Low-Dose Lidocaine Intravenous Regional Anesthesia for Forearm Fractures in Children

Pj, Juliano; Jm, Mazur; Rj, Cummings; Wp, McCluskey

doi:10.1097/01241398-199209000-00013

Cited by 27 publications

(5 citation statements)

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“…Lidocaine is frequently reported in combination with other local anesthetics, usually bupivacaine or etidocaine, in order to combine the quicker onset of anesthesia with lidocaine with the longer duration of anesthesia of the other local anesthetic. [96,97,[108][109][110] There are several reports of the use of lidocaine for intravenous regional anesthesia (Bier block) in children to facilitate the treatment of forearm fractures; [111][112][113][114] volumes of lidocaine have ranged from 0.3 to 1 ml/kg with total lidocaine doses from 1 to 5 mg/kg. Olney et al [115] report a 9-year-old child who experienced myoclonic muscle twitching approximately 30 minutes after tourniquet release after Bier block with 3 mg/kg lidocaine; the serum concentration of lidocaine 4 hours after tourniquet release was 1.2 μg/ml.…”

Section: Lidocaine (Lignocaine)mentioning

confidence: 99%

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

157

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Regional anesthesia has become a routine part of the practice of anesthesiology in infants and children. Local anesthetic toxicity is extremely rare in infants and children; however, seizures, dysrhythmias, cardiovascular collapse, and transient neuropathic symptoms have been reported. Infants and children may be at increased risk from local anesthetics compared with adults. Larger volumes of local anesthetics are used for epidural anesthesia in infants and children than in adults. Metabolism and elimination of local anesthetics can be delayed in neonates, who also have decreased plasma concentrations of alpha(1)-acid glycoprotein, leading to increased concentrations of unbound bupivacaine. Most regional anesthetic procedures in infants and children are performed with the patient heavily sedated or anesthetized; because of this, and because a test dose is not a particularly sensitive marker of intravenous injection in the anesthetized patient, detection of intravascular local anesthetic injection is extremely difficult. The same local anesthetics used in adult anesthetic practice are also used in infants and children. Because of its extremely short duration of action, chloroprocaine has been used primarily for continuous epidural techniques in infants and children. The use of tetracaine has generally been limited to spinal and topical anesthesia. Lidocaine (lignocaine) has been used extensively in infants and children for topical, regional, plexus, epidural and spinal anesthesia. The association between prilocaine and methemoglobinemia has generally restricted prilocaine use in infants and children to the eutectic mixture of local anesthetics (EMLA). Because of its greater degree of motor block compared with other long-acting local anesthetics, etidocaine has generally been limited to plexus blocks in infants and children. Mepivacaine has been used for both plexus and epidural anesthesia in infants and children. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anesthetic, is the most commonly reported local anesthetic for pediatric regional anesthesia. Given the lower toxic threshold of bupivacaine compared with other local anesthetics, the risk-benefit ratio of bupivacaine may be greater than that of other local anesthetics. Two new enantiomerically pure local anesthetics, ropivacaine and levobupivacaine, offer clinical profiles comparable to that of bupivacaine but without its lower toxic threshold. The extreme rarity of major toxicity from local anesthetics suggests that widespread replacement of bupivacaine with ropivacaine or levobupivacaine is probably not necessary. However, there are clinical situations, including prolonged local anesthetic infusions, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring a large mass of local anesthetic, where replacement of bupivacaine with ropivacaine, levobupivacaine or (for continuous techniques) chloroprocaine appears prudent.

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Section: Lidocaine (Lignocaine)mentioning

confidence: 99%

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

157

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“…Previous studies have confirmed that LAMP using lignocaine for distal forearm fractures in children is safe. 1–5,14,15 Our study suggests that prilocaine at a dose of 2.5 mg/kg (with up to 1.5 mg/kg additional bolus, if required) is also a safe local anaesthetic agent for this procedure with no periprocedural adverse respiratory, haemodynamic or neurological sequelae.…”

Section: Discussionmentioning

confidence: 80%

“…This is consistent with the successful fracture reduction rates reported in previous studies where LAMP with lignocaine was used. 4,5,14,15 Particular to our study, both the anaesthetic and manipulation were undertaken by ED staff, which differs from other studies that used orthopaedic and/or anaesthetic staff. Complication rates of the procedure in our study were minor (two failures and nine temporary neurovascular problems) and comparable with similar studies.…”

Section: Discussionmentioning

confidence: 99%

Intravenous regional anaesthesia in the treatment of paediatric forearm fractures in the emergency department

Ojala

Kelly

1999

Emergency Medicine

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Objective: To describe our experience using local anaesthetic‐assisted manipulation and plaster with prilocaine as a method of facilitating fracture reduction in paediatric patients; in particular, issues of efficacy and safety. Methods: Retrospective explicit chart review was performed on all paediatric patients presenting with distal forearm fractures for a 6 month period between 1 January and 31 July 1996. Data collected included: (i) the success of the procedure (defined by clinical and radiological parameters); (ii) age and gender of the patient; (iii) use of adjuvant medications; and (iv) occurrence of complications. Results: In the study period, 156 paediatric patients presented with distal forearm fractures. Of these, 78 patients required manipulation. Fifty‐three patients were treated with a local anaesthetic‐assisted manipulation and plaster, while 25 patients were admitted for a reduction under general anaesthesia. Successful fracture reduction using local anaesthetic‐assisted manipulation and plaster was achieved in 96.3% of the cases in which this method was used. With respect to safety, no adverse respiratory/haemodynamic sequelae or problems with prilocaine toxicity were found. Adjuvant medication was used frequently (49%); however, the reasons for use could not be determined in this study. Conclusions: This study suggests that local anaesthetic‐assisted manipulation and plaster using prilocaine has a high success rate and a good safety record. This should be confirmed by study of a larger population. Factors to be taken into account when considering the use of this procedure are: (i) patient and parental preference; (ii) age of the patient; (iii) experience of the available staff; (iv) availability of personnel resources; (v) impact on patient flow in the emergency department; and (vi) anticipated delay in therapy if admission for treatment under general anaesthesia is chosen.

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“…1 Some literature suggests that a more dilute lidocaine solution may provide equally effective anesthesia. 2 , 3 , 4 , 5 Eckstein et al 6 investigated the efficacy of 0.5%, 0.33%, and 0.25% solutions of mepivacaine administered at 1.0-1.5 mL/Kg for IVRA. In reducing the concentration by way of an increase in volume, along with a simultaneous reduction in the absolute amount of drug given, the number of successful blockades increased as the concentrations of mepivacaine successively decreased.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study: 0.2% vs. 0.5% Lidocaine For Intravenous Regional Anesthesia

2008

IJA

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Background: Standard intravenous regional anesthesia (IVRA) uses 3 mg/Kg of 0.5% lidocaine. However, a lower dose, larger volume lidocaine may be as effective. Methods: Randomized single blind study of emergency department patients with closed Colles fractures reduced with either 3 mg/Kg (0.6 mL/Kg) 0.5 % lidocaine (N=11) or 2 mg/Kg (1.0 mL/Kg) 0.2% lidocaine (N=10). Anesthesia outcome measured with 4-category pain rating scale. Results: Analysis of pooled data showed no significant difference in pain rating between IVRA methods (p=0.35). There were no significant differences in age, tourniquet time, or vital signs between groups. Mean body weight was 11.3 Kg less in experimental group (p<0.05). Mean±SD lidocaine volume and dose (standard vs experimental) were: 46.7±6.9 mL vs 66.9±12.4 mL, and 233.7±35.2 mg vs 133±24.8 mg. One woman (standard group) experienced transient lidocaine toxicity. Conclusion: Low-dose lidocaine is as effective and may be safer than the standard dose for IVRA.

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Low-Dose Lidocaine Intravenous Regional Anesthesia for Forearm Fractures in Children

Cited by 27 publications

References 0 publications

Benefit and Risks of Local Anesthetics in Infants and Children

Benefit and Risks of Local Anesthetics in Infants and Children

Intravenous regional anaesthesia in the treatment of paediatric forearm fractures in the emergency department

A Pilot Study: 0.2% vs. 0.5% Lidocaine For Intravenous Regional Anesthesia

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