Bupivacaine

Wow.

And danced for 13 weeks like that, getting Marcaine injections in my feet.

How did you get the stress fractures?

So dopey, [laughs] I don't know if I've ever publicly shared this.

In the body, I'm oftentimes working with my anesthesiologist to do, they do what's called pectoralis blocks, okay? So use an ultrasound guided needle, They inject the two major nerves in the pectoralis muscle, which can really help with post-operative pain control.

And variants of using some long-acting local anesthetics, there's Expiril, which is a long-acting, Marcaine, if you will.

Marcaine is a little shorter-acting drug than Expiril.

And so I think all of those work really well.

The other thing I tend to use quite a bit in tummy tucks is I like a very old-school pain pump, believe it or not.

Thank you for stepping up and speaking up." I also think that when we encourage people to speak up when they may be wrong, and we don't smack them down, is also very helpful, right? And, and I think that this is unfortunately, you know, when you look at the power distance that develop in hospitals- Somebody coming up to you and saying, "Uh, Dr.

Testa, you know, you have Marcaine in your hand.

I think you meant to have Lidocaine in your hand." And I could say, "No, actually, thank you for the cross-check, but I actually did want to have this Marcaine.

It wasn't Lidocaine that I was looking for, and I, and I appreciate-- but I appreciate you asking me that," opposed to, "Back off.

I got the Marcaine.

I know what I'm doing here." Like, "Thank you.

Done." Like, those are two different responses.

Four of those joint replacement patients received the wrong medication during spinal anesthesia.

The medication that was supposed to be administered was mapivacaine, which is obviously a derivative of like buvivacaine or not a derivative, but like in the same class as bupivacaine.

Bupivacaine, lidocaine.

Bupivacaine.

Yeah, all of that stuff.

It's a numbing medication.

In my practice, I really only take people who have a good core block.

So the first core block, personally, I use lidocaine and Marcaine, so a short-acting, long-acting.

I don't even put in Kenalog-

Oh, okay

It will occlude the blood supply and cause ischemic gangrene

What about bupivacaine or Marcaine? We use it for longer blocks, but it's highly cardiotoxic

The math here is two milligrams per kilogram plain or three milligrams per kilogram with epinephrine, and you must apply demographic adjustments.

Pediatric patients under eight get eighty percent of the max, and elderly or liver/renal disease patients get their max cut by a full fifty percent