The use of local anaesthetic in orthopaedic medicine

 

For injections and infiltrations lidocaine and procaine are used.

Procaine

The anaesthetizing effect of procaine starts after 5-10 min. and lasts about 45 min. The maximal quantity should not exceed 50 ml in a 0.5 % concentration.

Procaine is used in concentrations of 0.5 % and 2 %.

Lidocaine

The anaesthetizing effect starts after 2 min. and lasts about 60 min.

Lidocaine is used in a 2 % concentration.

 

  • Procaine 0.5 % is used as a diagnostic aid, but also therapeutically in cases of chronic bursitis, muscle belly lesions and in epidural local anaesthesia.
  • Procaine 2 % is used to dissolve calcium deposits in tendons or bursae, and in case of a sinuvertebral nerve block.
  • Lidocaine 2 % without ADR is used as a diagnostic aid, and for superficial anaesthesia of the skin in epidural local anaesthesia.

 When using local anaesthetics, both a toxic and an allergic reaction can occur.

 

1. Toxic reaction

 

This reaction presents mainly when the maximal dose is exceeded or in intravenous application of the anaesthetic.

Either a stimulation or a depression of the central nervous system occurs, in conjunction or not with a cardiovascular suppression.

Next to an immediate reaction, also a delayed one is possible ; it occurs 5-30 min. after the injection. Therefore, after an epidural local anaesthesia, the patient must be kept under observation for another 30 min.

 

2. Allergic reaction

 

Its frequency, when using procaine, is 1/50.000.

Besides the general urticarian reaction, a serious anaphylactic shock can occur, fortunately only very exceptionally with respiratory and cardiac arrest.

Next to an immediate reaction, also a delayed one is possible, as long as 30 min. after the application.

Previous interrogation of the patient as to the presence of an allergy can help avoiding allergic reactions ; in case of doubt, a small intradermal application can be considered.

 

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