Local anaesthesia

Appropriately used, local anaesthesia can give complete analgesia in a wide variety of clinical situations with minimal drawbacks. Particular indications include:

• painful procedures, e.g. chest drains
• intra- and postoperative analgesia
• analgesia after trauma
• infants with respiratory disease who are unable to tolerate large doses of opioid

Local anaesthesia may take several forms:

• surface anaesthesia:
  • indicated, e.g. for trauma such as repeated heel pricks
  • EMLA cream is applied sparingly every 4 hours
  • in children over a year, the cream is applied thickly and left under an occlusive dressing
• local infiltration:
  • e.g. peripheral nerve or regional block
  • used to enhance analgesia during surgery
  • central extradural block can be administered by an experienced team