Local Anaesthetic Drugs

Drug Lidocaine Mepivacaine Prilocaine Bupivocaine Levobupivocaine Ropivacaine Brand Name Xylocaine Scandonest Citanest Marcain Chirocaine Naropin Maximum Safe Dose 3mg/kg 6mg/kg 6mg/kg 2mg/kg 2mg/kg 4.3mg/kg Onset 2 5 mins 2 5 mins 2 5 mins 15 30 mins 10 15 mins 10 15 mins Duration 1 1.5 hrs 1.5 2 hrs 1.5 2 hrs 4 6 hrs 4 6 hrs + 4 6 hrs + pKa 7.7 7.6 7.7 8.1 8.1 8.1

Local Anaesthetic Drugs

Lidocaine with Adrenaline (1:200,000)

MSD 7mg/kg
MSD 2mg/kg

Bupivicaine with Adrenaline (1:200,000)

Local Anaesthetic Drugs

Adrenaline
Increase MSD (not Bupivicaine) Reduce rate of absoprption Prolong duration

Local Anaesthetic Drugs

What is pKa ?

pKa is the pH at which the LA drug performs to its maximum potential Normal body tissue pH is 7.4

Diagramatic representation of relative ionisation of bupivacaine and lidocaine

At body pH (7.4) Lidocaine is 25% ionised Bupivacaine is only 10% ionised

8.1

pH

7.7 7.4

Bupivacaine Lidocaine

10%

25%

50% % ionised

100%

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

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

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

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

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

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

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

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

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

Dose Calculations

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

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

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

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

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

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

Important

Do not mix Local Anaesthetic Drugs in same syringe

Podiatric Uses of Local Analgesia

Surface LA painful HNV Regional Infiltration painful HNV

Podiatric Uses of Local Analgesia

Para-digital nerveblock

TNA/PNA; Wedge resections; HNV on IPJs

Electrosurgery; VP curettage; Plantar HNV; Precurser to injection therapies; Dermatological biopsies Electrosurgery; VP curettage; 1st MTPJ HNV

Tibial block

1st Ray block

Podiatric uses of Local Analgesia

Diagnostic Aid
Plantar digital neuritis Tarsal tunnel syndrome

Therapeutic Aid
Rheumatoid Arthritis Ulceration

Chronic Pain Relief

Plantar Fasciitis

Podiatric Uses of Local Anaelgesia

In conjunction with corticosteroid injection (do not mix)

Tibial Nerve

Superficial and Deep Peroneal Nerves

Sural Nerve

Saphenous Nerve