Local Anaesthetics

Question 1

Part of the pain pathway local anaesthetic act on

Answer 1

Transmission

Question 2

Multimodal analgesia

Answer 2

Using drugs which work at different parts of the pain pathway to provide effective analgesia, whilst utilising smaller doses of drugs which limits their side effects

Question 3

Dose rang for lidocaine

Answer 3

2-4mg/kg

Question 4

Dose range for Bupivacaine

Answer 4

1-2mg/kg

Question 5

Dose range for Ropivacaine

Answer 5

0.1-2mg/kg

Question 6

Local anaesthetic nerve blocks that will block teeth

Answer 6

Maxillary and mandibular

Question 7

What is blocked by an Infraorbital nerve block

Answer 7

Upper lip and nose (nasal plenum and room of nasal cavity), and the skin rostroventral to infraorbital foramen

Question 8

Where is the infraorbital foramen?

Answer 8

Midway between the rostrodorsal bored of the zygomatic arch and the canine root tip

Question 9

The maximum volume to be injected into an infraorbital nerve block

Answer 9

3ml

Question 10

Injection point for Maxillary nerve block

Answer 10

Pterygopalatine fossa

Question 11

Location of the Pterygopalatine fossa

Answer 11

Between the rostrum alar foramen and the maxillary foramen

Question 12

What does the Maxillary nerve block cover?

Answer 12

nose (nasal plenum and most of the bridge of the nose), upper lip, the upper teeth, the palate and the maxilla

Question 13

Maximum amount to be injected in a maxillary nerve block

Answer 13

3ml

Question 14

What does a mental nerve block cover?

Answer 14

The lower lip and chin roster also to the side of the block. No teeth

Question 15

How to perform a mandibular nerve block

Answer 15

Insert a needle percutaneously at the lower angle of the jaw and advance it against the medial side of the mandible and direct it towards the foramen. Often the needle can be guided, as you can feel the foramen and nerve from inside the mouth on the medial surface of the mandible.

Question 16

What does a mandibular nerve block cover?

Answer 16

Lower teeth, mandible, skin and mucosa of the lower lip

Question 17

What nerves does a Retrobulbar block cover?

Answer 17

Cranial nerves II, III, IV, V (ophthalmic and maxillary branches), and VI

Question 18

When should local anaesthetics not be used?

Answer 18

Should not be injected through inflamed or infected tissue

Question 19

Why should local anaesthetic not be used in inflamed or infected tissues?

Answer 19

It may disseminate infection and will be less effective due to altered pH of the tissue

Question 20

What is Intravenous Regional analgesia?

Answer 20

Local anaesthetic is injected distal to a tourniquet which is kept in place to keep the lidocaine in the desired area. The block works for as long as the tourniquet is in place.

Question 21

How long should a tourniquet be left in place for an intravenous regional anaesthesia?

Answer 21

No more then 60-90 minutes

Question 22

Which local anaesthetics should be used to intravenous regional anaesthesia and why?

Answer 22

Lidocaine as it is the least cardiotoxic

Question 23

How long after injecting lidocaine should you begin surgery?

Answer 23

5 minutes

Question 24

How long is the minimum time the tourniquet should be in place for intravenous regional block

Answer 24

At least 15 minutes

Question 25

Digital nerve block

Answer 25

Insert a short needle in the gap between the digits either side of the affected digit. Check aspiration for blood and inject a maximum of 0.5ml each side.

Question 26

Dose rate for lidocaine

Answer 26

4mg/kg