In “Cone biopsy: perfecting the procedure” [January], Marc Toglia, MD, stated that he injects between 20 and 30 cc of 2% lidocaine with epinephrine in a concentration of 1:200,000 paracervically. The maximum recommended dosage of this premixed solution is 500 mg or 25 cc. Using 30 cc, or 600 mg, of lidocaine is potentially lethal.
Stephen Straubing, MD
Fairfield, Ohio
Dr. Toglia responds:
I would like to thank Dr. Straubing for pointing out my error in the dose of lidocaine used for a paracervical block. Rather, I should have directed the physician to inject a premixed solution of 1%—not 2%—lidocaine with epinephrine paracervically. I typically use 10 to 20 cc and prefer not to exceed a total of 200 mg.