Regional Anesthesia

Regional anesthesia can be produced through local infiltration, nerve blocks or spinal/epidural anesthesia. Regional anesthesia can be induced by drugs that fall into two classes: the aminoesters and the aminoamides. Anesthetics with a pH close to neutral have a rapid onset of action and those with intense protein binding have an increased potency. The duration of action is determined mostly by local absorption which can be attenuated by mixing the agent with epinephrine.

Cocaine is rarely used to anesthetize the mucous membranes of the upper airway by topical application causing vasoconstriction and blocking uptake of norepineph-rine at sympathetic nerve endings. Procaine is used for local infiltration of field blocks lasting from 30 minutes to one hour in duration.

Lidocaine is the most popular local anesthetic and can be used for local infiltration, nerve blocks, and spinal anesthesia. Bupivicaine is a potent amide with a long duration of action.

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