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 SPINAL ANESTHESIA
INTRODUCTION:-

Spinal anesthesia, also known as subarachnoid block, is a type of regional

anesthesia that is used to numb a specific region of the body. It involves the injection
of a local anesthetic into the cerebrospinal fluid in the subarachnoid space, which
surrounds the spinal cord and brain.

Spinal anesthesia is commonly used for procedures involving the lower abdomen,
pelvis, and legs, such as cesarean sections, hip and knee replacement surgeries,
and bladder surgeries. It can also be used for diagnostic procedures such as a
lumbar puncture or a myelogram.

The benefits of spinal anesthesia include faster onset of anesthesia compared to

general anesthesia, less postoperative nausea and vomiting, and improved pain
control after surgery. However, there are also risks associated with spinal
anesthesia, such as headache, nerve damage, and infection.

Spinal anesthesia should only be performed by a trained healthcare professional

who is familiar with the procedure and its potential risks and complications. Before
undergoing spinal anesthesia, patients should discuss the procedure and any
concerns with their healthcare provider.

The term neuraxial anesthesia refers to the placement of local anesthetic in or

around the CNS. Spinal anesthesia is a neuraxial anesthesia technique in which
local anesthetic is placed directly in the intrathecal space (subarachnoid space).

MECHANISM ACTION OF SPINAL ANESTHESIA:-

Spinal anesthesia works by blocking the transmission of nerve impulses from the
spinal cord to the brain, resulting in loss of sensation and muscle function in the
region of the body supplied by the nerves that are affected by the anesthetic. This is
achieved by injecting a local anesthetic, such as bupivacaine, into the cerebrospinal
fluid in the subarachnoid space, which surrounds the spinal cord and brain.

The local anesthetic binds to and blocks the voltage-gated sodium channels on the
nerve cell membrane, preventing the nerve from generating an action potential and
transmitting impulses. This results in the loss of sensation and muscle function in the
affected area of the body.

The level of anesthesia achieved depends on the dose and concentration of the local
anesthetic injected, as well as the position of the patient during and after injection.
By adjusting the dose and concentration of the local anesthetic, the anesthesiologist
can control the level of anesthesia achieved and the duration of its effects.
Other drugs, such as opioids and alpha-2 adrenergic agonists, may be added to the
local anesthetic to enhance the effects of spinal anesthesia and provide better pain
relief. These drugs act on different receptors in the spinal cord and brain to provide
additional analgesia and reduce the side effects of the local anesthetic.

DRUGS USED IN SPINAL ANESTHESIA

The most commonly used drugs in spinal anesthesia are local anesthetics such as
bupivacaine, lidocaine, and ropivacaine. These drugs are injected into the
cerebrospinal fluid in the subarachnoid space, which surrounds the spinal cord and
brain, to provide anesthesia or numbness to a specific area of the body.

In addition to local anesthetics, other drugs such as opioids (such as fentanyl or

morphine) and alpha-2 adrenergic agonists (such as clonidine) may also be used in
spinal anesthesia to enhance the effects of the local anesthetic and provide better
pain relief. The specific choice of drug or combination of drugs used for spinal
anesthesia depends on the individual patient's needs and the type of surgery being
performed.

Commonly used drugs in spinal anesthesia are local anesthesia are given bellow;

 Lidocaine
 Tetracaine
 Mepivacaine
 Ropivacaine
 Levobupivacaine
 Chloroprocaine

MECHANISM ACTION OF LIDOCAINE:-

Lidocaine is a local anesthetic of the amide type. It is used to provide local
anesthesia by nerve blockade at various sites in the body. It does so by stabilizing
the neuronal membrane by inhibiting the ionic fluxes required for the initiation and
conduction of impulses, thereby effecting local anesthetic action. In particular, the
lidocaine agent acts on sodium ion channels located on the internal surface of nerve
cell membranes. At these channels, neutral uncharged lidocaine molecules diffuse
through neural sheaths into the axoplasm where they are subsequently ionized by
joining with hydrogen ions. The resultant lidocaine cations are then capable of
reversibly binding the sodium channels from the inside, keeping them locked in an
open state that prevents nerve depolarization. As a result, with sufficient blockage,
the membrane of the postsynaptic neuron will ultimately not depolarize and will thus
fail to transmit an action potential. This facilitates an anesthetic effect by not merely
preventing pain signals from propagating to the brain but by aborting their generation
in the first place. In addition to blocking conduction in nerve axons in the peripheral
nervous system, lidocaine has important effects on the central nervous system and
cardiovascular system. After absorption, lidocaine may cause stimulation of the CNS
followed by depression and in the cardiovascular system, it acts primarily on the
myocardium where it may produce decreases in electrical excitability, conduction
rate, and force of contraction.

ERROR:

INGREDIENTS:
All active ingredients should be provided.

DIRECTION:
For external use only, should be present.

MANUFACTURING AND EXPIRY DATE:

Expiry and expiry date is not mentioned.

BATCH NO:
Batch no is missing although drug code is written.

NAME OF PRESCRIBER, ADDRESS AND MANUFACTURED BY:

Name of prescriber, address and manufactured by should be present.

STORAGE:
Store at controlled room temperature between 15 °C to 30 °C should be provide.
MECHANISM ACTION OF TETRACAINE:
Tetracaine is a local anesthetic that works by blocking the generation and conduction
of nerve impulses. It achieves this by binding to and blocking voltage-gated sodium
channels on the cell membrane of nerve cells.

When a nerve cell is stimulated, sodium channels open, allowing sodium ions to flow
into the cell and generating an action potential that travels down the nerve fiber.
Tetracaine binds to the sodium channels and blocks the entry of sodium ions,
preventing the generation and propagation of the action potential. This results in a
loss of sensation in the area supplied by the affected nerves.

ERRORS:
INGREDIENTS:
All active ingredients should be provided.

MANUFACTURING AND EXPIRY DATE:

Expiry and expiry date is not mentioned.

BATCH NO:
Batch no is missing although drug code is written.

NAME OF PRESCRIBER, ADDRESS AND MANUFACTURED BY:

Name of prescriber, address and manufactured by should be present.

STORAGE:
Store at controlled room temperature between 2°C to 25°C should be provide.

MECHANISM ACTION OF MEPIVACAINE:

Mepivacaine is an amide local anesthetic similar to lidocaine. Local anesthetics bind
selectively to the intracellular surface of sodium channels to block influx of sodium
into the axon. As a result, depolarization necessary for action potential propagation
and subsequent nerve function is prevented.
ERRORS:
INGREDIENTS:
All active ingredients should be provided.

DIRECTION:
For external use only, should be present.

INSTRUCTIONS:
Do not inject Interavenously
The injection is not to be used if colour is pinkish or darker then slightly yellow.

MANUFACTURING AND EXPIRY DATE:

Expiry and expiry date is not mentioned.

BATCH NO:
Batch no is missing although drug code is written.

NAME OF PRESCRIBER, ADDRESS AND MANUFACTURED BY:

Name of prescriber, address and manufactured by should be present.

MECHANISM ACTION OF ROPIVACAINE:

Ropivacaine causes reversible inhibition of sodium ion influx, and thereby blocks
impulse conduction in nerve fibres.This action is potentiated by dose-dependent
inhibition of potassium channels. Ropivacaine is less lipophilic than bupivacaine and
is less likely to penetrate large myelinated motor fibres; therefore, it has selective
action on the pain-transmitting A β and C nerves rather than Aβ fibres, which are
involved in motor function.
ERRORS:
INGREDIENTS:
All active ingredients should be provided.

DIRECTION:
For Epidural use only, should be present.

INSTRUCTIONS:
Do not for intervenous administration

MANUFACTURING AND EXPIRY DATE:

Expiry and expiry date is not mentioned.

BATCH NO:
Batch no is missing although drug code is written.

NAME OF PRESCRIBER, ADDRESS AND MANUFACTURED BY:

Name of prescriber, address and manufactured by should be present.