Anesthesia Pharmacology: Autonomic Adrenergic
Practice Clinical Case Questions
Click on the correct answer.
A 22 year-old man suffers 4 broken ribs in a motor vehicle accident.
Although
displacement of the ribs at fracture sites was minimal, the patient complained of severe pain, and required large doses of fentanyl for relief.
case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D. Associate Professor, University of Kansas Medical Center
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What would be another reasonable way to provide analgesia for this patient?
thiopental (Pentothal)
phenobarbital (Luminal), orally
intercostal nerve block with 2% lidocaine
general anesthesia, "balanced"
Since the duration of lidocaine action is relatively short, why not use bupivacaine, a longer-acting local anesthetic?
too expensive
increased toxicity
bupivacaine (Marcaine) tends to have many drug-drug interactions, since it is a powerful inducer of drug metabolizing enzyme.
all of the above
Is there a way that the duration of action of 2% lidocaine (Xylocaine) can be significantly increased?
No, but one could use a signficantly higher initial concentration to achieve longer action.