Pain Management Pathway

Objectives

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Scope

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Audience

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Initial Assessment & Management

Pain Management - Scoring

Fentanyl Lozenge

Pain Management - Drugs

Pain Management - Splintage

Advanced Assessment & Management

Pain Management - Advanced Techniques and
Neuropathic Pain Management

Local Anaesthetic Toxicity

In general the Central Nervous System (CNS) is more sensitive to local anaesthetics
than the Cardiovascular System (CVS).

CNS signs and symptoms

Early or mild toxicity: light – headedness, dizziness, tinnitus, circumoral numbness,
abnormal taste, confusion and drowsiness.
Severe toxicity: tonic – clonic convulsion leading to progressive loss of consciousness,
coma, respiratory depression and respiratory arrest.

Note: depending on the drug and the speed of the rise in blood level the patient may go
from awake to convulsing within a very short time.
Drugs to stop fitting such as Diazepam 0.2 – 0.4mg/kg intravenously slowly over 5
minutes repeated after 10 minutes if required, or 2.5mg – 10mg rectally.

CVS signs and symptoms
Early or mild toxicity: tachycardia and rise in blood pressure. This will usually only occur
if there is adrenaline in the local anaesthetic. If no adrenaline is added then bradycardia
with hypotension will occur.
Severe toxicity: usually about 4 – 7 times the convulsant dose needs to be injected
before cardiovascular collapse occurs. Collapse is due to the depressant effect of the
local anaesthetic acting directly on the myocardium. Bupivacaine is considered to be
more cardiotoxic than lignocaine.
Also see Treatment Guidelines; Adult ALS and Hypokalaemia

Prolonged Casualty Care

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Paediatric Considerations