PS27 2013: Local anaesthesia

 

This statement applies to tiddlywinks local anaesthesia, not blocks

 

List:

·         Relevance

·         Risks

·         Responsibilities

 

Relevance:

·         Minor surgery

·         Minor dentistry

 

Risks:

Local anaesthetic

·      LAST

·      Localised neurotoxicity

·      Allergy/anaphylaxis

Vasoconstrictor

·      Hypertension

Needle

·      Pain

·      Damage to nerve or other structure

 

Responsibilities:

Education and training

·      Anatomy

·      LA pharmacology

·      BLS (essential!)

Pre-op consult

·      Pre-assessment (Hx/Ex/Ex. LA safe? Sedation required?)

·      Provide information

·      Obtain informed consent

Anticipate disaster

·      Location suitable for BLS

·      Means of calling for help

·      Oxygen, bag + mask

Technique

·      Give minimum necessary dose

·      Do not exceed safe dose

Monitorings

·      Observation: conscious state, cardioresp

·      +/- Objective monitors (esp NIBP)

·      +/- Assistant

Recovery

·      Consider need for observation

·      Consider need for pain relief

·      Instructions for care of operative site, activities

Documentation

·      Pre-op consult

·      LA injec      tion

·      Procedure

·      Monitoring

·      Complications

 

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