Managing Complications in Pregnancy and Childbirth: - IAWG

C-40 Anaesthesia and analgesiaFor larger surfaces, however, especially when more than 40 mL isneeded, adrenaline is required to reduce the absorption rate andthereby reduce toxicity.The best concentration of adrenaline is 1:200 000 (5 mcg/mL). Thisgives maximum local effect with the least risk of toxicity from theadrenaline itself (Table C-3, page C-40).Note: It is critical to measure adrenaline carefully and accurately using asyringe such as a BCG or insulin syringe. Mixtures must be preparedobserving strict infection prevention practices (page C-17).TABLE C-3Formulas for preparing 0.5% lignocaine solutionscontaining 1:200 000 adrenalineDesired Amount ofLocal AnaestheticNeededNormal Saline Lignocaine 2% Adrenaline1:1 00020 mL 15 mL 5 mL 0.1 mL40 mL 30 mL 10 mL 0.2 mL100 mL 75 mL 25 mL 0.5 mL200 mL 150 mL 50 mL 1.0 mLCOMPLICATIONSPREVENTION OF COMPLICATIONSAll local anaesthetic drugs are potentially toxic. Major complicationsfrom local anaesthesia are, however, extremely rare (Table C-5, page C-41). The best way to avoid complications is to prevent them:• Avoid using concentrations of lignocaine stronger than 0.5%.• If more than 40 mL of the anaesthetic solution is to be used, addadrenaline to delay dispersion. Procedures that may require morethan 40 mL of 0.5% lignocaine are caesarean section or repair ofextensive perineal tears.• Use the lowest effective dose.• Observe the maximum safe dose. For an adult, this is 4 mg/kg bodyweight of lignocaine without adrenaline and 7 mg/kg body weightof lignocaine with adrenaline. The anaesthetic effect should last forat least 2 hours. Doses can be repeated if needed after 2 hours(Table C-4).