原作者： Mimi Lu,肖鋒譯 文章來源： 《中華急診醫學雜志》編輯部 發布日期：2013-04-11
Title: Anesthetics
題目：局麻藥在兒科中的應用
Author 作者: Mimi Lu
In children, it is important to consider the maximum doses of local anesthetics when performing a laceration repair or painful procedure like abscess drainage. If there are multiple lacerations, or large lacerations, it may be possible to exceed those doses if one is not careful.
對于兒童來說，在做撕裂傷的修復或象膿腫引流這樣痛苦的操作時，一定要考慮到局麻藥的最大劑量。如有多發或大的撕裂傷，不小心很可能會超量的。
Max doses of common anesthetics 常用局麻藥的最大劑量
Lidocaine WITHOUT epinephrine – 4 mg/kg (0.4 mL/kg of 1% lidocaine)
沒有腎上腺素的利多卡因－4mg／kg（0.4ml／kg的1％利多卡因）
Lidocaine WITH epinephrine – 7 mg/kg (0.7 mL/kg of 1% lidocaine)
有腎上腺素的利多卡因－7mg／kg（0.7ml／kg的1％利多卡因）
Bupivicaine WITHOUT epinephrine – 2 mg/kg (0.8 mL/kg of 0.25% bupivicaine)
沒有腎上腺素的布比卡因－2mg／kg（0.8ml／kg的0.25％布比卡因）
Bupivicaine WITH epinephrine – 3 mg/kg (1.2 mL/kg of 0.25% bupivicaine)
有腎上腺素的布比卡因－3mg／kg（1.2ml／kg的0.25％布比卡因）
Pearls 要點:
For added safety, some advocate not exceeding 80% of the max dose in children < 8 years of age
為安全起見，有人建議對8歲以下的兒童不要超過80％的最大劑量
Higher concentration of lidocaine beyond 1% does not improve the time of onset or duration of action and may increases the risk of toxicity
濃度在1％以上的利多卡因并不改善起效或作用時間，反而有增加毒性的危險
The addition of epinephrine increases the maximum dose and duration of action, but may be more painful during infiltration
加入腎上腺素雖然可增加最大量和作用時間，但在注射時可能會更疼
If the repair requires large amount of local anesthetic, consider doing an regional block
如修復需要大劑量的局麻藥，要考慮做局部神經阻滯
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