TrichoMap Tools · For Physicians

Local Anesthetic Budget Planner for Hair Restoration Surgery

Plan lidocaine and bupivacaine dosing for a hair transplant case: weight-based ceilings, combined (additive) amide toxicity, allocation across nerve blocks, tumescent solution, and intradermal touch-ups — with a copy-ready dose summary for the operative note.

Case Inputs

Remaining Lidocaine Budget

— mg lidocaine w/ epi

Protocol Allocation Ledger

Solution & what it's for
Total mLs
Lido dose
Buffered lido 1% — block syringes (mL)
2.25 mL lido + 0.75 mL bicarb per 3 mL · 2 donor + 3 recipient · 7.5 mg/mL
— mg
Super tumescent solution (mL)
~0.55 mg lido per mL (0.055%) · one bag ≈ 110 mL · FUE: 2 bags ≈ 220 mL · FUT: 1 bag ≈ 110 mL
— mg
Buffered lido 0.25% — touch-up vial (mL)
3 mL stock + 8 mL NS + 1 mL bicarb = 12 mL · drawn only if needed · 2.5 mg/mL
— mg
0total amide capacity
Marcaine (as lido-equiv) Buffered 1% blocks Tumescent bags 0.25% touch-up
Lidocaine planned: — mg
Within budget
Assumptions: Lidocaine w/ epi max 7 mg/kg (flat cap 500 mg). Bupivacaine w/ epi max 3 mg/kg (flat cap 225 mg). Additive toxicity by the fractional method. Safety margin scales both maxima. Buffered 1% mix delivers 7.5 mg lidocaine per mL (bicarb dilution included). Tumescent solution modeled at ~0.55 mg lidocaine per mL (≈0.055%, epi ~1:200,000, bicarbonate-buffered). Bupivacaine is never buffered (precipitation) and should remain physician-administered with aspiration at every site and 20% lipid emulsion available.

Why a milligram budget instead of a volume habit

Local anesthetic systemic toxicity (LAST) is arguably the highest-consequence preventable risk in office-based hair restoration surgery. Cases run long, the scalp is one of the most vascular fields in the body, and total infiltrated volumes are large — yet many practices still dose by habit ("a few syringes of one percent") rather than by a running milligram ledger. This planner replaces the habit with arithmetic: enter the patient's weight and the planned bupivacaine, and it returns the remaining lidocaine allowance and how the planned solutions consume it.

Tiered concentration: the core idea

Randomized trial data in cutaneous surgery show that dilute lidocaine performs far better than tradition suggests — 0.25% with epinephrine was non-inferior to 0.5% for Mohs surgery and excisions, and dermal anesthesia has been demonstrated below 0.1% when epinephrine is present and the solution is given time to dwell. The practical consequence for hair restoration: reserve 1% (buffered) for the named nerve blocks where dense, fast onset matters; let a dilute, buffered, epinephrine-containing tumescent solution provide field turgor and finish dermal coverage; and keep a small buffered 0.25% vial for intradermal touch-ups. Long-acting bupivacaine is budgeted separately and subtracted from the lidocaine allowance by the fractional method, because amide toxicity is additive.

How to use it

Set the case type (FUE or FUT), patient weight, planned Marcaine volume, and a safety margin — the default plans to 75% of labeled maxima, which leaves headroom for the unplanned. Adjust the three lidocaine lines to your own protocol volumes; the tool converts everything to milligrams, checks it against the budget, and totals the 1% stock required to prepare the case. "Copy plan to clipboard" produces a documentation-ready summary, including the dosing basis and safety measures, for the operative note.

Developed by Spencer Hawkins, MD, FAAD — fellowship-trained hair restoration surgeon and the team behind TrichoMap, the first app to localize dermoscopy to a map of the scalp. If you photograph scalps for a living, TrichoMap is free to try.
This calculator is an educational tool for licensed physicians. It does not constitute medical advice, does not account for patient-specific factors (hepatic function, drug interactions, cardiac disease, pregnancy, and others), and is not a substitute for clinical judgment or institutional protocols. Verify all doses independently. No patient data is entered, stored, or transmitted by this page.