[Verse 1] Amides got two I's in the name, that's how you know 'em Lidocaine, bupivacaine, ropivacaine — let me show 'em Esters got one I: procaine, tetracaine, benzocaine squad Amides metabolized hepatic, esters get cleaved by plasma cholinesterase broad They block sodium channels, voltage-gated, phase-zero flat Depolarization halted — nerve conduction stops right at that Onset depends on pKa — lower means more un-ionized base More lipid-soluble cross the membrane, hit the binding place Bupivacaine slow onset but duration long — eight hours cardiac-bound Lidocaine fast, intermediate — thirty minutes, good ground Add epinephrine, vasoconstrict, cut the bleed and extend duration Bicarbonate alkalinizes — speeds onset, slick equation Dexamethasone prolongs the block through anti-inflammatory mediation Clonidine alpha-two agonist adding sedation and sensation [Chorus] Amide or ester, sodium channel blocker Two I's in the name or one — be a proper stocker Max dose by weight, by site, by vascularity LAST creeping in — lipid emulsion is the clarity Lipo-somal slow release, topical patch it down IV lidocaine periop — keep the pain profound-ly bound [Verse 2] Max dose principles — weight times limit, site matters most Intercostal high absorption, gluteal low — that's the pharmacokinetic toast Lidocaine plain — four-point-five milligrams per kilo is the cap With epi push it seven — vasospasm buying extra lap Bupivacaine two-point-five plain, never use with epi cardiac trap Age and liver disease cut your ceiling — elderly patient, mind the gap Now LAST — local anesthetic systemic toxicity, the specter at the feast Prodromal: perioral numb, tinnitus, metallic taste, agitation released Seizures follow, then cardiovascular collapse — arrhythmia, the beast Twenty percent lipid emulsion — one-point-five per kilo bolus, cease Infuse at point-two-five per kilo per minute, ASRA checklist greased Avoid vasopressin, propofol won't replace the lipid piece [Chorus] Amide or ester, sodium channel blocker Two I's in the name or one — be a proper stocker Max dose by weight, by site, by vascularity LAST creeping in — lipid emulsion is the clarity Lipo-somal slow release, topical patch it down IV lidocaine periop — keep the pain profound-ly bound [Bridge] Liposomal bupivacaine — Exparel's extended-release shell Seventy-two hours infiltration, mixed data on nerve blocks — too early to tell Lidocaine patch five percent — postherpetic neuralgia's nemesis EMLA eutectic mixture forty-five minutes occlusive — venipuncture genesis Capsaicin eight percent — defenestrates TRPV-one receptors, strips the wire Depletes substance P, burning application, three months' respite entire IV lidocaine infusions — perioperative: less opioid, faster gut return Chronic pain neuropathic — membrane stabilizer, aberrant signals adjourn Monitor EKG and pressure, watch the QRS and rate discern
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