{"id":753,"date":"2010-12-02T16:44:37","date_gmt":"2010-12-02T16:44:37","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/material-for-local-anaesthesia\/"},"modified":"2024-06-27T16:20:02","modified_gmt":"2024-06-27T15:20:02","slug":"material-for-local-anaesthesia","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/minor-surgery\/set-up-and-equipment\/material-for-local-anaesthesia\/","title":{"rendered":"Material For Local Anaesthesia"},"content":{"rendered":"\n<p>Technique is described in section &#8220;<em>Skills<\/em>.&#8221;<\/p>\n\n\n\n<p><strong>Necessary Equipment<\/strong><br>Depending on the type of local anaesthesia selected (<em>see &#8220;Skills&#8221;<\/em>) the following must be present:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1 canister of ethyl chloride spray for freezing the skin prior to abscess incision.<\/li>\n\n\n\n<li>Syringes, 2 and 5 ml, with low-gauge needles for drawing up fluids and high-gauge needles for infiltration.<\/li>\n\n\n\n<li>Local anaesthetic with or without a vasoconstrictor.<\/li>\n\n\n\n<li>Medication for acute intervention in case of an allergic reaction to local anaesthetic or a toxic reaction due to absolute or relative overdose.<\/li>\n<\/ul>\n\n\n\n<p><strong>Local Anaesthetics<\/strong><br>The <strong>local anaesthetics<\/strong> most widely used in general practice are <strong>lidocaine<\/strong> and <strong>prilocaine<\/strong>, 1% or 2%, with or without additional epinephrine (1:100,000). Adding a <strong>vasoconstrictor<\/strong> slows the resorption of the local anaesthetic, which prolongs its effects. The advantage of this approach is that the patient goes home without feeling pain. A secondary effect of vasoconstrictors is a reduced tendency for bleeding at the surgical site. However, this also increases the risk of infection.<\/p>\n\n\n\n<p><strong>Contraindications<\/strong><br>Contraindications for the use of a local anaesthetic with additional epinephrine are:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Application in an area containing terminal arteries, such as the fingers, toes, penis, end of nose, earlobes, or eyelids.<\/li>\n\n\n\n<li>Poor vascularisation (<em>arteriosclerosis; diabetes mellitus<\/em>).<\/li>\n\n\n\n<li>Coronary insufficiency.<\/li>\n\n\n\n<li>Arrhythmias.<\/li>\n\n\n\n<li>Hyperthyroidism.<\/li>\n<\/ul>\n\n\n\n<p><strong>Dose<\/strong> <br>For paediatric patients, the maximum dose is calculated based on body weight; the maximum dose of lidocaine without epinephrine is 4 mg\/kg <strong><em>[Table 1]<\/em><\/strong>. For adults, the maximum dose is 200 mg without epinephrine and 500 mg with epinephrine.<br>The time to effect with lidocaine is 3-5 minutes. The duration of effect for lidocaine without additional epinephrine is 1 hour. The duration of effect for lidocaine with epinephrine is 2 hours. Prilocaine works faster than lidocaine (within 3 minutes) and its effects last longer (2 hours without additional epinephrine).<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><p>Lidocaine 1% without epinephrine<\/p><\/td><td>\n<p>20 ml (= 200 mg)<\/p>\n<\/td><\/tr><tr><td><p>Lidocaine 1% with epinephrine 1:100,000<\/p><\/td><td>50ml<\/td><\/tr><tr><td><p>Lidocaine 2% without epinephrine<\/p><\/td><td>\n<p>10 ml (= 200 mg)<\/p>\n<\/td><\/tr><tr><td><p>Lidocaine 2% with epinephrine 1:100,000<\/p><\/td><td>25 ml<\/td><\/tr><tr><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td><p>Prilocaine 1% without epinephrine<\/p><\/td><td>40 ml<\/td><\/tr><tr><td><p>Prilocaine 1% with epinephrine 1:200,000<\/p><\/td><td>60 ml<\/td><\/tr><tr><td><p>Prilocaine 2% without epinephrine<\/p><\/td><td>20 ml<\/td><\/tr><tr><td><p>Prilocaine 2% with epinephrine 1:200,000<\/p><\/td><td>30 ml<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><em>Table 1<\/em><\/p>\n\n\n\n<p><strong>Adverse Effects<\/strong><br>Reactions to local anaesthesia can be caused by the active agent itself or the added vasoconstrictor. Allergic reactions to the local anaesthetic itself may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skin reactions.<\/li>\n\n\n\n<li>Anaphylactic shock.<\/li>\n<\/ul>\n\n\n\n<p><strong>Management of Allergic Reactions<\/strong><br>For skin reactions, administer an <strong>antihistamine<\/strong> by <strong>intravenous injection<\/strong> (<em>e.g. 2 ml Tavegil\u00ae<\/em>). For anaphylaxis, administer the following medication:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1 ampoule Tavegil\u00ae 2 mg = 2 ml i.v.<\/li>\n\n\n\n<li>2 ampoules dexamethasone (Oradexon\u00ae) 5 mg = 1 ml i.v.<\/li>\n\n\n\n<li>0.3 ml epinephrine 1:1000 (1 mg = 1 ml) i.m.<\/li>\n<\/ul>\n\n\n\n<p><strong>Epinephrine<\/strong> is available in ready-to-use automatic syringes (<em>Epipen\u00ae<\/em>), which provide a fixed dose of 0.3 mg.<\/p>\n\n\n\n<p><strong>Management of Toxic Reactions<\/strong><br>Toxic reactions caused by local anaesthetics may include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Agitation, confusion.<\/li>\n\n\n\n<li>Visual or auditory disturbances, dysarthria.<\/li>\n\n\n\n<li>Sweating, vomiting.<\/li>\n\n\n\n<li>Fasciculations.<\/li>\n\n\n\n<li>Convulsions.<\/li>\n\n\n\n<li>Unconsciousness.<\/li>\n\n\n\n<li>Coma.<\/li>\n\n\n\n<li>Respiratory arrest.<\/li>\n<\/ul>\n\n\n\n<p>These reactions can lead to <strong>excitation<\/strong> or <strong>depression<\/strong> of the central nervous system and are related to blood concentrations.<br>The systemic reactions that can occur due to lidocaine overdose must be managed symptomatically. The ABC rule applies here. If necessary, the resuscitation team at the hospital may be called. The general practitioner must call 112 in case of emergency.<br>There is no known antidote for lidocaine.<br>Toxic reactions caused by the vasoconstrictor can occur in the following situations:<\/p>\n\n\n\n<p><strong>a<\/strong>\u00a0 When epinephrine is inadvertently administered intravasally.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Paleness.<\/li>\n\n\n\n<li>Agitation; shaking.<\/li>\n\n\n\n<li>Sweating.<\/li>\n\n\n\n<li>Tachycardia.<\/li>\n\n\n\n<li>Hypertension.<\/li>\n\n\n\n<li>Extrasystole.<\/li>\n\n\n\n<li>Ventricular fibrillation.<\/li>\n<\/ul>\n\n\n\n<p><strong>b<\/strong>&nbsp; When epinephrine is used in an area containing terminal arteries, extreme vasoconstriction can eventually lead to acral necrosis.<\/p>\n\n\n\n<p><strong>Management of Tachycardia<\/strong><br>Tachycardia due to intravasally administered epinephrine is usually transient, because the half-life of epinephrine is short. While taking the patient\u2019s pulse, wait a few minutes until the frequency decreases to 100\/min. Administration of medication is not advised due to the hypotensive effect. Carotid massage is ineffective as long as the epinephrine <br>(<em>a sympathomimetic<\/em>) is in effect.<\/p>\n\n\n\n<p><strong>Management of Extrasystole<\/strong><br>Intravenous injection of lidocaine should not be given for extrasystole in this instance, because the patient has already received lidocaine intravasally by accident.<\/p>\n\n\n\n<p><strong>Management of Ventricular Fibrillation<\/strong><br>Switch to resuscitation if the patient loses consciousness and carotid artery pulsations are no longer palpable.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Technique is described in section &#8220;Skills.&#8221; Necessary EquipmentDepending on the type of local anaesthesia selected (see &#8220;Skills&#8221;) the following must be present: Local AnaestheticsThe local anaesthetics most widely used in general practice are lidocaine and prilocaine, 1% or 2%, with or without additional epinephrine (1:100,000). Adding a vasoconstrictor slows the resorption of the local anaesthetic, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[73],"tags":[146],"class_list":["post-753","post","type-post","status-publish","format-standard","hentry","category-set-up-and-equipment","tag-minor-surgery"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Material For Local Anaesthesia - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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