Have you run into lidocaine toxicity during hair transplants? How is it mitigated?

The dose of lignocaine is based on patient's weight. It is rare to encounter lignocaine toxicity when doing hair transplant because the requirement is usually small, especially when using a nerve block. If in any case, when lignocaine toxicity is suspected, lipid infusion (intralipid 20%) can be administered. Patient will then be transferred to the nearest hospital for monitoring.

Lidocaine toxicity is extremely rare during hair transplantation procedures when administered properly. Hair transplants typically use tumescent local anesthesia, which includes lidocaine, epinephrine, and saline. The lidocaine is infiltrated into the scalp in a controlled and staged manner to maintain effective anesthesia while minimizing systemic absorption.

How clinics mitigate lidocaine toxicity:

Weight-based dosing:
The maximum recommended dose of lidocaine without epinephrine is about 4.5 mg/kg, and with epinephrine (which slows absorption), it's 7 mg/kg. Clinics calculate the safe dosage based on your weight and never exceed this threshold.

Fractionated administration:
Instead of injecting all the lidocaine at once, it is given gradually in intervals during the procedure. This prevents sudden spikes in blood levels and allows for ongoing patient monitoring.

Use of epinephrine:
Epinephrine causes vasoconstriction, which reduces systemic absorption of lidocaine and prolongs local anesthesia. This is a standard practice in hair transplants.

Monitoring for symptoms:
Trained professionals watch for early signs of toxicity, such as metallic taste, tinnitus, lightheadedness, or numbness around the mouth, although these are rare with proper dosing.

Dilution and spread:
The lidocaine is often diluted and injected over a wide surface area, which further reduces the risk of toxicity and improves patient comfort.

If you’re healthy and undergoing the procedure at a reputable clinic with experienced providers, the risk of lidocaine toxicity is exceptionally low. Your concern is understandable, but rest assured that standard safety protocols are very effective in preventing this complication.

Hello,

Your concern about lidocaine toxicity is understandable but quite rare when performed by experienced professionals. Clinics mitigate this risk by carefully calculating the lidocaine dosage based on your weight and health profile and monitoring you closely during the procedure. Additionally, the total amount used is typically well within safe limits. If this is a concern, discuss it with your surgeon beforehand—they’ll ensure your safety and address any specific questions you have.

Best regards,
Dr. Marco Barusco