Local and regional anesthesia are essential tools in the ED for procedural- and trauma-related pain management, such as for wound repair, lumbar puncture, insertion of intravenous catheters, arterial lines, chest tubes, arthrocentesis, fracture pain, and fracture manipulation and reduction. Local anesthetic (LA) techniques provide short-term pain relief by (1) infiltration or application of LA directly into the area to be anesthetized, (2) infiltration of local anesthetic into the environment of nerve fibers supplying the area, or (3) intravenous regional block. Knowledge of the dosages, actions, and toxicity of the LA medications is required for safe use of these agents. In addition, specific skills and anatomic knowledge for regional anesthesia techniques are necessary for the effectiveness of these procedures.
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