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What is the purpose of local anesthetics?
They block nerve conduction at the site of application to decrease local pain signals from reaching the CNS
What suffix is most commonly used for local anesthetics?
-caine
As in lidocaine, procaine, bupivacaine
How do local anesthetics affect cells?
Block sodium channels, don't allow action potential propagation, blocks local pain signals
What are the routes of administration for local anesthetics? (7)
Topical
Transdermal
Infiltration
Nerve blocks
Epidurals
Sympathetic blocks
IV regional blocks
What are topical anesthetics used for?
Minor abrasions and burns, used prior to IV insertions, may be useful for spasticity
How are transdermal local anesthetics used?
Applied to surface of skin and then enhanced via ionto, phono or other enhancers
Lidocaine patches fit here
Can we put a hot pack over a Lidocaine patch?
No, will cause the drug to move too quickly into the skin
What is infiltration for a local anesthetic?
Drug is applied subcutaneously near a wound, allows drug to penetrate the area, causes local wound to numb
How is a peripheral nerve block applied? What does it do?
Injected close to a nerve or plexus (NOT within nerve), anesthetizes a specific area of the body
Define an epidural local anesthetic
An injection near the spinal cord, before the meninges
Define a spinal block local anesthetic
An injection near the spinal cord, after the meninges
What is the benefit of using an epidural vs a spinal block?
Epidural: Safer, easier to do
Spinal block: Stronger
How are both an epidural and spinal block used?
Used to decrease sensation below the spinal level of application
Define a sympathetic block. What condition is it used for?
Sympathetic output is blocked to a local area
Used for CRPS to reduce sympathetic activity
Define a Bier block
A local anesthetic is injected into the venous system, and a tourniquet is applied to keep the anesthetic in place
Define a continuous nerve block
A catheter that's implanted near a nerve provides a constant drip of local anesthetic to the area
Define a differential nerve block
A nerve block that affects the smallest fibers first, which are the pain fibers
Pts cannot feel pain but can still feel touch
Define local anesthetic systemic toxicity (LAST). What are the major systems affected?
When there is too much local anesthetic applied
Affects brain and heart
What are the brain effects caused by LAST? (7)
Tinnitus
Agitation
Restlessness
Seizures
Decreased sensation in tongue and mouth
CNS depression
Respiratory depression
What are the heart effects caused by LAST? (4)
Bradycardia
ECG abnormalities
Fatigue and dizziness
Cardiac arrest
