Local Anesthesia and Regional Anesthesia

  • George B. Winton

Abstract

The use of local and regional anesthesia in surgical practice is considered to be safe, certainly much safer than the use of general anesthesia. For example, a 1955 survey of local anesthesia used for dental procedures found only two deaths in an estimated 90 million cases over a span of 10 years [1]. Such a statistic can lull one into an inappropriate sense of security. Significant complications other than death can and do occur with the use of local anesthetics which can cause considerable difficulty for patients [2]. The incidence of adverse reactions to regional blocks in a hospital setting is approximately 0.2% [3] while the incidence of adverse responses to dental local anesthesia may be as high as 2.5% [4]. The latter figure includes a substantial number of psychological reactions. It is imperative that any physician utilizing local and regional anesthesia understand the potential risks and be prepared to manage complications. This chapter covers local and systemic adverse reactions including allergy, drug interactions, and reactions peculiar to certain drugs, and also reviews precautions that one should take to prevent difficulties.

Keywords

Respiration Oncol Catecholamine Diazepam Glaucoma 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Seldin HM, Recant BS (1955) The safety of anesthesia in the dental office. J Oral Surg 13: 199–208PubMedGoogle Scholar
  2. 2.
    Laskin DM (1984) Diagnosis and treatment of complications associated with local anesthesia. Int Dent J 34: 232–237PubMedGoogle Scholar
  3. 3.
    Dhuner KG (1972) Frequency of general side reactions after regular anesthesia with me- pivacaine with and without vasoconstrictor. Acta Anesthesiol Scand Suppl 48: 23–52CrossRefGoogle Scholar
  4. 4.
    Persson G (1969) General side effects of local dental anesthesia with special reference to catecholamines as vasoconstrictors and to the effect of some premedicaments. Acta Ondontol Scand Suppl 53: 1–141Google Scholar
  5. 5.
    Thomas RM (1982) Local anesthetic agents and regional anesthesia of the face. J Assoc Milit Dermatol 8: 28–33Google Scholar
  6. 6.
    Abadin A (1975) Capsule anesthesiology: use of local anesthetics in dermatology. J Der-matol Surg Oncol 1: 65–70Google Scholar
  7. 7.
    Farber GA (1982) Anesthesia for skin surgery. In: Epstein E, Epstein E Jr (eds) Skin surgery, 5th edn. Thomas, Springfield, pp 54–64Google Scholar
  8. 8.
    Robinson JK (1979) Reply to letter to the editor. J Dermatol Surg Oncol 5: 945Google Scholar
  9. 9.
    Moore DC (1981) Regional block, a handbook for use in the clinical practice of medicine and surgery. Thomas, Springfield, pp 19–43Google Scholar
  10. 10.
    Milgram P, Fiset L (1986) Local anaesthetic adverse effects and other emergency problems in general dental practice. Int Dent J 36: 71–76Google Scholar
  11. 11.
    Buckley JA, Ciancio SG, McMullen JA (1984) Efficacy of epinephrine concentration in local anesthesia during periodontal surgery. J Periodontol 5: 653–657Google Scholar
  12. 12.
    Henderson JJ, Nimmo WS (1983) Practical regional anesthesia. Blackwell, Oxford, pp 96–102Google Scholar
  13. 13.
    Baker JD, Blackman BB (1985) Local anesthesia. Clin Plast Surg 12: 25–31PubMedGoogle Scholar
  14. 14.
    Foster CA, Aston SI (1983) Propranolol-epinephrine interaction, a potential disaster. Plast Reconstr Surg 72: 74–78PubMedCrossRefGoogle Scholar
  15. 15.
    Dzubow LM (1986) The interaction between propranolol and epinephrine as observed in patients undergoing Mohs surgery. J Am Acad Dermatol 15: 71–75PubMedCrossRefGoogle Scholar
  16. 16.
    Winton GB (1988) Anesthesia for dermatologic surgery. J Dermatol Surg Oncol 14: 41–54PubMedGoogle Scholar
  17. 17.
    Ralston DH, Schnider SM (1968) The fetal and neonatal effects of regional anesthesia and obstetrics. Anesthesiology 48: 34–64CrossRefGoogle Scholar
  18. 18.
    Gormley DE (1990) Cutaneous surgery and the pregnant patient. J Am Acad Dermatol 23: 269–279PubMedCrossRefGoogle Scholar
  19. 19.
    Martin IC (1988) Medical problems with local analgesia. Dent Update Suppl 2: S15–S18Google Scholar
  20. 20.
    Ecker RI (1980) More on local anesthesia of the digits. J Dermatol Surg Oncol 6: 165PubMedGoogle Scholar
  21. 21.
    Grabb WC (1979) A concentration of 1:500 000 epinephrine in a local anesthetic solution is sufficient to provide excellent hemostasis. Plast Reconstr Surg 63: 834PubMedGoogle Scholar
  22. 22.
    Graham WP III (1983) Anesthesia in cosmetic surgery. Clin Plast Surg 10: 285–287PubMedGoogle Scholar
  23. 23.
    Siegel RJ, Vistnes LM, Iverson RE (1973) Effective hemostasis with less epinephrine. Plast Reconstr Surg 51: 129–133PubMedCrossRefGoogle Scholar
  24. 24.
    Robinson JK (1979) Advantages and technique of inducing local anesthesia with a small-bore, angled needle. J Dermatol Surg Oncol 5: 465–466PubMedGoogle Scholar
  25. 25.
    Stegman SJ, Tromovitch TA, Glogau RG (1982) Basics of dermatologic surgery. Year-book Medical Publishers, Chicago, pp 23–31Google Scholar
  26. 26.
    Grekin RC, Auletta MJ (1988) Local anesthesia in dermatologic surgery. J Am Acad Dermatol 19: 599–614PubMedCrossRefGoogle Scholar
  27. 27.
    Stewart JH, Cole GW, Klein JA (1989) Neutralized lidocaine with epinephrine for local anesthesia. J Dermatol Surg Oncol 15: 1081–1083PubMedGoogle Scholar
  28. 28.
    Stewart JH, Chinn SE, Cole GW, Klein JA (1990) Neutralized lidocaine with epinephrine for local anesthesia II. J Dermatol Surg Oncol 16: 842–845PubMedGoogle Scholar
  29. 29.
    Gordh T (1979) Complications and their treatment. In: Eriksson E (ed) Illustrated hand-book in local anesthesia. Lloyd-Luke, London, pp 16–19Google Scholar
  30. 30.
    Cousins MJ, Bridenbaugh PO (1988) Neural blockade in clinical anesthesia and manage-ment of pain. Lippincott, Philadelphia, pp 130–131Google Scholar
  31. 31.
    Chan Tyk, Davidson T (1990) Femoral nerve block after intra-operative subcutaneous bupivacaine injection. Anaesthesia 45: 163–164PubMedCrossRefGoogle Scholar
  32. 32.
    Stromberg BV (1985) Regional anesthesia in head and neck surgery. Clin Plast Surg 12: 123–126PubMedGoogle Scholar
  33. 33.
    Rettinger G, Christ P (1989) Visual loss following intranasal injection. Rhinology Suppl 9: 66–72Google Scholar
  34. 34.
    Bridenstein JA (1989) Lidocaine during liposuction. J Dermatol Surg Oncol 15: 775–776PubMedGoogle Scholar
  35. 35.
    Mulroy MF (1989) Regional anesthesia: an illustrated procedural guide. Little Brown, Boston, pp 31–41Google Scholar
  36. 36.
    De Fazio CA (1981) Local anesthetics: action, metabolism, and toxicity. Otolaryngal Clin North Am 14: 515–519Google Scholar
  37. 37.
    Maloney JM III, Lertora JJL, Yarborough J et al. (1982) Plasma concentrations of lidocaine during hair transplantation. J Dermatol Surg Oncol 8: 950–954PubMedGoogle Scholar
  38. 38.
    Wildsmith JAW, Armitage EN (1987) Principles and practice of regional anaesthesia. Churchill Livingstone, Edinburgh, pp 28–29Google Scholar
  39. 39.
    De Jong RH (1977) Local anesthesia, 2nd edn. Thomas, Springfield, pp 112–114Google Scholar
  40. 40.
    Verill PJ (1975) Adverse reactions to local anesthetics and vasoconstrictor drugs. Practicioner 214: 380Google Scholar
  41. 41.
    Fregert S, Tegner E, Thein I (1979) Contact allergy to lidocaine. Contact Dermatitis 5: 185–188PubMedCrossRefGoogle Scholar
  42. 42.
    Adriani J, Zepernick R (1981) Allergic reactions to local anesthetics. South Med J 74: 694–699PubMedCrossRefGoogle Scholar
  43. 43.
    Ruzicka T, Gerstmeier M, Przybilla B, Ring J (1987) Allergy to local anesthetics: comparison of patch test with prick and intradermal test results. J Am Acad Dermatol 16: 1202–1208PubMedCrossRefGoogle Scholar
  44. 44.
    Aldrete JA, Johnson DA (1969) Allergy to local anesthetics. JAMA 207: 356–357PubMedCrossRefGoogle Scholar
  45. 45.
    DeShazo RD, Nelson HS (1979) An approach to the patient with a history of local anesthetic hypersensitivity: experience with 90 patients. J Allergy Clin Immunol 63: 387–394PubMedCrossRefGoogle Scholar
  46. 46.
    Incaudo G, Schatz M, Patterson R, Rosenberg M et al. (1978) Administration of local anesthetics to patients with a history of prior adverse reaction. J Allergy Clin Immunol 61: 339–345PubMedCrossRefGoogle Scholar
  47. 47.
    Levy SM, Baker KA (1986) Considerations in differential diagnosis of adverse reactions to local anesthetic: report of a case. J Am Dent Assoc 113 (2): 271–273PubMedGoogle Scholar
  48. 48.
    Chin YC, Brecht K, Das Gupta DS, Mhoon E (1986) Myocardial infarction with topical cocaine anesthesia for nasal surgery. Arch Otolaryngol Head Neck Surg 112: 988–990Google Scholar
  49. 49.
    Gordon BR (1987) Topical cocaine nasal anesthesia (Letter). Arch Otolaryngol Head Neck Surg 113: 211PubMedGoogle Scholar
  50. 50.
    Das Gupta DS (1987) Topical cocaine nasal anesthesia (Reply). Arch Otolaryngol Head Neck Surg 113: 211Google Scholar
  51. 51.
    Reynolds F (1987) Adverse effects of local anesthetics. Br J Anaesthesia 59: 78–95CrossRefGoogle Scholar
  52. 52.
    Shira RB (1988) The use of amide local anesthetics in patients susceptible to malignant hyperthermia. Oral Surg Oral Med Oral Pathol 66: 405–415CrossRefGoogle Scholar
  53. 53.
    Zenz M, Panhans C, Niesel HC, Kreuscher H (1988) Regional anesthesia. Year Book Medical Publishers, Boca Raton, pp 15–16Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • George B. Winton

There are no affiliations available

Personalised recommendations