Transvenous Cardiac Pacing Medication

Updated: Oct 28, 2021
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Vincent Lopez Rowe, MD  more...
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Medication Summary

The first step in transvenous pacing is obtaining venous access. Before venous access is obtained, the subcutaneous tissue and area around the course of the needle should be anesthetized with lidocaine 1% or 2%, with or without epinephrine.


Topical Anesthetics

Class Summary

Topical anesthetic agents are indicated for pain relief.

Lidocaine (Anestafoam, Xylocaine, Lidoderm, Topicaine)

Lidocaine is an amide local anesthetic used in 1-2% concentration. The 1% preparation contains 10 mg of lidocaine for each 1 mL of solution; the 2% preparation contains 20 mg of lidocaine for each 1 mL of solution. Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels.

To improve local anesthetic injection, cool the skin with ethyl chloride before injection. Use smaller-gauge needles (eg, 27 gauge or 30 gauge). Make sure the solution is at body temperature. Infiltrate very slowly to minimize the pain. The time from administration to onset of action is 2-5 minutes, and the effect lasts for 1.5-2 hours.