The accuracy of timed maximum local anaesthetic dose calculations with an electronic calculator, nomogram, and pen and paper

Local anaesthetic agents suppress action potentials in excitable tissues by blocking voltage-gated sodium channels. In doing so they inhibit the depolarisation of nociceptive nerve fibres and so prevent the transmission of pain impulses. UK legislation allows HCPC-registered Podiatrists with POM-A annotation access to six local anaesthetic drugs and two of these with the addition of adrenaline. The use of local anaesthetia has transformed the treatment of nail pathology by Podiatrists. In the UK, the drug of choice in podiatric practice is 3% mepivacaine hydrochloride: it is a good choice of drug for digital anaesthesia. This paper will review the chemistry, pharmacology and dose calculation of mepivacaine, and challenge some of the orthodoxy over the rigid calculation of maximum safe dosages.

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An Update on the Chemistry, Pharmacology and Dose Calculations of Mepivacaine Hydrochloride for Podiatrists in the United Kingdom

10.20944/preprints202012.0555.v2 ◽

2021 ◽

Author(s):

Ian Reilly ◽

Nicola Burt ◽

Rebecca Reilly ◽

Ajay Swami

Keyword(s):

Local Anaesthetic ◽

Dose Calculation ◽

Good Choice ◽

Dose Calculations ◽

Drug Of Choice ◽

Anaesthetic Agents ◽

The United Kingdom ◽

Voltage Gated Sodium Channels ◽

Blocking Voltage ◽

The Uk

Local anaesthetic agents suppress action potentials in excitable tissues by blocking voltage-gated sodium channels. In doing so they inhibit the depolarisation of nociceptive nerve fibres and so prevent the transmission of pain impulses. UK legislation allows HCPC-registered Podiatrists with POM-A annotation access to six local anaesthetic drugs and two of these with the addition of adrenaline. The use of local anaesthetia has transformed the treatment of nail pathology by Podiatrists. In the UK, the drug of choice in podiatric practice is 3% mepivacaine hydrochloride: it is a good choice of drug for digital anaesthesia. This paper will review the chemistry, pharmacology and dose calculation of mepivacaine, and challenge some of the orthodoxy over the rigid calculation of maximum safe dosages.

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Study of knowledge and practices of local anaesthetic systemic toxicity among Doctors in Sri Lanka

10.1101/2021.04.19.21255661 ◽

2021 ◽

Author(s):

B.M. Munasinghe ◽

AG. Arambepola ◽

N. Subramaniam ◽

S. Nimalan ◽

KUIS. Gunathilake ◽

...

Keyword(s):

Body Weight ◽

Sri Lanka ◽

Local Anaesthetic ◽

Total Body Weight ◽

Systemic Toxicity ◽

Basic Knowledge ◽

Definitive Treatment ◽

Dose Calculations ◽

Definitive Therapy ◽

Total Body

AbstractBackgroundLocal anaesthetic systemic toxicity (LAST) could be potentially life threatening. This study focused on describing the knowledge and practices of use of local anaesthetics (LA) among the doctors in Sri Lanka and the ability to detect and manage an event of LAST.Materials and methodsA descriptive cross-sectional study was conducted among doctors in Sri Lanka using an online self-administered questionnaire based on AAGBI guidelines (2010). Descriptive statistics were analyzed by cross-tabulations and presented as numbers and percentages using IBM-SPSS 25.ResultsThe response rate was 60% out of 600. Majority were males (58%) while 45% of the respondents were anesthetists. Ultrasound was used by 47.4% during LA. The majority considered total body weight for dose calculations. Around 50% of respondents identified bupivacaine as the most cardiotoxic. The majority utilized some form of monitoring and were knowledgeable on identification, prevention and initial management of LAST. Approximately 45% identified Intralipid (ILE) as the definitive treatment of LAST, out of which, 66.8% knew the correct dose and 77.2% and 26.5%, the availability and location of storage, respectively.ConclusionThe basic knowledge on LAST was satisfactory among the respondents. A statistically significant difference on knowledge on maximum safe doses of LA, ILE in established LAST, its dosage and the availability was identified between anaesthetic and non-anaesthetic doctors and post graduate trainees and the rest of the doctors. Overall, significant lapses were noted with regard to the use of total body weight for dose calculations, use of ultrasound during LA administration and dosage, availability and storage of the definitive therapy, ILE, suggesting updates in these key areas.

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The influence of continuous local wound infusion on postoperative pain in patients undergoing transfemoral amputation

VASA ◽

10.1024/0301-1526/a000457 ◽

2015 ◽

Vol 44 (5) ◽

pp. 381-386 ◽

Cited By ~ 1

Author(s):

Christian Uhl ◽

Thomas Betz ◽

Andrea Rupp ◽

Markus Steinbauer ◽

Ingolf Töpel

Keyword(s):

Pain Management ◽

Pilot Study ◽

Local Anaesthetic ◽

Phantom Pain ◽

Transfemoral Amputation ◽

Postoperative Wound ◽

Stump Pain ◽

Management Protocol ◽

Group 2 ◽

Group 1

Abstract. Summary: Background: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. Patients and methods: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1). Group 2 was treated with analgesics in accordance with the WHO standard pain management protocol, exclusively. Results: The study demonstrated a significantly reduced postoperative VAS score for stump pain in Group 1 for the first 5 days. Furthermore, the intake of opiates was significantly reduced in Group 1 (day 1, Group 1: 42.1 vs. Group 2: 73.5, p = 0.010; day 2, Group 1: 27.7 vs. Group 2: 52.5, p = 0.012; day 3, Group 1: 23.9 vs. Group 2: 53.5, p = 0.002; day 4, Group 1: 15.7 vs. Group 2: 48.3, p = 0.003; day 5, Group 1 13.3 vs. Group 2: 49.9, p = 0.001). There were no significant differences between the two groups, neither in phantom pain intensity at discharge nor postoperative complications and death. Conclusions: Continuous postoperative wound infusion with a local anaesthetic in combination with a standard pain management protocol can reduce both stump pain and opiate intake in patients who have undergone transfemoral amputation. Phantom pain was not significantly affected.

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