Pain pp 1013-1017 | Cite as

Local Anesthetics

  • Carrie Schroeder
  • Kristopher SchroederEmail author


Local anesthetics block nerve conduction via blockade of voltage-gated sodium channels. The physiochemical properties of the individual drugs lead to variability in individual drug potency, onset, and duration. Systemic toxicity can occur via drug overdose, intravenous dosing, or impaired drug elimination. Clinical signs of toxicity can be manifested via the central nervous system and may progress to the cardiovascular system. Treatment of local anesthetic systemic toxicity (LAST) is directed at supportive treatment and administration of lipid emulsion.


Pharmacology Local anesthetics Regional anesthesia 


  1. 1.
    Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90–102.CrossRefGoogle Scholar
  2. 2.
    Berde CB, Strichartz GR. Local anesthetics. In: Miller RD, Cohen NH, Eriksson LI, et al., editors. Miller’s anesthesia. 8th ed. Philadelphia: Elsevier Saunders; 2015. p. 1028–55.Google Scholar
  3. 3.
    French J, Sharp LM. Peri-operative care series: local anaesthetics. Ann R Coll Surg Engl. 2012;94:76–80.CrossRefGoogle Scholar
  4. 4.
    Lirk P, Picardi S, Hollna MW. Local anaesthetics: 10 essentials. Eur J Anaesthesiol. 2014;31:575–85.CrossRefGoogle Scholar
  5. 5.
    Neal JM, Woodward CM, Harrison TK. American society of regional anesthesia and pain management checklist for managing local anesthetic systemic toxicity: 2017 version. Reg Anesth Pain Med. 2018;43:150–53. Also available at
  6. 6.
    Dr Gregorio G, Schwartz D, Ripper R, et al. Lipid emulsion is superior to vasopressin in a rodent model of resuscitation from toxin-induced cardiac arrest. Crit Care Med. 2009;37(3):993–9.CrossRefGoogle Scholar
  7. 7.
    Neguib M, Magboul MM, Samarkandi AH, Attia M. Adverse effects and drug interactions associated with local and regional anaesthesia. Drug Saf. 1998;18(4):221–50.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Surgical SciencesUniversity of Wisconsin School of Veterinary MedicineMadisonUSA
  2. 2.Department of Anesthesiology, University of Wisconsin School of Medicine and Public HealthMadisonUSA

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