Local anesthetic maximum doses
These are ceilings, not targets. Systemic toxicity has occurred well below published maxima, and the number that matters at the bedside is shaped by the injection site’s vascularity, whether epinephrine is present, and the patient in front of you. Use the smallest dose that will do the block.
| Agent | Plain (mg/kg) | Plain cap (mg) | With epi (mg/kg) | Epi cap (mg) | Source |
|---|---|---|---|---|---|
| Lidocaine | 4.5 | 300 | 7 | 500 | Xylocaine PI; Miller’s 10e Ch. 47 |
| Mepivacaine | 5 | 400 | 7 | 500 | Carbocaine PI (adult absolute cap); Miller’s 10e |
| Bupivacaine | 2.5 | 175 | 3 | 225 | Marcaine PI; Miller’s 10e; ASRA |
| Ropivacaine | 3 | 225 | — | — | Naropin PI; Miller’s 10e / Stoelting’s |
| Chloroprocaine | 11 | 800 | 14 | 1000 | Nesacaine PI |
| Procaine | 7 | 500 | 9 | 600 | Novocain PI |
| Prilocaine | 6 | 400 | 8 | 600 | Citanest PI |
| Tetracaine | 1 | 100 | — | — | Pontocaine PI |
Four entries that need their footnote
Bupivacaine — 2.5 mg/kg, 175 mg plain
The conservative figure, and the one taken from the FDA label directly: single doses up to 175 mg plain and 225 mg with epinephrine. Higher mg/kg values circulate in teaching; this page follows the package insert.
Ropivacaine — no with-epinephrine ceiling is listed, deliberately
That column is blank because the source is blank. Ropivacaine has intrinsic vasoconstrictor properties, and the FDA Naropin label does not endorse epinephrine co-administration, so there is no labeled with-epi maximum to quote. The label does carry a cumulative ceiling of 770 mg per 24 hours; the single-dose mg/kg figure comes from the anesthesia texts.
Anyone using ropivacaine with epinephrine off-label should be working from a more specialized source than a summary table.
Prilocaine — the ceiling reflects methemoglobinemia, not just LAST
The mg/kg figure follows anesthesia-text convention rather than the dental package insert alone, because the limiting toxicity here is methemoglobinemia. The US FDA-approved form is the dental preparation.
Tetracaine — the infiltration number is largely historical
Modern use is spinal, at 5–20 mg total, and topical. The infiltration maximum is listed for completeness rather than because it describes current practice.
Things the table cannot tell you
- Site matters more than the number. Intercostal and interpleural injection produce the highest plasma levels for a given dose; subcutaneous infiltration the lowest. The same milligrams are not the same risk.
- Mixing agents does not buy you headroom. Toxicity is additive. Two agents at half their maxima is a full dose, not two half doses.
- Children are dosed by weight with no adult absolute cap applied — and infants under six months warrant further reduction.
- Know where the lipid is before you need it. If a maximum dose is in play, the LAST protocol should be findable in seconds, not minutes.
Reference information for licensed clinicians and students. Not a medical device, and not a substitute for clinical judgment. Verify against your institutional protocol and current package inserts.
Every value above is the one that ships inside Helix Anesthesia, where the citation shows on screen beside the number and the calculator does the weight math for you. The full source map for every dose in the app is public at clinical sources.
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