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Pharmacology of Local and Neuraxial Anesthetics

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Basic Sciences in Anesthesia

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Abstract

Local anesthetics are the pharmacologic cornerstone of regional anesthesia producing reversible and complete blockade of neuronal transmission when applied near the axons. Development of local anesthetics, since the 1950s, has focused on amide local anesthetics. Ester local anesthetics exhibit a number of limitations including instability when in solution, short shelf life, degradation when exposed to high temperatures, and an increased propensity to cause allergic reactions. Local anesthetics are widely used to prevent or treat acute pain; to treat inflammatory, cancer, and chronic pain; and for diagnostic and prognostic purposes. Nociceptive pain, as well as neuropathic pain, is targeted with this group of drugs. Any part of the nervous system, from the periphery to the brain, may be where local anesthetics act to produce a desired anesthetic or analgesic effect.

This chapter describes the basic chemical structure of local anesthetics, and gives an overview of pharmacologic properties of the different drugs. Clinical use, advantages, and side effects are compared, and local anesthetic toxicity is described.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Anesthesiology Institute and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA

    Hesham Elsharkawy

  2. Anesthesia Institute, Cleveland Clinic, Cleveland, OH, USA

    Sree Kolli

Authors
  1. Hesham Elsharkawy
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  2. Sree Kolli
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Corresponding author

Correspondence to Hesham Elsharkawy .

Editor information

Editors and Affiliations

  1. Departments of General Anesthesia and Outcomes Research, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine, Case Western University, Cleveland, OH, USA

    Ehab Farag

  2. Center for Anesthesiology Education, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Maged Argalious

  3. Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    John E. Tetzlaff

  4. Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA

    Deepak Sharma

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Elsharkawy, H., Kolli, S. (2018). Pharmacology of Local and Neuraxial Anesthetics. In: Farag, E., Argalious, M., Tetzlaff, J.E., Sharma, D. (eds) Basic Sciences in Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-62067-1_9

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  • DOI: https://doi.org/10.1007/978-3-319-62067-1_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62065-7

  • Online ISBN: 978-3-319-62067-1

  • eBook Packages: MedicineMedicine (R0)

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