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Subject: Field Block Anesthesia
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Syringes (TB, 5 mL, or 10 mL), anesthetic solutions, and needles (18 or 20 gauge, 1 in long for drawing up anesthetic; 25 or 27 gauge, 1.25 in 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.
Surrounding large lesions that would provide a large area of anesthesia
Around infected cysts or abscesses
To prevent distortion of skin landmarks from administration of local anesthesia
Around facial structures (e.g., nose, pinnae, forehead, cheek, eyelids, upper lip)
Digital blocks (see Digital Nerve Block Anesthesia)
Surrounding localized structures (e.g., penis, perineum)
Allergy to anesthetics
Cellulitis in the injection area (relative)
PITFALL: Make sure to anesthetize enough area to allow for undermining.
PITFALL: Be very careful not to inject anesthetic into cystic lesions because this may cause them to rupture, either below the skin or upward toward the provider.
PITFALL: To avoid inadvertent intravascular injection, apply negative pressure to the syringe immediately before injection to check for a backflow of blood.
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, usually in single-use vials.
Palpitations or feelings of warmth (due to epinephrine component).
Temporary weakness or paralysis when large nerves are involved.
If a large volume (10 to 20 mL) of local anesthetic is injected into a vein, it may produce convulsions, arrhythmias, or cardiac arrest. The plasma levels are usually 3 to 5 mcg/mL with regional nerve blocks. Toxicities may be observed at 6 mcg/mL but are more common at levels >10 mcg/mL.