Add 0.01 ml of 1:1,000 epinephrine per ml of lidocaine.
- 10 ml of lidocaine would need 0.1 ml of 1:1,000 epinephrine
- 30 ml of lidocaine would need 0.3 ml of 1:1,000 epinephrine
We keep 5 and 30 ml vials of lidocaine in the ED. To make 30 ml of 1:100,000 lidocaine with epi, draw up 0.3 ml of 1:1000 epinephrine with a tuberculin or insulin syringe and inject into the 30 ml vial. To make 10 ml, use two 5 ml vials. Inject the 0.1 ml of epi into one of the 5 ml vials of lidocaine, then draw up both 5 ml vials of lidocaine into one 10 ml syringe. Voila.
Confusing units:
- 1:100,000 = 1 GRAM / 100,000 MILLILITERS
- 1:1,000 = 1 GRAM / 1,000 MILLILITERS
- 1 mg/ml
- 0.1 %
- 1% = 1 GRAM / 100MILLILITERS
- “Grams per deciliter”
- 1:100
If I haven’t lost you yet, here is the math:
Searcy EM 
Does anyone know the stability of lidocaine with epi, when mixed by us (not premixed)? How long is it good for? Does it last longer when refrigerated?
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Mixing these is considered “compounding” and state health boards and state pharmacy regulations come into play. Since these are not mixed in a sterile hood in a properly vented room, this is considered a “high-risk preparation.” The Arkansas Department of Health says such preparations can be at room temperature for up to 24 hours before use at room temperature and up to 3 days if refrigerated at 2-8 degrees centigrade – and implies that it should be for a single patient. The pharmacists I work with are even more conservative, they say it should be for a single patient and immediate use only. Most of the vials we have are are preservative-free, so once exposed to air (the epinephrine comes in a vial so it is always exposed to air when opened) they are essentially contaminated. To get longer shelf-life, they would have to be mixed in a sterile environment with sterile technique and you would still only get 48 hours at room temperature or 14 days if refrigerated per state regulations.
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Correct. My observation is that locally reconstituted vials are not as effective as factory packed cartridges. I’m now 35 years in practice.
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