Chapter 8 Local Anesthesia Injection
Common indications
Local anesthesia is administered with three different methods when attempting to provide patients with complete anesthesia for minor skin surgery. These include local infiltration, field block, and digital block. Select an appropriate anesthetic based on the site of the procedure, the length of desired anesthesia, and the circulatory status of the site. Never use anesthetics with vasoconstrictive agents, such as epinephrine, for digital blocks, penile blocks, or in areas of poor vascular redundancy such as the tip of the nose or the pinna of the ear (Figure 8-1).
Equipment
Draw up the anesthetic with a volume sufficient to infiltrate the procedure site. Usually 1 to 5 cc is adequate, depending on the procedure. Buffering the anesthetic with one-third dilution of sodium bicarbonate can substantially reduce the pain of injection. Use an 18-gauge needle to draw up the anesthetic, then switch to a 25- to 30-gauge needle for the injection (Figure 8-2). The injection can be done with clean gloves before the final cleansing and draping of the skin when sterility must be maintained.
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