Local Anesthetics

Chapter 17: 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

 Spinal anesthesia (subarachnoid)

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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