The most common usage of LA in the ED is local infiltration for wound repair and invasive painful procedures. It is a rapid-onset technique. Infiltration can be into the wound margins or as a field block in a "diamond-shaped wheal" of LA surrounding the wound. Lidocaine is the drug of choice for local anesthetic infiltration for brief procedures. Bupivacaine is preferable for longer procedures due to its longer duration of action, but with due caution regarding the increased toxicity. Epinephrine can be added to enhance safety and efficacy, and bicarbonate to minimize pain of infiltration. The maximal dosages commonly cited (see Table. ...3.2.-8.) apply to infiltration of local anesthetic, in contrast to the lower maximal dosages for most regional procedures.
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