Local Anaesthesia

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Medicines  used  as  local  anaesthetics  cause  revisable  absence  of  pain  sensation,  although  other  senses are often affected as well. Also, when it is used on specific nerve pathways, paralysis can  also be achieved.  

A:  lidocaine  (site):  Maximum  4.5mg/kg  without  vasoconstrictors  (adrenaline)  or  7mg/kg with vasoconstrictors (Not for Spinal Anaesthesia) 

OR 

C: bupivacaine (site): 625µg/ml(0.0625%)1.25mg/ml(0.125%) 

OR 

C:  bupivacaine  +  glucose:  bupivacaine  hydrochloride  5mg/ml  (0.5%)  with  80  mg/ml  glucose  (specific  gravity  of  1.026).  The  addition  of  glucose  produces  a  hyperbaric  solution relative to cerebrospinal fluid.  

Medicines for Local Anaesthetics Overdose 

S: Lipid emulsion (intralipid 20% or 30% solution) for severe local anaesthetic toxicity with cardiovascular or neurological impairment. 

Dose: 1.5ml/kg (IV) over 1min, then continuous infusion 0.25ml/kg/min. Repeat bolus 1–2 times for persistent cardiovascular collapse. Double infusion rate to 0.5ml/kg/min if BP remains  low.  Continue  infusion  for  at  least  10  minutes  after  cardiovascular  stability  attained.  Recommended upper limit: approximately 10ml/kg lipid emulsion over the first 30 minutes. 

Epidural and combined spinal-epidural anaesthesia Techniques 

Epidural anaesthesia is a type of neuraxial anaesthesia; local anaesthetic (LA) is injected into the  epidural space to anaesthetize the spinal nerve roots that traverse the space. Epidural anaesthesia  is used for anaesthesia of abdominal, pelvic, and lower extremity procedures and, less commonly,  thoracic procedures.  

A: lidocaine 1 to 2 %(Epidurally) 

OR 

C: bupivacaine 0.25 to 0.75% (Epidurally)                                    

Epidural Labour Analgesia (Local Anaesthetics, Adjuvant Drugs) 

D:  bupivacaine  0.1-0.25%  with  or  without  Fentanyl  50  –  100µg  (Epidurally).    e.g. (Bupivacaine 0.1% Plus Fentanyl 2µg/ml at   infusion rate of 0-12mls/hour)  

Peripheral nerve blocks 

Peripheral nerve blocks are widely used for surgical anaesthesia as well as for both postoperative  and nonsurgical analgesia. 

Blocks  are  often  used  to  avoid  the  effects  of  alternative  anesthetics  or  analgesics.  The  most  common rationale for their use is to avoid side effects and complications of general anaesthesia  (GA), particularly respiratory-related effects, and to provide analgesia while minimizing opioid use. 

Local Anaesthetics 

B:  lidocaine (Perineurally) 1 to 2%  

OR 

C: bupivacaine (Perineurally) 0.25 to 0.75%  

OR 

C:bupivacaine+glucose(Perineurally) 0.25 to .75%  

Adjuvants 

A: adrenaline (Perineurally) Typical Concentration 5-10µg  

OR 

B: dexamethasone (Perineurally) 4-10mg 

OR 

S: clonidine (perineurally) 0.5-2µg  

Topical Anaesthesia 

B: lidocaine gel (Topically) 2 to 5%  

OR  

B:  lidocaine  topical  spray  2%  and  10%  solutions  for  topical  anaesthesia  of  the  upper airway (i.e., oropharynx and vocal cords), the trachea, and nasal passages.