Centipede Envenomation Treatment & Management

Updated: Jun 23, 2022
  • Author: Andrew G Park, DO, MPH, FAWM; Chief Editor: Joe Alcock, MD, MS  more...
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Treatment

Emergency Department Care

Management of centipede stings is entirely supportive. No antivenoms for centipede stings exist.  More research regarding the structure and function of the various proteins involved in centipede envenomation could be helpful in determining future treatment considerations.

The most effective pain management plan may be a local anethestic block.  Often bites occur in more remote settings where medical care is less accessible.  Centipedes bites have been shown to be quite painful and sometimes difficult to control with oral pain medication.  Providing the patient with an initial oral anti-inflammatory medication like ibuprofen and then proceeding with a local nerve block may be the most efficient and effective way to treat pain.  If the initial local anesthetic block isn't fully effective, a regional anesthetic block would provide a more expanded coverage for the nerve block.  Local injectable anesthetics (eg, lidocaine, bupivacaine) can be used for the nerve blocks.  Pain may be managed with systemic narcotic analgesics if additional pain relief is required.  A standard text should be consulted regarding techniques of regional anesthesia.

Tetanus status should be updated as needed.

Prophylactic antibiotics are not necessary, but secondary infections should be cultured and treated with appropriate antibiotics (to cover gram-positive bacteria).

Antihistamines can be used for patients with significant pruritus.

Patients should be observed for approximately 4 hours for evidence of systemic toxicity.

Patients presenting with anaphylaxis should be managed in standard fashion.

If soft tissue swelling is severe or rhabdomyolysis is evident after centipede envenomation, the patient should be admitted and observed for development of compartment syndrome and management of myoglobinuria as needed.

Next:

Consultations

Most centipede stings are minor and do well with conservative management. In rare, more severe cases, consultation with a regional poison control center specialist may be helpful. Occasionally, a specialist will need to be involved, such as the following:

  • Surgeon: When there is concern for a possible developing compartment syndrome (for compartmental pressure testing and, if elevated, fasciotomy)

  • Cardiologist: If the patient has findings concerning for cardiac complications

  • Nephrologist: If rhabdomyolysis occurs and is complicated by acute renal injury

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