Minor operation

Ext. Kritakarn Telapol

49107010047

LOCAL ANESTHESIA
FOR MINOR OPERATION

Local anesthesia
Classification
Ester group:
chioroprocaine, procaine, teracaine, cocaine
pseudocholinesterase enzyme plasma
alcohol and paraamino benzoic acid

Amide group:
Lidocaine, mepivacaine, etidocaine, prilocaine,
bupivacaine, ropivacaine
microsomal enzyme

Local anesthesia

Local anesthesia
Potency
Increase in Cm (minimum concentration)
Acid
Ca, K
Size of nerve fiber, Na channel, myelin sheath,
between Nodes of Ranvier
Except B fiber

Local anesthesia

pKa:
mepivacaine > lidocaine > etidocaine > ropivacaine >
bupivacaine > tetracaine > chloroprocaine

Low lipid soluable

Acid
Solvent: Acid, Adrenaline
High molecular weight
Low concentration
Temperature

Local anesthesia
Duration:
1 acid glycoprotein 1 3 hr

:
Conc., circulation and vessel

Distribution:
Tissue perfusion
Tissue/blood partition coefficient
Tissue mass

Local anesthesia
Maximum dose

(./.)

Amide
Bupivacaine (Marcaine)
Lidocaine (xylocaine)
Etidocaine (Duranest)
Mepivacaine (Carbocaine)
Prilocaine (Citanest)
Ropivacaine
Dibucaine (Nupercaine)
Ester

3
4.5 7
4
4.5 7
4.5 7
3
1

Local anesthesia
Maximum dose

(./.)

Amide
Ester
Chloroprocaine (Nesacaine)
Tetracaine (Pontacaine)
Cocaine
Procaine

12
3
3
12

Local anesthesia
Systemic toxicity
Intravascular injection
Absorption ~20 min after use
Concentration
Rate of infusion
Potency
Tissue perfusion
Combinated with vasoconstrictive agent

Local anesthesia
Systemic toxicity (CNS)

excitation
depression

-
-
-
-
-

Local anesthesia
Systemic toxicity (CNS)

excitation
(Blockage of Inhibitory
pathway)

depression

-
-
-
-
- GTC

Local anesthesia
Systemic toxicity (CNS)

excitation
depression

-
-
-
-
-

Local anesthesia
Systemic toxicity (CVS)

-
-

Local anesthesia
Systemic toxicity (CVS)

-
-
-

Local anesthesia
Systemic toxicity (CVS)

-
-
-
-

Local anesthesia
Systemic toxicity (RS)
hypoxic drive
medullary respiratory center

Local anesthesia
Others systemic toxicity
aminoester
Methemoglobinemia prilocaine, benzocaine
Tissue toxicity

Local anesthesia
:
:

Diazepam 0.1 mg/kg

Resuscitation

Antihistamine steroid
Oxygen supplement

Local anesthesia
Lidocaine (Xylocaine)
Amide group
Onset: 5 10 mins
Duration: ~100 mins
Maximum dose:
4.5 mg/kg in w/o vasoconstrictive agent
7 mg/kg in with vasoconstrictive agent

Local anesthesia
Topical anesthesia:
Cocaine, Amethocaine, Lignocaine, Prilocaine
Onset 5 10 mins
Duration 30 60 mins

Infiltration anesthesia
Unmyelinated nerve ending blockage
Rapid onset of action

DIGITAL NERVE BLOCK

Method

SEBACEOUS CYST
AND LIPOMA

Sebaceous cyst and lopoma

Sebaceous cyst and lopoma

Sebaceous cyst and lopoma

THE NAIL

The Nail

Nail extraction

Ingrown toe nail

Paronychia

Subungual hematoma

Simple laceration of nail

WART, LENTIGO AND NEVUS

Wart
table

Wart

Lentigo

Nevus

Cauterization pigmented lesions

ABSCESS INCISION AND DRAINAGE

Abscess incision and drainage

Indication
Abscess on the skin which is palpable

Abscess incision and drainage

Contraindication
Extremely large abscesses which require extensive
incision, debridement, or irrigation
Deep abscesses in very sensitive areas
(supralevator, ischiorectal, perirectal) which
require a general anesthetic to obtain proper
exposure
Palmar space abscesses, or abscesses in the deep
plantar spaces
Abscesses in the nasolabial folds (may drain to
sphenoid sinus, causing a septic phlebitis)

Abscess incision and drainage