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Subject: Local Anesthesia Administration
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Syringes (TB, 5 mL, or 10 mL), anesthetic solutions, and needles (18 or 20 gauge, 1 inch long for drawing up anesthetic; 25 or 27 gauge, 1.25 inch long for delivering anesthetic) can be ordered from surgical supply houses or pharmacies. A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Local or regional anesthesia for minor procedures
Allergy to local anesthetics
PITFALL: Replace the needle used for drawing the anesthetic from the stock bottle with a smaller (30-gauge) needle before injection into the patient. A sharp needle decreases pain.
PITFALL: Avoid movement of the needle after it enters the skin. Many physicians hold the syringe like a pencil for needle insertion. After insertion, they stop stretching the skin with the nondominant hand and grab the syringe, shift the dominant hand back onto the plunger, and pull back on the plunger to check for vascular entry of the needle tip. They then shift the hands again and move the dominant hand into a position for injection. All of these shifts cause movement of the needle tip in the skin and substantially increase the discomfort for the patient.
PITFALL: Plunging in anesthetic immediately after needle entry causes continued discomfort and anxiety. Most vagal or syncopal episodes are related to the catecholamine storm produced by the patient’s anxiety. Pausing after needle insertion and slow administration allow patients to relax, reducing their catecholamine production and reducing complications.
PEARL: When the needle tip is correctly placed, there is resistance to injecting the anesthetic within the skin.
Bleeding and hematoma formation.
Allergic reaction is rare. Patients who believe they are allergic to lidocaine are more likely allergic to the preservative methylparaben. Preservative-free lidocaine is available.
Palpitations or feelings of warmth (due to epinephrine component).
Stretch the skin using your nondominant hand during administration.
Encourage the patient to talk as a distraction and to monitor vagal responses.
Talk to the patient during administration; silence increases patient discomfort.
Use the smallest gauge needle possible (preferably 30 gauge).
Consider spraying aerosol refrigerant onto the skin before needle insertion.
Consider vibrating nearby skin or patting distant sites to distract during administration.
Administer anesthetic at room temperature (i.e., nonchilled solutions).
Insert the needle through enlarged pores, scar, or hair follicles (i.e., less sensitive sites).
Pause after the needle penetrates the skin to allow for patient recovery and relaxation.
Inject a small amount of anesthetic and pause, allowing the anesthetic to take effect.
Empower the patient by temporarily stopping the injection when burning is detected.
Inject anesthetics slowly.
Begin the injection subdermally and then withdraw the needle tip for intradermal injection.
Consider addition of bicarbonate to buffer the acidity of the anesthetic.
Permit adequate time for the anesthetic to take effect before initiating a surgical procedure.