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pore
Ion selective
Gating
+++
Voltage sensor
Intracellular Solution
Local Anesthetic Binding Site
LA LA
H+
Extracellular solution
H+
Intracellular Solution
Hyd
ro
Path phobic
way
LA+
LA
LA
+
LA+
+++
Voltage sensor
Hydrophilic
Pathway
-70 mV
-15 mV
MODE OF ACTION
INJECTION LAH+ LA
SEQUENCE OF EVENTS WHICH RESULT
IN CONDUCTION BLOCKADE
Aromatic Amine
Group Intermediate
Chain
STRUCTURE OF LOCAL
ANESTHETIC
LIPO- HYDR
PHILIC O-
GROUP PHILIC
GROUP
AMIDE OR
ESTER
LINK
PHARMACOLOGY
ESTERS AMIDES
• Procaine • Lignocaine
• Chlorprocaine • Bupivacaine
• Cocaine • Levo-Bupivacaine
• Tetracaine • Ropivacaine
• Benzocaine
• Etidocaine
• Prilocaine
• Mepivacaine
Pharmacology - Continued
• Esters
– Short, moderate or long duration of effect
– Metabolized by cholinesterases in blood and
skin
– Chlorprocaine, cocaine and procaine (short
acting)
– Tetracaine - long duration of effect
Pharmacology - Continued
• Amides
– Long duration of effect
– Metabolized by liver
– Lidocaine, mepivacaine and prilocaine
(moderate duration of effect )
PROPERTIES OF LOCAL
ANESTHETICS
PROPERTIES ESTERS AMIDES
METABOLISM Rapid by plasma Slow, hepatic
cholinesterase
SYSTEMIC TOXICITY Less likely More likely
ONSET = pKa
Speed of Onset
• low pKa = fast onset
• Bupivacaine 8.1
Lidocaine 7.7
• ? LA action in septic tissue
– acid tissue -> ionized % of LA
-> slow entry into membrane
-> low concentration of LA for block
Effects of pH
on Local Anesthesia
Weak Bases ( pka of 8-9)
pH Ionized form
pH Ionized form
Important Clinical Properties of Local
Anesthetics
INCREASED DOASGE
DURATION OF ACTION
Anesthetic Potency
Concentration 5microgram/ml
Identifying intravascular injection
Duration of action
Peak plasma concentration of by 20% -
50%.
Quality of motor block.
ADDITION of
Sodium Bicarbonate
NaHCO3 - increase pH & nonionized base
Speeds onset of block
1 mEq NaHCO3 per 10 ml Lido/Mepivacaine
0.1 mEq NaHCO3 per 10 ml Bupivacaine
Important Clinical Properties of
Local Anesthetics
Metabolism
• ESTERS
Metabolism via pseudocholinesterase
So pt with abnormal pseudocholinesterase
at high risk for toxic side effects
• AMIDES
Metabolism via hepatic enzymes (hepatic, CHF)
Common
Routes of Administration
• Topical
– Usually ester
– Usually ointments or drops
• Injection
– Intradermal
– Spinal
– Epidural
– Caudal
Clinical use of LA
• Regional anesthesia and analgesia
• Intravenous regional anesthesia
• Blunt tracheal intubation stress response
• Antiarrhythmic e.g. Lidocaine
• Topical
COMMONLY USED LOCAL
ANESTHETICS
• Lignocaine
• Bupivacaine
• Prilocaine
• Mepivacaine
NEW LOCAL ANESTHETICS
• Levo-Bupivacaine
• Ropivacaine
Adverse Effects and toxicity
• Cardiac Effects
– Depress cardiac conduction system
– Negative chronotropic effect
– Negative ionotropic effect