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Related Concept Videos

Local Anesthetics: Mechanism of Action01:23

Local Anesthetics: Mechanism of Action

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Local anesthetics (LAs) block sensory and motor impulses by inhibiting the sodium channels on the nerve cell membranes. This induces temporary loss of sensation, relieving pain in a specific body area.
Local anesthetics are amphiphilic molecules consisting of a hydrophobic aromatic part linked to a hydrophilic group by an ester or amide linkage. They are weak bases and are usually available as salts, which increases their solubility and stability. Once administered, LAs exist in the body either...
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Local Anesthetics: Chemistry and Structure-Activity Relationship01:27

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Local anesthetics (LAs) are drugs that induce a temporary loss of sensation in a limited body area, preventing pain. Cocaine was the first local anesthetic discovered in the late 19th century. Cocaine is a benzoic acid ester obtained from the leaves of coca shrubs and was often used for its psychotropic effects. Cocaine was first isolated in 1860 by Albert Niemann. Sigmund Freud studied the physiological actions of cocaine. Carl Koller later introduced it into clinical practice in 1884 as a...
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Depolarizing Blockers: Pharmocokinetics01:19

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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: Pharmacokinetics01:13

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Local Anesthetics: Common Agents and Their Applications01:23

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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: Differential Sensitivity of Nerve Fibers01:24

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Changing the Buffer in Buffered Lidocaine.

Ann Plohal1, Eric P Dutchover, Jennifer Root

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Summary
This summary is machine-generated.

Saline-buffered lidocaine offers comparable pain relief to bicarbonate-buffered lidocaine during central vascular access device insertion. This finding provides an alternative option for pain management when bicarbonate-buffered lidocaine is unavailable.

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Area of Science:

  • Medical procedures
  • Anesthesiology
  • Vascular access

Background:

  • Central vascular access device (CVAD) insertion requires pain management, commonly using lidocaine.
  • Lidocaine buffered with sodium bicarbonate enhances pain relief during injection.
  • Lidocaine shortages necessitate exploring alternative buffering agents.

Purpose of the Study:

  • To compare the efficacy of lidocaine buffered with saline versus bicarbonate in minimizing pain during CVAD insertion.
  • To evaluate vasoconstriction as a secondary outcome.

Main Methods:

  • A pilot study involving 60 adult patients undergoing peripherally inserted central catheter (PICC) insertion.
  • Patients received either lidocaine buffered with bicarbonate (n=30) or lidocaine buffered with saline (n=30) prior to insertion.
  • Pain and vasoconstriction were the primary outcomes assessed.

Main Results:

  • Saline-buffered lidocaine demonstrated comparable pain relief to bicarbonate-buffered lidocaine.
  • Both buffering agents resulted in similar levels of vasoconstriction.
  • The pilot study, though short (2 weeks), provided valuable clinical comparison.

Conclusions:

  • Lidocaine buffered with saline is a viable alternative for pain management during CVAD insertion.
  • This finding is particularly relevant during shortages of bicarbonate-buffered lidocaine.
  • Further research may be warranted to confirm these outcomes in larger populations.