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
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.