ohiovolffemtp Posted December 29, 2014 Share Posted December 29, 2014 What are folks thoughts about doing this? I normally use a mixture of lido & marcaine/carbocaine/buvipicane - depending on what's stocked that day. I've not seen it be very helpful in reducing the pain from injecting lac's or abscesses prior to closure or I&D. Does anyone else buffer with bicarb? Other techiniques? Thanks, Paul Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 30, 2014 Moderator Share Posted December 30, 2014 lido1% 9 parts to bicarb 1 part. really helps with injection related pain as it becomes neutral ph. inject slowly. use small needle. I generally only do this for kids or folks really anxious about the procedure. Link to comment Share on other sites More sharing options...
primadonna22274 Posted December 30, 2014 Share Posted December 30, 2014 You know I have really never done this. Like twice. In 15 years. I used to wonder if I should but honestly just never seemed necessary. Maybe I'm mean. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 30, 2014 Moderator Share Posted December 30, 2014 You know I have really never done this. Like twice. In 15 years. I used to wonder if I should but honestly just never seemed necessary. Maybe I'm mean. yup, you are.....:) Link to comment Share on other sites More sharing options...
primadonna22274 Posted December 30, 2014 Share Posted December 30, 2014 Lol pretty sure that's what the laboring ladies say about me too. 2 more weeks of OB. I think I can I think I can I think...oh damn, why didn't I become an internist again?! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 30, 2014 Moderator Share Posted December 30, 2014 Lol pretty sure that's what the laboring ladies say about me too. 2 more weeks of OB. I think I can I think I can I think...oh damn, why didn't I become an internist again?! 2 more weeks of ob then never again. you can do it! Link to comment Share on other sites More sharing options...
primadonna22274 Posted December 30, 2014 Share Posted December 30, 2014 That's what I said until I looked at my spring schedule and I have another month of combined OB/peds in June! Waaahhhh ???? Ok back to your original scheduled programming. Carry on. Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 30, 2014 Moderator Share Posted December 30, 2014 Might be wrong here- but I am fairly sure they started adding bicarb to all lido bottles?? small needle, pierce skin quick, inject slowly, room temperature lido - seems to be enough for most - will add long acting many times for more time to repair and longer duration of numbness(pain relief) and doing one last injection before they are done with a long acting agent to another 1-2 hours of relief (trick stolen from ortho guys) Gets them out of ER and home before pain returns Honestly been using more LET topical (lido, Epi, tetracaine) soak a few cottonballs, tape lightly over wound, leave on >30 min - ideally 45 (even pour a little more solution on 1/2 way through when skin is blanched it is numb sometimes can do the entire repair with out needing to inject any lido at all! Key is TIME - has to blanch and typically needs to be 45 min - not a quick process, but well worth it for peds or adults that are really anxious (ie needle phobic patients) Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 31, 2014 Moderator Share Posted December 31, 2014 LET is nice for kids and faces. less effective for larger lacs. I think some places have pharmacy premix lido with bicarb but it's not a standard mix from the factory. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 31, 2014 Administrator Share Posted December 31, 2014 I use ethyl chloride skin refrigerant all the time. It's mostly harmless assuming no one is smoking in the vicinity.... Link to comment Share on other sites More sharing options...
Derbingle Posted December 31, 2014 Share Posted December 31, 2014 Peds ER director at one of my hospitals prefers we use bicarb 8.4% vials, 1 or 2 ml to lido 9 or 8 ml respectively on kids, takes more time so usually skip bicarb on adults but the ones have tried seems to work well. Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted January 9, 2015 Author Share Posted January 9, 2015 Any problems with the marcaine/buvipicaine/carbocaine precipitating? Link to comment Share on other sites More sharing options...
physetermacro Posted February 12, 2015 Share Posted February 12, 2015 I routinely use neut with my lidocaine or marcaine injections (as described above, 1-2 parts neut, 8-9 parts lido), and notice a significant difference in patient tolerance, especially kids. In addition, I use the ethyl chloride spray in kids as well. Again, makes a big difference. For bad lacs, especially on digital blocks, I routinely mix lido and marcaine 50/50 for short and longer-acting analgesia. Link to comment Share on other sites More sharing options...
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