Buprenorphine: Because of its local anesthetic properties it is frequently used to supplement the effect of iocal anesthetics for nerve blocks. Tramadol: Although weak but tramadol! do have local anesthetic properties. Methoxyflurane The droplets of methoxyflurane has got Iccal anesthetic properties. ‘Mechanism of action of local anaesthetics ‘© Act by inhibition of action potential generation within nerve cells ‘© Nerve fibres are blocked in a predictable sequence © Preferentially block small diameter, myelinated and high frequency nerve fibres Contraindications for local anaesthetics ‘© Previous allergic reaction to local anaesthetic ‘© Inflamed or Infected tissues- unlikely to have effect if used locally due to low pH of tissue ‘© Caution in patients with family history of malignant hyperthermia Doses of local anaesthetic ‘© Dose variable depending on LA ‘© Concentration of LA solution expressed as % eg Lidocaine 1% © Can be converted into mg/ml by remembering 1% solution = 10mg/ml, 0.5% solution =5mg/ml ‘© Typical solutions (with or without adrenaline) © Lidocaine 1% (10mg/ml), 2% (20mg/ml) ‘© Bupivacaine 0.25% (2.5mg/ml), 0.5% (Smg/ml) Adrenaline use with local anaesthetics ‘Adrenaline (vasoconstrictor) can be combined with LA Improves local haemostasis by vasoconstriction High doses risk ischaemia, tachycardia, hypertension and arrhythmias ‘Typical doses expressed as grams of solvent in millitres of solvent eg 1:200,000 is 1g adrenaline in 200,000m! solution ‘© Commonly used solutions of LA contain 1:200,000 or 1:80,000 adrenaline eo o00 © scanned wen onEn scone