as antiarrhythmic
CatNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Cat · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Monitoring1
Clinical: Aspiration before every injection; total-dose arithmetic vs weight BEFORE administration; CNS/behavior during blocks (early toxicity = talkative/restless in humans, tremors in animals); ECG with systemic use
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Monitoring Parameters · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Contraindications1
Amide hypersensitivity; severe SA/AV/intraventricular block (unpaced), Adams-Stokes (systemic use)
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Precautions5
Hepatic disease/CHF/shock/hypovolemia (systemic absorption + clearance); bupivacaine never IV for regional purpose; malignant-hyperthermia-susceptible monitoring
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Draw the dose map first: know the animal's max mg (e.g., cat bupivacaine <2 mg/kg, toxic at 5) before the syringe is filled — "a little more for good effect" is how LA deaths happen.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Lidocaine = fast/short/safe-ish (CNS warns first); bupivacaine = slow/long/cardiotoxic (no warning, arrest) — which drug for a dental nerve block vs a line block follows directly.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Lipid rescue (IVFE): intralipid is the antidote for systemic local-anesthetic toxicity — bupivacaine's lipophilicity is literally its Achilles heel.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
IV lidocaine's triple life: local anesthetic → ventricular antiarrhythmic → perioperative analgesic/anti-hyperalgesic CRI (cats: caution at every turn).
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Interactions4
Other antiarrhythmics, beta-blockers, CCBs — Additive cardiac depression
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Cimetidine/beta-blockers (human) — ↑ lidocaine levels
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Opioids/α2 (deliberate) — Multimodal epidural/perineural synergy
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
IV lipid emulsion — The rescue therapy for systemic LA toxicity (see pearls)
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pharmacokinetics4
Mechanism — Reversible sodium-channel blockade → conduction failure (small unmyelinated fibers first: pain → warm/cold → touch → motor)
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Onset/duration — Lidocaine: fast (~minutes), short (~1–2 h with epi); Bupivacaine: slow (~20 min), long (6–8 h) — the trade that defines their roles
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Cardiac ratio — Bupivacaine is markedly more cardiotoxic (high protein-binding, "fast-in slow-out" channels) — CVS toxicity before CNS signs (opposite of lidocaine)
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Epinephrine add — Prolongs duration, reduces bleeding, permits higher total dose
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pregnancy / lactation considerations1
Anesthetic-context use; no specific monograph restriction.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 727–730 (lidocaine, incl. local/systemic uses); Saunders Handbook of Veterinary Drugs (Papich), 4th ed., p. 86–87 (bupivacaine) — Pregnancy & Lactation · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Sources: Plumb DC. Plumb's Veterinary Drug Handbook. 7th ed. PharmaVet Inc; 2011.
Owner information handout
Plain-language medication information to review with the owner. Open the handout to print it or download a PDF.