Local Anesthesia

Question 1

What are the indications for local anesthesia?

Answer 1

Any clinical procedure causing pain that could be eliminated by use local anesthetic

Question 2

What are the contraindications for local anesthesia?

Answer 2

1. Allergy to anesthetic (amide and/or ester class)
2. Large areas requiring anesthesia
3. Severely unstable BP
4. Severe liver dz when amide anesthetics are being considered
5. Severe renal dz when ester anesthetics are being considered
6. Mental instability

Question 3

What are the contraindications to epinephrine?

Answer 3

1. Fingers, toes, penis, nose and pinna of the ear, or use in digital block
2. Untreated hyperthyroidism or untreated pheochromocytoma

Question 4

What are the topical creams for local anesthesia?

Answer 4

1. TAC
2. LET
3. EMLA
4. Works better on highly vascular areas such as face/scalp than on extremities or trunk
5. Limited to lacs 5 cm or less
6. Topical Spray
   A. Ethyl chloride

Question 5

What are the injections for local anesthesia?

Answer 5

1. Lidocaine (xylocaine)1 & 2% w/ or w/o epinephrine
2. Carbocaine 1 & 2%
3. Marcaine 0.25 & 0.5%
4. For ester or amide or both allergic pts-+/-Benadryl 5%: 1 ml dyphenhydramine + 4 ml NS

Question 6

What is TAC cream?

Answer 6

Tetracaine, adrenaline (epi), cocaine topical anesthetic

Question 7

What is LET topical cream?

Answer 7

Lidocaine 4%, epi 0.1%, tetracaine 0.5% aqueous sol’n or methylcellulose based gel

Question 8

What are the indications and contraindications for LET?

Answer 8

1. Used 75-90% in children (>2 yo)for scalp/facial wound lacerations
2. NOT on mucus membranes or extremities

Question 9

Where should LET not be applied in children?

Answer 9

LET should not be applied in areas that have an end arterial supply, such as the digits, penis, nose, and ears

Question 10

What are the contraindications to local anesthesia in children?

Answer 10

1. Lacerations of mucus membranes (eg, lip, vulva) or digits, penis, ear, nose)
2. Grossly contaminated wounds
3. Patients with allergy to amide or ester local anesthetics

Question 11

What is EMLA?

Answer 11

1. Lidocaine 2.5% and prilocaine 2.5% in a cream base

2. Longer onset than LET

Question 12

What is ethyl chloride?

Answer 12

1. cryoanesthetic
2. Flammable
3. DOA is short

Question 13

What are the 2 general classes of drugs for local anesthesia?

Answer 13

1. Amides (2 ‘i’s)

2. Esters (1 “i”)

Question 14

What are examples of amides?

Answer 14

1. Lidocaine
2. Mepivacaine
3. Bupivacaine
4. Prilocaine
5. Ropivacaine

Question 15

What are examples of esters?

Answer 15

1. Procaine
2. Chloroprocaine
3. Tetracaine
4. Cocaine
5. Benzocaine

Question 16

What is the max dose of lidocaine?

Answer 16

Lidocaine maximum dose is 3-5 mg/kg

Question 17

What equipment is needed for local anesthesia?

Answer 17

1. Personal protective equipment
2. Alcohol wipes
3. Antiseptic solution
4. Needles
   A. 18 gauge to draw up solution
   B. 25-30 gauge for injection
5. Syringe (10 ml)
6. Anesthetic agent

Question 18

What is a digital block used for?

Answer 18

1, Nail avulsion

2. Paronychial drainage
3. Laceration repairs
4. Closed reduction of finger dislocations

Question 19

True/false: epi is used for digital blocks

Answer 19

False, no epi

Question 20

What is the procedure for local anesthesia?

Answer 20

1. Wash hands
2. Explain procedure to patient/informed consent
3. Check medical history and allergies
4. PE and Neurovascular check before and after wound repair
5. Position patient properly: SUPINE
6. Put on personal protective equipment
7. Using alcohol wipe, wipe top of vial of anesthetic
8. Draw up anesthetic with 18 gauge needle
9. Discard needle in sharps container
10. Warm local anesthetic to body temp

Question 21

What are the methods of local anesthesia?

Answer 21

1. Direct Infiltration of Wounds with local anesthesia

2. Field Block for larger wound area

Question 22

What is the procedure for digital blocks?

Answer 22

1. Cleanse area to be anesthetized with antiseptic solution
2. Hold syringe perpendicular to finger and insert needle into SQ tissue of the web space at the base of the finger, just distal to the MCP joint
3. Aspirate to rule out intravascular placement
4. Inject anesthetic into SQ dorsal tissue and infiltrate the tissues surrounding the digital nerve
5. Slowly advance the needle straight through web space toward the palmar surface, injecting as the needle is advanced (infiltrating tissues surrounding the palmar nerve)
6. Withdraw needle completely and Repeat the procedure on the opposite side of the finger
7. 1..5 - 2 cc of anesthetic for each side of digit
8. Only total 3-4 cc needed of lidocaine or marcaine

Question 23

What are the potential complications from local anesthesia?

Answer 23

1. Vasovagal syncope (d/t anxiety)
2. Bleeding/Bruising
3. Infection
4. Inflammation/Edema
5. Prolonged or permanent nerve damage
6. Systemic complications can occur (rare)
   A. Cardiac arrhythmias
   B. Seizures
   C. Allergic reaction

Question 24

What are the follow up care instructions for local anesthesia?

Answer 24

1. Complications from local anesthesia are uncommon
2. However, pt may exhibit delayed allergic rxn
   A. Rash or inflammatory rxn
   B. Instruct to notify office if unusual skin color, itching, or pain occur in the area where anesthetic was injected or if sensation does not return promptly after the anesthesia was to have worn off