Lidocaine intravenous regional

Ketamine has also been studied as an adjuvant to lidocaine intravenous regional anesthesia for hand surgery in 40 patients who received ketamine 0.1 mg/kg either as an adjuvant to the lidocaine or as an intravenous injection [26 ]. There were no significant differences in tourniquet pain or opiate requirements, either intraoperatively or during the recovery period. There were no difference in the incidence of psychotomimetic effects and satisfaction was high in both groups. The authors felt that it would be unethical to include a control group, as ketamine has already been shown to be superior to placebo. However, this makes the conclusions hard to interpret. 

Viscomi CM, Friend A, Parker C, Murphy T, Yamell M. Ketamine as an adjuvant in lidocaine intravenous regional anesthesia a randomized, double-blind, systemic control trial. Reg Anesth Pain Med 2009 34(2) 130-3. 

Lidocaine is used for all forms of infiltration anaesthesia, in addition to peripheral, regional, spinal and epidural block. Unlike bupivacaine, it is suitable for use in intravenous regional anaesthesia. Duration of anaesthesia is about 1 hour but this can be prolonged to 2 hours by the addition of adrenaline. The maximum doses are shown in Table 5.2. 

Lidocaine Xylocaine Rapid Intermediate Infiltration Peripheral Nerve Block Epidural Spinal Transdermal Topical Sympathetic block Intravenous regional block... 

Intravenous. A double cuff is applied to the arm, inflated above arterial pressure after elevating the limb to drain the venous system, and the veins filled with local anaesthetic, e.g. 0.5-1% lidocaine without adrenaline (epinephrine). The arm is anaesthetised in 6-8 min, and the effect lasts for up to 40 min if the cuff remains inflated. The cuff must not be deflated for at least 20 minutes. The technique is useful in providing anaesthesia for the treatment of injuries speedily and conveniently, and many patients can leave hospital soon after the procedure. The technique must be meticulously conducted, for if the full dose of local anaesthetic is accidentally suddenly released into the general circulation severe toxicity and even cardiac arrest may result. Bupivacaine is no longer used for intravenous regional anaesthesia as cardiac arrest caused by it is particularly resistant to treatment. Patients should be fasted and someone skilled in resuscitation must be present. 

Prilocaine is used similarly to lidocaine (t,i 1.5 h), but it is slightly less toxic. It used to be the preferred drug for intravenous regional anaesthesia but it is... 

A study of hdocaine toxicity in intravenous regional anesthesia showed that two of 24 patients who were given 0.5% lidocaine 40 ml for carpal tunnel decompression had serum hdocaine concentrations above the target range 2 minutes before and 2, 5, and 10 minutes after distal tourniquet deflation (274). However, no patients had signs of central nervous system or cardiovascular toxicity. 

When 20 patients each received 40 ml of 0.5 % chloropro-caine or 0.5 % lidocaine for intravenous regional anesthesia, chloroprocaine caused a significantly higher incidence of a metallic taste (22 versus 0%) than hdocaine when the study was repeated using alkahnized instead of plain chloroprocaine, there was no significant difference between the groups (280). 

Kireker HD, Aynacioglu AS, Goksu S. Determination of 0.5% lidocaine serum concentrations and evaluation for toxicity in intravenous regional anaesthesia. Turk Anesteziyol Reanim 2000 28 211-16. 

Chan VW, Weisbrod MJ, Kaszas Z, Dragomir C. Comparison of ropivacaine and lidocaine for intravenous regional anesthesia in volunteers a preliminary study on... 

Cherng CH, Wong CS, Ho ST. Acute aphesia following tourniquet release in intravenous regional anesthesia with 0.75% lidocaine. Reg Anesth Pain Med 2000 25(2) 211-12. 

Hartmannsgruber MW, Halaszynski TM. Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery. Anesthesiology 2001 95(3) 627-31. 

Lavin PA, Henderson CL, Vaghadia H. Non-alkalinized and alkalinized 2-chloroprocaine vs lidocaine for intravenous regional anesthesia during outpatient hand surgery. Can J Anaesth 1999 46(10) 939-45. 

Acalovschi I, Cristea T, Margarit S, et al Tramadol added to lidocaine for intravenous regional anesthe-... 

Local anesthetics are used to locally anesthetize a wide range of specific body parts or areas to allow painless surgery. Local anesthetics are most commonly used for dental procedures and repair of lacerations. They can also be used to provide neural blockade for larger, more painful procedures. Sites of LA application include localized injection, peripheral nerve blocks as well as central nerve blockade. The only safe agents which can be utilized for intravenous regional anesthesia (Bier block) are lidocaine and prilocaine. Other typical indications are outlined in Table 64.1. 

For intravenous regional anesthesia, lidocaine is administered in 0.5% solution. For peripheral neural blockade, the 2% solution with or without epinephrine is most commonly administered to provide fastest onset of action as well as maximal surgical motor blockade. More dilute concentrations such as 1-1.5% may also be administered, but provide less motor blockade than the 2% solution. 

Amide-type agents include articaine, lidocaine, bupivacaine, prilocaine, mepivacain and ropiva-caine. These are metabolized in the liver by microsomal enzymes with amidase activity. The amide group is preferred for parenteral and local use. If by accident rapidly administered intravascularly these agents, especially bupivacaine but also lidocaine, can produce serious and potentially lethal adverse effects including convulsions and cardiac arrest. They can more easily accumulate after multiple administrations. Intravenous lidocaine is sometimes used for regional anesthesia, for infiltration procedures, for the induction of nerve blockade and for epidural anesthesia. However, it is also used as an antiarrhythmic. Bupivacaine is a long-acting local anesthetic used for peripheral nerve blocks and epidural anesthesia. 

Intra-arterial injection of thiopentone is a serious complication as crystals of the thiobarbiturate can form in the arterioles and capillaries, causing intense pain, vasoconstriction, thrombosis, and even tissue necrosis. Accidental intra-arterial injections should be treated promptly with intra-arterial administration of a vasodilator (papaverine 20 mg) and lignocaine (lidocaine) Note leave the needle/cannula in the artery), as well as a regional anaesthesia-induced sympathectomy (stellate ganglion block, brachial plexus block) and anticoagulation with intravenous heparin. The risk of ischaemic damage is much higher with a 5% solution and the use of this concentration is not recommended. 

BETA-BLOCKERS LIDOCAINE 1. Risk of bradycardia (occasionally severe), 1 BP and heart failure with intravenous lidocaine 2. Risk of lidocaine toxicity due to t plasma concentrations of lidocaine, particularly with propranolol and nadolol 3. t plasma concentrations of propranolol and possibly some other beta-blockers 1. Additive negative inotropic and chronotropic effects 2. Uncertain, but possibly a combination of beta-blocker-induced reduction in hepatic blood flow (due to 1 cardiac output) and inhibition of metabolism of lidocaine 3. Attributed to inhibition of metabolism by lidocaine 1. Monitor PR, BP and ECG closely watch for development of heart failure when intravenous lidocaine is administered to patients on beta-blockers 2. Watch for lidocaine toxicity 3. Be aware. Regional anaesthetics should be used cautiously in patients with bradycardia. Beta-blockers could cause dangerous hypertension due to stimulation of alpha-receptors if epinephrine is used with focal anaesthetic... 

Local anesthetics are widely used to provide anesthesia via local subcutaneous Injection topical application to skin and mucous membranes and epidural, spinal, and regional nerve blocks. In addition, lidocaine (see p 462) is used intravenously as an antiarrhythmic agent and cocaine (see p 171) is a popular drug of abuse. Gommonly used agents are divided into two chemical groups ester-linked and amide-linked (Table 11-2). 

Twenty patients undergoing surgery were given repeated 1-mg intravenous doses of midazolam as induction anaesthesia every 30 seconds until they failed to respond to three repeated commands to squeeze the anaesthetist s hand. This was considered as the induction end-point titrated dose. It was found that the 10 who had been given prior spinal anaesthesia with tetracaine 12 mg needed only half the dose of midazolam (7.6 mg) than the 10 other patients who had not received tetracaine (14.7 mg). The reasons are not known. The authors of this report simply advise care in this situation. In another study in which patients were given intravenous midazolam following an intramuscular injection of either bupivacaine, lidocaine or saline, it was found that both anaesthetics enhanced the effect of midazolam. This effect was dose-dependent and it was concluded that the use of lidocaine or bupivacaine for regional blocks or local infiltration could alter the effect of midazolam from sedative to hypnotic. ... 

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