local anesthesia


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Anesthesia, Local

 

Definition

Local or regional anesthesia involves the injection or application of an anesthetic drug to a specific area of the body, as opposed to the entire body and brain as occurs during general anesthesia.

Purpose

Local anesthetics are used to prevent patients from feeling pain during medical, surgical, or dental procedures. Over-the-counter local anesthetics are also available to provide temporary relief from pain, irritation, and itching caused by various conditions, such as cold sores, canker sores, sore throats, sunburn, insect bites, poison ivy, and minor cuts and scratches.
Types of surgery or medical procedures that regularly make use of local or regional anesthesia include the following:
  • biopsies in which skin or tissue samples are taken for diagnostic procedures
  • childbirth
  • surgeries on the arms, hands, legs, or feet
  • eye surgery
  • surgeries involving the urinary tract or sexual organs
Surgeries involving the chest and abdomen are usually performed under general anesthesia.
Local and regional anesthesia have advantages over general anesthesia in that patients can avoid some unpleasant side effects, can receive longer lasting pain relief, have reduced blood loss, and maintain a sense of psychological comfort by not losing consciousness.

Description

Regional anesthesia typically affects a larger area than local anesthesia, for example, everything below the waist. As a result, regional anesthesia may be used for more involved or complicated surgical or medical procedures. Regional anesthetics are injected. Local anesthesia involves the injection into the skin or muscle or application to the skin of an anesthetic directly where pain will occur. Local anesthesia can be divided into four groups: injectable, topical, dental (noninjectable), and ophthalmic.
Local and regional anesthesia work by altering the flow of sodium molecules into nerve cells or neurons through the cell membrane. Exactly how the anesthetic does this is not understood, since the drug apparently does not bind to any receptor on the cell surface and does not seem to affect the release of chemicals that transmit nerve impulses (neurotransmitters) from the nerve cells. It is known, however, that when the sodium molecules do not get into the neurons, nerve impulses are not generated and pain impulses are not transmitted to the brain. The duration of action of an anesthetic depends on the type and amount of anesthetic administered.

Regional anesthesia

Types of regional anesthesia include:
  • Spinal anesthesia. Spinal anesthesia involves the injection of a small amount of local anesthetic directly into the cerebrospinal fluid surrounding the spinal cord (the subarachnoid space). Blood pressure drops are common but are easily treated.
  • Epidural anesthesia. Epidural anesthesia involves the injection of a large volume of local anesthetic directly into the space surrounding the spinal fluid sac (the epidural space), not into the spinal fluid. Pain relief occurs more slowly but is less likely to produce blood pressure drops. Also, the block can be maintained for long periods, even days.
  • Nerve blocks. Nerve blocks involve the injection of an anesthetic into the area around a nerve that supplies a particular region of the body, preventing the nerve from carrying nerve impulses to the brain.
Anesthetics may be administered with another drug, such as epinephrine (adrenaline), which decreases bleeding, and sodium bicarbonate to decrease the acidity of a drug so that it will work faster. In addition, drugs may be administered to help a patient remain calm and more comfortable or to make them sleepy.

Key terms

Canker sore — A painful sore inside the mouth.
Cold sore — A small blister on the lips or face, caused by a virus. Also called a fever blister.
Epidural space — The space surrounding the spinal fluid sac.
Malignant hyperthermia — A type of reaction (probably with a genetic basis) that can occur during general anesthesia in which the patient experiences a high fever, the muscles become rigid, and the heart rate and blood pressure fluctuate.
Subarachnoid space — The space surrounding the spinal cord that is filled with cerebrospinal fluid.
Topical — Not ingested; applied to the outside of the body, for example to the skin, eye, or mouth.

Local anesthesia

INJECTABLE LOCAL ANESTHETICS. These medicines are given by injection to numb and provide pain relief to some part of the body during surgery, dental procedures, or other medical procedures. They are given only by a trained health care professional and only in a doctor's office or a hospital. Some commonly used injectable local anesthetics are procaine (Novocain), lidocaine (Dalcaine, Dilocaine, L-Caine, Nervocaine, Xylocaine, and other brands), and tetracaine (Pontocaine).
TOPICAL ANESTHETICS. Topical anesthetics, such as benzocaine, lidocaine, dibucaine, pramoxine, butamben, and tetracaine, relieve pain and itching by deadening the nerve endings in the skin. They are ingredients in a variety of nonprescription products that are applied to the skin to relieve the discomfort of sunburn, insect bites or stings, poison ivy, and minor cuts, scratches, and burns. These products are sold as creams, ointments, sprays, lotions, and gels.
DENTAL ANESTHETICS (NON-INJECTABLE). Some local anesthetics are intended for pain relief in the mouth or throat. They may be used to relieve throat pain, teething pain, painful canker sores, toothaches, or discomfort from dentures, braces, or bridgework. Some dental anesthetics are available only with a doctor's prescription. Others may be purchased without a prescription, including products such as Num-Zit, Orajel, Chloraseptic lozenges, and Xylocaine.
OPHTHALMIC ANESTHETICS. Other local anesthetics are designed for use in the eye. The ophthalmic anesthetics proparacaine and tetracaine are used to numb the eye before certain eye examinations. Eye doctors may also use these medicines before measuring eye pressure or removing stitches or foreign objects from the eye. These drugs are to be given only by a trained health care professional.

Recommended dosage

The recommended dosage depends on the type of local anesthetic and the purpose for which it is being used. When using a nonprescription local anesthetic, follow the directions on the package. Questions concerning how to use a product should be referred to a medical doctor, dentist, or pharmacist.

Precautions

People who strongly feel that they cannot psychologically cope with being awake and alert during certain procedures may not be good candidates for local or regional anesthesia. Other medications may be given in conjunction with the anesthetic, however, to relieve anxiety and help the patient relax.
Local anesthetics should be used only for the conditions for which they are intended. For example, a topical anesthetic meant to relieve sunburn pain should not be used on cold sores. Anyone who has had an unusual reaction to any local anesthetic in the past should check with a doctor before using any type of local anesthetic again. The doctor should also be told about any allergies to foods, dyes, preservatives, or other substances.
Older people may be more sensitive to the effects of local anesthetics, especially lidocaine. This increased sensitivity may increase the risk of side effects. Older people who use nonprescription local anesthetics should be especially careful not to use more than the recommended amount. Children also may be especially sensitive to the effects of some local anesthetics, which may increase the chance of side effects. Anyone using these medicines on a child should be careful not to use more than the amount that is recommended for children. Certain types of local anesthetics should not be used at all young children. Follow package directions carefully and check with a doctor of pharmacist if there are any questions.

Regional anesthetics

Serious, possibly life-threatening, side effects may occur when anesthetics are given to people who use street drugs. Anyone who uses cocaine, marijuana, amphetamines, barbiturates, phencyclidine (PCP, or angel dust), heroin, or other street drugs should make sure their doctor or dentist knows what they have used.
Patients who have had a particular kind of reaction called malignant hyperthermia (or who have one or more family members who have had this problem) during or just after receiving a general anesthetic should inform their doctors before receiving any kind of anesthetic. Signs of malignant hyperthermia include fast and irregular heartbeat, very high fever, breathing problems, and muscle spasms or tightness.
Although problems are rare, some unwanted side effects may occur when regional anesthetics are used during labor and delivery. These anesthetics can prolong labor and increase the risk of Cesarean section. Pregnant women should discuss with their doctors the risks and benefits of being given these drugs.
Patients should not drive or operate other machinery immediately following a procedure involving regional anesthesia, due to numbness and weakness, or if local anesthesia also included drugs to make the patient sleep or strong pain medications. Injection sites should be kept clean, dry, and uncovered to prevent infection.

Injectable local anesthetics

Until the anesthetic wears off, patients should be careful not to injure the numbed area. If the anesthetic was used in the mouth, do not eat or chew gum until feeling returns.

Topical anesthetics

Unless advised by a doctor, topical anesthetics should not be used on or near any part of the body with large sores, broken or scraped skin, severe injury, or infection. They should also not be used on large areas of skin. Some topical anesthetics contain alcohol and should not be used near an open flame, or while smoking.
Anyone using a topical anesthetic should be careful not to get this medication in the eyes, nose, or mouth. When using a spray form of this medication, do not spray it directly on the face, but apply it to the face with a cotton swab or sterile gauze pad. After using a topical anesthetic on a child, make sure the child does not get the medicine in his or her mouth.
Topical anesthetics are intended for the temporary relief of pain and itching. They should not be used for more than a few days at a time. Check with a doctor if:
  • the discomfort continues for more than seven days
  • the problem gets worse
  • the treated area becomes infected
  • new signs of irritation, such as skin rash, burning, stinging, or swelling appear

Dental anesthetics (non-injectable)

Dental anesthetics should not be used if certain kinds of infections are present. Check package directions or check with a dentist or medical doctor if uncertain. Dental anesthetics should be used only for temporary pain relief. If problems such as toothache, mouth sores, or pain from dentures or braces continue, check with a dentist. Check with a doctor if sore throat pain is severe, lasts more than two days, or is accompanied by other symptoms such as fever, headache, skin rash, swelling, nausea, or vomiting.
Patients should not eat or chew gum while the mouth is numb from a dental anesthetic. There is a risk of accidently biting the tongue or the inside of the mouth. Also nothing should be eaten or drunk for one hour after applying a dental anesthetic to the back of the mouth or throat, since the medicine may interfere with swallowing and may cause choking. If normal feeling does not return to the mouth within a few hours after receiving a dental anesthetic or if it is difficult to open the mouth, check with a dentist.

Ophthalmic anesthetics

When anesthetics are used in the eye, it is important not to rub or wipe the eye until the effect of the anesthetic has worn off and feeling has returned. Rubbing the eye while it is numb could cause injury.

Side effects

Side effects of regional or local anesthetics vary depending on the type of anesthetic used and the way it is administered. Anyone who has unusual symptoms following the use of an anesthetic should get in touch with his or her doctor immediately.
There is a small risk of developing a severe headache called a spinal headache following a spinal or epidural block. This headache is severe when the patient is upright and hardly felt when the patient lies down. Though rare, it can occur and can be treated by performing a blood patch, in which a small amount of the patient's own blood is injected into the area in the back where the anesthetic was injected. The blood clots and closes up any area that may have been leaking spinal fluid. Relief is almost immediate. Finally, blood clots or abscess can form in the back, but these are also readily treatable and so pose little risk.
A physician should be notified immediately if any of these symptoms occur:
  • large swellings that look like hives on the skin, in the mouth, or in the throat
  • severe headache
  • blurred or double vision
  • dizziness or lightheadedness
  • drowsiness
  • confusion
  • anxiety, excitement, nervousness, or restlessness
  • convulsions (seizures)
  • feeling hot, cold, or numb
  • ringing or buzzing in the ears
  • shivering or trembling
  • sweating
  • pale skin
  • slow or irregular heartbeat
  • breathing problems
  • nusual weakness or tiredness

Interactions

Some anesthetic drugs may interact with other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who receives a regional or local anesthetic should let the doctor know all other drugs he or she is taking including prescription drugs, nonprescription drugs, and street drugs (such as cocaine, marijuana, and heroin).

Resources

Books

Harvey, Richard A., et al., editors. "Anesthetics." In Lippincott's Illustrated Reviews: Pharmacology. Philadelphia: J.B. Lippincott & Co., 1992.

anesthesia

 [an″es-the´ze-ah]
1. lack of feeling or sensation.
2. artificially induced loss of ability to feel pain, done to permit the performance of surgery or other painful procedures. It may be produced by a number of agents (anesthetics) capable of bringing about partial or complete loss of sensation.(See accompanying table.)
Patient Care. Interventions of the health care team will be individualized based on the type of procedure the patient has undergone and the type of anesthesia administered. Patients recovering from general anesthesia must be assessed constantly until they have reacted. The vital signs and blood pressure are checked regularly; any sudden change is reported immediately. They must be observed to see that the airway is clear at all times. The observation is in specialized recovery rooms called postanesthesia care units that are equipped with a variety of monitors to measure such variables as blood pressure, respiratory and pulse rates, cardiac output, body temperature, fluid balance, and oxygenation. When necessary, patients are initially managed with ventilators that inflate the lungs mechanically through endotracheal tubes. Changes in breathing pattern, eye movements, lacrimation, and muscle tone are indicators for the depth of anesthesia. Breathing patterns are the most sensitive of these.

When patients are awakening from general anesthesia they may be restless, attempting to get out of bed or even striking out at those around them because they are afraid and disoriented. This state is called emergence delirium and should be assessed, as it can indicate hypoxia. Retrograde amnesia may be associated with the administration of anesthesia and adjuncts, causing the patient to forget events occurring in the immediate postoperative period.
ambulatory anesthesia anesthesia performed on an outpatient basis for ambulatory surgery.
balanced anesthesia anesthesia that uses a combination of drugs, each in an amount sufficient to produce its major or desired effect to the optimum degree and to keep undesirable effects to a minimum.
basal anesthesia a reversible state of central nervous system depression produced by preliminary medication so that the inhalation of anesthetic necessary to produce surgical anesthesia is greatly reduced.
block anesthesia regional anesthesia.
caudal anesthesia a type of regional anesthesia that was used in childbirth between the 1940s and the 1960s. The anesthetizing solution, usually procaine, was injected into the caudal area of the spinal canal through the lower end of the sacrum and affected the caudal nerve roots, rendering the cervix, vagina, and perineum insensitive to pain. Called also caudal block.
central anesthesia lack of sensation caused by disease of the nerve centers.
closed circuit anesthesia that produced by continuous rebreathing of a small amount of anesthetic gas in a closed system with an apparatus for removing carbon dioxide.
compression anesthesia loss of sensation resulting from pressure on a nerve.
crossed anesthesia loss of sensation on one side of the face and loss of pain and temperature sense on the opposite side of the body.
dissociated anesthesia (dissociation anesthesia) loss of perception of certain stimuli while that of others remains intact.
electric anesthesia anesthesia induced by passage of an electric current.
endotracheal anesthesia anesthesia produced by introduction of a gaseous mixture through a tube inserted into the trachea.
epidural anesthesia regional anesthesia produced by injection of the anesthetic agent into the epidural space. It may be performed by injection of the agent between the vertebral spines in the cervical, thoracic, or lumbar regions. An old method was caudal anesthesia, which involved injecting the agent into the sacral hiatus. Called also epidural block.
general anesthesia a state of unconsciousness produced by anesthestic agents, with absence of pain sensation over the entire body and a greater or lesser degree of muscular relaxation; the drugs producing this state can be administered by inhalation, intravenously, intramuscularly, or rectally, or via the gastrointestinal tract.
gustatory anesthesia loss of the sense of taste.
hysterical anesthesia loss of tactile sensation occurring as a symptom of conversion disorder, often recognizable by its lack of correspondence with nerve distributions.
infiltration anesthesia local anesthesia produced by injection of the anesthetic solution directly into the area of terminal nerve endings. Called also infiltration analgesia.
inhalation anesthesia anesthesia produced by the respiration of a volatile liquid or gaseous anesthetic agent.
insufflation anesthesia anesthesia produced by introduction of a gaseous mixture into the trachea through a tube.
local anesthesia that produced in a limited area, as by injection of a local anesthetic or by freezing with ethyl chloride.
open anesthesia general inhalation anesthesia in which there is no rebreathing of the exhaled gases.
paraneural anesthesia perineural block.
paravertebral anesthesia regional anesthesia produced by the injection of a local anesthetic around the spinal nerves at their exit from the spinal column, and outside the spinal dura. Called also paravertebral block.
perineural anesthesia perineural block.
peripheral anesthesia lack of sensation due to changes in the peripheral nerves.
rectal anesthesia anesthesia produced by introduction of the anesthetic agent into the rectum.
refrigeration anesthesia cryoanesthesia.
regional anesthesia insensibility caused by interrupting the sensory nerve conductivity of any region of the body; the two primary types are field block, the encircling of an operative field by means of injections of a local anesthetic and nerve block, the making of injections in close proximity to the nerves supplying the area. Called also block.
saddle block anesthesia saddle block.
segmental anesthesia loss of sensation in a segment of the body due to a lesion of a nerve root.
spinal anesthesia
anesthesia due to a spinal lesion.
regional anesthesia produced by injection of the agent beneath the membrane of the spinal cord. Called also spinal block.
surgical anesthesia that degree of anesthesia at which operation may safely be performed.
tactile anesthesia loss of the sense of touch.
topical anesthesia that produced by application of a local anesthetic directly to the area involved.

lo·cal an·es·the·si·a

a general term referring to topical, infiltration, field block, or nerve block anesthesia but usually not to spinal or epidural anesthesia; may also refer to pharmacologic agents used to achieve local anesthesia.
See also: local anesthetics.

local anesthesia

n.
Anesthesia characterized by the loss of sensation only in the area of the body where an anesthetic drug is applied or injected.

lo·cal an·es·the·si·a

(lō'kăl an'es-thē'zē-ă)
A general term referring to topical, infiltration, field block, or nerve block anesthesia but not usually to spinal or epidural anesthesia.

lo·cal an·es·the·si·a

(lō'kăl an'es-thē'zē-ă)
General term referring to topical, infiltration, field block, or nerve block anesthesia but usually not to spinal or epidural anesthesia; may mean pharmacologic agents used to achieve local anesthesia.
See also: local anesthetics
References in periodicals archive ?
I went home and did a literature review and was disheartened to find absolutely nothing in the literature on the safety record of dermatologists in the office setting or on the safety of office surgery in general under local anesthesia. We had nothing to back us up.
In the present study, an effort was made to assess the blood glucose concentration in diabetic patients undergoing tooth extractions under local anesthesia among 60 patients.
(11,12) Administration of local anesthesia for pain control in patient care is a critical component of both dental and dental hygiene curricula.
This survey study demonstrated that there is some general knowledge about local anesthesia and LATS among ophthalmologists.
Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children.
Local anesthesia is an essential component of the dental hygiene profession.
Patients had to close their eyes during the procedure and the audible sound on the Wand was deactivated; therefore, they did not know which type of local anesthesia was used.
Sanjay et al15 had shown that the commonly perceived problem with local anesthesia in hernia repair is the pain of infiltration which can be extreme enough for the patient to decline further surgery in local anesthesia forcing conversion to general anaesthesia.
Two minutes after local anesthesia, 18-gauge Tuohy needle (Espocan; B.Braun, Melsungen, Germany) was introduced using loss of resistance to air, and the duramater was punctured with a 27-gauge Quincke needle using the "needle-through-needle" technique.
Key words: Pain, local anesthesia analgesia complications, cost, hospital stay, and hemorrhoidectomy.
A special use of local anesthesia is one of the advanced techniques in anesthesiology offered at the Cornell University Hospital for Animals.
In addition as reported in our results above there are less hemodynamic fluctuations during local anesthesia as compared to GA21.

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