Nerve block, amide allergy
Started by caligas
I use cocaine
Not for blocks though, just thought I'd mention it
Not for blocks though, just thought I'd mention it
Is the nerve block for a brief or long surgical procedure or for post op pain? We cannot get tetracaine easily at my institutions. Of course PF Chloroprocaine may last 60 minutes- good enough for short procedure regional anesthesia but no real post op pain benefit. Tetracaine can last up to 9 hours in a nerve block but has some degree of toxicity.
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The vast majority of allergies are due to preservatives in the local. Most surgeons do not use preservative free local anesthetic. Second, the ester based locals are also a possibility.
The only way to know for sure are intradermal injections of small amounts of local prior to the nerve block.
steroids benadryl.
have epi ready
have epi ready
Post op pain
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deleted875186
Either do the block with bupivacaine if the history is not reliable for true local allergy, or forgo the block all together if it’s too risky.
In the future, perhaps things like the sprint temporary peripheral nerve stimulator will be available.
In the future, perhaps things like the sprint temporary peripheral nerve stimulator will be available.
To come up with a creative solution we would have to know the specifics of the patient and case.. maybe a CPc epidural ?
Always remember that surgery without regional blocks is actually possible.
I know diphenhydramine has local anesthetic properties that useful for dermatological procedures. I’m curious if it works as a block. Probably, kill three birds with one stone (block, sedation, and antihistamine for the allergic reaction)
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agreed.
but some people get REALLY close to needing a block. like the ICMO EF 10% for an ankle fracture I did last week, with questionable ongoing ischemia but tibia poking through the skin. surgical fem/pop + some versed and fentanyl and some oxygen. she lived.
It’s a Na+ blocker, and I find it generally unknown or overlooked in this role. It is roughly unit equipotent to 1% lido. I looked and couldn’t find any case reports of using it perineurally and no chance I’d be the first. I do use it occasionally for skin infiltration in these cases of allergy, where it works great.
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deleted875186
How on earth is Benadryl supposed to work for a block? Am I supposed to pop open 10 vials if 1 mL Benadryl and injected 500 mg? At that point just inject it subcutaneous with some versed and you’ll be at GA/coma level.
Of course meperidine is also a local anesthetic that I used to use as the sole agent in spinal anesthesia. But the duration is too short to be of benefit for post op pain control.
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deleted87051
I once had a mosquito bite on my hand that was driving me crazy. I injected a small wheal of IV Benadryl into the bite. That spot on my hand was numb for 3-4 months.
I said specifically I wouldn’t use it as a block (?). Just mentioning its utility for infiltration.
Exparel brand Benadryl?
I call dibs on the patent right now
Was your intention for the antihistamine effects or the local or both? But, at least now we know it works.
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deleted87051
"The stranger"?
Boogered the nerve that innervates the skin. Likely through compression by the wheal. I've been hit in the IA by the dentist. Lip curled up on that side for 18 mo afterwards. Sensation returned to normal.
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deleted87051
Interesting prompt; I did a literature search.
I’ve not done it before, but if you had to, a peripheral nerve catheter with Chloroprocaine from an OnQ pain ball would be an option.
Probably not a good idea if Pt has pseudocholinesterase deficiency (genetic or liver disease) or if Pt is allergic to PABA.
If lower extremity procedure, place epidural, administer Chloroprocaine for intraop and duramorph for post op. Not a true post op block, but it will likely have a benefit.
Assuming…
1. you’ll have to make your own test dose with an ester and epi.
2. You’ll have to admit Pt overnight for monitoring as they received neuraxial morphine.
Or just don’t do a block at all.
I’ve not done it before, but if you had to, a peripheral nerve catheter with Chloroprocaine from an OnQ pain ball would be an option.
Probably not a good idea if Pt has pseudocholinesterase deficiency (genetic or liver disease) or if Pt is allergic to PABA.
If lower extremity procedure, place epidural, administer Chloroprocaine for intraop and duramorph for post op. Not a true post op block, but it will likely have a benefit.
Assuming…
1. you’ll have to make your own test dose with an ester and epi.
2. You’ll have to admit Pt overnight for monitoring as they received neuraxial morphine.
Or just don’t do a block at all.
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