Intralipid Availability

[Gnarvin]

---

Members do not see this ad.

I just graduated from fellowship this last June and have started at a private practice gig where most of the procedures short of implants are done in office. I am anesthesia trained and it has been emphasized to me since residency to have Intralipid available and know where it is at any location I will be performing blocks. That being said, I looked through the emergency kit in the office and didn’t see any intralipid. Of course most of the blocks I do for chronic pain are lower doses of local compared to acute pain doses/procedures, but in certain cases LAST can happen with small doses of local.

I am sure Intralipid is expensive and everything, but I feel like it would be hard to defend a catastrophic case of LAST in front of the courts and say I didn’t have Intralipid available. Long story short, do you other private practice guys have Intralipid available in your offices? If so, what are the logistics involved? Thanks

 

[BobBarker]

Very, very few private practice docs have intralipid available. How much local are you planning on giving?? You aren’t going to be doing interscalene blocks in the pain clinic.

 

[Gnarvin]

That is a good point, but there are cases where relatively small amounts could cause problems unexpectedly.

I also am considering doing some fascial plane blocks for abdominal wall pain etc. that require larger volumes/doses of local.

 

[BobBarker]

Get with @oreosandsake and discuss US and identifying the nerves directly. These things don’t pay well in the clinic for the risk so most of us focus on spine and joint.

 

[SommeRiver]

I don’t keep it around, and I've never seen it used.

 

[Gnarvin]

Thanks for the responses. During my residency there was a patient who developed a legit case of LAST and I gave Intralipid so maybe I am hypervigilant about the issue. The case from residency was after an acute pain procedure, though (no it was not me who decided on the dose of LA nor did I perform the block, but I was the closest resident when the patient developed symptoms). Judging from the responses and the thumbs ups, it seems that everyone that has responded here would say it would not be below the standard of care not to have Intralipid in the office, correct?

 

[epidural man]

Thanks for the responses. During my residency there was a patient who developed a legit case of LAST and I gave Intralipid so maybe I am hypervigilant about the issue. The case from residency was after an acute pain procedure, though (no it was not me who decided on the dose of LA nor did I perform the block, but I was the closest resident when the patient developed symptoms). Judging from the responses and the thumbs ups, it seems that everyone that has responded here would say it would not be below the standard of care not to have Intralipid in the office, correct?

I am not aware of chronic pain societies recommending it be kept in office practices.

If you are going to routinely inject large volumes, you should have some.

I don’t think a seizure caused by a tiny amount of local in a small artery leading to the brain is best treated with intralipid.

 

[Gnarvin]

Thank you. I may consider getting some Intralipid to have in office if I decide to do fascial plane blocks in the office.

At least from a quick google search it looks like a 250mL bag of Intralipid is probably $100 or less so I may buy some just to have for my peace of mind.

 

[deleted875186]

Thank you. I may consider getting some Intralipid to have in office if I decide to do fascial plane blocks in the office.

At least from a quick google search it looks like a 250mL bag of Intralipid is probably $100 or less so I may buy some just to have for my peace of mind.

Agreed. It’s not that expensive, and the shelf life is very long, doesn’t seem like a bad idea.

 

[SommeRiver]

If it's that cheap I may buy some.

No idea how to use it and never needed it though.

 

[BobBarker]

You just give it as fast as possible. Like two 60ml pushes and then start a drip. There is a rec dosage but when you pencil it out with the concentration of the drug it is basically just slamming it in there.

 

[deleted875186]

If it's that cheap I may buy some.

No idea how to use it and never needed it though.

https://www.asra.com/content/documents/asra_last_checklist_2018.pdf

we had the ASRA checklist above printed and put on our APS chart in residency.