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Lidocaine

Grade

Local Anaesthesia

Sole Agent Use

  • Dosing: <0.5 mg/kg, Local infiltration or injection, q4-5h  at any single site; <2 mg/kg total dose if multiple sites.

  • Technique: The total dose (2mg/kg) or less is drawn up and then used to effect depending upon the size, location and number of treatment target areas.

Multi-Agent Use with Bupivacaine

  • Dosing: Lidocaine (0.4 mg/kg)/Bupivacaine (0.2 mg/kg) local infiltration at a single site such as a castration or coeliotomy site. (Miller et al., 2022). A total dose of 2 mg/kg lidocaine and 1 mg/kg bupivacaine is proposed (Barter, 2011).

  • Technique: The total dose (2mg/kg) or less of both agents is drawn up and then used to effect depending upon the size, location and number of treatment target areas.

Targeted Blocks

Targeted blocks include line, ring, intraarticular, paravertebral, sciatic-femoral, radial, ulnar, median, and musculocutaneous nerve, and intercostal blocks. Other sections of this monograph cover dental, ocular and epidural analgesia.


Therapeutics

Therapeutics

Sole Use

  • Onset of Action: The onset of action in most veterinary species is presumed to be 5-10 minutes (Barletta and Reed, 2019).

  • Duration of Action: The duration of action in most veterinary species is presumed to be 60-90 minutes (Barletta and Reed, 2019).

Multi-Modal Use

  • Combined use with Bupivacaine: The bupivacaine component has a slower onset of action (20-30 mins), but the benefit persists far longer ( 3-10 hours). A combined administration has the pharmacological benefit of early-onset persistent local analgesia.

Maximum Dose

  • Rabbits: Until clear information regarding toxic doses is available, we recommend a maximum therapeutic dose of 2 mg/kg per administration for rabbits regardless of route, with a maximum administration of 0.5 mg/kg at any site.

  • Toxic Dose: Several studies have safely administered 2mg/kg multiple times intravenously or through deep body injection without adverse effects, and therefore, dosing as high as 4mg/kg appears well tolerated, and rabbits are presumed to metabolise this agent faster than most major pet species (Di Bella et al., 2021; Schnellbacher et al., 2017, 2013) 

Treatment Goals

  • To reduce or avoid patient exposure to pain during surgical and traumatic procedures.

Treatment End Point

  • To complete surgical and traumatic procedures with minimal exposure to pain and the best possible post-procedure recovery.

Alternative Products

Alternative Protocols

  • Lidocaine can be administered alongside Bupivacaine to extend the duration of activity without increasing the time of onset of local analgesia.


Evidence

Evidence Base

1 Species-Specific Evidence Review

  1. Barter, L.S., 2011. Rabbit Analgesia. Veterinary Clinics of North America: Exotic Animal Practice, Analgesia and Pain Management 14, 93–104. https://doi.org/10.1016/j.cvex.2010.09.003

  2. Di Bella, C., Pennasilico, L., Staffieri, F., Serino, F., Palumbo Piccionello, A., 2021. Ultrasound-Guided Lateral Transversus Abdominis Plane (TAP) Block in Rabbits: A Cadaveric Study. Animals (Basel) 11, 1953. https://doi.org/10.3390/ani11071953

  3. Gardhouse, S., Sanchez, A., 2022. Rabbit Sedation and Anesthesia. Veterinary Clinics of North America: Exotic Animal Practice 25, 181–210. https://doi.org/10.1016/j.cvex.2021.08.012

  4. Kluge, K., Larenza Menzies, M.P., Kloeppel, H., Pearce, S.G., Bettschart-Wolfensberger, R., Kutter, A.P.N., 2017. Femoral and sciatic nerve blockades and incision site infiltration in rabbits undergoing stifle joint arthrotomy. Lab Anim 51, 54–64. https://doi.org/10.1177/0023677215622734

  5. Miller, A.L., Clarkson, J.M., Quigley, C., Neville, V., Krall, C., Geijer-Simpson, A., Flecknell, P.A., Leach, M.C., 2022. Evaluating Pain and Analgesia Effectiveness Following Routine Castration in Rabbits Using Behavior and Facial Expressions. Front Vet Sci 9, 782486. https://doi.org/10.3389/fvets.2022.782486

  6. Monge, E., Donnelly, T.M., Coutant, T., Bennett, R.A., Pignon, C., 2023. Lateral ear canal resection and bulla osteotomy with marsupialization to treat otitis media in rabbits: forty-eight procedures. Veterinary Surgery 52, 1100–1111. https://doi.org/10.1111/vsu.14017

  7. Schnellbacher, R.W., Carpenter, J.W., Mason, D.E., KuKanich, B., Beaufrère, H., Boysen, C., 2013. Effects of lidocaine administration via continuous rate infusion on the minimum alveolar concentration of isoflurane in New Zealand White rabbits (Oryctolagus cuniculus). Am. J. Vet. Res. 74, 1377–1384. https://doi.org/10.2460/ajvr.74.11.1377

  8. Schnellbacher, R.W., Divers, S.J., Comolli, J.R., Beaufrère, H., Maglaras, C.H., Andrade, N., Barbur, L.A., Rosselli, D.D., Stejskal, M., Barletta, M., Mayer, J., Rodriguez, P., Quandt, J.E., 2017. Effects of intravenous administration of lidocaine and buprenorphine on gastrointestinal tract motility and signs of pain in New Zealand White rabbits after ovariohysterectomy. Am. J. Vet. Res. 78, 1359–1371. https://doi.org/10.2460/ajvr.78.12.1359

  9. Serpieri, M., Bonaffini, G., Ottino, C., Quaranta, G., Mauthe von Degerfeld, M., 2024. Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy. Animals 14, 551. https://doi.org/10.3390/ani14040551

  10. Vasseur, P.B., Paul, H.A., Dybdal, N., Crumley, L., 1984. Effects of local anesthetics on healing of abdominal wounds in rabbits. Am. J. Vet. Res. 45, 2385–2388.

2 Condition-Specific Evidence Review

  1. Barletta, M., Reed, R., 2019. Local Anesthetics. Veterinary Clinics of North America: Small Animal Practice 49, 1109–1125. https://doi.org/10.1016/j.cvsm.2019.07.004

  2. Barter, L.S., 2011. Rabbit Analgesia. Veterinary Clinics of North America: Exotic Animal Practice, Analgesia and Pain Management 14, 93–104. https://doi.org/10.1016/j.cvex.2010.09.003

  3. DiGeronimo, P.M., da Cunha, A.F., 2022. Local and Regional Anesthesia in Zoological Companion Animal Practice. Veterinary Clinics of North America: Exotic Animal Practice, Sedation and Anesthesia of Zoological Companion Animals 25, 321–336. https://doi.org/10.1016/j.cvex.2021.08.015

  4. Gardhouse, S., Sanchez, A., 2022. Rabbit Sedation and Anesthesia. Veterinary Clinics of North America: Exotic Animal Practice 25, 181–210. https://doi.org/10.1016/j.cvex.2021.08.012

  5. Kluge, K., Larenza Menzies, M.P., Kloeppel, H., Pearce, S.G., Bettschart-Wolfensberger, R., Kutter, A.P.N., 2017. Femoral and sciatic nerve blockades and incision site infiltration in rabbits undergoing stifle joint arthrotomy. Lab Anim 51, 54–64. https://doi.org/10.1177/0023677215622734

  6. Miller, A.L., Clarkson, J.M., Quigley, C., Neville, V., Krall, C., Geijer-Simpson, A., Flecknell, P.A., Leach, M.C., 2022. Evaluating Pain and Analgesia Effectiveness Following Routine Castration in Rabbits Using Behavior and Facial Expressions. Front Vet Sci 9, 782486. https://doi.org/10.3389/fvets.2022.782486

  7. Monge, E., Donnelly, T.M., Coutant, T., Bennett, R.A., Pignon, C., 2023. Lateral ear canal resection and bulla osteotomy with marsupialization to treat otitis media in rabbits: forty-eight procedures. Veterinary Surgery 52, 1100–1111. https://doi.org/10.1111/vsu.14017

  8. Serpieri, M., Bonaffini, G., Ottino, C., Quaranta, G., Mauthe von Degerfeld, M., 2024. Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy. Animals 14, 551. https://doi.org/10.3390/ani14040551

  9. Vasseur, P.B., Paul, H.A., Dybdal, N., Crumley, L., 1984. Effects of local anesthetics on healing of abdominal wounds in rabbits. Am. J. Vet. Res. 45, 2385–2388.

3 Substance-Specific Evidence Review

  1. Barletta, M., Reed, R., 2019. Local Anesthetics. Veterinary Clinics of North America: Small Animal Practice 49, 1109–1125. https://doi.org/10.1016/j.cvsm.2019.07.004

  2. Barter, L.S., 2011. Rabbit Analgesia. Veterinary Clinics of North America: Exotic Animal Practice, Analgesia and Pain Management 14, 93–104. https://doi.org/10.1016/j.cvex.2010.09.003

  3. DiGeronimo, P.M., da Cunha, A.F., 2022. Local and Regional Anesthesia in Zoological Companion Animal Practice. Veterinary Clinics of North America: Exotic Animal Practice, Sedation and Anesthesia of Zoological Companion Animals 25, 321–336. https://doi.org/10.1016/j.cvex.2021.08.015

  4. Gardhouse, S., Sanchez, A., 2022. Rabbit Sedation and Anesthesia. Veterinary Clinics of North America: Exotic Animal Practice 25, 181–210. https://doi.org/10.1016/j.cvex.2021.08.012

  5. Kluge, K., Larenza Menzies, M.P., Kloeppel, H., Pearce, S.G., Bettschart-Wolfensberger, R., Kutter, A.P.N., 2017. Femoral and sciatic nerve blockades and incision site infiltration in rabbits undergoing stifle joint arthrotomy. Lab Anim 51, 54–64. https://doi.org/10.1177/0023677215622734

  6. Miller, A.L., Clarkson, J.M., Quigley, C., Neville, V., Krall, C., Geijer-Simpson, A., Flecknell, P.A., Leach, M.C., 2022. Evaluating Pain and Analgesia Effectiveness Following Routine Castration in Rabbits Using Behavior and Facial Expressions. Front Vet Sci 9, 782486. https://doi.org/10.3389/fvets.2022.782486

  7. Monge, E., Donnelly, T.M., Coutant, T., Bennett, R.A., Pignon, C., 2023. Lateral ear canal resection and bulla osteotomy with marsupialization to treat otitis media in rabbits: forty-eight procedures. Veterinary Surgery 52, 1100–1111. https://doi.org/10.1111/vsu.14017

  8. Serpieri, M., Bonaffini, G., Ottino, C., Quaranta, G., Mauthe von Degerfeld, M., 2024. Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy. Animals 14, 551. https://doi.org/10.3390/ani14040551

  9. Vasseur, P.B., Paul, H.A., Dybdal, N., Crumley, L., 1984. Effects of local anesthetics on healing of abdominal wounds in rabbits. Am. J. Vet. Res. 45, 2385–2388.

4 Efficacy Review

  1. Kluge, K., Larenza Menzies, M.P., Kloeppel, H., Pearce, S.G., Bettschart-Wolfensberger, R., Kutter, A.P.N., 2017. Femoral and sciatic nerve blockades and incision site infiltration in rabbits undergoing stifle joint arthrotomy. Lab Anim 51, 54–64. https://doi.org/10.1177/0023677215622734

  2. Miller, A.L., Clarkson, J.M., Quigley, C., Neville, V., Krall, C., Geijer-Simpson, A., Flecknell, P.A., Leach, M.C., 2022. Evaluating Pain and Analgesia Effectiveness Following Routine Castration in Rabbits Using Behavior and Facial Expressions. Front Vet Sci 9, 782486. https://doi.org/10.3389/fvets.2022.782486

  3. Schnellbacher, R.W., Carpenter, J.W., Mason, D.E., KuKanich, B., Beaufrère, H., Boysen, C., 2013. Effects of lidocaine administration via continuous rate infusion on the minimum alveolar concentration of isoflurane in New Zealand White rabbits (Oryctolagus cuniculus). Am. J. Vet. Res. 74, 1377–1384. https://doi.org/10.2460/ajvr.74.11.1377

  4. Schnellbacher, R.W., Divers, S.J., Comolli, J.R., Beaufrère, H., Maglaras, C.H., Andrade, N., Barbur, L.A., Rosselli, D.D., Stejskal, M., Barletta, M., Mayer, J., Rodriguez, P., Quandt, J.E., 2017. Effects of intravenous administration of lidocaine and buprenorphine on gastrointestinal tract motility and signs of pain in New Zealand White rabbits after ovariohysterectomy. Am. J. Vet. Res. 78, 1359–1371. https://doi.org/10.2460/ajvr.78.12.1359

  5. Serpieri, M., Bonaffini, G., Ottino, C., Quaranta, G., Mauthe von Degerfeld, M., 2024. Effects of Intratesticular Lidocaine in Pet Rabbits Undergoing Orchiectomy. Animals 14, 551. https://doi.org/10.3390/ani14040551

  6. Vasseur, P.B., Paul, H.A., Dybdal, N., Crumley, L., 1984. Effects of local anesthetics on healing of abdominal wounds in rabbits. Am. J. Vet. Res. 45, 2385–2388.

5 Supplementary Material

5.1 UK SPC Links

  1. EMLA Cream 5% (5g pack) - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/871/smpc (accessed 2.11.24).

  2. Lidocaine Hydrochloride Injection B.P. 0.5% w/v - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/6593/smpc (accessed 2.12.24).

  3. Lidocaine Hydrochloride Injection BP 1% w/v - Summary of Product Characteristics (SmPC) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/6277/smpc (accessed 2.12.24).

  4. Lidocaine Hydrochloride Injection B.P. 1.0% w/v - Summary of Product Characteristics (SmPC1) - (emc) [WWW Document], n.d. URL https://www.medicines.org.uk/emc/product/4781/smpc (accessed 2.12.24).

  5. Lignol 2.0% w/v Solution for Injection [WWW Document], n.d. URL https://www.vmd.defra.gov.uk/productinformationdatabase/product/A001223 (accessed 2.12.24).

5.2 Additional Material Consulted

  1. Carpenter, J., 2022. Carpenter’s Exotic Animal Formulary - 6th Edition [WWW Document]. URL https://shop.elsevier.com/books/carpenters-exotic-animal-formulary/carpenter/978-0-323-83392-9 (accessed 2.11.24).

  2. Plumb, 2024. Lidocaine/Lidocaine Combinations, Topical [WWW Document]. URL https://app.plumbs.com/drug/3nKfkkEknXPROD?source=search&searchQuery=lidocaine (accessed 2.11.24).

  3. Quesenberry, K.E. (Ed.), 2021. Ferrets, rabbits, and rodents: clinical medicine and surgery, Fourth edition. ed. Elsevier, St. Louis, Missouri.

  4. Varga-Smith, M., 2022. Textbook of Rabbit Medicine - 9780702084034 | Elsevier Health [WWW Document]. Elsevier UK. URL https://www.uk.elsevierhealth.com/textbook-of-rabbit-medicine-9780702084034.html (accessed 1.23.24).

5.3 Conference Proceedings

  1. Di Girolamo, N., 2020. ExoticsCon Virtual 2020 Proceedings. VIN.com \ https://www.vin.com/doc/?id=9742199.

  2. Fisher, P., 2011. Rabbit medicine overview (Proceedings) [WWW Document]. DVM 360. URL https://www.dvm360.com/view/rabbit-medicine-overview-proceedings (accessed 2.12.24).

  3. Lichtenberger, M., 2015. British Small Animal Veterinary Congress 2008. VIN.com.

5.4 Expert Opinion

  1. McArthur, S. (2024) Extrapolating pharmacological properties in man and veterinary species. Additional material employed in collating the data displayed is expert opinion derived from clinical experience or reputable texts.


Monograph Details

Monograph Details

Monograph Parameters

Analysis Criteria

  • Species:

  • Active Substance:

  • Indication:

  • Dosing Suggestion:

  • Monograph Location: 

  • Reference Location: 

Consensus Team Members

  • Monograph Authors:

  • Monograph Editors:

  • Monograph Administrator:

  • Consensus Affiliations:

  • Consensus Conflict of Interest Declarations:

  • Funding: No funding was received for this work.

  • Acknowledgement:

Contact(s)

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  • Primary Author:

  • Monograph Admin: Sarah Pellett MRCVS;

  • VCI Admin: Stuart McArthur MRCVS; Email: stuart.mcarthur@me.com

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