question

List three ways of using regional anesthesia

answer

1. Alone, for surgical procedures 2. As an adjunct to general anesthesia 3. For lameness diagnosis

question

List three types of drugs used in regional anesthesia

answer

1. Local anesthetic agents 2. Opioids (intra-articular or epidural) 3. Alpha-2 Agonists (epidural)

question

How do the three most commonly used local agents vary in time of onset and duration of effect?

answer

1. Lidocaine: Rapid 2 minute onset, duration up to one hour or up to 2 hours with epinephrine 2. Bupivacaine: Slow onset of 20 - 30 minutes, duration is 4-8 hours 3. Mepivacaine: Moderate 3 - 5 minute onset, duration 1.5 - 3 hours

question

What are the three most commonly used locval agents?

answer

1. Lidocaine 2. Bupivacaine 3. Mepivicaine

question

Bupivicaine blocks ____ more than _____ activity

answer

-sensory -motor

question

T or F Combining lidocaine and bupivicaine will provide faster onset with longer duration of blockade

answer

True

question

Combining lidocaine and _______ will provide ____ onset with _____ duration of blockade

answer

-Bupivacaine -faster -longer

question

T or F Splashing lidocaine onto a surgical skin incision is an effective means of providing post-op analgesia

answer

F

question

T or F The use of local anesthesia has decreased over the years with the development of safer general anesthetics

answer

T

question

Local anesthesia agents are being used for _______ analgesia during painful procedures performed under general anesthesia such as ... (3)

answer

-Pre-emptive 1. Dental extractions 2. Feline declaws 3. Orthopedic surgery

question

In cattle local agents are commonly used for _____ surgery and ______ procedures. Local agents are also useful for ____ examination in horses and dogs

answer

-abdominal -reproductive -lameness

question

Regional anesthesia occurs when an _____ or _______ drug blocks _____ and possible ____ function in that location. The effects is due to action only at the site of injection and is not _________.

answer

-Injectable -Topical -Sensory -Motor -Systemic

question

Depending on the technique used regional anesthesia blocks either ______, _______ or _______/________ of painful stimuli

answer

transduction, transmission or modulation/projection

question

Other than local anesthetic agents list two other drug types that can produce regional anesthetic effects

answer

1. Opioids used intra-articularly and epidurally 2. Alpha-2 Agonists used epidurally

question

Which local anesthetic agent is very commonly available in clinic and comes with or without epinephrine? It can also be diluted with ______

answer

-Lidocaine -saline

question

Lidocaine with epinephrine is used for local blocks with duration of ____ hours

answer

1-2

question

Lidocaine neat is used when?

answer

For emergencies in anesthesia such as for PVC's or for blocks with duration of max 1 hour

question

List two disadvantages of lidocaine

answer

1. More irritating to tissues than other choices 2. Diffuses poorer into local tissues

question

List two advantages of lidocaine

answer

1. Cheapest 2. Fast onset of action (2 minutes)

question

List three of the local anesthetic agents

answer

1. Lidocaine 2. Mepivacaine 3. Bupivacaine

question

List two advantages to Mepivacine

answer

1. Rapid diffusion into tissues/ onset of analgesia 3-5 minutes 2. Lasts 1.5 - 3 hours

question

List one disadvantage to Mepivacine

answer

Slightly more expensive than Lidocaine

question

List one advantage of Bupivacaine

answer

Lasts up to eight hours

question

List two disadvantages to Bupivacaine

answer

1. Slower onset (20 mins) 2. Quite a bit more expensive

question

How long does Bupivacaine last?

answer

up to eight hours

question

How long does Mepivacaine last?

answer

1.5 - 3 hours

question

When a local anesthetic agent is deposited close to a nerve it blocks the nerves ability to ________. The affect depends on what?

answer

-Depolarize -The type of nerve blocked

question

Local anesthetics also affect the autonomic nervous system this is most important in the _____ nervous system where we might see ______ and increased __ _______ in the blocked area.

answer

-sympathetic -vasodilation -increased skin temperature

question

Describe how the different nerves are affected when a local anesthetic agent is deposited close

answer

1. Motor neurons are unable to transmit messages to the muscle fibres causing temporary weakness or paralysis 2. Sensory neuron temporarily lose their ability to transmit their sensations to the brain (including pain)

question

It is important to note that local anesthetic agents do not infiltrate well into what five tissues/areas

answer

1. Scar tissue 2. Fat 3. Edema 4. Hemorrhagic areas 5. Inflamed areas

question

List the forms lidocaine is available in

answer

1. Injectable (+/- epinephrine) 2. Gels 3. Ointments 4. Sprays

question

List the forms Bupivacaine is available in

answer

Injectable only

question

List the forms Mepivacaine is available in

answer

Injectable

question

Which of the local anesthetic agents has the longest duration of action?

answer

Bupivacaine 4-8 hours

question

List four signs of toxicity to local anesthetic drugs

answer

1. Hypotension 2. Cardiovascular collapse 3. Seizures 4. Allergic reactions

question

List seven commonly used regional anesthetic techniques

answer

1. Topical 2. Infiltrative blocks 3. Peripheral nerve blocks 4. Intra-articular blocks 5. Intravenous block (Bier block) 6. Epidural block 7. Spinal (subarachnoid ) block

question

By adding one or more regional analgesic techniques into your anesthetic/analgesic protocol ______ ____ __________ is achieved

answer

multimodal pain management

question

Local anesthetic agents may be effective when applied topically particularly if applied to _____ _______. Used topically the onset time is _____ and it is less effective as an _______. List some common topical techniques.

answer

-mucous membranes -longer -analgesic 1. Intrathoracic infusion during thoracectomy 2. Skin creams for minor procedures (have lidocaine and prilocaine) 3. Spray onto larynx 4. Ointment for eyes 5. Splashing lidocaine on ovarian and uterine pedicles during spray (questionable)

question

T or F The topical administration of injectable agents on a surgical site is not effective as it will not penetrate on its own

answer

T

question

Local infiltration involves _______ injection of the local agent to block the nerve receptors in the immediate area

answer

extravascular

question

Lidocaine is painful due to its _____ so when giving a local ______ be prepared for a reaction from awake patients. _____ _____ can be added to decrease the sting of injection but it will _____ the onset of action and _____ the duration

answer

-Acidity -Infiltration -Sodium Bicarbonate -Hasten -Shorten

question

Using a combination of an _____ and a ______ (______ ______) prior to local infiltration can make your patient more comfortable and easier to handle

answer

-Opioid -Sedative -Neurolept analgesia

question

What kind of local anesthetics are used in a local infiltration? Any analgesics?

answer

Lidocaine and/or Bupivacaine, it can also be combined with morphine or buprenorphine to improve the duration of analgesia

question

For a peripheral nerve block _______ or ______ is injected directly into the ______ ______ of a nerve

answer

-Bupivacaine -Lidocaine -Connective Tissue

question

What requires a smaller volume of local agent, a peripheral nerve block or a local infiltration?

answer

Peripheral Nerve Block

question

What can we do to make a peripheral nerve block with a faster onset and longer duration ?

answer

Combine Lidocaine and Bupivacaine (1/2 dose of each)

question

List some locations/procedures where it is common to use peripheral nerve blocks

answer

1. Dental blocks 2. Brachial plexus blocks (forearm) 3. Onychectomy 4. Intercostal blocks (Thoracotomy) 5. Selective blockade of the hind limb

question

List three local anesthetic agents and one opioid that can be injected directly into a joint to provide ____operative analgesia. This is called a ________ _______.

answer

-Post operative -Intra-articular block 1. Lidocaine 2. Bupivacaine 3. Mepivacaine 4. Morphine

question

Intra-articular bupivacaine can last ___ hours, agent is injected until the joint capsule feels _______

answer

-3-6 hours -distended

question

What two drugs can be combined in an intra-articular block to get better analgesia?

answer

Bupivacaine and morphine

question

__________ blocks can be used in assessment of lameness by blocking out a ____ _____ and observing return to soundness

answer

-Intra-articular block -Sore Joint

question

Intravenous Regional Anesthesia is aka ____ ____. What does it involve?

answer

-Bier Block -Involves IV injection of lidocaine distal to a tourniquet

question

Epidural anesthesia/analgesia refers to the practice of delivering medication to the epidural space. The following drugs can be used either as a ____ _____ or as a _____ _________ via ________: (3)

answer

-Single dose -Continuous infusion via catheter 1. Local anesthetic agents: Lidocaine neat or bupivacaine 2. Opioids 3. Alpha-2 agonists

question

What can be used as an alternative to a general anesthetic for some patients? Where does it provide anesthesia?

answer

Epidural Local Anesthetic Agents -Hind limbs, perineum and can be used in some laparotomy procedures

question

What can also be used as an adjunct to general anesthesia, markedly reducing the amount of inhalant required and improving _____ ______

answer

-Epidural Local Anesthetic Agents -Muscle relaxation

question

T or F Epidural Local Anesthetic Agents can cause vasodilation leading to hypotension

answer

T (Effect on the sympathetic nervous system)

question

List three side effects of epidural local anesthetic agents.

answer

1. Respiratory depression 2. Urinary retention 3. Hypotension

question

What two types of patients should we be cautious with when using epidural local anesthetic agents?

answer

1. Hypovolemia 2. Cardiac disease

question

Epidural opioids provides ______ only for what two types of procedures?

answer

-Analgesia 1. Hind limb 2. Perineal

question

Do epidural opioids block motor function? Will they decrease the amount of inhalant required?

answer

-No -Yes

question

What is the drug of choice for epidural opioids?

answer

Preservative free morphine but hydromorphone is often used

question

The onset of epidural opioids is _____, approximately ___-___ mins after administration; therefore, it is generally given ______ the animal is anesthetized

answer

-Slow -30-60 minutes -before

question

Do epidural opioids block sympathetic nerve function? What does this mean?

answer

No so there are fewer side effects than with the local agents

question

Is it possible to combine opioids and local agents in an epidural? What can this do?

answer

-Yes -Combining them will enhance analgesia due to a synergistic effect

question

When you combine opioids and local agents in an epidural can the side effects associated with the local agents still occur?

answer

Yes but they will not be as great due to lower dose required

question

The use of epidural analgesia/anesthesia during general anesthesia will have what two benefits?

answer

1. Make anesthetic maintenance and recovery smoother 2. Will require less inhalant

D4: Analgesic Drugs – Local Anesthesia – Flashcards

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