5 Tips to Create a Local Anesthesia Plan of Care

Perioperative nurses play a vital role in ensuring safe, evidence-based care for patients receiving local-only anesthesia. While it can be easy to focus on the task at hand, it’s important to remember that local anesthetic injections carry risks that may not always be top of mind.

Why? Because every patient can respond differently to local anesthesia. For example, exceeding the recommended dose could trigger a serious cardiovascular event.

Read more on local anesthetic systemic toxicity (LAST) in this recent Periop Today story.

Set Up Your Patient for Local-Only Anesthesia Success

Identifying potential risks, such as a reaction to the anesthetic, is only the first step. Developing a clear, individualized plan for local-only anesthesia helps optimize each patient for the safest surgical outcome.

The care plan doesn’t need to be complex or time-intensive. Instead, it should focus on the patient’s unique history and needs before surgery, notes Emily Jones, PhD, RN, CNOR, EBP-C, AORN Senior Perioperative Practice Specialist. Jones recently led the update of the AORN Guideline for Care of the Patient Receiving Local-Only Anesthesia, which was last revised in 2020.

The latest evidence shows that a tailored plan of care for local-only anesthesia can enhance patient safety and support positive outcomes, especially as more procedures transition to outpatient settings to improve both cost efficiency and patient experience.

How to Optimize a Local-Only Anesthesia Care Plan

Dr. Jones offers five evidence-based tips to help perioperative teams tailor care plans for patients receiving local-only anesthesia:

1. Collaborate with the Team
   Partner with the surgeon and patient to develop a plan that reflects the patient’s unique needs, preferences, and clinical condition. A collaborative approach strengthens team coordination and empowers patients to play an active role in their care.
2. Identify Maximum Dose
   Verify the patient-specific maximum dose for the selected local anesthetic. Consult the surgeon, anesthesia provider, pharmacist, or your organization’s medication formulary. Dosage calculation tools and published references can provide added guidance..
3. Provide a Calm Environment
   Because these patients are awake, minimizing anxiety is essential. Support a calm environment and consider complementary care interventions shown to reduce stress, increase satisfaction, and help manage pain.
4. Educate the Patient Before Surgery
   Explain what to expect during surgery and how to communicate their pain level. Reinforce that they need to speak up if they are feeling dizzy, confused, have a metallic taste or experience any other signs of an adverse reaction to the local anesthetic.
5. Prepare for Adverse Reaction
   Be on high alert for signs and symptoms of reactions to the local anesthetic, including toxicity, allergic reaction, or methemoglobinemia (a rare and potentially serious condition triggered by exposure to local anesthetics where hemoglobin cannot effectively deliver oxygen to tissues and organs).

Support Safe Administration of Local Anesthesia with Evidence-Based Resources

• Periop 101: A Core Curriculum™
• eGuidelines+ is a facility-wide clinical decision support tool for the entire perioperative team. Provide access to the most current AORN Guidelines for Perioperative Practice including the Local-Only Anesthesia Guideline. Solidify best practices with more than 300 quick guides to best practices including a comprehensive guide on Local Anesthesia.