Pharmacology Of Local Anesthetics Research Articles

Principles of the pharmacology of local anesthetics

The development of local anesthetics revolutionized the performance of painful interventions. Local anesthetics have an effect on voltage-gated sodium channels in nerve fibers and modulate the conduction of impulses. With respect to the chemical structure, local anesthetics can be divided into amide and ester types. The structural differences of local anesthetics have an influence on the duration of action, the degradation pathways and specific side effects. Severe adverse events include cardiotoxicity and neurotoxicity. In addition to basic measures, such as the monitoring and securing of vital parameters, lipid infusion represents a treatment option in cases of intoxication. The recent developments of local anesthetics are particularly concerned with the reduction of toxicity and prolonging the duration of action.

Advancements in epidural anesthesia for small animals: a comprehensive literature review

Epidural anesthesia is a loco-regional blocking technique used to prevent and control pain in pathological processes and surgical procedures, widely used in veterinary medicine. The present work aims at performing a detailed literature review, preferably of the last twenty years, on the various aspects of this technique, including anatomy of the epidural space and peculiarities in small animals, pharmacology and toxicology of the main local anesthetics used, methods for identifying the epidural space, as well as recommended doses, indications, contraindications, and complications of the procedure. With the development of this literature review, it was found that the volume, concentration, and mass of local anesthetics, in addition to knowledge of anatomy and pharmacology of local anesthetics, plays a key role in the success of the technique. Moreover, it was noticed that, with the advent of ultrasonography, the identification of the epidural space is more accurate, compared to other methods. It was concluded that epidural anesthesia is a safe procedure, but not free of possible complications and side effects, as well as any anesthetic procedure. Therefore, it is essential to evaluate each case individually, always valuing the welfare of the patient.

Principles of the pharmacology of local anesthetics

The development of local anesthetics revolutionized the performance of painful interventions. Local anesthetics have an effect on voltage-gated sodium channels in nerve fibers and modulate the conduction of impulses. With respect to the chemical structure, local anesthetics can be divided into amide and ester types. The structural differences of local anesthetics have an influence on the duration of action, the degradation pathways and specific side effects. Severe adverse events include cardiotoxicity and neurotoxicity. In addition to basic measures, such as the monitoring and securing of vital parameters, lipid infusion represents a treatment option in cases of intoxication. The recent developments of local anesthetics are particularly concerned with the reduction of toxicity and prolonging the duration of action.

Каудальная анестезия в педиатрической практике

Caudal anesthesia has been used for more than a hundred years. Caudal epidural blockade is the most commonly used regional technique in children and is considered the safest access to the epidural space. This method of anesthesia is used in combination with general anesthesia. With the correct implementation of this anesthetic manual, the risk of complications is small. The technique is used for peri- and postoperative analgesia in children of different ages. The main advantage of the method is high-quality anesthesia during caudal blockade, it is provided in 95–98 % of cases. The level of anesthesia depends on the amount of anesthetic administered; in some cases it may reach the level of the chest. The same advantage is the rapid onset of adequate analgesia and its long-term effect. For successful regional anesthesia in a pediatric patient, it is necessary for the anesthesiologist to know the anatomical and physiological structures of the body, the pharmacology of local anesthetics and the availability of the necessary medical equipment. The research presents a method of using caudal anesthesia as a component of anesthetic support for surgical interventions performed in children. We present the advantages and disadvantages of such anesthesia, indications and contraindications to its use, analyze possible complications, the implementation method.

Evaluation and Analysis of Fellow Learning and Education Curriculum in a Regional Anesthesiology and Acute Pain Medicine Fellowship: A Prospective, Observational Pilot Study.

Since 2017, several regional anesthesiology and acute pain medicine fellowship programs throughout the country have developed various educational didactic curriculums to address the core medical knowledge requirements as set by the Accreditation Council for Graduate Medical Education. Given the paucity of existing literature regarding the medical knowledge acquisition of regional anesthesiology and acute pain medicine fellows, this study aimed to determine how quickly these fellows learn during their fellowship year, with a secondary aim of analyzing a new educational didactic curriculum in its goal of delivering the required medical knowledge. An 89-question, multiple-choice examination was administered to the 2020-2021 regional anesthesiology and acute pain medicine fellows at the University of Pittsburgh Medical Center during orientation and again at 4 months and 8 months into the fellowship. A secondary analysis of anonymous deidentified answers was completed. Fellows averaged 64%, 74%, and 79% correct responses on the orientation, 4-month, and 8-month exams, respectively. An analysis of the orientation exam revealed that the most commonly incorrect answers stemmed from topics including lower extremity nerve blocks, truncal blocks, and neuraxial anesthesia. The 4-month exam showed overall marked improvement; however, truncal blocks remained the most missed topic. Topics with 100% correct response rates in all examinations were local anesthetic pharmacology and systemic opioids. The results of this study indicate that a large portion of learning occurs during the first 4 months of the fellowship and slows thereafter. Using this simple form of fellowship evaluation, changes to an educational didactic curriculum can be implemented to reach medical knowledge goals more effectively and efficiently as required by the Accreditation Council for Graduate Medical Education.

Neurotoxicity of local anesthetics in dentistry.

During dental treatment, a dentist usually applies the local anesthesia. Therefore, all dentists should have expertise in local anesthesia and anesthetics. Local anesthetics have a neurotoxic effect at clinically relevant concentrations. Many studies have investigated the mechanism of neurotoxicity of local anesthetics but the precise mechanism of local anesthetic-induced neurotoxicity is still unclear. In addition, it is difficult to demonstrate the direct neurotoxic effect of local anesthetics because perioperative nerve damage is influenced by various factors, such as the anesthetic, the patient, and surgical risk factors. This review summarizes knowledge about the pharmacology of local anesthetics, nerve anatomy, and the incidence, risk factors, and possible cellular mechanisms of local anesthetic-induced neurotoxicity.

Sais anestésicos utilizados na odontologia: revisão de literatura

Os anestésicos locais permitem um melhor e adequado controle da dor em pacientes que se submetem a tratamentos dentários. A farmacologia dos anestésicos locais é muito complexa, por isso é importante saber selecionar a droga correta para cada procedimento a ser realizado. Sendo assim, observamos a necessidade e a importância de um artigo como revisãode literatura para reunir as informações atuais e importantes sobreos anestésicos locais mais utilizados na área da odontologia.

Editorial introductions

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Keith J. RuskinKeith J. RuskinKeith J. Ruskin is currently Professor of Anesthesia and Critical Care and Director of Neurosurgical Anesthesia at the University of Chicago. He attended medical school at the University of Miami School of Medicine and completed his residency in anesthesiology at New York University Medical Center. His major academic interests include neurosurgical anesthesia, medical informatics and educational technology, human performance, and aerospace medicine. Keith is a member of the American Society of Anesthesiologists’ Committee on Patient Safety and Education and Chair of the Aerospace Medical Association's Human Performance Committee. He has published numerous book chapters, articles and scientific abstracts in each of these areas, and he lectures internationally. His most recent book is a comprehensive textbook on perioperative quality and safety; it will be released in October, 2016. Keith is also a commercial pilot with single- and multi-engine ratings and a DC-3 type rating. Thomas BuchheitThomas BuchheitDr Buchheit is Associate Professor and Chief of the Division of Pain Medicine in the Department of Anesthesiology at Duke University, overseeing outpatient and inpatient medical and interventional pain services. He has a career-long interest in improving therapies for nerve injury pain syndromes and is a member of Duke's Nerve Injury and Pain Mechanisms Laboratory as well as the Center for Translational Pain Medicine. He is actively involved in research, and has funding through Duke University as well as the Department of Defense (PT1100575), defining the clinical phenotypes of neuropathic pain, the underlying epigenetic mechanisms that drive the transition from acute to chronic pain, and clinical trials to prevent these maladaptive processes. Dr Buchheit has multiple publications in the field of nerve injury pain and epigenetic mechanisms and has served multiple national and regional leadership positions over the past decade. He currently also serves as President of Pain Society of the Carolinas, working actively with State Medical Boards and physician education regarding medication safety. Stephan C. KettnerStephan C. KettnerStephan C. Kettner, MD, is an associate Professor of Anesthesiology and Intensive Care Medicine at the Medical University of Vienna, Austria. He is Head of Trauma Anesthesiology in the Department of General Anesthesia and Intensive Care at the General Hospital in Vienna. He earned his medical degree at the University of Hannover, Hannover Medical School, Germany. He finished his residency training at the Medical University of Vienna, Austria. During his residency in anesthesiology he completed fellowships in neonatology and emergency medicine. The clinical interests of Dr Kettner are regional anesthesia techniques for acute trauma in adult or pediatric patients, resuscitation of trauma victims, and postoperative pain therapy following orthopedic surgery. His scientific focus is on regional anesthesia, pharmacology of local anesthetics, and the advancement of ultrasound guided regional anesthesia. Since 2009 Dr Kettner is an editor for the Cochrane Anaesthesia, Critical, and Emergency Care Group. From 2012 to 2014 he served as chairperson of the subcommittees 8 Regional Anaesthesia of the European Society of Anaesthesiology. He is an active member of the European Society of Regional Anaesthesia and Pain Therapy.

Physiological and pharmacologic aspects of peripheral nerve blocks.

A successful peripheral nerve block not only involves a proper technique, but also a thorough knowledge and understanding of the physiology of nerve conduction and pharmacology of local anesthetics (LAs). This article focuses on what happens after the block. Pharmacodynamics of LAs, underlying mechanisms of clinically observable phenomena such as differential blockade, tachyphylaxis, C fiber resistance, tonic and phasic blockade and effect of volume and concentration of LAs. Judicious use of additives along with LAs in peripheral nerve blocks can prolong analgesia. An entirely new group of drugs-neurotoxins has shown potential as local anesthetics. Various methods are available now to prolong the duration of peripheral nerve blocks.

MCQs in Regional Anaesthesia and Pain Therapy (MasterPass)HSehmbi & U JShahRadcliffe Publishing Ltd, 2012, ISBN: 978 1846199714, 384 pp., Price £ 45.00

MCQs in Regional Anaesthesia and Pain Therapy is designed to provide examination practice and knowledge for readers considering sitting the European Diploma in Regional Anaesthesia (EDRA) Part 1 (written), as well as those with an interest in expanding their knowledge base in regional anaesthesia or pain therapy. It is presented as nine chapters covering neuroanatomy and physiology, pharmacology of local anaesthetics, analgesics and adjuvants, equipment and physics, central neuraxial blocks, peripheral nerve blocks, regional anaesthesia in specific populations, pain therapy, complications in regional anaesthesia and statistics. Each chapter begins with a number of MCQs followed by an answer section. There is also an appendix with multiple tables of useful information for quick reference. The content of the text is wide and varied with an appropriate depth covered. There are numerous diagrams and tables that help cement and better explain the information to readers, while each answer is appropriately referenced. There is possibly some overlap between the written questions and those that have previously appeared in the EDRA, although any candidates hoping to use it to learn MCQ answers by rote or improve MCQ technique will be disappointed as the format of the MCQs is in a “Best of Four” format, rather than the “Best of Five/Single Best Answer” format in the EDRA examination or that more recent FRCA candidates are familiar with. This very significant shortfall makes the text less useful as an MCQ preparation aid, but does not eliminate the value of the content within the answers section. It is also well directed at the European approach to regional anaesthesia, with significant focus on eponymous blocks and non ultrasound-guided techniques. The text contains some errors and inconsistencies, as most books of this nature do, however the grammar and use of English is poor, with innumerable spelling mistakes and inappropriate abbreviations. Questions are at times difficult to follow, while the diagrams would have been better presented had there been professional illustrator input. Overall, this text fills a vital niche in the market and currently seems to be regarded as the only MCQ book that candidates use before sitting the EDRA. It does have a much broader scope than this, however, as it provides invaluable information for anyone interested in learning about regional anaesthesia. The poor production and writing do not negate the depth of content provided to readers.

English

Local anesthetics are one of the most commonly used drugs in the field of medicine. Local anesthetics are widely used to induce anesthesia and analgesia for surgical procedures and pain management. Local an aesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of regional anesthesia and has been recognized and reported since the late1800s. This narrative review summarizes the pharmacology of local anesthetics, clinical manifestations of systemic toxicity associated with these agents, necessary preventive measures and recent treatment strategies.

Local Anesthesia Part 2: Technical Considerations

An earlier paper by Becker and Reed provided an in-depth review of the pharmacology of local anesthetics. This continuing education article will discuss the importance to the safe and effective delivery of these drugs, including needle gauge, traditional and alternative injection techniques, and methods to make injections more comfortable to patients.

Knowledge of Local Anesthetic Use Among Dermatologists

Local anesthesia is widely used in general dermatology practices. The onus is on the practitioner to have a sound knowledge of the pharmacology and dosing of any drug used, including local anesthesia. The dermatologist should also be aware of the signs, symptoms, and management of toxicity of local anesthetic use. The level of knowledge of dermatologists on this topic has not been previously assessed. To assess levels of knowledge of local anesthetic pharmacology, local anesthetic systemic toxicity (LAST), and the management of the latter of dermatologists. A survey designed to test knowledge of absolute dosing limits; calculation of patient-specific dosing using clinical vignettes; and awareness of the signs, symptoms, and management of LAST was distributed electronically to the membership of three professional dermatological organizations in the United Kingdom and Ireland, including one specialist dermatologic surgery group. Knowledge of local anesthetic use of dermatologists was comprehensive enough to practice safely, without necessarily being entirely accurate. Awareness of the signs and symptoms of local anesthetic toxicity was good, but awareness of the specific agent now recommended for the management of LAST in official guidelines was poor. Knowledge of local anesthetic dosing and toxicity is reasonable among dermatologists. Awareness of the guidelines for management of LAST, released by the American and Great Britain and Ireland associations of anesthetists, and in particular the use of lipid emulsion in this setting, could be improved.

Ultrasound-guided Regional Anesthesia

University of California, Irvine, Orange, California. jcahn@uci.eduBy Fernando L. Arbona, M.D., Babak Khabiri, D.O., John A. Norton, D.O. New York, Cambridge University Press, 2011. Pages: 206. Price: $99.00.The relatively recent incorporation of ultrasound technology for placement of peripheral nerve blocks and perineural nerve catheters has revolutionized the field of regional anesthesia. For those practitioners who have trained using the nerve stimulator technique, incorporating ultrasound into their busy practice may seem like a daunting task. As the title suggests, Ultrasound-guided Regional Anesthesia : A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters targets not only this audience but also current trainees by providing a pragmatic guide for those interested in learning ultrasound-guided regional anesthesia.Well written with a straightforward style, Ultrasound-guided Regional Anesthesia presents a comprehensive yet concise introduction to ultrasound-guided nerve blocks. Visually interesting, the book is filled with ample illustrations along with photographs of mock patients and their corresponding ultrasound images. The text reads easily and it often feels as if the authors are conversing and instructing you in person. Detailed instructions on how to identify the target structures, set up for the procedures, and perform the blocks are methodical and easy to follow. The “Author's Clinical Practice” section at the end of each procedure references the authors' individual practices and gives the reader practical insight into how these techniques translate to real life. In addition, each chapter is peppered with a highlighted “Key Points” or “Additional Considerations” section filled with relevant clinical pearls and useful tips designed to maximize success.The text is divided into four major sections. The first section focuses on fundamental concepts, including the pharmacology of local anesthetics, ultrasound physics, and the clinical application of ultrasound in regional anesthesia. The second and third sections are dedicated to upper and lower extremity blocks, respectively. Each of these sections begins with a review of relevant anatomy, contraindications to the procedure, potential complications, and, finally, instructions on how to perform the block. Descriptions of the procedure are further organized into categories, including equipment, scanning techniques, needle insertion, and local anesthetic injection. The final section of the book details peripheral perineural catheter placement and management. The first chapter in this section discusses proper patient selection and both inpatient and outpatient management. Dosing regimens and pump selection are reviewed, and the authors describe catheter insertion techniques for both solo and dual practitioners. The remaining chapters cover catheter placement for the various blocks reviewed in the book's previous chapters.Writing a book with the primary intent to teach procedural techniques can be a challenge, but Ultrasound-guided Regional Anesthesia : A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters is a well-executed guide. As the title suggests, this book is practical: the text is easy to digest, the instructions are clear, and the graphics and clinical insights are beneficial. This book would make a welcome addition to any library as a fast and useful reference for the busy anesthesia provider wishing to incorporate ultrasound-guided regional anesthesia in his or her practice.University of California, Irvine, Orange, California. jcahn@uci.edu

ADSA/NDBA Abstracts

ADSA/NDBA Abstracts

Local anesthetic pharmacology in pediatric anesthesia

In the last 25 years there has been an increase in the use of regional blocks in children. This is due to several converging factors: a better knowledge of the pharmacology of local anesthetic agents in the child, the availability of equipment adapted for children’s anatomy, the recognition of the remarkable hemodynamic stability of the young child during an neuraxial block, as well as the recognition of the need to treat pain not just in the operative period, but in the postoperative period of time as well. The safety of performing regional anesthetic blocks in children depends on the practitioner’s recognition of three important differences between adults and children: (1) their frequent inability to allow the performance of a regional anesthetic block unless under general anesthesia (which is a subject of controversy that is beyond the scope of this review), (2) the anatomic differences between adults and children, and (3) the pharmacologic/pharmacodynamic differences between adults and children. The purpose of this review is to examine the pharmacology of the local anesthetic agents commonly used in children.

Local anesthetics

Local anesthetics are used in a wide range of clinical situations to prevent acute pain and to stop or ameliorate pain produced by cancer or pain associated with chronic painful conditions. Knowledge of the pharmacology of local anesthetics is essential for their safe use and selection of specific agents to achieve intended goals. Local anesthetics are a group of drugs defined by their ability to prevent sodium entry into axons, thereby preventing the generation of propagated action potentials in axons. They have other actions, however, such as prevention of axonal sprouting and effects on G-protein-coupled receptors, and on conductance of ions in addition to sodium that might be important in the management of pain. The recent literature focuses on the spectrum of pharmacodynamic actions of local anesthetics, on comparison of pharmacodynamic and pharmacokinetic properties of racemic mixtures versus solutions of pure enantiomer, and on formulations to prolong duration of action. There is new evidence that lipid suspension is useful in the treatment of bupivacaine cardiac toxicity. Local anesthetics have similar chemical structure but differing pharmacokinetic properties and spectra of pharmacodynamic effects that influence selection of agents for use in various clinical situations.

Essentials of Local Anesthetic Pharmacology

It is impossible to provide effective dental care without the use of local anesthetics. This drug class has an impressive history of safety and efficacy, but all local anesthetics have the potential to produce significant toxicity if used carelessly. The purpose of this review is to update the practitioner on issues regarding the basic pharmacology and clinical use of local anesthetic formulations.

Pharmacology of local anesthetics.

Local anesthesia is a common technique used to provide anesthesia for ocular surgical procedures. Despite improvements in operative conditions, there is still the potential for complications, both local and systemic, during routine procedures. This article discusses the physiology of neuronal function, the chemistry of various local anesthetic agents, and the pathogenesis of toxicity. It is vital for the practitioner to have thorough knowledge of these subjects in order to reduce risks when performing ophthalmic procedures.

A concise review of the basic biology and pharmacology of local analgesia

Local analgesics are the most commonly used group drugs in dental practice. However, due to their frequent use and high margin of safety, often dental practitioners neglect to properly understand the biology and pharmacology of these drugs. This article reviews the basic concepts of pain, pain pathways, the mode of action of local analgesics and factors which affect their usage. Specific details and properties of some currently available solutions are also outlined. A greater understanding of the biology and pharmacology of local anaesthetics will ultimately lead to safer and more effective use in everyday clinical practice.