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Local Anesthetics 

Local Anesthetics
Chapter:
Local Anesthetics
Author(s):

Chris D. Glover

and Kim-Phuong Nguyen

DOI:
10.1093/med/9780199381623.003.0014
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date: 17 August 2019

Local anesthetics bind to Na+ channels located on nerve fibers, preventing transmission of nerve impulses. There are two types of local anesthetics (aminoamides and aminoesters), which are distinguished by their chemical linkage and metabolism. Ester local anesthetics undergo hydrolysis by plasma esterases, whereas amides undergo biotransformation mainly in the liver. The physiochemical and pharmacokinetic properties of the individual local anesthetic determine its onset of action, potency, duration of action, and clinical applicability. Combination of certain additives with the local anesthetics may increase efficacy for clinical use. The patient’s condition, addition of adjuncts, total local anesthetic dose, and systemic absorption must be considered to avoid systemic toxicity. While local anesthetics remain essential to the practice of anesthesia with a broad range of applications, a deep understanding of their toxic effects must be attained to safely administer these drugs.

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