Drugs

, Volume 65, Issue 6, pp 745–759 | Cite as

Anaesthetic Agents for Advanced Regional Anaesthesia

A North American Perspective
Therapy in Practice

Abstract

Interest in the use of regional anaesthesia, particularly peripheral nerve blocks (PNBs) and continuous PNBs, has increased in recent years. Accompanying this resurgence in interest has been the development of new local anaesthetics and additives designed to enhance block duration and quality. This manuscript provides a literature-based review on accepted uses of local anaesthetics and adjuncts for a variety of regional anaesthesia techniques. A brief review of local anaesthetic pharmacodynamics describes the action of these drugs in preventing nerve depolarisation, thus blocking nerve impulses. Toxic adverse effects of local anaesthetics, specifically CNS and cardiac manifestations of excessive local anaesthetic blood concentrations and the direct neurotoxic properties of local anaesthetics, are discussed generally and specifically for many commonly used local anaesthetics. Clinically useful ester and amide local anaesthetics are evaluated individually in terms of their physical properties and toxic potential. How these properties impact on the clinical uses of each local anaesthetic is explored. Particular emphasis is placed on the long-acting local anaesthetic toxic potential of racemic bupivacaine compared with levobupivacaine and ropivacaine, which are both levorotatory stereoisomers. Guidelines for using ropivacaine and mepivacaine, based on the authors’ experience using advanced regional anaesthesia in a busy practice, is provided. Finally, epinephrine (adrenaline), clonidine and other local anaesthetic additives and their rationale for use is covered along with other future possibilities.

Keywords

Lidocaine Bupivacaine Local Anaesthetic Spinal Anaesthesia Ropivacaine 

Notes

Acknowledgements

This manuscript was supported by the Army Regional Anesthesia & Pain Management Initiative, Walter Reed Army Medical Center, Washington, DC, USA. The authors have no conflicts of interest directly relevant to the content of this review.

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Copyright information

© Adis data information BV 2005

Authors and Affiliations

  • Chester C. BuckenmaierIII
    • 1
    • 2
  • Lisa L. Bleckner
    • 1
    • 2
  1. 1.Walter Reed Army Medical CenterWashington, DCUSA
  2. 2.Uniformed Services University of the Health SciencesBethesdaUSA

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