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Related Concept Videos

Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

771
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Blinding01:11

Blinding

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Blinding is a commonly used method of not telling participants which treatment a subject is receiving. Blinding is a critical part of a randomized control trial or RCT. It reduces the bias that affects the results. In an RCT, blinding is used in the form of a placebo. A placebo effect occurs when untreated subjects falsely believe they have received the treatment and report improved symptoms. A placebo or a dummy treatment is administered to subjects to negate the bias caused by such an effect.
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Double-Blind, Randomized Clinical Trial Comparing One Percent Buffered Versus Two Percent Unbuffered Lidocaine

Suzanne D Baker1, Jessica Y Lee2, Raymond P White3

  • 1Dr. Baker is in private practice, North Carolina State University, Raleigh, N.C., USA.

Pediatric Dentistry
|April 24, 2021
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Buffered lidocaine in children demonstrated equal effectiveness to unbuffered formulations, but with significantly lower blood lidocaine levels. This buffered local anesthetic offers a safer alternative for pediatric pain management.

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Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Pain Management

Background:

  • Buffered local anesthetics are an alternative to conventional formulations.
  • Limited evidence exists regarding their use in pediatric populations.

Purpose of the Study:

  • To compare anesthetic and physiological differences between buffered 1% and unbuffered 2% lidocaine with epinephrine in children.
  • To assess safety and efficacy in pediatric patients.

Main Methods:

  • Randomized, double-blinded, crossover study involving 25 children aged 10-12 years.
  • Inferior alveolar nerve blocks administered with either buffered 1% or unbuffered 2% lidocaine.
  • Primary outcomes included blood lidocaine levels, onset, duration, and pain on injection.

Main Results:

  • Buffered lidocaine resulted in a 63% lower mean blood lidocaine level compared to unbuffered lidocaine (P<0.05).
  • No significant differences were observed in pain on injection, onset, or duration of anesthesia between the two formulations.

Conclusions:

  • Buffered local anesthetic formulations are equally effective as higher-concentration unbuffered formulations.
  • Buffered lidocaine significantly reduces systemic absorption, offering a potential advantage in preventing local anesthetic toxicity in children.