What type of anesthesia are LET/LAT, EMLA, and Ethyl Chloride?
What is LET/LAT (replaced TAC)?
Lidocaine, epinephrine/adrenaline and tetracaine,
LET/LAT indicated for:
Scalp and Facial lacerations
LET/LAT indicated especially for ________.
List contraindications for LET/LAT topical anesthesia?
Hypersensitivity to ingredient Mucous membranes Compromised skin near wound Nose, penis, fingers, toes Non-facial or non-scalp lacerations
Explain technique when you use LET/LAT for topical anesthesia?
– Soak gauze with 1.5-3.0 mls of LET – Let sit for 10 to max 30 mins
List some complications that can occur when you are using LET/LAT?
– Theoretically-infection – Adverse reactions if allergic to any component – High concentration absorbed – cardiac and/or CNS stimulation
What type of topical anesthesia also avail OTC now?
What is EMLA?
When can you use EMLA (Lidocaine/Prilocaine)?
Venipuncture, Lumbar & Arterial puncture Suture removal Dermabrasion Split-thickness skin donor site Molluscum contagiosum, Veneral warts, Post-herpetic neuralgias Intracutaneous allergy testing Meralgia paresthetica Superficial shave biopsy Removal of foreign body embedded in skin
Explain technique steps when you use EMLA?
occlusive dressing x 60-90 minutes
There is an EMLA disc that has a __________.
built in occlusive
What is the name of the topical anesthesia that is QUICKER onset of action than EMLA?
When do you use Ethyl chloride?
Skin tag clipping Abscess I&D Suture removal
Explain technique when you use Ethyl Chloride?
Spray site for 1-2 seconds Perform procedure
What is the name of common INJECTABLE anesthetic (Amides)?
Lidocaine aka Xylacaine
What is the another name for Infiltrative anesthesia?
List Infiltrative Anesthesia types:
Local anesthesia, Field block Digital Block
List some of the standard procedures that require LOCAL INFILTRATIVE anesthesia?
Laceration repair, skin biopsies, curettage, and digital blocks
Even with the recent advances in topical anesthesia, infiltrative anesthesia remains a mainstay for:
painful office procedures
List indications for use of Infiltrative (Local) anesthesia?
Relief of pain during clinical procedures & trauma Diagnostic tool
What are the contraindications for Infiltrative (Local) anesthesia use?
Known sensitivity-very rare Epinephrine-not used in certain areas
What areas does Epinephrine usually not use?
“Fingers, nose, penis, toes.”-not as rigid as it used to be
Xylocaine (Lidocaine) without* Epinephrine can cause:
How long does Xylocaine (Lidocaine) without* Epinephrine lasts?
When do you use Xylocaine (Lidocaine) without* Epinephrine?
Xylocaine (Lidocaine) with* epinephrine can cause:
Xylocaine (Lidocaine) with* epinephrine has _______ duration of action.
Xylocaine (Lidocaine) with* epinephrine use in:
Do not* use Xylocaine (Lidocaine) with* epinephrine on:
fingers, nose, penis, toes and earlobes
Approaches to the allergic patient: (This is rare)
Use a cooling agent Small lesion-no anesthetic Use bacteriostatic saline Substitute an amide for an ester Use Benadryl
Explain steps of technique that is use with Xylocaine (lidocaine)?
– Prep area – Clean vial top with ETOH swab – Choose appropriate needle and syringes – Draw back on plunger – Inject into site – Wait a few minutes for anesthetic to take effect before beginning procedure
Lidocaine (Xylocaine) has ______ duration.
Lidocaine (Xylocaine) equivalent concentration can be ___ or ___%.
1 or 2%
What is the ONSET of Lidocaine (Xylocaine)?
What is the DURATION of Lidocaine (Xylocaine)?
1.5 to 2 hours
What is the MAXIMAL dose- mg per kg for Lidocaine (Xylocaine)?
4 mg per kg not to exceed 280 mg
What is the MAXIMAL dose- ml per 70 kg for Lidocaine (Xylocaine)?
28 ml -1% 14 ml – 2%
What is Field block?
-Provides anesthesia to a SMALL area -Provides a wall of anesthesia across path of nerves providing sensation to the operative area
What type of during is Filed block?
Longer duration of anesthesia
Remember filed block has no* distortion of ________.
How long do you wait for Filed block anesthesia to take effect**?
How much of Digital block given for FINGERS?
About 4cc of 1% or 2% lidocaine
How much of Digital block given for TOES?
What type of technique is used when Digital block is used?
X-technique – advance needle into tissue
When using digital block for fingers and toes, advance needle into tissue than withdraw needle _____ upon touching bone.
After injecting solution for digital block check for _________ before performing procedure.
check for effect
When you doing Digital block entry of the needle it needs to passed:
Dorsal digital nerve Palmar digital nerve
Pre-procedure of nerve blocks make sure to obtain* _______.
List pre-procedure steps for Nerve blocks:
Obtain consent Perform neuro check Locate nerve and identify injection site
Explain Nerve Block procedure?
Pull back on plunger and check for blood, none inject rest of anesthetic
What do you need to educate patient about nerve block procedure?
– Few complications – Duration of anesthesia may be prolonged – Rarely-nerve traumatized – Avoid heat/cold until normal sensation returns