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Related Concept Videos

Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

505
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
505
Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

564
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...
564
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

1.3K
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
1.3K
Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

876
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...
876
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

509
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...
509
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

212
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
212

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Systemic Risks of Topical Anesthetics in Barrier-Compromised Dermatologic Patients.

George Chamoun1, Alyssa Forsyth1, Sarah Kazemeini2

  • 1Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA.

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|June 16, 2025
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Summary

Topical anesthetics are absorbed more easily through damaged skin, increasing the risk of systemic toxicity from lidocaine and other agents. Understanding these risks is key to safe dermatologic procedures.

Keywords:
anesthetic pharmacokineticscutaneous analgesialocal pain reliefnumbing agentspain managementskin barrier dysfunctionskin barrier permeabilitytopical anesthetictopical anesthetic systemic toxicitytopical lidocaine

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Area of Science:

  • Dermatology
  • Pharmacology
  • Toxicology

Background:

  • Topical anesthetics are common in dermatologic procedures.
  • Their safety relies on intact skin barrier function.
  • Inflammatory skin conditions compromise the stratum corneum (SC).

Purpose of the Study:

  • To review topical anesthetic absorption.
  • To examine enhanced systemic exposure in compromised skin.
  • To discuss clinical strategies for mitigating toxicity.

Main Methods:

  • Review of existing literature on topical anesthetic absorption.
  • Analysis of mechanisms of percutaneous absorption in inflammatory skin disorders.
  • Examination of factors influencing systemic toxicity.

Main Results:

  • Impaired epidermal barrier in conditions like psoriasis and atopic dermatitis enhances anesthetic absorption.
  • Compromised SC, altered tight junctions, increased TEWL, and vascular permeability facilitate systemic uptake.
  • Potent agents (lidocaine, tetracaine, prilocaine) pose risks of CNS and cardiovascular toxicity at high plasma concentrations.

Conclusions:

  • Systemic absorption of topical anesthetics is significantly increased with compromised skin barrier integrity.
  • Factors like occlusive dressings and prolonged use exacerbate toxicity risks.
  • Clinical awareness and management strategies are essential for safe anesthetic use in dermatology.