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Local Anaesthetics
- 1. Local Anaesthesia CME presentation by Gareth Wahl
- 2. Contents Local anaesthetic pharmacology Commonly used preparations at SCGH Local anaesthetic toxicology Pearls
- 5. Physiology of Local Anaesthetics Amides Metabolised in the liver, renally excreted Generally have two I’s in their name Esters Metabolised by plasma cholinesterases More prone to allergic reactions
- 6. Physiology of Local Anaesthetics Implications Acidic environments will have a greater proportion of LA in the ionised (less active) form Buffered LA will be more unionised and thus more active Consider metabolism when devising a dosage
- 8. Local Anaesthetics available at SCGH Lignocaine 1% +/- adrenaline, 2% vials Viscous, 4% cream Ropivacaine 0.75% Bupivacaine 0.5% +/- adrenaline Prilocaine 0.5% Tetracaine Clonidine
- 9. Physiology of Local Anaesthetics Table taken from Tintinalli J et al (2011), Tintinalli’s Emergency Medicine: A Comprehensive study guide.
- 10. Lignocaine Widely used and highly familiar Onset <5 min Duration 30-90 min (half life up to triple in severe liver disease) Various formulations for easy use Use of adrenaline in end artery territory?
- 11. Ropivacaine Successor to bupivacaine as less cardiotoxic with more predictable toxicity syndrome Long duration of action (up to 20 hours) Longer onset time (10-30 minutes)
- 12. Prilocaine Least cardiotoxic of the amide local anaesthetics Metabolised by hepatic amidases to aminophenols These oxidise haemoglobin to form methemoglobin Management 1-2mg/kg (up to 50mg) in 50mL in NS over 3-5 minutes Can repeat every 30 minutes, up to 7mg/kg with
- 16. Treatment options Standard toxicology Na channel blockade treatment Sodium Bicarbonate Hyperventilate IV lipid emulsion 1.5mL/kg over ONE minute followed by 0.25mL/kg/minute until haemodynamically stable >10min. Note 0.25mL/kg/min = 1050mL/hr for a 70kg patient Can rebolus a further 1.5mL/kg after ~30min and increase rate to 0.5mL/kg/min. Where is it kept?
- 17. Pearls
- 18. Pearls Remember post procedure analgesia Any others?