Dear Dr AJ Hi Thanks for your query I appreciate your concern for the safety of Lidocaine in a patient with liver disease. Lignocaine clearance is reduced in patients with liver disease and appears to be a sensitive index of liver dysfunction. The average elimination half-life of Lidocaine may be increased from 1.6 hours in normal patients to more than 6 hours in patients with severe liver disease this will lead to the systemic toxicity which is more commonly seen following inadvertent intravascular injection or absorption of the local anesthetic from the site of administration. The systemic side effects that can occur due to toxic doses of Lidocaine include: Involvement of CNS: Light-headedness, visual and auditory disturbances, and circumoral and tongue numbness and a metallic taste. At higher concentrations, nystagmus and muscular twitching occur, followed by tonic-clonic convulsions. Involvement of CVS: Fall in BP and pulse rate In patients with liver disease a dosage reduction to one-half the rates for normal would seem appropriate. Hope this answers your query. Rate this answer if you are convinced.