Chapter 14
- Local Anesthetics
- Gary R. Strichartz
- Charles B. Berde
Local anesthesia, or the blockade of nerve impulses to abolish
sensation, may be produced by many tertiary amine bases, certain alcohols, and a
variety of other drugs and toxins. However, all currently available clinically useful
agents are either aminoesters or aminoamides. These drugs, when applied in sufficient
concentration at the site of action, prevent conduction of electrical impulses by
the membranes of nerve and muscle. When local anesthetics are given systemically,
the functions of cardiac, skeletal, and smooth muscle, as well as the transmission
of impulses in the peripheral and central nervous systems and within the specialized
conducting system of the heart, may all be altered. Local anesthetics may abolish
sensation in various parts of the body by topical application, injection in the vicinity
of peripheral nerve endings and major nerve trunks, or instillation within the epidural
or subarachnoid space. Toxicity may be local or systemic. The central nervous and
cardiovascular systems are most commonly involved in acute clinical toxicity.
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