Local Anesthesia (Family Medicine)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • To relieve pain caused by a procedure (incision) or trauma (laceration/fracture)
  • Diagnostic nerve blocks to isolate pathology
CONTRAINDICATIONS
  • "Known" sensitivity to amide anesthetic medications has never been reported and is a relative contraindication. Parabens most likely are the cause of the "allergy" ascribed to the amides.
  • History of CNS symptoms associated with anesthetic toxicity.
  • History of cardiovascular reactions associated with previous anesthetic use.
  • Because of its vasoconstrictive properties, epinephrine generally should be avoided in the distal extremities, in contaminated wounds, or when the viability of a skin flap is in question. Do not use epinephrine in patients taking monoamine oxidase inhibitors.
EQUIPMENT

Supplies necessary for the local administration of anesthetic typically are inexpensive and readily accessible:

  • Anesthetic agents of choice
  • 18-gauge needle to draw up solution
  • 25- to 30-gauge needles of various lengths
  • Syringes (1-10 mL)
  • Antiseptic to cleanse the skin in the area to be injected
  • Sodium bicarbonate 7% to 10% for buffering the anesthetic, if desired

Options for Anesthetic-Allergic Patients

  • Use a cooling agent (e.g., ice cube, ethyl chloride).
  • For small lesions, use no anesthetic.
  • Use single-dose vials instead of multidose vials.
  • Use bacteriostatic saline.
  • Substitute an amide for an ester (if offending agent can be identified).
  • Use diphenhydramine (50 mg/mL diphenhydramine mixed with 4 mL normal saline). Inject 10 to 50 mg in the usual fashion.
ANATOMY
  • Epithelium
  • Dermis
    • Immediately adjacent to the epithelium, the dermis is less dense and contains terminal capillaries and nerve endings.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Instruct patients to report redness, pus, swelling, streaking, or increased pain.
  • If a long-acting agent was used, warn the patient to exercise caution with activity.
COMPLICATIONS

With proper administration, anesthetic complications are rare:

  • Sensitivity reactions
  • CNS toxicity
  • Cardiovascular toxicity
  • Marked, prolonged vasoconstriction in digit if epinephrine was used
  • Methemoglobinemia
  • Infection
  • Bleeding
  • Tissue/nerve trauma
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