BASIC MEDICATION OPTIONS
TABLE 6: BASIC MEDICATION OPTIONS |
||
|---|---|---|
| Drug (Class) | Dose Range | Comment |
| Local Anesthesia and Additives | ||
| Lidocaine (Xylocaine) (0.5% – 1%) |
Most common 200 mg (20 mL 1% or 40 mL 0.5%), maximum dose 300 mg |
Most common in U.S.; lower concentration as effective but more expensive |
| Bacteriostatic Saline | 20 mL | Less effective than lidocaine |
| Bicarbonate Buffer | 1mL / each 10mL of lidocaine | Faster absorption; only for use with lidocaine |
| Vasopressin (Vasostrict) | 3-5 units mixed with anesthetic, max 5 units total | Decreases bleeding, slows systemic absorption, allows higher max dose of anesthetic; Used especially > 14 wk or hemorrhage RFs |
| Lidocaine with epinephrine |
Packaged as 20 mL 1% with 1:100,000 epinephrine | Consider mixing plain lidocaine with 4mL lido+epi 1:100,000. Use if vasopressin is unavailable or cost-prohibitive |
| Oral and IV Pain Medications | ||
| Ibuprofen (Motrin; Advil) | 600 – 800 mg PO | More effective at least 30 minutes before procedure |
| Naproxen (Naprosyn; Aleve) | 250 – 500 mg PO | More effective at least 30 minutes before procedure |
| Acetaminophen | 650 – 1000 mg PO or IV | In addition to NSAIDs or if allergy to NSAIDs |
| Hydrocodone | 5mg – 10mg hydrocodone | Equivalent medications or those with acetaminophen can be used |
| Fentanyl (Sublimaze) | 50 – 100 μg IV | Give over 30-60 seconds. Antidote is naloxone |
| Ketamine | 10-20 mg IV push over 30-60 seconds | Dissociative, eyes may remain open; minimal cardiovascular compromise |
| Anxiolytics | ||
| Lorazepam (Ativan) | 0.5–2mg mg SL or 1-4 mg PO | Shorter acting benzodiazepine. Antidote is flumazenil |
| Diazepam (Valium) | 5 –10 mg PO | Longer acting benzodiazepine. Antidote is flumazenil |
| Midazolam (Versed) | 1 – 3 mg IV | Give over 30-60 seconds. Antidote is flumazenil |
| Uterotonics for Post-Aspiration Hemorrhage | ||
| Methylergonovine (Methergine) | 0.2 mg PO/IM or intracervical | Use with caution if hypertensive |
| Misoprostol (Cytotec) | 800mcg SL or 800-1000mcg PR |
Given a rapid time to peak concentration, SL or buccal may be preferable to PR if possible (Kerns 2013) |
| Carboprost (Hemabate)* | 0.25 mg IM, may repeat every 15-90 minutes to max of 2mg | Use with caution in asthma * Available for use outside inpatient medical facilities |
| Oxytocin (Pitocin) | 10 u IM, or 10-40 u IV in crystalloid, or 10 u IVP | More uterine oxytocin receptors > 18 weeks |
| Tranexamic acid (TXA) | 1 g / 100mL NS IV over 10 min | May repeat 1 g dose in 30min for total of 2 g |
| Emergency Medications | ||
| Atropine Sulfate (Atropen) | 0.2 mg (0.5 mL) IV push or 0.4 mg (1 mL) IM, each 3-5 min to max dose of 2 mg | For prolonged symptomatic bradycardia with vasovagal Some use in paracervical block to prevent vasovagal |
| Diphenhydramine (Benadryl) | 25 – 50 mg IM/IV/PO | For allergic reaction Use PO for mild symptoms and IM/IV for anaphylaxis |
| Epinephrine 1:1000 (Adrenalin) | 0.3 – 0.5 mg (1 mg/mL) SQ/IM Repeat in 5-15 min as necessary |
For anaphylaxis. Preferable to inject in mid-anterolateral thigh |
| Naloxone (Narcan) | 0.1 mg – 0.2 mg (0.25-0.50 mL) IV / IM each 2-3 min Max dose 0.4 mg OR 2- 4 mg nasal |
Opiate antidote |
| Flumazenil (Romazicon) | 0.2 mg (2 mL) IV each min Max dose of 1 mg |
Benzodiazepine antidote |
1 Alternative or supplemental options for pain management include dexmedetomidine IV, gabapentin (Gray 2019), and nitrous oxide (Singh 2017), although data are limited on pain improvement with use.