Local and Regional Anesthesia Rural Track Mark Deutchman MD Rural Track Mark Deutchman MD 1

Sterile technique purposes Prevent infectionPrevent infection Prevent cross-contaminationPrevent cross-contamination 22

Sterile technique methods Identify sterile materialsIdentify sterile materials Properly handle sterile materialsProperly handle sterile materials Set up a sterile fieldSet up a sterile field Maintain a sterile fieldMaintain a sterile field Skin preparationSkin preparation 33

Practice Hand washingHand washing Opening sterile packagesOpening sterile packages Putting gloves onPutting gloves on Adding objects to a sterile fieldAdding objects to a sterile field Drawing up liquid medications in a sterile fashionDrawing up liquid medications in a sterile fashion Avoiding cross-contaminationAvoiding cross-contamination 44

Local Anesthesia 55

Local Anesthesia General Principles Organize your supplies. Organize your supplies. Talk to the patient ! Talk to the patient ! Know what you are drawing up! Know what you are drawing up! Give the anesthetic time to work ! Give the anesthetic time to work ! Move slowly and deliberately ! Move slowly and deliberately ! Keep talking with the patient ! Keep talking with the patient ! Dress the wound neatly ! Dress the wound neatly ! Arrange follow-up ! Arrange follow-up ! Treat the patient like you would like to be treated ! Treat the patient like you would like to be treated ! Organize your supplies. Organize your supplies. Talk to the patient ! Talk to the patient ! Know what you are drawing up! Know what you are drawing up! Give the anesthetic time to work ! Give the anesthetic time to work ! Move slowly and deliberately ! Move slowly and deliberately ! Keep talking with the patient ! Keep talking with the patient ! Dress the wound neatly ! Dress the wound neatly ! Arrange follow-up ! Arrange follow-up ! Treat the patient like you would like to be treated ! Treat the patient like you would like to be treated ! 6

Agents Amides Vs. Esters – less allergy to amides like lidocaineAmides Vs. Esters – less allergy to amides like lidocaine Speed of onsetSpeed of onset Duration of actionDuration of action Addition of epinephrineAddition of epinephrine –Prolongs duration and adds some hemostasis –Avoid on acral parts: fingers, toes, ears, penis, nose 77

Agents - details 88

Needles Large to draw up (18 to 20)Large to draw up (18 to 20) Small to inject (22 to 30)Small to inject (22 to 30) 99

Prep agents Alcohol Alcohol Chlorhexidine Chlorhexidine Povidone iodine Povidone iodine 1010

Reducing injection pain Use a small needleUse a small needle Inject slowlyInject slowly When re-injecting, go through numb areaWhen re-injecting, go through numb area Inject subcutaneously firstInject subcutaneously first Warm the lidocaineWarm the lidocaine Buffer lidocaine with 8.4% sodium bicarb 9:1Buffer lidocaine with 8.4% sodium bicarb 9:1 1111

Topical anesthesia 1212

1313

Regional anesthesia Head and face Head and face Field block Field block Supraorbital and infraorbital blocks Supraorbital and infraorbital blocks Ear block Ear block Upper and lower lips Upper and lower lips Mental nerve Mental nerve Extremities Extremities Median, radial and ulnar nerves Median, radial and ulnar nerves Digital (ring) block Digital (ring) block Dorsal penile nerve block Dorsal penile nerve block Head and face Head and face Field block Field block Supraorbital and infraorbital blocks Supraorbital and infraorbital blocks Ear block Ear block Upper and lower lips Upper and lower lips Mental nerve Mental nerve Extremities Extremities Median, radial and ulnar nerves Median, radial and ulnar nerves Digital (ring) block Digital (ring) block Dorsal penile nerve block Dorsal penile nerve block 14

Field block 15

Ear Block 16

Orbital blocks 17

Lip blocks 1818

Mental nerve block 19

Median, radial, ulnar blocks 2020

Digital (ring) block 21

Dorsal penile nerve block 2222