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Hi,

I apologise if this is covered elsewhere in the forum- I have looked! :)

I am currently updating our Pre-Surgery checklists for partial nail avulsion's, I seem to remembered being taught the following at University (in Australia), but am having trouble finding anything to confirm my memory;

anti-psychotics, anti-convulsants, and anxiolytics (particularly BDZs) may mask the symptoms of an adverse drug reaction to local anaesthetic (we usually use lignocaine). LA's may be administered to patients taking these medications with caution, also keeping in mind some of these medications may be specifically requested from GPs to calm certain pt's for surgery.

Looking forward to this being confirmed or corrected for me!

 

MIMS online lists 160 drug interactions for Lignocaine. Prilocaine only has 20. Mostly the interactions either increase or decrease the drug affect. There are none listed for any interactions b/w Lignocaine and the benzos or the modern anti psychotics or anti convulsants. Though I also remember being taught it, but I also was told that half of what you are taught at Uni is wrong, but it may take you 10 or more years to work out which half....

Realistically, in the quantities that we use LAs are incredibly safe.

 

Unless a patient gives a history of a TRUE allergic reaction to local anesthesia (very unlikely) or has severe PVD, there is no contraindication to performing a digital block for a nail procedure.

If you do get a reaction chances are it is a vasovagal reaction, a result of injecting IV, or you used too much and are getting a toxic reaction.

My best "guess-timate" is that I have given at least 45,000+ toe/foot/ankle/popliteal injections utilizing local anesthesia, and except for perhaps a hand full of vasovagal reaction, have never had a patient reaction or complication.

Steve