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local anaesthesia for nail surgery in children

Discussion in 'Foot Surgery' started by woodj, Oct 19, 2010.

  1. woodj

    woodj Member


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    Hello.
    Just wondering what other podiatrists are doing with regard to using local anaesthesia in children for undertaking nail surgery? I'm thinking of agents used and why, the need to sign a disclaimer / or not, licencing of product (eg Scandonest).
    Any thoughts and opinions welcome.
    Thanks!
    Judith x
     
  2. W J Liggins

    W J Liggins Well-Known Member

    Keep it simple. Lignocaine (Lidocaine) is an effective drug which has stood the test of time and is perfectly acceptable in the treatment of children. You really don't need to worry about anything other than the usual contra-indications/consents etc.

    All the best

    Bill.
     
  3. Page123

    Page123 Welcome New Poster

    From the Society website:

    "3. Can I use Mepivacaine on children
    Mepivacaine, marketed as Scandonest, is a licensed product that is not indicated for podiatric use in children. This is because the manufacturers have not applied for a product license for this particular application.

    The latest advice from the Medicines Control Agency is that this does not mean that this product is unlicensed if administered to children. The law allows podiatrists who hold a certificate of competence in local analgesia to administer the substance without any requirement that such administration must be in accordance with the terms of the licence. It does of course require that any administration must be in the course of the podiatrist¡¦s professional practice.

    The Society would consider the administration of Scandonest, suitably dose adjusted for children, to be acceptable professional practice. This would not of course preclude any civil liability should something go wrong but this would be the situation whatever treatment was being administered.

    The Society recognises that the use of Mepivacaine is widespread amongst suitably qualified podiatrists and is supported by a responsible body of opinion within the profession."

    The most important element is parental/guardian consent. I would stick with Mepivacaine. Some research has indicated that Lignocaine, although generally safe, can have certain negative health implications relating to the heart in young children.
     
  4. W J Liggins

    W J Liggins Well-Known Member

    Hi

    Would you be kind enough to give the reference to the negative health implications relating to the heart in young children? I cannot find anything.

    Many thanks

    W J Liggins
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    I too would love to see this so called "research"? All local anesthesia has cardiac conductive disturbance side effects - its the nature of the drug and how it works. I would be more concerned about acute or developed allergies to substances (local anesthetic included) than anything else.

    I'll wait patiently for the research to be provided as mentioned above......
     
  6. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    The use of LA agents in paediatric situations seems to be something of a grey area and would benefit from a fuller review and discussion of individual practice.
     
  7. woodj

    woodj Member

    I'd be up for looking at undertaking a review.....anyone else interested?
     
  8. Footsie 100

    Footsie 100 Member

    I think that either Lignocaine or Mepivacaine should be fine provided you have completed a detailed pre-operative assessment and found no contraindications.

    In this cohort of patients, you need to establish whether they will be able to “psychologically” tolerate administration of local anaesthetic and the nail procedure itself. This depends on the level of their mental maturity as an extremely nervous child will be uncooperative and this can lead to stress, to all concerned, and the real danger of sharps injury for example.

    Good luck.

    Footsie 100
     
  9. footsiegirl

    footsiegirl Active Member

    I am wondering whether the cautionary note was added because the risk of cardiac output depression is increased with very low body weight, which would put very small children at increased risk of such problems?
     
  10. W J Liggins

    W J Liggins Well-Known Member

    It is unusual - to say the least - to use any form of L.A. in very young and small children. Anybody who has undergone an HPC recognised course in LA in the UK and similar in other parts of the world, will be aware that Lignocaine (Lidocaine) can effect cardiac membrane responsiveness, decrease the action potential in the Purkinje fibres and increase or decrease the refractory period as well as potentially decreasing the AV conduction time. However, these are in therapeutic concentrations of the drug and are applicable to all cases.

    Rather than guesses, I would really like to see the research which was instanced by a previous poster.

    Bill Liggins
     
  11. footsiegirl

    footsiegirl Active Member

    i will butt out ...
     
  12. Paul Bowles

    Paul Bowles Well-Known Member

    What is considered "very young" and "small" children? 3mg/kg MSD is out the window now?
     
  13. pgcarter

    pgcarter Well-Known Member

    I've had a 13 yo faint on me, she had been given a small squirt of xylocaine just before that. She had been given xylocaine previously by her dentist with no ill effect. What is considered too young? or too small? Her Mum was right there and not the least bit concerned about it, I did not proceed on that occasion, but three months later did the full job without any unusual reaction.
    regards Phill Carter
     
  14. Paul Bowles

    Paul Bowles Well-Known Member

    That's a vaso-vagal - nothing to do with the anaesthesia, more to do with her anxiety. There is only one thing in my opinion you need to be concerned about using LA: acute or developed anaphylaxis. Healthy children to adults, in sub toxic clinical doses there is no evidence of lignocaine causing any adverse cardiac reactions that I am aware of. I have only ever seen once in my career a patient have some response to a slight over exuberant application of bupivacaine to a bilateral ankle block, and the only reason we seen it is that it was whilst she was having HAV surgery, and under TIVA with an ECG and monitors. It had no real clinical effect and we wouldn't have noticed it if she didn't have an ECG on. The anesthetist was the one that pointed it out to us.
     
  15. Catfoot

    Catfoot Well-Known Member

    All,
    I would also like to have a definition of "very young" and "small" children, please.

    As Paul B says isn't this why we have a MSD ??

    regards

    Catfoot
     
  16. Julie7783

    Julie7783 Banned

    I think there is no different between small children and very young children. Both of the terms refers to the children below the age of about 6 years.
     
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