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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
- 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 = 10mg)
- 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 lignocaine with adrenaline, 7mg/kg is about double this
- **always calculate before administering the drug and double check the concentration indicated on the vial**
- 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
- Local anaesthetic / adrenaline combinations are widely available for use
- Advantages include:
- increased safe dose
- prolonged duration of anaesthesia
- reduced blood loss
- Exercise caution when using adrenaline combinations near end arteries (digits, penis, pinna, nose)
- 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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