HWN Suggests

Getting on our Nerves: Using Local Anesthetic

Much of the literature on digit necrosis with anesthetics containing epinephrine go back to the days of using procaine and cocaine (also a potent vasoconstrictor!), and the more recent studies in people who have accidentally stuck themselves in the finger with an epi-pen (significantly more epinephrine than you will inject doing a digital block or lac repair) show no long-term effects like digit necrosis.

If you are concerned about systemic toxicity, get your whole team involved, including your pharmacist. Find out if your institution has easy access to intralipid. It had been reported (erroneously) that propofol, because it comes in a medium/large chain triglyceride lipid emulsion,…

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Featured

 Clinical Pharmacology of Local Anesthetics

Local and regional anesthesia and analgesia appear to be undergoing a renaissance, as judged by attendance at specialty meetings and substantial increase in research activity, as evidenced by growing number of scientific publications. In contrast to general anesthesia, in which the molecular mechanism remains the subject of speculation, the site at which local anesthetic (LA) drugs bind to produce nerve blocks has been cloned and mutated.

 Emergency Department Anesthesia

Bupivacaine Use this if it is important to block pain for LONG period of time (ie. abscess drainage). Lidocaine with epinephrine Use this for a wound that is still bleeding. Sodium bicarbonate Adding a solution of sodium bicarbonate raises the pH, and makes injection less painful for the patient. The higher pH also means better diffusion through tissue, and faster onset of anesthesia. Sodium bicarbonate must be added at the bedside in a ratio of 1 cc:10cc NAHCO3:xylocaine, the medication breaks down if stored in this fashion. Warming the vials - warm anesthetic is less painful. Keep vials in your pants pocket to keep them warm.

 Local anesthetic toxicity calculations

Local anesthetics (LAs) are widely employed to achieve tissue infiltration, peripheral and regional anesthesia, and neuraxial blockades. Despite their well-established toxic dose limits, these agents continue to pose a substantial risk of morbidity and mortality due to local anesthetic toxicity and overdose.

Articles of Interest

Abscess incision and drainage

Local anesthetic such as lidocaine or bupivacaine should be injected within the roof of the abscess where the incision will be made. Care should be taken to avoid injecting anesthetic into the abscess cavity,

Articaine vs. Lidocaine: A Comparison of Local Anesthetics

Local anesthetic in the form of cocaine was first used in 1859 for ophthalmic surgery. However, as you can imagine, many adverse events led to the need to develop a safer alternative. In 1905, procaine was developed and used for over 40 years before other local anesthetics were developed. Lidocaine was marketed in 1948, followed by mepivacaine (1957), prilocaine (1960), bupivacaine (1963), and articaine (1975). Interestingly, though articaine has been used since 1975 in Europe, it wasn’t approved for use in the U.S. until April 3, 2000.

Buff up the Lido for the Local Anesthetic

We agree that buffering lidocaine with sodium bicarbonate decreases pain during infiltration and that a 3:1 mixture is better than a 9:1 mixture.

Chapter 123. Local Anesthesia

Modern medicine can trace the use of local anesthetics back to the year 1884, when the Austrian Physician Karl Koller first used topical cocaine to assist with an ophthalmological operation. The following year, the premier Surgeon William Halstead first used injected cocaine to generate the intentional blockade of nerve transmission. Unfortunately for Halsted, his experiments with cocaine soon led to a concurrent dependency.

Lidocaine and Pain Management in the Emergency Department: A Review Article

The antinociceptive properties of lidocaine are derived from multifaceted mechanisms, turning it into a medication that is safe to administer via different routes which makes it available for use in a variety of medical conditions.

Local and Topical Anesthetics for Pediatric Patients in the Emergency Department

Local and topical anesthetics when used appropriately, generally, have few, if any, systemic side effects, such as hypotension or respiratory depression, which is an advantage over procedural sedation.

Medical History Mysteries: Ester versus amide local anesthetics: Do you know the difference?

Drs. Tom Viola and Pamela Maragliano-Muniz explain the advantages and disadvantages of each type of local anesthetic, chemically speaking.

Topical storm? The dental hygienist’s guide to topical anesthetics

The chief role of topical anesthetics has been their routine use prior to injections. When properly administered, topical anesthetics provide anesthetic effect in oral mucosa to a depth of about 2–3 mm.

Resources

Bupivacaine - Marcaine Use

Bupivacaine has a longer duration of action than lidocaine, to which it is chemically related - approx. 6-8 hours as opposed to 1-2 hours for lidocaine. Duration of action is affected by the concentration of bupivacaine used and the volume injected. Concentration affects the time for local anesthesia to occur and the density of the block. Volume determines the area that is infiltrated and therefore anesthetized.