Local and Regional Anesthesia

1. Local and Regional Anesthesia Rural Track Mark Deutchman MD

2. Sterile technique purposes • Prevent infection • Prevent cross-contamination

3. Sterile technique methods • Identify sterile materials • Properly handle sterile materials • Set up a sterile field • Maintain a sterile field • Skin preparation

4. Practice • Hand washing • Opening sterile packages • Putting gloves on • Adding objects to a sterile field • Drawing up liquid medications in a sterile fashion • Avoiding cross-contamination

5. Local Anesthesia

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

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

8. Agents - details

9. Needles • Large to draw up (18 to 20) • Small to inject (22 to 30)

10. Prep agents • Alcohol • Chlorhexidine • Povidone iodine

11. Reducing injection pain • Use a small needle • Inject slowly • When re-injecting, go through numb area • Inject subcutaneously first • Warm the lidocaine • Buffer lidocaine with 8.4% sodium bicarb 9:1

12. Topical anesthesia

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

15. Field block

16. Ear Block

17. Orbital blocks

18. Lip blocks

19. Mental nerve block

20. Median, radial, ulnar blocks

21. Digital (ring) block

22. Dorsal penile nerve block