1. Dr Ardra B. Thorat
Assistant professor
Dept. of Shalyatantra, YAC. Kodoli
2. It is used to prevent the perception of pain
by blocking its different pathways such as
Peripheral nerve fibers
Nerves
Plexus
Ganglion
Anterior / posterior nerve roots at spinal level
3. Advantages
The patient remain conscious and still does not feel
pain
No pre anesthetic preparation of the patient required
Complications and unwanted effect of GA are avoided
Does not required hospitalization
Blood less field can be produced
4. Disadvantages
Not good for uncooperative patients
Ideal surgical condition not produced
Hypersensitivity reaction
May cause nerve injury
Can not be used in infective area
5. Classification
On basis of chemical structure
Aminoesterase Aminoamides
Procain Lignocain
Chloroprocain Mepivacain
Tetracain Prilocain
Benzocain Bupivacain
Cocain Etidocain
Ropivacain
6. Based on duration of action
Short duration low potency
Chloroprocain
Procain
Intermediate duration, intermediate potency
Lignocain
Mepivacain
Prilocain
Cocain
7. Long duration high potency
Bupivacain
Levobupivacain
Tetracain
Etidocain
Dibucain
Ropivacain
8. Mechanism of action
Drug in dissociated (non ionized ) form penetrates the
axonal membrane and inside it gets dissociated
(ionized). This ionized form binds to receptor situated
in Na channel & blocks the channel, thus prevents
depolarization and hence action potential
9. General consideration
Potency – correlates with lipid solubility. Cm is the
minimum conc. Of local anaesthesia that will block
nerve impulse conduction
Onset of action- sequence of block in functional
term is autonomic sensory motor
sequence of recovery is in reverse order
motor sensory autonomic
Among sensory fibers sequence of blockage is
temperature (cold hot) pain touch
deep pressure proprioception
10. Methods of LA
Infiltration- local anaesthetic is infiltrated at operation site
Topical-(surface anaesthesia)-
1. for skin= EMLA cream is used which is mixture of prilocain
5% +lignocain5% in equal amaunts
2. Xylocain spray 4%- at mucous membrane of mouth, pharynx,
larynx
3. Xylocain jelly 2%- catheterization, proctoscopy
4. Cocain drops & tetracain ointment
Nerve block-drug is injected around the nerve supplying the
operation site
Field block
Root block
Regional intravenous anaesthesia (Beir’s block)