02.03 Local Anesthesia

Hey guys! Today I am going to talk to you a little bit about local anesthesia!

Ok so what is local anesthesia?  Local anesthesia is when a specific medication is applied either topically or infiltrated (injected) into a specific area of the body that needs to be operated on.  Specifically local anesthesia will be used for shorter procedures for therapeutic or diagnostic reasons. Guys we would NOT be using local anesthesia to replace a heart valve!  Be sure to check out the other lessons we have on general anesthesia and moderate sedation!

Ok so lets talk about some more of the local anesthesia specifics!  The type of medication is going to be chosen and also administered by the provider which is typically the surgeon.  They will choose the medication they want based on the site they are operating on, the desired result they want to see, and also the health of the patient.  It’s super important to understand that the anesthesia team is NOT present during local anesthesia procedures. The patient will be monitored by a perioperative RN during the procedure who is specifically dedicated to this patient.  There will also be another perioperative RN involved in the procedure with circulating responsibilities. Guys check out our lesson on perioperative nursing roles!

Ok so here are some examples of topical anesthetic agents,  tetracaine, lidocaine, and also cocaine hydrochloride. A few injectable local anesthetic examples are lidocaine and bupivacaine and these can be with or without epinephrine.  Epinephrine is often used to prolong the effects of the local anesthetic, decrease systemic absorption of the medication, and can also decrease bleeding because of its vasoconstriction properties.  But guys epinephrine typically is not used in areas where there are small vessels like fingers, toes, nose for fear of lack of blood supply and tissue death. And take caution with epinephrine guys in patients with cardiac issues again because of its vasoconstricting properties.

Because the perioperative RN is responsible for monitoring the patient during the procedure with local anesthesia they must have knowledge of the equipment and how to interpret the data they are seeing.  Also guys you are going to want to have an understanding of these drugs including the recommended dose, maximum dose, how long they are going to last in the patient, contraindications and signs of reactions.

So before the procedure you are going to want to know your patient’s medical history, after all they are having a surgery.  Make sure you know what their baseline vital signs are so you have something to compare in the event of a reaction. Allergies are huge because we are administering specific medications and we certainly do not want to see any reactions in our patients.  And this is super important, remember the patient is completely awake during local anesthesia so they need to be able to communicate and follow directions.

Ok how and what do we do when we are monitoring the patient?  So remember we have our baseline vital signs as a starting point.  We are going to continuously monitor our patient’s heart rate, respiratory rate, blood pressure, oxygen saturation, and of course pain level.  The anesthetic agent should be making the procedure tolerable for the patient so guys if your patient is telling you they are having pain or can feel what is going on make sure to communicate that to the provider.  And of course report any changes to the provider during the procedure.

So guys facilities can have different policies or guidelines regarding the local anesthesia process, nurse to patient ratio, and postoperative guidelines so make sure you check these out for your specific state and facility!

I wanted to mention a serious issue that can be seen with local anesthesia known as local anesthesia systemic toxicity or LAST.  Although it’s rare you need to know it exists and how to recognize it. So if your patient starts complaining of a metallic taste in their mouth or numbness and tingling of their lips, LAST should come to mind.  Also guys you might see tachycardia initially but then bradycardia with increased toxicity. Respiratory arrest can occur if this issue is not recognized. This is why monitoring the patient and communicating with them is critical.  Notify anesthesia immediately if your patient is exhibiting any of these issues!

Ok so nursing concepts that are important are of course comfort, that is the reason for local anesthesia.  Safety is huge because after all our patient is having surgery! In surgery we focus on one patient at a time so we can provide the best patient-centered care!

Ok so look at some key points!  Local anesthesia is the application of an anesthetic agent to a specific area of the body so a procedure can occur comfortably for the patient.  The provider picks the agent based on the desired action and surgery site and administers it. Local anesthetic agents are topical or injectable, common medications are lidocaine and bupivacaine.  Before the administration of local anesthesia we want to have an assessment including medical history, allergies, mental status, vital signs. During the procedure one RN is dedicated specifically to monitoring the patient and will keep an eye on all vital signs and pain level.  Remember that local anesthesia systemic toxicity is an issue that can occur where there are mental status changes, metallic taste in the mouth, shivering, numbness or tingling of the lips. Contact anesthesia immediately if any of these issues occur. Finally teach your patient what they can expect before, during, and after the local anesthesia with emphasis on the fact that the patient will be conscious the entire time during the procedure.

Okay guys I hope you enjoyed this lesson on local anesthesia!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!