In message <001401bfe9cc$f12383e0$af867d3e@d3u8f0>, mcglonerg <mcglonerg
@netscapeonline.co.uk> writes
>What do the UK A&E Consultants intend to do once the Prilocaine 0.5% runs out?
We've already run out of 0.5%. We use 20 mls of 1%, neat, for the
average-sized punter. Our anaesthetic dept have sent round a circular
suggesting up to 40mls 1% (400mg, >5mg / Kg for your standard 75Kg pt).
This seems a little OTT to us lowly A&E bods. I've done several Bier's
with 1%, not just since the demise of 0.5%. Never had a side-effect or a
failure, but just occasionally need to top up 20mls standard volume with
5-10mls extra if slow onset. We tend to put an extra "venous" pressure
tourniquet (like for normal phlebotomy) just above the # site for the
1st few minutes after injection (distally). The idea is to keep the ant-
pain medicine concentrated in the # site initially. In theory this gives
a combination haematoma block and (once vebous tourniquet released) a
IVRA block too. No evidence, except that I've never seen a Bier's fail
in this dept in 8 years (famous last words).
ps: we are arranging with a local hospital pharmacy dept to mix up our
own regional supply of 0.5% from 1%, presumably with the pH / tonicity
safeguards suggested.
Dr G Ray
Staff Grade
A&E
Sussex
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