A rat is rescued from an extended period of bupivacaine-induced cardiac arrest via infusion of Intralipid. Visit http://www.lipidrescue.org for more information.

Intralipid infusion is used to reverse a period of bupivacaine-induced cardiac arrest in a rat model. Arterial pressure and ECG waveforms are shown. Visit http://www.lipidrescue.org for more information.

Shown are the left ventricular pressure and electrocardiogram of an intact, anesthetized rat during acute bupivacaine cardiotoxicity and successful recovery with a lipid emulsion infusion.

Shown are the left ventricular pressure and electrocardiogram of an intact, anesthetized rat during acute bupivacaine cardiotoxicity, and attempted rescue with a saline infusion.

Shown are the left ventricular pressure and electrocardiom of an intact, anesthetized rat during acute bupivacaine exposure without intravenous administration of therapy.

INTRODUCTION The saphenous nerve block is useful for providing anesthesia and analgesia on the medial aspect of the lower leg and foot. It is a purely sensory nerve block that, with the popliteal nerve block, is particularly efficacious in providing post-op pain relief for major corrective surgery on the foot. Long-acting local anesthetic solutions can be used that will not delay discharge of outpatients from the short procedure unit. Although there are several approaches to this block, a relatively easy and effective approach that can be accomplished in several minutes is described here. INDICATIONS @ Surgery on the lower leg: orthopedic, podiatric, vascular procedures (medial, anteromedial, and posteromedial aspect of lower leg, from just below the knee to the foot) @ Postoperative pain relief for major corrective foot surgery (when combined with popliteal nerve block) EQUIPMENT Appropriate equipment for resuscitation, including oxygen, suction, and appropriate medications 1.5-inch, 25-gauge block needle 10-mL syringe Local anesthetic, 10 mL (e.g., 0.5 % ropivacaine, 2% lidocaine, 0.5% bupivacaine) Sterile prep solution Sterile gloves and mask ANATOMY The saphenous nerve is a sensory branch of the femoral nerve (see Figure 2, see Figure 3, see Figure 4). Whereas most of the leg below the knee is supplied by the sciatic nerve, the saphenous nerve supplies sensation to the medial aspect of the lower leg and foot. There is a fair degree of anatomic variation among individuals, and the cutaneous branches of the saphenous nerve form a network that interfaces with branches from cutaneous branches of other nerves (e.g., the superficial peroneal nerve branches of the foot). The saphenous nerve descends from the femoral nerve, lateral to the femoral artery (at the inguinal canal), and proceeds vertically to the medial side of the knee behind the sartorius muscle. At the level of the knee it becomes subcutaneous. It continues along the medial aspect of the tibia alongside the saphenous vein. Blockade of the saphenous nerve can be achieved at the level of the femoral artery (just lateral to the artery at the level of the inguinal crease), at the level of the knee (by piercing the sartorius muscle with a block needle and depositing local anesthetic just deep to the belly of the muscle), or by isolating the saphenous vein (which is adjacent to the nerve at the medial aspect of the upper tibia) and depositing local anesthetic around it. Ultrasound can be used to identify the saphenous vein and nerve, allowing direct deposit of the local anesthetic around the nerve. However, a field block at the level of the tibial tuberosity or medial malleolus will anesthetize the saphenous nerve. Because of the networks of cutaneous nerves that cross-innervate areas of the lower limb, anesthesia can be patchy and may require other nerves to be blocked as well. When combined with a popliteal block of the sciatic nerve or ankle block, adequate anesthesia is obtained. **Field block of saphenous nerve at level of the knee** -Place the patient in the supine position. -Use sterile gloves and mask. -Palpate the tibial tuberosity, which is the bony prominence on the front of the tibia a few centimeters below the knee. -Prep the skin with sterile prep solution. -Inject a skin wheal of local anesthetic over the tibial tuberosity. -Using the syringe and block needle, place a deep subcutaneous ring of local anesthetic solution (10 mL) through the skin wheal, linearly from the tibial tuberosity extending medially to the upper calf (dorsomedial aspect). **Field block of saphenous nerve at level of the ankle (ankle block)** -Palpate the medial malleolus. -Prep the skin just above the medial malleolus with sterile prep solution. -Using the syringe and block needle, place a subcutaneous ring of local anesthetic solution (6 to 8 mL) immediately above the medial malleolus, extending medially and laterally above the medial malleolus.

Floatocaine The worlds lightest local anesthetic. Made by combining local anesthetic with Helium, this stuff floats upwards for better epidural spread ! See the video showing Floatocaine coming out of a syringe and miraculously floating upwards.

unilateral pandular nystagmus post cataract using subtenon bupivacaine and lignocaine, lasted for 3-4 days.