Question

A patient is having a carpal tunnel procedure on his right extremity. The patient was injected with Lidocaine 1%. A total of 4 mL was given before incision. During the procedure the patient complained of pain at the incision site. What would be the best intervention?

a) tell the surgeon that the patient is experiencing pain and if surgeon can give more local
b) the pain level is 4 out of 10, ask the patient if he can hold off on the pain meds
c) tell the patient he might have an allergic reaction called LAST if the surgeon injects more lidocaine into his incision
d) all of the above

Answer 1

The best intervention is to inform the surgeon of the patient's pain and consider additional anesthesia. Lidocaine works by blocking sodium channels in neurons, preventing pain signal transmission. LAST should not be suggested without evidence.

Step-by-step explanation:

The best intervention when a patient complains of pain during a carpal tunnel procedure, despite having been injected with Lidocaine 1%, would be to inform the surgeon about the patient’s discomfort and inquire whether additional local anesthesia can be administered. It is not appropriate to ignore the patient’s pain or to suggest that the patient might experience a local anesthetic systemic toxicity (LAST) without evidence. Moreover, LAST is a rare but serious reaction that should be handled with urgency if it occurs.

Local anesthetics like lidocaine work by blocking voltage-gated sodium channels in neurons. This blockage prevents the initiation and propagation of nerve impulses that would otherwise transmit the sensation of pain from the surgical site to the brain. Without these signals being effectively relayed, the experience of pain is greatly diminished or absent. This reversible blocking action is why lidocaine is an effective local anesthetic and is commonly used in procedures like carpal tunnel surgery.