CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries CRACKCast E003 - Pain
Jan 21, 2016
Anatomy of the afferent pain pathway and how signals reach the brain. Differences between acute and chronic pain and their effects. Various pain assessment tools across ages. Multimodal targets for analgesia and NSAID harms with GI bleeding risks. Local anesthetic classes, toxic doses, expected toxicities and treatment. Techniques to reduce injection pain and topical options for skin, mucosa, and wounds.
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Recognize Progression Of Local Anesthetic Toxicity
- Systemic local anesthetic toxicity progresses from circumoral numbness and tinnitus to seizures, coma, and cardiac arrest.
- Cortical and cardiac sodium channel blockade causes the neurologic then cardiovascular collapse sequence.
Manage Local Anesthetic Systemic And Local Toxicity
- Treat systemic toxicity with ACLS for arrest, benzodiazepines for seizures, and consider 20% lipid emulsion: 1.5 mL/kg bolus over 1 minute, then 0.25 mL/kg/min infusion for 20 minutes.
- For local vasoconstrictive ischemia from epinephrine, use warm compresses, topical nitroglycerin or phentolamine locally.
Practical Ways To Reduce Injection Pain
- Reduce injection pain by warming anesthetic, buffering with 1 mL bicarbonate per 10 mL lidocaine, applying topical anesthetic beforehand, distracting the patient, and injecting through wound edges.
- Buffering and warming reduce sting; distraction and technique minimize perceived pain.