Local anesthesia Flashcards
what are the disadvantages of spinal block?
time limited, no titration, not reversible
where is a spinal block administered?
into CSF in lumbar subarachnoid space to reach spinal roots
what are the advantages of an epidural block?
not time limited, can be used 4-7 days post-op, titratable
what is the disadvantage of an epidural block?
less reliable block compared to spinal
what is the primary mechanism of action of local anesthetics?
blockage of voltage gated sodium channels - inhibits depolarization and repolarization
biotoxins act at what site?
external sodium channel
lidocaine acts at what site?
internal sodium channel
benzocaine acts at what site?
embed in lipid bilayer in vicinity of receptor and disrupt geometry of lipid bilayer - causes receptor to lose conformation and function
local anesthetics exist in what two forms?
protonated and non-protonated form
which form of local anesthetics get through the membrane?
non-protonated
which form of local anesthetics bind to the internal portion of the sodium receptor?
protonated
how are local anesthetics characterized chemically?
weak bases
what are the amide local anesthetics?
- lidocaine
- articaine
- bupivacaine
- ropivacaine
have two “i”s
what are the ester local anesthetics?
- cocaine
- procaine
- benzocaine
- tetracaine
- chloroprocaine
have one “i”
what is the most active form of local anesthetic at the sodium receptor?
cationic (protonated)
which has a longer half life - amide or ester local anesthetics? why?
amides - metabolized in liver
what are the factors that influence LA onset and recovery?
- fiber size
- site of deposition
- pH
- nerve stimulation rate
- calcium concentration