Thursday, September 13, 2007

Sensitivity Training

We interrupt your schedule to bring you the latest Sensitivity Training...

I had quite a few cases today, but was reminded of an important aspect to any procedure that is performed in our laboratory: the proper way to give a local anesthetic.

Now the casual observer might think this is a minor issue - unless they're the one receiving the anesthetic.

Local anesthetics have revolutionized modern medicine: it is remarkable that I can implant a permanent pacemaker or an automatic defibrillator, or perform a catheter ablation procedure with the patient being awake, alert, and oriented throughout the procedure if necessary.

But the initial injection of the local anesthetic requires reassurance to the patient that they can get through the initial shock caused by the sting of the administration of the anesthetic, especially when working in the femoral triangle (near the groin area on the front of the leg where the hip joint bends).

What is said by the physician should be classified as "Green Light," "Yellow Light," or "Red Light" warnings (By the way, I have heard each of these used, so listen carefully):

"Mrs. Smith, I'm going to numb up your skin where we'll be working now. You're going to feel a little pinch and burn down here as the anesthetic goes in and then you'll be numb." (No over-dramatization, just the facts).

"Mrs. Smith, I'm going to numb up your skin where we'll be working now. It will feel a little bit like a bee sting." (I never thought bee stings were a mild discomfort. Hence, this might make the person unduly anxious).

"Mrs. Smith, I'm going to numb up your skin where we'll be working now. You're going to feel a little prick down here." (Wrong. Just wrong.)

Now, back to your regularly scheduled procedure...



Anonymous said...

The "Green Light" is definitely the best explanation, IMHO. That was used on both my trips to the cath lab, which resulted in my being completely relaxed about the procedure. But I'm sure having confidence in your doc helps calm the patients too.

Corrinne May said...

When I underwent a cathether ablation recently to correct avnrt,
I wasn't warned when the doctor was going to administer the anaesthetic, I didn't even know it was coming :) and so it was quite a shock to feel the pain of the sting. And it does feel exactly like what it is ie. a needle jab to your upper thigh. Sharp.

I'm glad that you're discussing this issue and the various ways the patient can be informed of what will be happening to them :)

Mitch Keamy said...

Hi. Funny. A couple of ways to decrease the pain of local field injection:

1) local anesthetics are shipped/stored buffered acidic to preserve it; the acid stings. Add a little bicarb to the mix. This will also speed onset of bupivacaine.

2) cold at the skin is good; ice or ethyl chloride

3) advance very slowly with slow steady injection-I learned this from a painless dentist. always use a tiptrol syringe

4) apply firm pressure over the skin on pelvic crest with one finger of your left hand while injecting with the right. The bit of discomfort you generate away from the injection site will distract/gate away the more noxious pain of the needle/local anes depolarization.

Nice blog!


DrWes said...


"Cool!" Thanks for the tips!

Anonymous said...

A quickie from a vet tech.

Change your needle after drawing stinging meds, sometimes it's the solution on the needle producing most of the sting. The slightly sharper needle may help too.

Particularly helpful if your patient bites.

Terry at Counting Sheep said...

Great little article and so important. It's the little things we do, and we can do them so much better with so little effort too.

I'm an anesthetist, and we always use local before starting our IVs. In addition to telling patients about the pinch and the slight burning, I also tell patients to take a deep breath while I'm injecting. A tip I learned from the dentist - it basically gives a patient something else to focus on. Also, always wait for the alcohol that you rubbed on the skin first to dry, as that will cause more burning if not dry during local needle insertion. As Mitch pointed out, slow injection is also quite helpful.

Thanks for wonderful advice.

Anonymous said...

Or my way of responding to a red or yellow light, "if it hurts, more than likely? my reaction will be to hurt you back."

Yea. Pain and me never did find that happy medium of compromise and friendship.