Do people have a preference for Xylocaine/Lignocaine strength i.e. 1 or 2%? What are the reasons for using 2% & I guess I'm assuming it just provides a longer lasting effect?????
Members do not see these Ads. Sign Up.
Tags:
-
-
Re: Local Anaethetic strength
I prefer 2% I feel it improves my chance of getting it anaethetised, so long as I do my calculations and don't overdo the dose, which is pretty hard to do. -
Re: Local Anaethetic strength
I thought we were only allowed to use 1% (in Australia)?:wacko: Or have I missed out on something? -
Re: Local Anaethetic strength
Donna it might be different in Qld, but in Victoria, it is the LAs Ligoncaine and Prilocaine that are allowed to be used with no restriction on strength. And personally I use 2% for the same reason as moe, it tends to work quicker, but both 1 and 2% will have about the same duration of action -
Regards
Donna :) -
Re: Local Anaethetic strength
I am a QLD pod, moving to NSW. I am excited about being able to use 2%! However, was just wondering what the maximum dosage is?
At the moment I use this:
Maximum dose permited 200mg (20ml of 1% lignocaine)
Children - 3mg per kg body weight
SO, is it just half? 10ml maximum dose of 2%?:rolleyes: -
Re: Local Anaethetic strength
Footsie,
The maximum dose for Lignocaine without adrenaline is quoted at 4mg/kg, so for a 70kg person this would be 280mg (28ml of 1% and 14ml of 2%) but this article http://bja.oxfordjournals.org/cgi/reprint/74/6/704.pdf found that rates as high as 18mg/kg to be non toxic (thats 125ml of 1%)
further I found this
-
Re: Local Anaethetic strength
Hi all,
I've emailed a MSD calculater program thingmy wotsit to Craig (da boss man). Having touble opening the program :confused: but he said he will try. If he's successful he said may post on here. Very useful tool as it calculates MSDs as single dose or multiples of different La agents.
If anyone wants to try opening it via email for themselves please PM me & I will forward the file. :D
Regards, -
Re: Local Anaethetic strength
SPELLING! calculator* Doh! :eek: -
Re: Local Anaethetic strength
99% of the time, a 1% solution of lignocaine will be appropriate for uncomplicated cutaneous surgery in podiatry.
2% is indicated in the presence of minor sepsis and chronic erythema (ie classic acute IGTN) where tissue pH is altered, as 1% takes forever to take effect even in large doses. Typically a 2% dose will be more uncomfortable for the patient during administration.
However, literature supports the use of bupivacaine (eg 0.5%) for procedures such as nail matrixectomy because of the additional benefit of longer duration of action and the resultant preemptive analgesia that occurs.
Queensland had Drugs & Poisons Regulations changed last year to allow podiatrists to use lignocaine up to 2% plain, as well as bupivacaine, levobupivacaine and prilocaine. An approved update course from the Board is pending, but should not be far away. Almost every State is different, so some national uniformity would be nice...:(
LL -
Re: Local Anaethetic strength
I am a new graduate who will be working in QLD next year, I have been studying at CSU in Albury. We were taught that we could use either prilocaine, lignocaine, mepivicaine, or bupivicaine. Mainly we use 2% mepivicaine.
Anyways my question is, when working in QLD next year, will I be able to use bupivacaine? You stated how an approved update course is being planned, would I still have to do this?
And is bupivacaine or lignocaine the only LAs I could use in QLD. I could not use mepivacaine?
Regards,
Dean -
Re: Local Anaethetic strength
The drugs approved for general podiatry registrants in Queensland, as of 2006 (but pending Board approved upskilling) are:
(i) bupivacaine of a strength of 0.5% or less;
(ii) levobupivacaine of a strength of 0.5% or less;
(iii) lignocaine of a strength of 2% or less;
(iv) prilocaine of a strength of 2% or less;
These are all plain solutions, and general podiatrists may not use these in combination with adrenaline. However, preloaded adrenaline may be used for emergency anaphylaxis care.
Other provisions exist for 'surgical podiatrists', including the use of a range of S4/ S8 medications, and the use of adrenaline.
I would recommend you forward a letter from your course co-ordinator when you apply to be registered in Queensland outlining which anaesthetics you are trained in, however you will not be able to use mepivacaine.
Because of the variation in local anaesthetic training across the country, I think it is important for all of the course podiatry co-ordinators to get together and agree on a comprehensive list of ALL local anaesthetics (regardless of whether that particular State endorses so), so that all new podiatrists are appropritately trained across the full range of choices. This would then facilitate mutual recognition of registrants from now on.
LL -
Re: Local Anaethetic strength
Regards,
Dean -
The difference between 1% and 2% lidocaine is the concentration of mg/ml.1% is 10mg/ml and 2% is 20mg/ml,double the concentration.Epinephrine allows increased dosage as the epi delays absorption and causes a vasoconstrictor effect.As I recall the maximum dose of xylocaine was 30ml of plain and 50ml xylocaine with epinephrine.Prudence and good judgement allow xylocaine with epi in the digits. I have never heard that 2% was used for minor sepsis.The difference in concentration allows longer duration of action.Any matixectomy could be performed with 1% or 2%.Personally,I always use 2% frequntly and regularly with epi.
I am curious...why are only certain local anesthetics permitted by certain practitioners?What are the educational differences between a surgical and non-surgical podiatrist?Does a surgical podiatrist work in a hospital?Do they have open and complete medication/ prescription writing ability?ie.narcotics,diuretics,antibiotics,anti-inflammatories,etc?Apparently podiatry is practiced differently here in the USA. dlbdpm -
Re: Local Anaethetic strength
LL -
Podiatry in most Commonwealth countries, including Australia, is very different to the USA.
In a nutshell, most podiatrists complete a 4 year undergradaute degree, and are typically only licenced to use a very narrow range of drugs (depending on the country/state jursidiction). They typically will only perform cutaneous surgical procedures.
A small percentage of podiatrists undertake podiatric surgery training to perform osseous foot and ankle procedures, and again, depending on the jurisdiction - they can prescribe a limited formulary complementary to surgical practice.
Don't ask why :bang:
LLLast edited by a moderator: Nov 19, 2007 -
Re: Local Anaethetic strength
Do you have this reference ???
Thanks,
Nick -
Re: Local Anaethetic strength
British Journal of Surgery. 1994 Mar;81(3):425-6. Local anaesthetic agents in surgery for ingrown toenail. Connolly AA, Meyer LC, Tate JJ.
Abstract:
To determine the most effective local anaesthetic for ingrown toenail surgery, 100 procedures were performed after patients had been randomized to receive lignocaine, bupivacaine or hyaluronidase and bupivacaine. The effect of each anaesthetic was monitored and 80 patients returned a follow-up questionnaire. There was no significant difference in the time for the local anaesthetic to take effect, or in the pain caused by its injection or the procedure. Significant differences were found between treatments with respect to pain at discharge and significantly fewer patients who received bupivacaine experienced pain 24 h after surgery (P = 0.002).
Quote from conclusion: “Bupivacaine provides quick-acting and long-lasting anaesthesia and should be used in preference to lignocaine”
LL -
-
Umm yeah...sorry Mark, was just having an "old fart" moment... :bang::p
-
Hi everyone:
Just speaking from experience and having anesthetized literally tens of thousands of toes/feet/ankles.... I "almost" always use 2% plain lidocaine for local or regional blocks. I rarely need to use more than 10cc and cannot recall ever having any problems with toxic reactions.
For normal digital blocks for a hallux, 2-3 cc of 2% is more than adequate.
3cc of 2% plain is enough for a Post. tibial block.
One should easily be able to block an entire foot (PT, AT, Sup. peroneals, sural) with 10 ccs.
Steve -
Re: Local Anaethetic strength
Thanks LL. This info has made me switch from Lido to Bupiv. My initial rational for Lido was that it seemingly acted quicker and stings less. However the ends justify the means.
Nick -
Thanks for any advice -
You cannot know exactly in a lot of instances, but many of the nerves are easily palpated eg superficial peroneal, PT etc. so you can be reasonably precise.
Otherwise, revise your anatomy, do a dissection course, and hang out with a podiatric surgeon who does a lot of these injections. Anatomical variations are always possible, but are rare.
Good surface anatomy knowledge is essential to minimising the dose required overall.
LL -
-
The technique I was taught by my surgical supervisor for digital block is as follows:
1. Use a 25g, 1.5 inch needle - it is flexible and 'bends' around the curves of the rather cylindrical anatomy of a toe.
2. Inject dorsally (medial or lateral) at the level of the metaphysis of the proximal phalanx, and raise a small weal to numb the skin. Make sure the very tip of the needle (apex) is the first point of entry (less surface area = less discomfort).
3. The dorsal, and by that matter the plantar, digital nerves are reasonably superficial but not palpable. Advance the needle about 5mm max. and deposit 1/2 a cc of solution around the nerve by gently bending the needle from side to side, such that the tip delivers solution to either side of the nerve bundle.
4. Advance the tip towards the plantar surface to approximately 5mm short of the plantar skin. Deposit a similar volume in the same manner as dorsally to the plantar digital nerve branch, ensuring that skin blanching is apparent to ensure correct position.
5. Repeat for the other side of the toe.
Note that this is not a "ring" block, but a block of the most likely location of the nerves, so that local is not being splashed all around the toe into tissue that do not relate to the digital nerves themselves. This = less volume of local, and becomes more important with a greater number of blocks (eg doing several toes at once).
Try not to ever use more than 2 points of entry. More skin penetration = more discomfort post-procedure - even though they are small puncture wounds.
Just sharing what I was taught...
LL -
Hi Berms:
When performing a digital block you want to be in the fascia plane under the sub-Q layer. There will be much less resistance, less pain and of course, this is where the nerves are. I guess this "feel" just comes with experience. There shouldn't be any resistance when injecting or moving the needle. If there is, you are most likely too superficial.
I normally use a little cold spray and inject from dorsal to plantar as proximal as you can get on the digit itself- one medial and one lateral. It works every time. I inject the lateral side first, since this is always less sensitive and it puts the patients at ease when they realize that the injection is relatively painless. Patients will feel the medial injection more.
I use a 3 cc syringe with a 25G 1 & 1/4 inch needle. I have found that this combination, when injected slowly, is less painful than using a 27G. I feel the solution comes out too fast with the smaller guage needle and is more painful.
Hope this helps.
Steve -
Hi all
This question may seem dumb, but what anesthesia do you prefer Lidocaine or mepivacaine?
Currently i am using mepivacaine and feel comfortable using it, but many of my colleagues say that i should use lidocaine 1%.
Am i wrong? :confused:
What is your opinion?
Regards
André -
Hello, I am wondering if anyone knows what the latest best practice is for phenolisation 'time' for nail surgery. For example: 3x 30 seconds. I have also asked this question in another blog. I am also not sure if 2% lignocaine can be used in South Australia. Thank you in advance!
Mimmypod.
Loading...
- Similar Threads - Local Anaesthetic strength
-
- Replies:
- 2
- Views:
- 1,404
-
- Replies:
- 1
- Views:
- 3,556
-
- Replies:
- 1
- Views:
- 3,240
-
- Replies:
- 0
- Views:
- 3,486
-
- Replies:
- 0
- Views:
- 4,011
-
- Replies:
- 5
- Views:
- 8,128
-
- Replies:
- 13
- Views:
- 11,303