Subcutaneous infiltration of local anesthetics
- Deborah C Hsu, MD, MEd
Deborah C Hsu, MD, MEd
- Associate Professor of Pediatrics, Section of Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Stanley J Miller, MD
Stanley J Miller, MD
- Section Editor — Dermatologic Surgery
- Associate Professor of Dermatology and Otolaryngology/Head and Neck Surgery, Part-Time
- Johns Hopkins Hospital
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The subcutaneous infiltration of local anesthetics for minor skin procedures (eg, wound repair, lumbar puncture, or insertion of vascular catheters) will be reviewed here.
Topical anesthetics in children, peripheral nerve blocks, and regional anesthesia are discussed separately:
- McCreight, A, Stephan, M. Local and regional anesthesia. In: Textbook of Pediatric Emergency Procedures, 2nd edition, King, C, Henretig, FM (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2008. p.439.
- Tetzlaff JE. The pharmacology of local anesthetics. Anesthesiol Clin North America 2000; 18:217.
- Yaster, M, Tobin, JR, Kost-Byerly, S. Local anesthetics. In: Pain In Infants, Children, And Adolescents, 2nd edition, Schechter, NL, Berde, CB, Yaster, M (Eds), Lippincott, Williams & Wilkins, Philadelphia, PA 2003. p.241.
- Christoph RA, Buchanan L, Begalla K, Schwartz S. Pain reduction in local anesthetic administration through pH buffering. Ann Emerg Med 1988; 17:117.
- Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr 1993; 122:S14.
- Ritchie JM, Ritchie B, Greengard P. The active structure of local anesthetics. J Pharmacol Exp Ther 1965; 150:152.
- Stanton-Hicks, MD. Local anesthetics: Pharmacology and clinical applications. Hosp Formul 1987; 22:156.
- Bartfield JM, Homer PJ, Ford DT, Sternklar P. Buffered lidocaine as a local anesthetic: an investigation of shelf life. Ann Emerg Med 1992; 21:16.
- Achar S, Kundu S. Principles of office anesthesia: part I. Infiltrative anesthesia. Am Fam Physician 2002; 66:91.
- Ahlstrom KK, Frodel JL. Local anesthetics for facial plastic procedures. Otolaryngol Clin North Am 2002; 35:29.
- Giovannitti JA, Bennett CR. Assessment of allergy to local anesthetics. J Am Dent Assoc 1979; 98:701.
- McGee, DL. Local and topical anesthesia. In: Clinical Procedures In Emergency Medicine, 5th edition, Roberts, JR, Hedges, JR (Eds), Saunders Elsevier, Philadelphia 2010. p.481.
- Selbst SM, Fein JA. Sedation and analgesia. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippincott Williams and Wilkins, Philadelphia 2006. p.69.
- Klotz U. Antiarrhythmics: elimination and dosage considerations in hepatic impairment. Clin Pharmacokinet 2007; 46:985.
- Kennedy RM, Luhmann JD. The "ouchless emergency department". Getting closer: advances in decreasing distress during painful procedures in the emergency department. Pediatr Clin North Am 1999; 46:1215.
- Hruza, GJ. Anesthesia. In: Dermatology, Volume 2, 2nd, Bolognia, JL, Jorizzo, JL, Rapini, RP (Eds), Mosby Elsevier, Spain 2008. p.2173.
- Carraccio C, Feinberg P, Hart LS, et al. Lidocaine for lumbar punctures. A help not a hindrance. Arch Pediatr Adolesc Med 1996; 150:1044.
- Cepeda MS, Tzortzopoulou A, Thackrey M, et al. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010; :CD006581.
- Mader TJ, Playe SJ, Garb JL. Reducing the pain of local anesthetic infiltration: warming and buffering have a synergistic effect. Ann Emerg Med 1994; 23:550.
- Colaric KB, Overton DT, Moore K. Pain reduction in lidocaine administration through buffering and warming. Am J Emerg Med 1998; 16:353.
- Martires KJ, Malbasa CL, Bordeaux JS. A randomized controlled crossover trial: lidocaine injected at a 90-degree angle causes less pain than lidocaine injected at a 45-degree angle. J Am Acad Dermatol 2011; 65:1231.
- Moore DC, Bridenbaugh LD, Thompson GE, et al. Bupivacaine: a review of 11,080 cases. Anesth Analg 1978; 57:42.
- Schwartz, DR, Kaufman, B. Anesthetics and related medications. In: Goldfranks Toxicologic Emergencies, 9th edition, Nelson, LS, Lewin, NA, Howland, MA, Hoffman, RS, Goldfrank, LR, Flomenbaum, NE (Eds), McGraw Hill, New York 2011. p.965.
- ANATOMY AND PHYSIOLOGY
- CLASSIFICATION OF LOCAL ANESTHETICS
- CHOICE OF ANESTHETIC
- History of adverse reaction
- Methods to decrease injection pain
- - Direct infiltration
- - Field block
- FOLLOW-UP CARE
- Systemic toxicity
- - Treatment
- Catecholamine sensitivity
- Vasovagal syncope
- Allergic reaction
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS