Safe to use epinephrine with lidocaine for ankle block?

[jd1572]

Just wondering what people think about how safe is it to use epinephrine with lidocaine for an ankle block. Anyone know of any case reports of complications from vasoconstriction?

Some other side questions:

If anyone does use epi, what dose are you using? 1:200k?

If you use Lidocaine for surgical anesthesia for your ankle blocks, how high of a concentration are you using? 1.5% or 2%?

Any benefits of using mepivicaine over lidocaine?

Thanks!

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[Noyac]

Yes its safe. With that being said, I rarely ever use epi with any blocks except epidurals.

 

[Planktonmd]

Just wondering what people think about how safe is it to use epinephrine with lidocaine for an ankle block. Anyone know of any case reports of complications from vasoconstriction?

It's probably safe but many text books might disagree.

If anyone does use epi, what dose are you using? 1:200k?

Yes.

If you use Lidocaine for surgical anesthesia for your ankle blocks, how high of a concentration are you using? 1.5% or 2%?

You could do a good block with Lido 1%.
I prefer Bupivacaine 0.5%.

Any benefits of using mepivicaine over lidocaine?

Theoretically more profound motor block

 

[pillowhead]

the handful of times i've done ankle blocks, it's been for toe amputations. these guys all have peripheral vascular disease and/or diabetes so i would not compromise already crappy circulation with epi.

that said, a totally healthy guy coming in for toe surgery--i don't imagine that would be a problem.

 

[Idiopathic]

im not surei understand the utility of an ankle block with lidocaine, unless you are just sewing a deep lac or something. your block woundt be great and id prefer the postop relief that a marcaine block might provide.

i dont see why you couldnt use 2% but a higher volume of 1% would be my choice

 

[periopdoc]

The only reasons that I can think of to omit epi are 1) probably unnecessary for this block in general 2) if the patient has pre-existing vascular insufficiency 3) if a tourniquet is going to be used for an extended period (relative contraindication)

I primarily use epi 1:400,000 for my PNBs as it is sufficient to detect intravascular injection. Watch the extremity distal to your injection for blanching with injection (evidence of intra-arterial injection) and listen for pulse changes (evidence of intra-venous injection)

I only use short acting local anesthetics if I am placing a catheter and running an infusion. Otherwise it is probably more optimal to use a longer acting agent, bupivicaine typically being my weapon of choice.

Oh and idiopathic the ankle block is not a volume block. It only requires a few cc's of local at each site to be successful. Why would you need to decrease the concentration to get adequate volume?
- pod

 

[coprolalia]

Oh and idiopathic the ankle block is not a volume block. It only requires a few cc's of local at each site to be successful.

Agreed. Like plankton, I use 0.5% bupivacaine... with 1:200k epi. I have done a lot of these for hammertoes and distal metatarsal arthroplasties. Many have been done in non-vascularly compromised patients.

The block works well provided you get ample and good placement at the posterior tibial and deep peroneal sites. For these, at least 5-7 ml at the posterior tibial and 3-5 ml at the deep peroneal seems to get the job done. I've found (anecdotal) the superficial peroneal, sural, and saphenous are probably not as important for the stuff done deep inside the foot, although necessary to block for the incisions. All totaled, I usually inject about 20-25 ml of solution.

They still need to sleep, especiall if they are going to use a tourniquet, which can be extremely uncomfortable for the patient.

-copro