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I did the first week of my anesthesia rotation for my GPR program and came across this case which kind of boggled my mind. Maybe I am just an idiot, but in any case here goes...
The patient in question had a severe wrist fracture which had to be "reduced" surgically. The anesthesiologist used this relatively new ultrasound technology (really cool!) in which he detected the subclavian artery (which shows up as a red hot spot on the ultrasound)as a reference point to detect the brachial plexus (to do a shoulder nerve block). As a local anesthetic, he used a combination of approximately 25ml of a 0.5% bupivacaine epi 1:400 000 solution and 25ml of 0.25% bupivacaine epi 1: 400 000 solution (a total of 50ml!!!!). The rationale for this was to delay post-operative pain for about 48 hours. The patient subsequently went under general anesthesia for the surgical reduction.
Doesn't all that anesthetic have some sort of deletirious systemic effects? The maximum recommended dose of marcaine (bupivacaine 0.5% with epinephrine 1: 200 000) is 1.3mg/kg -absolute max is 90mg. Maybe I should have asked the anesthesiologist...sometimes I simply ask too many questions so I didn't dare. In any case, any answers out there? Has anyone used bupivacaine as a dental student/dentist( implants or other surgeries?post-op pain management)? I haven't used it yet.
The patient in question had a severe wrist fracture which had to be "reduced" surgically. The anesthesiologist used this relatively new ultrasound technology (really cool!) in which he detected the subclavian artery (which shows up as a red hot spot on the ultrasound)as a reference point to detect the brachial plexus (to do a shoulder nerve block). As a local anesthetic, he used a combination of approximately 25ml of a 0.5% bupivacaine epi 1:400 000 solution and 25ml of 0.25% bupivacaine epi 1: 400 000 solution (a total of 50ml!!!!). The rationale for this was to delay post-operative pain for about 48 hours. The patient subsequently went under general anesthesia for the surgical reduction.
Doesn't all that anesthetic have some sort of deletirious systemic effects? The maximum recommended dose of marcaine (bupivacaine 0.5% with epinephrine 1: 200 000) is 1.3mg/kg -absolute max is 90mg. Maybe I should have asked the anesthesiologist...sometimes I simply ask too many questions so I didn't dare. In any case, any answers out there? Has anyone used bupivacaine as a dental student/dentist( implants or other surgeries?post-op pain management)? I haven't used it yet.
