Local and Regional Anaesthesia

    Indications in the ED

    • Cleaning / exploring / suturing wounds
    • Incision and drainage of collections
    • Short term pain relief while awaiting definitive management

    Techniques

    • Local infiltration
    • Regional nerve blocks (digital, facial, femoral,ankle)
    • Intravenous regional anaesthesia (e.g. Bier''s block)

    Tips and Tricks

    • Before the procedure: assess site and check agent
    • Dosage: 1% means 10mg per mL (1mL = 1000mg)
      • for lignocaine 1% the 3mg/kg upper limit for a 70kg adult is about 20mL
      • for lignocaine 2% the 3mg/kg upper limit for a 70kg adult is about 10mL
      • for lignogaine with adrenaline, 7mg/kg is about double this
    • Aspirate before injecting to check for and avoid intravascular injection (risk of systemic toxicity, failure of local action)
    • If using larger doses (generally>2mg/kg) or intravenous regional anaesthesia, place the patient on respiratory and cardiac monitoring

    Adrenaline

    Local Infiltration

    • Suitable for wounds extenting into subcutaneous tissue.
    • Inject anaesthetic agent directly into subcutaneous tissue.
    • Injecting through the raw edges of a wound may decrease the associated stinging.
    • Allow 20-30 seconds for onset of action.
    • Soft touch / pressure sensation is often preserved as these nerves have a wider receptive field -- inform the patient so that they are not surprised.

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