Anesthesia Pharmacology Chapter 17:  Local Anesthetics  

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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 and 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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