“Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bound or free.” -The Hippocratic Oath
Last week, Dr. Chamarti covered the Serratus Anterior Plane Block. Here we cover some of the basics of using local anesthetic for pain control.
Adequate analgesia is vital in the acute management of patients in the emergency department; today I intend to review the basics of the local anesthetics we use day-in and day-out in the emergency department.
Lidocaine without Epinephrine: 4mg/kg
Lidocaine with Epinephrine: 7mg/kg
Prilocaine without epinephrine 8mg/kg
Bupivacaine without epinephrine 2mg/kg
Bupivacaine with epinephrine 4mg/kg
If patient weighs greater than 70kg: Bolus 100mL of 20% lipid emulsion, followed by continuous infusion of 200-250ml over the next 20 minutes.
If patient weighs less than 70kg: Bolus 1.5mg/kg of 20% lipid emulsion, followed by continuous infusion of 0.25mg/kg/ideal body weight/minute.
When in doubt, go to this website for immediate help: http://www.lipidrescue.org/
- Nerve blocks are another tool in your pain control toolbox.
- Remember to have your local protocol for lipid rescue accessible to treat any adverse symptoms of LAST syndrome.
- Fortuna TJ. In: Tintinalli JE. eds. Tintinalli’s Emergency Medicine Online Updates. New York, NY: McGraw-Hill; 2011.
- Thomson CJ et al. Plast Reconstr Surg. 2007;119(1):260-6. PMID: 17255681
- Häfner HM et al. J Dtsch Dermatol Ges. 2005;3(3):195-9. PMID: 16372813
- Ilicki J. The Journal of Emergency Medicine 2015;49:799–809. PMID: 26254284