Klin Farmakol Farm. 2018;32(2):28-32 | DOI: 10.36290/far.2018.012

Local anesthetics from the anesthesiologist perspective

Olga Klementová¹, Pavel Michálek^2,3

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny Fakultní nemocnice Olomouc a LF UP v Olomouci

² Klinika anesteziologie, resuscitace a intenzivní medicíny, 1. LF UK a Všeobecná fakultní nemocnice, Praha

³ Department of Anaesthesia, Antrim Area Hospital, Antrim, United Kingdom

Local anesthetics are drugs that block the transmission of conduction in nerve structures and cause anesthesia or analgesia in thearea supplied by the given nerve. The only natural local anesthetic is cocaine, others are synthetic drugs. They can be divided intoaminoesthers and aminoamides. Estheric local anesthetics have a rapid onset and short duration of action, similar to lidocaine-typeaminoamide anesthetics. Aminoamide local anesthetics of the bupivacaine type have longer onset of action and longer duration.Local anesthetics are most commonly used in perioperative medicine for application to the mucosa, subcutaneous tissue, nervesand plexuses, or into the epidural and subarachnoid space. Increasingly widespread is the administration between the musclefascias in order to provide postoperative analgesia. Lidocaine is also administered intravenously, using its analgesic, anti-inflammatoryand immunomodulatory effects. The most serious complication associated with local anesthetics is their cardiotoxicity andneurotoxicity. The success rate of resuscitation increased significantly after the introduction of the lipid emulsion as an antidoteinto clinical practice. Long-term administration of local anesthetics to the nerves can result in tachyphylaxis, with a reduction intheir effect. The research of new molecules with local anesthetic action is mainly focused on tetrodotoxin derivatives.

Keywords: local anesthetic, cocaine, lidocaine, bupivacaine, toxicity, lipid emulsion, tachyphylaxes, tetrodotoxin

Published: August 13, 2018  Show citation