When caring for a patient with a laceration we often do lcoal infiltration prior to suturing but remember the benefits of regional nerve blocks
Benefits of Regional Nerve Blocks
Less Painful
Prevents distortion of the wound which can help with cosmetic closure
Allows for a greater area to be anesthesized with less anesthetic use (prevents toxic levels)
Can allow for longer anesthetic time
Quick reminder of properities of common anesthetic
Anesthetic
Onset of Action
Duration of Action
Max Dose No Epi
Max Dose With Epi
Lidocaine
Seconds
1 hr
4mg/kg
7mg/kg
Bupivicaine
Seconds +
> 6 hrs
2mg/kg
3mg/kg
Final reminder: There is no evidence that epinephrine causes necrosis and it can be used safely in digital blocks. Duration of action is max 90 minutes. Even individuals that have injected themselves with EpiPens into their hands have not had any long term sequelue or necrosis seen. Vast majority required no treatment at all.
References
Muck AE, Bebarta VS, Borys DJ, Morgan DL. Six years of epinephrine digital injections: absence of significant local or systemic effects. Ann Emerg Med. 2010 Sep;56(3):270-4.
doi: 10.1016/j.annemergmed.2010.02.019. Epub 2010 Mar 26.
