Local Anasthesia

Question 1

COPD patient , on Apixaban , has severe Abdominal pain . Going for emergency Laparotomy because of sepsis, he is Febrile , hypotensive and tachycardic .

Q1.Why epidural is not ideal in this patient ?

Answer 1

As COPD and Apixiban – > spinal hematoma while coughing
also high Epidural may affect Respiratory muscle in COPD pt and compromise him

Question 2

Q2: What other options can be done ?

Answer 2

Regional “Rectus sheath catheter” / Local anathesia , T10 N Block / General anathesia (Halothan , Isuflorane)

Question 3

Q3: What will prevent you to use morphine for pain ?

Answer 3

Pt may go into Res failure as Morphine cause res depression

Question 4

Q4. what is the post op options for pain management ?

Answer 4

Regional anathseia (Rec. sheath block) / Oral NSAIDs / local anathesia / tramadol

Question 5

Q5. what is systemic side effects of LA ?

Answer 5

perioral numbness, dysarthria, Arrythmias, bradycardia, sudden death

Question 6

Q6: what are the 1st neurological complications of LA ?

Answer 6

Dysarthria and perioral numbness

Question 7

Q7.How to manage LA toxicity?

Answer 7

Immediate; Stop injection – CCRISP (Maintain airway / 100% O2 / IV access / Control seizure)
ttt; Bolus IV Intralipid 20% – then IV infusion Intralipid 20%

Question 8

Q8. What is the safe dose of lidocaine and bupivacaine ?

Answer 8

Lid; 3 ml/kg +adrenaline 7 ml/kg
Bup; 2 ml/kg +adrenaline 2 ml/kg

Question 9

Q9.If solution concentration in 0.25%, 10 ml will be equal how many mg ?

Answer 9

0.25% equal 2.5x10 = 25 mg