Operational Medicine Medical Education and Training

Local/Regional Anesthesia

Advantages/Disadvantages of Regional and Local Anesthesia.

advantages

patient remains conscious

maintain his own airway

aspiration of gastric contents unlikely

smooth recovery requiring less skilled nursing care as compared to general anesthesia

advantages

postoperative analgesia

reduction in surgical stress

earlier discharge for outpatients

less expense

1% lidocaine without epinephrine

Local/Regional Anesthesia

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Disadvantages:

patient may prefer to be asleep

practice and skill is required for the best results

some blocks require up to 30 minutes or more to be fully effective

analgesia may not always be totally effective-patient may require additional analgesics, IV sedation, or a light general anesthetic

Disadvantages:

toxicity may occur if the local anesthetic is given intravenously or if an overdose is injected

some operations are unsuitable for local anesthetics, e.g., thoracotomies

Mechanism of Action of Local Anesthetics

produce a blockade of nerve impulse by preventing increases in permeability of nerve membranes to Na ions, slowing the rate of depolarization

interact directly with specific receptors on the sodium channel, inhibiting sodium influx

do not alter the resting membrane resting potential or threshold potential

Selection of Local/Regional Anesthetics

specific nerves to be blocked

onset time or latency

required duration of effect

Systemic Toxicity of Local Anesthetics

Drugs-not a great difference in toxicity between equally potent local anesthetics-one of low toxicity when a large dose is required

Site of injection-vascular sites lead to rapid absorption

accidental I.V. injection is the most common cause of toxicity

Systemic Toxicity of Local Anesthetics

Addition of Epinephrine-causes local vasoconstriction and slows absorption

Follow recommended dose

Signs and Symptoms of Local/Regional Anesthesia Toxicity

CNS

CV

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From SFC Hill

Joint Special Operations Medical Training Center
In

Operational Medicine 2001

Bureau of Medicine and Surgery

Department of the Navy

 

 

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