Advanced Cardiac Life Support (ACLS) provides a well structured framework for those who resuscitate infrequently. There is room to move beyond the algorithm to potentially provide better care for our patients for those who resuscitate frequently. I will describe some tweaks to the way CPR, defibrillation, and medications are delivered in the arrests I manage. Read more →
Author Archive for: robbryant13
When selecting a local anesthetic agent for skin wounds I have historically been taught to use lidocaine to provide a faster onset, and to use bupivacaine for a longer duration of action.
It can be time consuming to find 0.5% Bupivacaine with epinephrine and 2% Lidocaine with Epinephrine to produce a final mixture of 1% Lidocaine and 0.25% Bupivacaine with Epinephrine.
- If there is no difference in effect between these agents time could be saved when drawing up local anesthetics.
When I first learned digital nerve blocks in the late 1990’s I was taught to mix Lidocaine and Bupivacaine 50/50 to provide faster onset (Lidocaine) and a longer duration of action (Bupivacaine). My use of two agents for digital nerve blocks was recently questioned by one of my colleagues.
Any time additional medications are drawn up into a syringe there is opportunity for error, and there is additional time added to the procedure. A review of the (limited) literature will try to answer the following questions:
- Does the addition of Lidocaine to Bupivacaine decrease the time to onset of anesthesia?
- Does the addition of Lidocaine to Bupivacaine decrease the pain of injection?
- Does the use of Lidocaine with Epinephrine prolong the duration of digital block long enough to obviate the need for Bupivacaine?