Local anesthesia

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Local anesthesia

• Department of anesthesiology
• Cui Xiao Guang

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What is local anesthesia ?

• Local anesthetics produces transient loss of
  sensory, motor, and autonomic function when the
  drugs are injected or applied in proximity to
  neural tissue.

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advantage of local anesthesia

• Convenient and easy
• Safety
• Consciousness
• Complication
• Physiologic function

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Classification of local anesthetics

• According to structure
• aminoester procaine, chloroprocaine,
  and tetracaine.
• aminoamide lidocaine and bupivacaine.
• According to duration of action
• short procaine and chloroprocaine
• moderate lidocaine
• longest tetracaine, bupivacaine, and
  ropivacaine

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Procaine

• Toxicity??
• Safety??
• diffusibility and penetrating power ?? ???
  topical anesthesia
• ??? local infiltration anesthesia

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Tetracaine

• Toxicity ?
• Liposolubility?
• Diffusibility and penetrating power
  ?? ????,topical anesthesia.
• ??????????????????????????????????

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Lidocaine

• Toxicity ??????
• Diffusibility and penetrating power ??
• ????????? ????
• ?????????? ??????,???????????????,???????????????
  ???

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Bupivacaine

• Toxicity ??,???????.
• ?????????,????.
• ???????????????????????.

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Ropivacaine

• ??????????,
• ???????????,
• ????????,
• ????????????????????,
• ??????????????????????

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Toxicity reaction of local anesthetics

• Concept
• ??????????????????,????????????????????????????
• ????(hypersusceptibility)?????????????????????

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Cause

• ????????
• ??????
• ?????????????
• ????????????????

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???????????

• ????????,??????
• ??????????????
• ?????????????????? ??????????????
• ??????????????????, ??????????,?????,?? ????????
• ?????????,??????????

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????1???

• ?????????(tinnitus)???????????? ?(dizziness)?????
  (disorientation)????? (difficulty in
  focusing)????????
• ??????(dysphoria),??(fear),???? (anhelation)?????
  ?(apopnixis),????? ?????????,????(increased heart
  rate), ????(blood pressure step up)?
• ??????(breathing frequency)????????,? ?(hypoxia)?
  ???,???????(cyanosis), ?????????,???(muscle
  tension)??, ???(muscle tremors)????(convulsion),??
  ????,????????????

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????2???central nervous system and
cardiovascular system

• ??????(mind indifference),?
  ?(drowsiness)????????
• ???????,?????? (apnea)
• ??????(bradysphygmia), ??
  ??50bpm,????,????, ????????(heart arrest)?

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Treatment

• ??????
• ???????????,?????
• ?????,?????diazepam 0.1-
  0.2mg/kg,?midazolam, 0.05- 0.1mg/kg
• ??pentothal 1-2mg/kg,????
  1mg/kgdiazepam or midazolam
• ??????
• ??????

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Prevention

• ????,????
• ??????
• ???????????????
• ?????????????
• ??????????????
• ?????
• ?????????
• ????,????,????

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Commonly used methods of local anesthesia

• Topical anesthesia
• Local infiltration anesthesia
• Field block
• Nerve blockade
• cervical plexus block
• brachial plexus block

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Topical anesthesia

• Concept
• Indication ??????????????????????
• Anesthetics ?????1/31/2
• 12 tetracaine or 24 lidocaine
• Methods
• instill,???(spread method),???(nebulization),
  ???

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Local infiltration anesthesia

• Concept
• Indication????????? ?????
• Anesthetics procaine, lidocaine, tetracaine,
  bupivacaine, ropivacaine
• Method
• Announcements

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Announcements

• ????
• ?????????????,????
• ????,?????????????
• ???????
• ?????

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Field block

• Concept
• Indication
• Anesthetics, method and announcements the same
  to local infiltration anesthesia.

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Nerve blockade

• Concept
• Indication
• Contraindication ???????????????????????
• Announcements

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Announcements

• ???????
• ??????????
• ???????????????
• ?????,???????

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Cervical plexus block

• Anatomy
• C1-4??
• ??????,???????
• ??????????????????????

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Indication and contraindication

• ???????????? ????????
• ???????
• ?????????

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Superficial cervical plexus blockade
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Deep cervical plexus blockade
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Anesthetics

• 1 lidocaine
• 0.25 bupivacaine
• 0.25 ropivacaine
• 0.15-0.2 tetracaine
• mixed liquor

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Complication

• Epidural and intrathecal injections.
• Toxicity reaction of local anesthetics.
• Phrenic nerve block.
• Recurrent laryngeal nerve block.
• Horners syndrome.
• Vertebral artery damage local hematoma

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Brachial plexus block

• Anatomy C5-8 and T1 C4 and T2

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Indication

• ??????????

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Methods

• Interscalene approach
• Supraclavicular approach
• Axillary approach
• Subclavian perivascular approach

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Interscalene approach
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advantage

• ????,????????? ???
• ???
• ??????

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Shortcoming

• ???????
• ?????
• ????????????????
• ?????????????
• ????????
• ??

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Supraclavicular approach
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advantage and shortcoming

• ????,???????????
• ???????
• ?????

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Axillary approach
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???????????

• ??????????
• ????
• ???????
• ??????,??????
• ??????????

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advantage

• ??????
• ??????
• ????????????? ??????
• ????????????? ?????

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Shortcoming

• ????????????? ?????????
• ?????????
• ????????

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Subclavian perivascular approach
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advantage

• ???
• ?????????
• ?????????????
• ????????????????

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Shortcoming

• ??
• ??????????
• ???????,?????50

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Local anesthetics

• 0.25 bupivacaine
• 0.25 ropivacaine
• mixed liquor
• 1 lidocaine and 0.25 bupivacaine

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Complication

• Pneumothorax
• Hemorrhage and hematoma
• Toxicity reaction of local anesthetics
• Phrenic nerve block
• Recurrent laryngeal nerve block
• Epidural and spinal anesthesia
• Horners syndroma

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?????

• ????????????,???????????????????
• ??????0.01-5.0 mA
• ??1-2 Hz

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????

• ????
• ????
• ????????,??????
• ?????
• ????1.0 mA
• ??????,??????,?? ?????,?????

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advantage and shortcoming

• ????,????,??????
• ????
• ????
• ????
• ????

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Indication

• ???????????
• ???????????
• ??????
• ??????
• ??????
• ?????????????

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Complication

• ??????
• ????,???????