Local and Regional AnesthesiaLocal and Regional Anesthesia

Rural TrackRural Track

Mark Deutchman MDMark Deutchman MD

Rural TrackRural Track

Mark Deutchman MDMark Deutchman MD

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Sterile technique purposesSterile technique purposes

• Prevent infectionPrevent infection

• Prevent cross-contaminationPrevent cross-contamination

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Sterile technique methodsSterile technique methods

• Identify sterile materialsIdentify sterile materials

• Properly handle sterile Properly handle sterile materialsmaterials

• Set up a sterile fieldSet up a sterile field

• Maintain a sterile fieldMaintain a sterile field

• Skin preparationSkin preparation

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PracticePractice

• Hand washingHand washing

• Opening sterile packagesOpening sterile packages

• Putting gloves onPutting gloves on

• Adding objects to a sterile fieldAdding objects to a sterile field

• Drawing up liquid medications in a Drawing up liquid medications in a sterile fashionsterile fashion

• Avoiding cross-contaminationAvoiding cross-contamination

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Local AnesthesiaLocal Anesthesia

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Local Anesthesia General PrinciplesLocal Anesthesia General Principles

• Organize your supplies.Organize your supplies.• Talk to the patient !Talk to the patient !• Know what you are drawing up!Know what you are drawing up!• Give the anesthetic time to work !Give the anesthetic time to work !• Move slowly and deliberately !Move slowly and deliberately !• Keep talking with the patient !Keep talking with the patient !• Dress the wound neatly !Dress the wound neatly !• Arrange follow-up !Arrange follow-up !• Treat the patient like you would like Treat the patient like you would like to be treated !to be treated !

• Organize your supplies.Organize your supplies.• Talk to the patient !Talk to the patient !• Know what you are drawing up!Know what you are drawing up!• Give the anesthetic time to work !Give the anesthetic time to work !• Move slowly and deliberately !Move slowly and deliberately !• Keep talking with the patient !Keep talking with the patient !• Dress the wound neatly !Dress the wound neatly !• Arrange follow-up !Arrange follow-up !• Treat the patient like you would like Treat the patient like you would like to be treated !to be treated !

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AgentsAgents

• Amides Vs. Esters – less allergy to Amides Vs. Esters – less allergy to amides like lidocaineamides like lidocaine

• Speed of onsetSpeed of onset• Duration of actionDuration of action• Addition of epinephrineAddition of epinephrine– Prolongs duration and adds some Prolongs duration and adds some

hemostasishemostasis– Avoid on acral parts: fingers, toes, ears, Avoid on acral parts: fingers, toes, ears,

penis, nosepenis, nose

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Agents - detailsAgents - details

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NeedlesNeedles

• Large to draw up (18 to 20)Large to draw up (18 to 20)

• Small to inject (22 to 30)Small to inject (22 to 30)

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Prep agentsPrep agents

• AlcoholAlcohol

• ChlorhexidineChlorhexidine

• Povidone iodinePovidone iodine

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Reducing injection painReducing injection pain

• Use a small needleUse a small needle

• Inject slowlyInject slowly

• When re-injecting, go through numb When re-injecting, go through numb areaarea

• Inject subcutaneously firstInject subcutaneously first

• Warm the lidocaineWarm the lidocaine

• Buffer lidocaine with 8.4% sodium Buffer lidocaine with 8.4% sodium bicarb 9:1 bicarb 9:1

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Topical anesthesiaTopical anesthesia

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Regional anesthesiaRegional anesthesia

• Head and faceHead and face• Field blockField block• Supraorbital and infraorbital blocksSupraorbital and infraorbital blocks• Ear blockEar block• Upper and lower lipsUpper and lower lips• Mental nerveMental nerve

• ExtremitiesExtremities• Median, radial and ulnar nervesMedian, radial and ulnar nerves• Digital (ring) blockDigital (ring) block

• Dorsal penile nerve blockDorsal penile nerve block

• Head and faceHead and face• Field blockField block• Supraorbital and infraorbital blocksSupraorbital and infraorbital blocks• Ear blockEar block• Upper and lower lipsUpper and lower lips• Mental nerveMental nerve

• ExtremitiesExtremities• Median, radial and ulnar nervesMedian, radial and ulnar nerves• Digital (ring) blockDigital (ring) block

• Dorsal penile nerve blockDorsal penile nerve block14

Field blockField block

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Ear BlockEar Block

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Orbital blocksOrbital blocks

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Lip blocksLip blocks

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Mental nerve blockMental nerve block

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Median, radial, ulnar blocksMedian, radial, ulnar blocks

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Digital (ring) blockDigital (ring) block

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Dorsal penile nerve blockDorsal penile nerve block

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