Cirrhosis and Local Anesthetics

[oneforfighting]

What considerations do you take when doing injections on cirrhotic patients? Use lido with epinephrine? Any precautions? Tried looking in literature but couldn't find much except to pay careful attention to dosing.

Looking at doing MBB/RFA. LFT's wnl.

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[SSdoc33]

??? Just do the mbb.

Dont let your anesthesiology physiology psychobabble overthink things

 

[oneforfighting]

??? Just do the mbb.

Dont let your anesthesiology physiology psychobabble overthink things

So you don’t treat any differently then?
MBBs I’m less concerned. How about RFA’s where much more local is used?

 

[Ronin1]

Negligible amount of local for an RFA. I usually use 15 cc total. I would just go ahead and do what you usually do

 

[MitchLevi]

Zero concern with an RFA in a cirrhotic patient.

It's like giving tramadol 50mg BID to a patient on Lexapro 10mg.

Don't let your test taking skills get in the way of treating pts.

 

[Agast]

You have to remember systemic absorption changes with where you are injecting. For ex: massive amounts in liposuction vs IV lidocaine

 

[Ducttape]

There is a theoretical concern.

Definitely consider if patients are getting other procedures with amide local anesthetic in close proximity with the RFA...

Remember that dose bupiv should be less than 2.5 mg/kg.

Don't worry if you are using less than 20 ml of 0.25% bupiv.....

 

[MitchLevi]

There is a theoretical concern.

Definitely consider if patients are getting other procedures with amide local anesthetic in close proximity with the RFA...

Remember that dose bupiv should be less than 2.5 mg/kg.

Don't worry if you are using less than 20 ml of 0.25% bupiv.....

Dude...Don't do that.

You're creating unneccessary anxiety in someone who is trying to learn routine pain management skills.

It's ridiculous.

 

[RoloTomassi]

Has anyone here ever seen or heard of a patient having LAST from a pain procedure? We hear about the extremely rare cases of participate emboli and the like, yet I've never heard of a LAST case

 

[Ducttape]

We need to know our limitations and safe practice patterns.

Blithely ignoring paradigms of treatment means legal fees will be upcoming. I've seen this with young docs of all fields who are cavalier.

Nothing ages you faster than a legal complaint. Most times, it makes for a safer doc. But if it can be prevented before the complication happens.......

 

[Ducttape]

Has anyone here ever seen or heard of a patient having LAST from a pain procedure? We hear about the extremely rare cases of participate emboli and the like, yet I've never heard of a LAST case

A long time ago.


I was in the ER and tried to save a 20 yo college student who died from bupivicaine spray for bronch study.

 

[oneforfighting]

Thanks all. I always appreciate the collective input.
If it was as straightforward as some make it out to be, the literature would be clearer.