Quick poll: for infiltration during MAC, are you calculating max lidocaine with epinephrine as [redacted]/kg on IBW, or using TBW and still hard-capping at [redacted]? I’m optimizing opioid-sparing plans while keeping LAST risk near zero, and our protocol says IBW — but I’m seeing wide variance and want to sanity-check our safety margin.
IBW for calc and hard cap at [redacted] with epi here; in BMI>35 I’ll switch to lean body weight — belt-and-suspenders for LAST. I pre-calc the mg limit in the chart and tally infiltration plus any IV lido; ASRA’s LAST page is a good sanity check: https://www.asra.com/page/47/last. @OP are folks at your shop also running IV lido, or just infiltration?
I let absorption drive the margin: IBW for lido with epi, and when BMI’s high I dose off lean mass and still cap, especially for intercostal or nasal fields. For ‘opioid-sparing’ MAC, I favor a block and have the surgeon infiltrate ropi so the lido total stays conservative; ASRA’s LAST checklist lives: https://www.asra.com/page/47/last.
@twilliams789 I do IBW with a hard cap, but my practical trick is writing the mg ceiling on the record and subtracting each syringe; if it’s a scalp/oral field or they’re on a nonselective beta blocker, I trim the limit about 10% even with epi — do you count topical toward your total?
On MAC cases I dose off IBW, set a ‘soft stop’ at about 85% of my cap, and if we still need more I pause 15–20 minutes to let uptake settle — measure twice, inject once. @jgreenwood64 caveat: if BMI’s huge or the field’s very vascular (breast/perineal), I pivot to lean body weight and keep the ASRA LAST checklist/intralipid at the head; do you use an EHR mg counter?