Local Anesthetics

Chapter 15: Local Anesthesics

 

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Local Anesthetic Agents

Local Anesthetics: Esters

Benzocaine (ester)

Procaine (ester)

 

Local Anesthetics: Amides

Mepivacaine (Polocaine/Carbocaine)

Bupivacaine (Marcaine)




 

Pharmacokinetics

Vasocontrictors added to local anesthetic solutions

Local Anesthetic Combinations

Stoelting, R.K., "Local Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 158-181.

Local Anesthetic Side-Effects /Toxicities & Neurotoxicity

 

Local Anesthetic Systemic Toxicity

 

Local Anesthetics: Clinical Uses

Regional Anesthesia

Classification: Six Placement Sites

Surface/topical anesthesia

 Local infiltration

 Peripheral nerve block

 Bier block (IV regional anesthesia)

 Epidural anesthesia

 Spinal anesthesia (subarachnoid)

 

Epidural anesthesia (image courtesy of the University of Kansas Medical Center, Department of Nurse Anesthesia)

 

 

 Spinal anesthesia (subarachnoid) (image courtesy of the University of Kansas Medical Center, Department of Nurse Anesthesia)

 

Primary Reference: Stoelting, R.K., "Local Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 158-181; Miller, R.D., Local Anesthesia, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 425-433. 

Local Infiltration

Peripheral Nerve Block

 

Axillary Block: Drawing by Lindsey Parker, (c) University of Kansas Medical Center

Intravenous Regional Anesthesia (Bier Block)

Bier Block: Drawing by Lindsey Parker, (c) University of Kansas Medical Center

Primary Reference: Stoelting, R.K., "Local Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 158-181.; Miller, R.D., Local Anesthesia, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 425-433.

Epidural Anesthesia

Drawing by Lindsey Parker, (c) University of Kansas Medical Center

Comparison of Epidural vs. Spinal anesthesia

Epidural----------------------------------Spinal
  • Often no zone of differential sympathetic nervous system blockade 
  • Typically a zone of differential sympathetic nervous system blockade (differential effects due to concentration differences, different nerve fiber types and differences in nerve fiber sensitivity)
  • Zone of differential motor blockade may average up to four segments below the sensory level
  • Zone of differential motor blockade: average two segments below the sensory level
  • Larger local anesthetic dose required compared to spinal-- greater systemic absorption
  • Smaller local anesthetic dose required compared to epidural-- less systemic absorption

Spinal Anesthesia

Drawing by Lindsey Parker, (c) University of Kansas Medical Center

Primary Reference: Stoelting, R.K., "Local Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 158-181.;Miller, R.D., Local Anesthesia, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 425-433.

Cocaine Toxicity

Primary Reference: Stoelting, R.K., "Local Anesthetics", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, pp 158-181.; Miller, R.D., Local Anesthesia, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 425-433.

 

Local Anesthetics Listing
  • Benzocaine (generic)
  • Bupivacaine (Marcaine)
  • Butamben picrate (Butensin Picrate)
  • Chloroprocaine (Nesacaine)
  • Pramoxine (Tronothane, Prax)
  • Cocaine
  • Dibucaine (Nupercainal, generic)
  • Dyclonine (Dyclone)
  • Etidocaine (Duranest)
  • Lidocaine (Xylocaine)
  • Mepivacaine (Carbocaine)
  • Ropivacaine (Naropin)
  • Prilocaine (Citanest)
  • Procaine (Novocain)
  • Tetracaine (pontocaine)

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