Local anesthetics: Difference between revisions
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*Esters have one "i" (tetracaine, procaine, benzocaine, etc) | *Esters have one "i" (tetracaine, procaine, benzocaine, etc) | ||
*Ester local anesthetics more likely to cause allergic reaction due to metabolite PABA<ref>GlobalRPH. Local Anesthetics (ester and amide-type). http://www.globalrph.com/local-anesthetics.htm.</ref> | *Ester local anesthetics more likely to cause allergic reaction due to metabolite PABA<ref>GlobalRPH. Local Anesthetics (ester and amide-type). http://www.globalrph.com/local-anesthetics.htm.</ref> | ||
*If patient allergic to amides and esters, consider local [[Diphenhydramine]] (Na blocker)<ref>Pavlidakey PG et al. Diphenhydramine as an Alternative Local Anesthetic Agent. J Clin Aesthet Dermatol. 2009 Oct; 2(10): 37–40.</reF> | |||
**Sodium channel blocker mechanism | |||
**1-2 mL of 1% diphenhydramine at a time, to not exceed excessive sedation dose | |||
**Typical vial is 50 mg/mL, so to make 10 mg/mL: | |||
***10 mL NS removed from 50 mL vial | |||
***Add 10 mL of 50 mg/mL diphenhydramine to 40 mL of NS | |||
***Sedation is dose related and is similar to what would be expected for IM doses | |||
***Relative contraindications are the same for IM diphenhydramine administration | |||
{{Maximum doses of anesthetic agents}} | {{Maximum doses of anesthetic agents}} | ||
==Side Effects== | |||
*CNS | |||
**Perioral numbness | |||
**[[Seizure]] | |||
*Cardiovascular | |||
**AV blocks | |||
**VT and VF | |||
**Asystole | |||
*Allergic reaction | |||
*[[Methemoglobinemia]] | |||
==See Also== | ==See Also== | ||
*[[Local Anesthetic Systemic Toxicity (LAST)]] | *[[Local Anesthetic Systemic Toxicity (LAST)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] |
Latest revision as of 23:21, 27 August 2021
Background
- Amides have two "i's" (prilocaine, lidocaine, etc)
- Esters have one "i" (tetracaine, procaine, benzocaine, etc)
- Ester local anesthetics more likely to cause allergic reaction due to metabolite PABA[1]
- If patient allergic to amides and esters, consider local Diphenhydramine (Na blocker)[2]
- Sodium channel blocker mechanism
- 1-2 mL of 1% diphenhydramine at a time, to not exceed excessive sedation dose
- Typical vial is 50 mg/mL, so to make 10 mg/mL:
- 10 mL NS removed from 50 mL vial
- Add 10 mL of 50 mg/mL diphenhydramine to 40 mL of NS
- Sedation is dose related and is similar to what would be expected for IM doses
- Relative contraindications are the same for IM diphenhydramine administration
Maximum Doses of Anesthetic Agents
Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
Mepivicaine | 7 mg/kg | 8 mg/kg | ||
Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
Ropivacaine | 3 mg/kg | |||
Prilocaine | 6 mg/kg | |||
Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
Side Effects
- CNS
- Perioral numbness
- Seizure
- Cardiovascular
- AV blocks
- VT and VF
- Asystole
- Allergic reaction
- Methemoglobinemia
See Also
References
- ↑ GlobalRPH. Local Anesthetics (ester and amide-type). http://www.globalrph.com/local-anesthetics.htm.
- ↑ Pavlidakey PG et al. Diphenhydramine as an Alternative Local Anesthetic Agent. J Clin Aesthet Dermatol. 2009 Oct; 2(10): 37–40.