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
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.