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Local Anaesthetic Drugs

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Local Anaesthetic Drugs

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    1. Local Anaesthetic Drugs

    3. Local Anaesthetic Drugs Adrenaline Increase MSD (not Bupivicaine) Reduce rate of absoprption Prolong duration

    4. Local Anaesthetic Drugs

    5. What is pKa ? pKa is the pH at which the LA drug performs to it’s maximum potential Normal body tissue pH is 7.4

    7. Maximum Safe Dose - MSD This is maximum dose a drug that should be given to a patient in a 24 hour period It is calculated in milligrams per kilogram (mg/kg) Based on a maximum body weight of 70kg

    8. MSD - Examples A patient weighs 70 kg. How much Lidocaine can be given? MSD for Lidocaine = 3mg/kg Weight is 70 kg MSD is 3 x 70 = 210 mg

    9. MSD - Examples A patient weighs 50 kg How much mepivacaine can be given? MSD for mepivacaine = 6 mg/kg Weight is 50kg MSD is 6 x 50 = 300 mg

    10. MSD - Examples A patient weighs 97 kg How much marcain can be given? MSD for marcain = 2 mg/kg Work on a maximum body weight of 70 kg MSD is 2 x 70 = 140 mg

    11. Answers 1 - 7 68 x 3 = 204mg 37 x 2 = 74mg 90 rounded down to 70; 70 x 2 = 140mg 74 rounded down to 70; 70 x 6 = 420mg 44 x 3 = 132mg False: 140mg is MSD True: MSD is 63 x 6 = 378mg

    12. Answers 8 - 10 No. MSD = 70 x 3 = 210. Received 204. Another 20mg = 230mg 81 rounded down to 70; MSD = 70 x 6 = 420mg. 420 – 132 = 288mg 85 rounded down to 70; MSD = 70 x 6 = 420mg. 420 – 192 = 228mg

    13. Answer - 11 The MSD of scandonest is 6mg/kg He has received 192mg of scandonest How many kg of body weight has been used – 192/6 = 32 We still have 38kg left to work with (70 – 32) MSD of lidocaine is 3mg/kg therefore 38 x 3 = 114mg

    14. Answer 12 MSD of Lidicaine is 3mg/kg Received 100mg of lidocaine How many kg of body weight used; 100/3 = 33.3 – round up to 34kg We have 26kg left to work with (Pt is 60kg) MSD of chirocaine is 2mg/kg 26 x 2 = 52mg

    15. Dose Calculations The dose of local anaesthetic is measured in mg The formula for calculation of dose is; Dose (mg) = volume (ml) x drug concentration (%) x 10 Mg = ml x % x 10

    16. Dose Calculations mg = ml x % x 10 ml = the volume of solution used % = will be displayed on vial

    17. Dose Calculations - Example I use 4mls of 1% lidocaine to anaethsetise a digit. What dose have I given? Formula is; Dose = volume x concentration x 10 Mg = ml x % x 10 Mg = 4 x 1 x 10 Dose = 40mg

    18. Volume calculations I use 40mg of 1% lidocaine. How many mls did I inject? Ml = dose (mg) / Concentration (1%) / 10 Ml = 40 / 1 / 10 Ml = 4 I used 4 ml

    19. Answers to calculate mg 6 x 2 x 10 = 120mg 4 x 0.5 x 10 = 20mg 4.4 x 3 x 10 = 132mg 12 x .25 x 10 = 30mg 0.8 x 3 x 10 = 24mg 5 x 1 x 10 = 50mg 3.7 x 3 x 10 = 111mg 8.3 x 2 x 10 = 166mg

    20. Answers to calculate ml 20 / 1 / 10 = 2mls 120 / 3 / 10 = 4mls 35 / 2 / 10 = 1.75mls 15 / 0.5 / 10 = 3mls 66 / 3 / 10 = 2.2mls

    21. Answer to calculate mls MSD = 210mg for lidocaine 210 / 1 / 10 = 21mls 210 / 2 / 10 = 10.5mls MSD = 420mg for mepivicaine 420 / 3 / 10 = 14mls MSD = 140mg for marcain and chirocaine 140 / 0.25 / 10 = 56mls 140 / 0.5 / 10 = 28mls

    22. Important Do not mix Local Anaesthetic Drugs in same syringe

    23. Podiatric Uses of Local Analgesia Surface LA – painful HNV Regional Infiltration – painful HNV

    24. Podiatric Uses of Local Analgesia Para-digital nerveblock TNA/PNA; Wedge resections; HNV on IPJ’s Tibial block Electrosurgery; VP curettage; Plantar HNV; Precurser to injection therapies; Dermatological biopsies 1st Ray block Electrosurgery; VP curettage; 1st MTPJ HNV

    25. Podiatric uses of Local Analgesia Diagnostic Aid Plantar digital neuritis Tarsal tunnel syndrome Therapeutic Aid Rheumatoid Arthritis Ulceration Chronic Pain Relief Plantar Fasciitis

    26. Podiatric Uses of Local Anaelgesia In conjunction with corticosteroid injection (do not mix)

    27. Tibial Nerve

    28. Superficial and Deep Peroneal Nerves

    29. Sural Nerve

    30. Saphenous Nerve

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