Locals Chart Flashcards
trade names of bupivicaine
Marcaine Marcaine Preservative-Free Marchaine Spinal Sensorcaine Sensorcaine-MPF Sensorcaine- MPF Spinal
how is bupivicaine supplied
Racemic mixture @
- 25% = 2.5mg/mL
- 5% = 5mg/mL
- 75% = 7.5mg/mL
what is bupivicaine used for?
Subcutaneous
PNB
Epidural
Spinal
Subq dose of bupivicaine and form
0.25%
dose 2.5 mg/kg
PNB dose of bupivicaine and form
PNB 0.25-0.5%
dose 2.5 mg/kg
Epidural dose of bupivicaine and form
Epi: 0.5-0.75%
dose 2mg/kg
Spinal dose of bupivicaine and form
Spinal: 0.5-0.75%
dose 0.3 mg/kg
max dose of bupivicaine SUBQ AND PNB SAME!!
175mg
max dose of bupivicaine SUBQ AND PNB SAME WITH EPINEPHRINE
225mg
what is the MAX DOSE of Bupivicaine Epidural
170mg
**5 mg less than Subq and PNB
what is the MAX DOSE of Bupivicaine Epidural WITH EPINEPHRINE
225 mg
** this is the SAME as Subq and PNB with epinephrine
MAX DOSE WITH BUPIVICAINE
0.3 mg/kg
NO EPINEPHRINE WITH SPINALS
what is the toxic plasma concentration of bupivicaine
> 3mcg/mL
Protein binding of bupivicaine?
and what does this mean?
96%
LONG duration of action hours
*depends on dose and location for exact time
metabolism of bupivicaine
HEPATIC- ALL AMIDES
SLOWEST METABOLISM OF ALL LOCALS
w/etidocain and ropivicain
BER – toxicity risk
Amide Hydrolysis and conjugation
Aromatic hydrozylation
N-dealkylation
half life of bupivicaine
3.5 hours
what is the relationship of sensory vs. motor block with bupiviciane
sensory block often OUTLASTS motor
sensory- at site
motor 2 below
sympathetic- upto 6 above
duration of action of bupivicaine- why Subcutaneous PNB Epidural Spinal
LONG- because highly protein bound Subq: 2-8 hours PNB: 4-12 hr Epi: 2-5 hr Spinal: 1-6 hr
Adverse Reactions with Bupivicaine
what MUST you know about this drug?
CV- MOST CARDIOTOXIC*****
Binds Na channels- CV arrest, HR block, hypotension, palpitations, Ventricular arrhythmias
CNS: Anxiety, dizziness, circumoral numbness, restlessness, seizure, tinnitus, blurred vision, miosis
GI: N/V
MS: chondrolysis
Hypersensitive, anaphylaxis, itching, angioedema
pKa of bupivicaine and what does this mean?
8.1
*same as ropivicaine
intermediate onset
contraindications with bupivicaine
0.75% NEVER for OB epidural- CV arrest- difficult to resuscitate
NEVER Bier block- systemic toxicity risk with tourniquet release
Obstetrics- crosses placenta pregnancy category C never while breastfeeding
lipid solubility =
potency
protein binding =
duration of action
follow VERY far by lipid solubility
how does adding sodium bicarbonate to LAs affect them?
alkalinizing LAs
increases the lipophilic portion of Las
more potent- moves into cells faster
the longer the carbon backbone of LAs…
the creating the LIPID SOLUBILITY
PROTEIN BINDIN
POTENCY
DURATION OF ACTION
how does adding Epi (1:200,00) affect bupivicaine?
decreases blood levels by 10-20%
what conditions increase LAs toxicity
metabolic & respiritory ACIDOSIS
decreased SZ threshhold
decreased protein binding
System Absorption Rates of Various Sites
In Time I Can Please Everyone But Susie and Sally
IV Tracheal Intercostal Caudal Paracervical Epidural Brachial Plexus Subarachnoid (Sciatic, Femoral) Subq
trade name of Lidocaine
Xylocaine
Xylocaine-MPF
many topical names
how is lidocaine supplied?
0.5% = 5mg/mL
1% (5mL) = 10mg/mL
2% (5mL) = 20mg/mL
4% LTA
5% (2mL) = 50mg/mL
10% 100mg/mL
LTA Kit- 4%
what is lidocaine used for?
Topical Infiltration IVRA- Beir Block- tourniquet PNB Epidural Spinal
dose of topical lidocaine AND form %
Topical – 4%, 4 mg/kg
dose of infiltration lidocaine AND form %
Infliltration: 0.5-1% 4mg/kg
dose of IVRA lidocaine
AND form %
IVRA: 0.25-0.5%, 4 mg/kg
PNB dose of lidociane AND form %
PNM: 1-1.5% 4 mg/kg
epidural dose of lidocaine and form %
Epi 1.5-2% 4 mg/kg
spinal dose of lidocaine AND form %
Spinal: 1.5-5% 1.5 mg/kg
protein binding of lidocaine and WHAT does that mean?
70%
intermediate duration
protein binding most determines duration of action
metabolism of lidocaine
Hepatic
HEPATIC- ALL AMIDES
Dealkylation → mono-ethylglycin-exylidide 80% activity of lidocaine as an anti-arrhythmic
To
Hydrolysis → xylidide 10%
onset of lidocaine and WHY
FAST because- pKa 7.7 Etidocaine also 7.7 second only to Mepivacaine 7.6 closest to physiologic pH most non-ionized most to cross into cell
1/2 life lidocaine
96 min
duration of lidocaine: each route Topical Infiltration IVRA- Beir Block PNB Epidural Spinal
Topical: 0.5-3 hr Infliltration: 0.5-1 hr IVRA: 0.5-1 hr PNB: 1-3 r Epi: 1-2 hr Spinal: 0.5-1 hr
contraindications with Lidocaine
hypersensitivity Adam Stoke WPW severe SA, AV or IV Heart Block corn-derived dextrose- corn allergy
pregnancy category B
Adverse Reactions with Lidocaine
CV collapse, bradycardia, arterial spasm, arrhythmia, increased d-fib threshold, edema, flushing, SA node depression
Pronlonged PR and QRS
CNS: Anxiety, dizziness, circumoral numbness, metallic rest, lethargy restlessness, seizure, tinnitus,
HA, hyper-hypo-esthesia
GI: N/V
Hepatic- hepatic disease increases concentration- decreasing metabolism
use of lidocaine for spinal?
declined
d/t
Transient Neurologic Symptoms
what is lidocaine used most often for?
IVRA
how does lidocaine IV assist during DL?
attenuate increases in IOP,ICP, IAB
Mepivacaine trade names
Carbocaine
Polocaine
uses of mepivacaine
Infiltration
PNB
Epidural
Spinal
how is Mepivacaine supplied
1% (10mg/mL)
2% (20mg/mL)
Genergic 3% (30mg/mL)
Infiltration dose of mepivacaine :
0.5-1% 5 mg/kg
PNM: dose of mepivacaine
1-1.5% 5 mg/kg
Epi: dose of mepivacaine
1.5-2% 5 mg/kg
Spinal: dose of mepivacaine
2-4% 1.5 mg/kg
% protein binding of mepivacaine and what does that mean?
78% DURATION Intermediate Lidocaine is 65% Bupivicaine is 94%
1/2 life of mepivacaine
1 hour
metabolism of mepivacaine
AMIDE
Hepatic
onset of mepivacaine and what that mean?
FAST dose dependent 3-20 minutes pKa 7.6 FASTEST!! 7.7 for lido and etido close to physiologic pH- non-ionized portion greatest crosses lipid layer of neuron
Duration of each route of mepivacaine: and why
Infiltration:
PNM: 2-4
Epi
Spinal
intermediate because 76% protein bound
Infliltration: 1-4 hr
PNM: 2-4 hr
Epi 1-3 hr
Spinal1-2 hr
how are locals excreted?
amides- renal
adverse runs with mepivacaine
CV collapse, bradycardia, arrhythmia, edema, flushing,
CNS: Anxiety, dizziness, circumoral numbness, metallic rest, lethargy restlessness, seizure, tinnitus,
Blurred vision, miosis
GI: N/V, fecal incontinence
Resp: RD, arrest, hypoventilation
Hepatic- hepatic disease increases concentration- decreasing metabolism
MS- intra-artricular infusion related chondrolysis
WHAT is unique about Mepivacaine?
it does NOT cause vasodilation!
do NOT add epinephrine to this drug!
max dose mepivacaine infiltration PNB EPI Spinal
MAX DOSE: Infliltration: 400 mg PNB: 400mg Epi: 400 mg Spinal 100mg