Local anesthesia

Short description: Technique to induce the absence of sensation in a specific part of the body

Local anesthesia

MeSH| D000772

[edit on Wikidata]

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, i.e. 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.[2]

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 encompasses a great variety of local and regional anesthetic techniques.

## Contents

* 1 Medical
* 2 History and development
* 3 Non-medical local anesthetic techniques
* 4 See also
* 5 References
* 6 External links

## Medical

Main article: Medicine:Local anesthetic

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. Unlike other forms of anesthesia, a local can be used for a minor procedure in a surgeon's office as it does not put one into a state of unconsciousness. However, the physician should have a sterile environment available before doing a procedure in their office. Local anesthetics work primarily by reversibly blocking voltage-gated sodium channels in neuronal membranes, which prevents the initiation and propagation of action potentials along sensory nerves. This blocks nociceptive signals from reaching the brain.

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

* Topical anesthesia (surface) - Surface application on mucous membranes or skin.
* Infiltration anesthesia: Direct injection into tissue near the site of the procedure.
* Peripheral nerve blocks: Injection near specific nerves or plexuses (e.g., brachial, femoral).
* Neuraxial anesthesia: Includes spinal and epidural techniques, which anesthetize broader regions through nerve root blockade.

Adverse effects depend on the local anesthetic method and site of administration 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.[3]
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.

## History and development

Regional anesthesia has a rich history dating back to the late 19th century, with key pioneers advancing its development. Karl Koller introduced cocaine as the first local anesthetic in 1884, revolutionizing pain management.[4]

August Bier performed the first spinal anesthesia in 1898, while James Leonard Corning explored epidural techniques.[5]

Gaston Labat, often called the "father of regional anesthesia in America," founded the American Society of Regional Anesthesia in 1923 and authored the influential textbook Regional Anesthesia: Its Technic and Clinical Application. His work standardized techniques and promoted the field's growth.[6]

Later, Manuel Martínez Curbelo pioneered continuous spinal anesthesia in the 1940s.[7]

These innovations laid the foundation for modern regional anesthesia, enabling safer, targeted pain relief.

## 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.[8]
* 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.[9][10][11][12][13]

## See also

* Continuous wound infiltration

## References

1. ↑ thefreedictionary.com > local anesthesia In turn citing: Mosby's Medical Dictionary, 8th edition. Copyright 2009
2. ↑ Sukhminder Jit Singh Bajwa; Ashish Kulshrestha (2016). "Anaesthesia for laparoscopic surgery: General vs regional anaesthesia". J Minim Access Surg 12 (1): 4–9. doi:10.4103/0972-9941.169952. PMID 26917912.
3. ↑ "Nerve damage associated with peripheral nerve block". Risks Associated with Your Anaesthetic (The Royal College of Anaesthetists) Section 12. January 2006. http://www.rcoa.ac.uk/docs/nerve-peripheral.pdf. Retrieved 2007-10-10.
4. ↑ Goerig, Michael; Bacon, Douglas; van Zundert, André (2012). "Carl Koller, cocaine, and local anesthesia: some less known and forgotten facts". Regional Anesthesia and Pain Medicine 37 (3): 318–324. doi:10.1097/AAP.0b013e31825051f3. ISSN 1532-8651. PMID 22531385.
5. ↑ "Corning and cocaine: the advent of spinal anaesthesia". 2009-09-15. http://www.grandroundsjournal.com/articles/gr09l001.
6. ↑ "Labat Spinal Outfit" (in en-US). https://www.woodlibrarymuseum.org/museum/labat-spinal-outfit/.
7. ↑ Curbelo, Manual Martinez (January–February 1949). "Continuous Peridural Segmental Anesthesia by Means of a Ureteral Catheter." (in en-US). Anesthesia & Analgesia 28 (1): 13. doi:10.1213/00000539-194901000-00002. ISSN 0003-2999. https://journals.lww.com/anesthesia-analgesia/citation/1949/01000/continuous_peridural_segmental_anesthesia_by_means.2.aspx.
8. ↑ "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. January 2010. doi:10.1212/WNL.0b013e3181c918fc. PMID 20042705. http://www.neurology.org/content/74/2/173.full.pdf.
9. ↑ "Neural modulation by blocks and infusions". Pain Practice 6 (1): 34–8. 2006. doi:10.1111/j.1533-2500.2006.00056.x. PMID 17309707.
10. ↑ 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.
11. ↑ "Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience". Pain 121 (1–2): 43–52. 2006. doi:10.1016/j.pain.2005.12.006. PMID 16480828.
12. ↑ "Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain" (PDF). Pain Physician 10 (1): 7–111. 2007. PMID 17256025. http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf?PHPSESSID=ea188711febadee5420f1c9061ebd249.
13. ↑ "Ablative procedures for chronic pain". Neurosurg. Clin. N. Am. 15 (3): 335–42. 2004. doi:10.1016/j.nec.2004.02.009. PMID 15246341.

## External links

* New York School of Regional Anesthesia
* Anesthesia Books[Usurped!]
* General information and tutorials in peripheral regional anesthesia
* worldanaesthesia.org 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

* v
* t
* e

Anesthesia and anesthesiology

Types|

* General
* Sedation
* Twilight anesthesia
* Local
* Topical
* Intercostal nerve block
* Neuraxial blockade
* Spinal
* Epidural
* Dental
* Inferior alveolar nerve

Techniques|

* Airway management
* Anesthesia provision in the US
* Arterial catheter
* Bronchoscopy
* Capnography
* Dogliotti's principle
* Drug-induced amnesia
* Intraoperative neurophysiological monitoring
* Nerve block
* Penthrox inhaler
* Tracheal intubation

Scientific principles|

* Blood–gas partition coefficient
* Concentration effect
* Fink effect
* Minimum alveolar concentration
* Second gas effect

Measurements|

* ASA physical status classification system
* Baricity
* Bispectral index
* Entropy monitoring
* Fick principle
* Goldman index
* Guedel's classification
* Mallampati score
* Neuromuscular monitoring
* Thyromental distance

Instruments|

* Anaesthetic machine
* Anesthesia cart
* Boyle's machine
* Gas cylinder
* Laryngeal mask airway
* Laryngeal tube
* Medical monitor
* Odom's indicator
* Relative analgesia machine
* Vaporiser
* Double-lumen endotracheal tube
* Endobronchial blocker

Complications|

* Emergence delirium
* Allergic reactions
* Anesthesia awareness
* Local anesthetic toxicity
* Malignant hyperthermia
* Perioperative mortality
* Postanesthetic shivering
* Postoperative nausea and vomiting
* Postoperative residual curarization

Subspecialties|

* Cardiothoracic
* Critical emergency medicine
* Geriatric
* Intensive care medicine
* Obstetric
* Oral sedation dentistry
* Pain medicine

Professions|

* Anesthesiologist
* Anesthesiologist assistant
* Nurse anesthetist
* Operating department practitioners
* Certified Anesthesia Technician
* Certified Anesthesia Technologist
* Anaesthetic technician
* Physicians' assistant (anaesthesia)

History|

* ACE mixture
* Helsinki Declaration for Patient Safety in Anaesthesiology
* History of general anesthesia
* History of neuraxial anesthesia
* History of tracheal intubation

Organizations|

* American Association of Nurse Anesthetists
* American Society of Anesthesia Technologists & Technicians
* American Society of Anesthesiologists
* Anaesthesia Trauma and Critical Care
* Association of Anaesthetists of Great Britain and Ireland
* Royal College of Anaesthetists
* Association of Veterinary Anaesthetists
* Australian and New Zealand College of Anaesthetists
* Australian Society of Anaesthetists
* International Anesthesia Research Society

* Category
* Outline

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