Local anesthetics for emergency regional anesthesia

Quick primer

* Intralipid - don't know what this is? Don't have it ? Don't know where it is?  Don't do the block!  You have some homework to do first!

ASRA guideline

NYSORA guideline

1. The short procedure you plan on doing yourself: perfect for shoulder reductions 
-3% Chloroprocaine 

~Why? non-toxic with a 40 sec half-life in the blood, rapid on ( 15 min ) and gone in about 60-90minutes

2. The more complex procedure that may be delayed or where you must depend on a consultant who may show up late: the abscess with cellulitis getting admitted
- 1.5% Mepivacaine 

- Why? Proven track record with for 2-3 hours dense anesthesia and 8 hours analgesia.  Similar toxicity to lidocaine--potentially serious, but lower risk than ropiv or bupiv.
- Alternative = 2% lidocaine ( 1% also works, though more inconsistent )

3. Long bone fracture analgesia: the hip fracture
- 0.5% Ropivicaine or 0.25% Bupivicaine 

- Why? long acting, powerful local anesthetics that should be used with caution due to potential for cardiovascular toxicity.