Principles of Local Anesthesia

by Marc Beylin, DPM
 

The patient is sedated, the tourniquet is up, the incision has been outlined …….. A bead of sweat appears on your forehead.  Will your block hold up?  This is a bad time for I.B.S.  Lessen the anxiety and view Dr. Beylin’s lecture on local anesthetics.

Various nerve blocks of the foot, ankle, and leg are reviewed. The technique is demonstrated using excellent photographs and neuroanatomical illustrations. You will have no trouble identifying the six nerves that are blocked when performing an ankle block. (Hmm...Interesting Residency Rumble question) You might even become one of the few people that recall how a Bier Block is done.

Local Anesthetics are drugs that block nerve conduction, reversibly. Initially, the concentration of local anesthetic is higher outside the nerve, but in time the block proceeds from the outer bundles to the inner bundles resulting in deeper anesthesia. Smaller C fibers are more susceptible than large delta fibers. PKA is a determining factor in the success of your local anesthesia.

Regional anesthesia in an infected foot is much more difficult because of the acidic environment. Next time, consider a little bicarb.

Learn about safe use of epinephrine, systemic toxicities, and allergic reactions. Remember to aspirate each time the needle is advanced, to avoid inadvertent intravascular injections.

Knowledge creates confidence.
 

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