• May be used in which a pt’s pain or anxiety may impede performance and success
  • Relative Contraindications: old age, dementia, respiratory difficulty
  • Aim to use local anesthesia and minimize procedural sedation
  • Local Anesthesia: lidocaine 1% or 2% – add Epi if >30 mins of analgesia required
  • Creating wheal: clean surface w/ chlorhexidine or alcohol swab; with 22-25G needle, advance needle parallel to skin and aspirate to ensure no blood vessel involved, then inject anesthetic to create 1-2 cm of raised skin; If deeper subcutaneous anesthesia is needed, advance needle perpendicular to skin, aspirate as advancing then inject the tract. Inject anesthetic as needle withdrawn.
  • Local anesthesia can alter landmarks, always double check anatomy after injection
  • Minimal Sedation: 0.25mg-2mg Ativan IV or 1mg-2.5mg Midazolam IV
  • Midazolam (Versed): faster on (2-5 min) and faster off (30-60 min)
  • Lorazepam (Ativan): onset 5-10 min; Duration 4-8 hours