Antidepressants as local anesthetics: is there a place in regional anesthesia?

Abstract

Antidepressants have multiple sites of action. Among these, the ability to inhibit sodium channels has led to the increased interest in their use as local anesthetics. The following review summarizes the results of recent studies on this topic. Various animal and human models have shown that antidepressants exhibit many properties of local anesthetics with an extended duration of action. Due to limitations in study designs, however, these dramatic effects might have been misinterpreted and therefore possible toxicity may not have been recognized. Indeed, more recent studies focusing on toxic effects of antidepressants when used as local anesthetics proved this to be the case. Although antidepressants indeed act as potent local anesthetics, their use in the clinical setting cannot be recommended as of today due to extensive local tissue toxicity.