Guide to Local Anesthesia conversion from ML to mgs
| Local Anesthetic Cartridges |
½ mg |
1 mg |
1.5 mg |
2 mg |
2.5 mg |
3 mg |
4 mg |
5 mg |
6 mg |
7 mg |
8 mg |
9 mg |
10 mg |
MAX |
| A2% Lidocaine 1.8 ML |
18 Mg |
36 |
54 |
72 |
90 |
108 |
144 |
180 |
216 |
252 |
288 |
324 |
360 |
11
|
| 1:100,000 EPI |
.009 Mg |
.018 |
.027 |
.036 |
.045 |
.054 |
.072 |
.090 |
.108 |
.126 |
.144 |
.162 |
.180 |
| 4% Articaine (Septocaine 1.7 ML |
36 Mg |
72 |
108 |
144 |
180 |
216 |
288 |
360 |
432 |
504 |
576 |
648 |
720 |
9.0
|
| 1:100,000 EPI |
.009 Mg |
.018 |
.027 |
.036 |
.045 |
.054 |
.072 |
.090 |
.108 |
.126 |
.144 |
.162 |
.180 |
| 3% Mepivicaine (Carbocaine) 1.8 ML |
27 Mg |
54 |
81 |
135 |
162 |
216 |
270 |
378 |
-- |
-- |
-- |
-- |
-- |
7.5
|
| NO EPI |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
-- |
| 0.5% Bupivicaine |
4.5 |
9 |
13.5 |
18 |
23.5 |
27 |
36 |
45 |
54 |
63 |
72 |
81 |
90 |
90 mg Absolute |
| (Marcaine) 1.8 ML 1:200,000 EPI |
.0045 |
.009 |
.0135 |
.018 |
.0225 |
.027 |
.036 |
.045 |
.054 |
.063 |
.072 |
.081 |
.090 |
Max |
*****Remember MRD is based on a 180-200 lb. lean healthy male*****
**Calculating from ML to mg: (Cartridges may read 1.7 ML or 1.8ML in the USA. Actual volume is 1.76 so we base calculations on 1.8ML for ALL). NOTE THE VISIT FORM USES 1.7 mg!
1.8 ML of 2% lidocaine:
(x% anesthetic) x (10) = x mg/ML
(x mg/mL) x (x Ml/cartridge) x (X cartridges) = x mg of anesthetic
Ex. ( 2% Lidocaine) x (10) –20 mg/ML Lidocaine
(20 mg/mL lidocaine) x 1.8 mL/cartridge) x (2 cartridges) = 72 mg lidocaine
1:100,000 epi = .01 epi so:
1.8 ML x .01 = .018mg epi, so you would dispense one cartridge 36 mg with .018 mg epinephrine for a 2% lidocaine.
The epi is 1g per milliliters of solution. So, first convert the 1 gram to 1000mg then divide by however many milliliters of solution (100,000 or 20,000 or 50,000 etc.) So for 50,000 it's .02, for 200,000 it's .005 (not .02), for 20,000 it's .05, etc.
See Page 58 in Malamed, table for conversions bottom page
FYI: Percent solutions all are 1000mg/100cc. For example a 2% = 20mg/cc, 5% = 50mg/cc, 5.5% = 55mg/cc, etc...
This is why 2% solution is 20mg/ml
Calculating MRD= MAX REC DOSAGE (based on a 160 lb male) for 2% lidocaine w/ Epinephrine
160 lb. patient:
MRD 3.2 mg/lb
160 x 3.2 mg/lb = 500* rounded
Divide 500 by 36 = 11 = Max cartridges (this is because the dose-limiting factor
2nd example:
100 lb. patient:
MRD 3.2 mg/lb
100x 3.2 mg/lb = 320 mg/lb
320/35 = 10.0 cartridges MAX
MRD Calculations:
Lidocaine HCL w/epi; MRD 3.2 mg/lb
Mepivacaine HCL plain; 3.0 mg/lb
Articaine HCL 1:100,000; 3.6 mg/lb
Articaine HCL 1:200,000; 3.6 mg/lb
Prilocaine HCL 1:200,00; 3.6 mg/lb
Bupivacaine; 0.9 mg/lb (90 mg absolute maximum)
Considerations:
Pregnancy/Breastfeeding Category B (safe) Lidocaine
Category C (uncertain safety): Mepivacaine, Bupivacaine, Articaine
Epinephrine concerns:
Uncontrolled hyperthyroidism-Contraindicated
Tricyclic antidepressants (Elavil, amitryptyline) CARDIAC DOSE, Cannot use synthetic epi Beta Blockers; CARDIAC DOSE=2 cartridges 2% lidocaine with EPI
Pts taking MAO inhibitors (monoamine oxidase) (marplan, Eldepryl, Parnat, Nardil); consult with faculty and DDS Allergy to sodium bisulfite preservative (for epi cartridges) use carbocaine NO cartridges with EPI may be used.