Why should we do them ? How effective are they ? What are the limitations ? What drugs are available ? What are the risks ?
The technique behind the femoral,
femoral, ankle and a wrist blocks |
are excellent for providing prolonged anaesthesia and analgesia
are generally safe and easy to perform
require very little equipment or set up time
allow for minor procedures to be done outside of
theatre without the need for general anaesthesia
4peed + duration depends on the local anaesthetic used, the volume and concentration, and whether any adjuncts used loss of sensation develops faster than motor blockade
Onset of Duration of Duration of
action anaesthesia analgesia Bupivacaine 0.5% 15 15--30 mins 5-15 hours 6-30 hours (Marcain®) Lignocaine 1.0% 10 10--20 mins 2-5 hours 3-8 hours ] !ge Patient refusal !llergy to local anaesthetic 4uperficial infection Previous neurological deficit Risk of compartment syndrome
!nkle blocks in particular are painful and may
need some iv sedation +/- +/- short acting opiate analgesia
Lignocaine 1% and marcain® 0.5% plain are available
In theatres other drugs are used that are less cardiotoxic
and adrenalin is often added to increase duration and speed of onset
Bicarbonate can also increase speed of onset and
theoretically reduce pain of injection
4ometimes other drugs are added in the theatre setting
Marcain® is safe at dosage below « 1 mg/kg plain (1.5 mg/kg with adrenalin)
Marcain® 0.25% in 20mls = 50mg
Marcain® 0.5% in 20mls = 100mg
This only important when large volumes injected
ie : femoral nerve blocks
Lignocaine is safe at dosage below « 3 mg/kg plain
(5 (5--7 mg/kg with adrenalin) § Related to ¶drug· and to ¶injection·
Haematoma - ( minimum needle insertions )
Infection - ( rare with aseptic technique )
Nerve injury - ( paraesthesia )
Toxicity - ( aspiration / vigilance )
4ome debate over significance of eliciting
paraesthesia
Nerve injury is reduced by listening to the patient
and not injecting if resistance encountered
Most accidental nerve block neuropathies resolve
over time and patients need to warned about this possible complication
Tinnitus and tingling around lips
!gitation/anxiety Convulsion Coma
Cardiovascular side effects include bradycardia, decreased
myocardial contractility, atrioventricular block, vasodilation, ventricular arrhythmia, and cardiac arrest !naesthetics in the amide class are metabolised by the liver and excreted by the kidneys «lignocaine dose should be decreased in patients with liver or renal disease Ê
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