Local anesthesia

Local anesthesia
Intervention
MeSH	D000772

Local anesthesia is any technique to induce the absence of sensation in a specific part of the body,^[1] generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. It is also used for relief of non-surgical pain and to enable diagnosis of the cause of some chronic pain conditions. Anesthetists sometimes combine both general and local anesthesia techniques.

The following terms are often used interchangeably:

• Local anesthesia, in a strict sense, is anesthesia of a small part of the body such as a tooth or an area of skin.
• Regional anesthesia is aimed at anesthetizing a larger part of the body such as a leg or arm.
• Conduction anesthesia is a comprehensive term, which encompasses a great variety of local and regional anesthetic techniques.

Medical

A local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways (nerve block), effects such as analgesia (loss of pain sensation) and paralysis (loss of muscle power) can be achieved. Clinical local anesthetics belong to one of two classes: aminoamide and aminoester local anesthetics. Synthetic local anesthetics are structurally related to cocaine. They differ from cocaine mainly in that they have no abuse potential and do not act on the sympathoadrenergic system, i.e. they do not produce hypertension or local vasoconstriction, with the exception of Ropivacaine and Mepivacaine that do produce weak vasoconstriction.

Local anesthetics vary in their pharmacological properties and they are used in various techniques of local anesthesia such as:

• Topical anesthesia (surface)
• Infiltration
• Plexus block
• Epidural (extradural) block
• Spinal anesthesia (subarachnoid block)

Adverse effects depend on the local anesthetic agent, method, and site of administration and is discussed in depth in the local anesthetic sub-article, but overall, adverse effects can be:

1. localized prolonged anesthesia or paresthesia due to infection, hematoma, excessive fluid pressure in a confined cavity, and severing of nerves & support tissue during injection.^[2]
2. systemic reactions such as depressed CNS syndrome, allergic reaction, vasovagal episode, and cyanosis due to local anesthetic toxicity.
3. lack of anesthetic effect due to infectious pus such as an abscess.

Non-medical local anesthetic techniques

Local pain management that uses other techniques than analgesic medication include:

• Transcutaneous electrical nerve stimulation, which has been found to be ineffective for lower back pain, however, it might help with diabetic neuropathy.^[3]
• Pulsed radiofrequency, neuromodulation, direct introduction of medication and nerve ablation may be used to target either the tissue structures and organ/systems responsible for persistent nociception or the nociceptors from the structures implicated as the source of chronic pain.^{[4][5][6][7][8]}

See also

• Continuous wound infiltration

References

1. thefreedictionary.com > local anesthesia In turn citing: Mosby's Medical Dictionary, 8th edition. Copyright 2009
2. "Nerve damage associated with peripheral nerve block" (PDF). Risks associated with your anaesthetic (The Royal College of Anaesthetists). Section 12. January 2006. Retrieved 2007-10-10.
3. Dubinsky RM, Miyasaki J (January 2010). "Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology 74 (2): 173–6. doi:10.1212/WNL.0b013e3181c918fc. PMID 20042705.
4. Varrassi G, Paladini A, Marinangeli F, Racz G (2006). "Neural modulation by blocks and infusions". Pain Practice 6 (1): 34–8. doi:10.1111/j.1533-2500.2006.00056.x. PMID 17309707.
5. Meglio M (2004). "Spinal cord stimulation in chronic pain management". Neurosurg. Clin. N. Am. 15 (3): 297–306. doi:10.1016/j.nec.2004.02.012. PMID 15246338.
6. Rasche D, Ruppolt M, Stippich C, Unterberg A, Tronnier VM (2006). "Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience". Pain 121 (1–2): 43–52. doi:10.1016/j.pain.2005.12.006. PMID 16480828.
7. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L (2007). "Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain" (PDF). Pain physician 10 (1): 7–111. PMID 17256025.
8. Romanelli P, Esposito V, Adler J (2004). "Ablative procedures for chronic pain". Neurosurg. Clin. N. Am. 15 (3): 335–42. doi:10.1016/j.nec.2004.02.009. PMID 15246341.

External links

• New York School of Regional Anesthesia
• Anesthesia Books
• General information and tutorials in peripheral regional anesthesia
• Free online manual of regional anaesthesia- John Hyndman
• Clinical Use of Peripheral Nerve Stimulators and The Neuromuscular Junction
• ESRA - The European Society for Regional Anaesthesia Congress