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PREFACE
A. BACKGROUND
Physicians commonly use local anesthetics to perform minor
procedures and to improve analgesia for procedures performed under general
anesthesia. Local anesthetics improve postoperative pain control and reduce
the amount of postoperative narcotic required. This, inturn, can reduce
postoperative nausea, emesis and delayed return to bowel function. An ideal
local anesthetic provides complete sensory blockade on application and has
an adequate duration of effect to include the procedure and a generous
postoperative period.
Bupivacaine and lidocaine are two commonly used local analgesics.
The two amino amides are often used concurrently to combine the more rapid
onset of lidocaine and the longer duration of bupivacaine. Compared with
lidocaine, bupivacaine has a significantly longer duration of action and slower
time to onset. Bupivacaine has an onset of 5 min, a duration of 2 h to 4 h and
maximum dose of 2 mg/kg. The addition of epinephrine has an unknown
effect on onset while increasing duration and maximum dose to 3 h to 7 h and
3mg/kg, respectively. Lidocaine is known to have an onset <2 min, a duration
of 1 h to 2 h, and a maximum dose of 5 mg/kg, which improves to an onset
<2 min, a duration of 2 h to 6 h and toxicity of 7mg/kg with the addition of
epinephrine.
Each characteristic is dependent on multiple factors including volume
and concentration infused, location of administration and tissue pH. This
review discusses the different, characteristics, and compare lidokain and
buivacaine in used to local anesthesia.
B. OBJECTIVE
1. To Know How the Characteristics of Lidocaine as a Local Anesthetics
2. To Know How the Characteristics of Bupivacaine as a Local Anesthetics
3. To Compare Lidocaine snd Bupivacaine as a Local Anesthetics
Neural Membrane
+ 60 mV
Na+
Neural Membrane
-90 mV
K+
Inside Cell
B. LOCAL ANESTHETICS
1. Historical Preseptive
Anesthesia by compression was common in the antiquity. Cold as
an anesthetic was widely used until the 1800s. The native Indians of Peru
chewed coca leaves and knew about their cerebral-stimulating effects and
possibly about their local anesthetic properties (there are some reports of
natives using an emulsion of chewed coca leaves and saliva on wounds).
The leaves of erythroxylon coca were taken to Europe where Niemann in
Germany isolated cocaine in 1860. Cocaine was introduced into Europe
in the 1800s following its isolation from coca beans. Sigmund Freud, the
N
Lipophilic Group
Benzene Ring
Intermediate Bond
Hydrophilic Group
Proton Acceptor
drugs
is
greater.
Hydrophobicity also
b. Protein binding
Local anesthetics are bound in large part to plasma
and
tissue
proteins.
pharmacologically
The
active.
bound
The
portion
plasmatic
is
not
unbound
with
the
duration
of
action
of
local
as
lidocaine,
tetracaine,
bupivacaine
and
Ionized Form
that
2-chloroprocaine
has
better
tissue
exceptions
are
chloroprocaine
and
benzocaine.
Chloroprocaine has a high pKa and rapid onset. Benzocaine does not
exist in an ionized form and exerts its effects by alternate mechanisms.
4. Mechanism of Action
Local anesthetics produce a conduction block of neural impulses,
preventing the passage of Na+ through Na+ channels. Local anesthetics
do not alter the resting membrane potential. The Na+ channel acts as a
receptor
for
local
anesthetic
molecules.
Local
anesthetics
are
+
Na
open
+
Na
+
Na
+
Na
channels. This
Because
of
the
relative
more
acidic
intracellular
that
accepted
that
the
main
action
of
local
open
and
inactivated.
Under
adequate
drugs,
(amitriptyline),
like
meperidine,
tricyclic
volatile
antidepressants
anesthetics
and
cholinesterase
by
or
predispose
patients
to
having
greaterblood
smooth
muscle.
At
low,
sub-clinical
doses,
C. LIDOCAINE
1. Introduction
Lidocaine has been used as an anesthetic and analgesic for more
than half a century. First synthesized in 1943, the injectable formulation
of lidocaine was approved for local and regional anesthesia. Since that
time, a variety of intravenous, intramuscular, and topical methods for
administering lidocaine have been developed. Although not well studied
in pediatric patients, this technique has the potential to reduce reliance on
opioids and may prove to be a valuable addition to pain management in
children.
2. Mechanism of Action
Lidocaine, is an amide local anesthetic agent. The amide
anesthetics block fast voltage-gated sodium channels in the cell
membrane of postsynaptic neurons, preventing depolarization and
inhibiting the generation and propagation of nerve impulses. At lower
blood concentrations, sensory neurons are primarily affected while at
higher concentrations the effects become generalized. Lidocaine also
possesses
anti-inflammatory
and
immunomodulating
properties.
in
patients
with
known
Bupivacaine
is
rapidly
absorbed
from
the
injection
site,
fibers).
Studies
have
shown
that
the
most
common
patients. Each patient was asked to rate his pain on a 0 to 10 scale (0, no pain;
10, severe pain) prior to administration of the anesthetic. They then rated pain
on an identical scale at 30 minutes, and one, two, three, four, five, six, 12, 18,
and 24 hours after completion of suturing.
The mean baseline pain was 2.96 for the lidocaine group and 3.07 for
the bupivacaine group. This decreased to less than 1.0 in both groups 30
minutes after infiltration. It remained low for the bupivacaine group for the
next five hours, but increased almost to preanesthesia levels by two hours in
the lidocaine group. A three-way analysis of variance revealed a significant
difference (P less than .001) between the pain response of the two groups.
There was no statistical difference (P greater than .05) between the age of the
patients, size of laceration, and amount of drug used. The study shows that
patients do experience pain after a wound is sutured and the anesthetic has
worn off. It also demonstrates that bupivacaine significantly reduces the pain
a patient may experience after repair of a wound (Spivey et al, 1987)
Valvano et al., (1996) compared the efficacy, degree of discomfort, and
time elapsed before anesthesia of digital block with a combination of 1%
lidocaine/.25% bupivacaine and with .25% bupivacaine alone. The results is
bupivacaine 25% digital block induces anesthesia in the same period of time
and with equivalent pain of injection as a 1:1 lidocaine 1%/bupivacaine 25%
combination. It is not necessary to use lidocaine/bupivacaine in an attempt to
achieve faster onset of local anesthesia (Valvano et al., 1996).
Thomson et al., (2006) used three local anesthetics for digital nerve
block: 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine, and 0.5%
bupivacaine. The local anesthetic agent to be used in each finger was
randomized. A double-blind design was used. Volunteers reported the time
that each of their fingers returned to normal sensation at the tip. At an average
of 24.9 hours, bupivacaine (0.5%) provides a significantly longer digital
anesthesia time than the average 10.4 hours achieved by 2% lidocaine with
epinephrine (1:100,000), which in turn provides twice as long an anesthesia
time as 2% lidocaine (average, 4.9 hours) (Thomson et al., 2006).
Alhelail et al., (2009) compared the efficacy in terms of pain of
injection, time of onset and duration of action of digital blocks of bupivacaine
0.5% alone and lidocaine 1% with epinephrine (1:100,000). Pain of injection
III. CONCLUSION
1. Local anesthetics produce anesthesia by inhibiting excitation of nerve endings
or by blocking conduction in peripheral nerves. This is achieved by
anesthetics reversibly binding to and inactivating
+
Na (sodium) channels.
2. The intrinsic potency, duration, and onset of action for a local anesthetic are
dependent
upon
lipophilic-hydrophobic
balancen,
protein
binding,
REFERENCES
Alhelail, M., Al-Salamah, M., Al-Mulhim, M., Al-Hamid, S. 2009. Comparison of
bupivacaine and lidocaine with epinephrine for digital nerve blocks.
Emergency Medicine Journal 26(5): 347-350.
Butterworth, J.F., D.C. Mackey, J.D. Wasnick. 2013. Local Anesthetics in Morgan
and Mikhails: Clinical Anesthesiology, 5th ed. New York: Lange
Medical Books
Clinical Anesthesiology, 4th edition. New York: Lange Medical Books.
Collins, J., Raman, C. M. 2011. Effectiveness Study of Differents Local Anesthetic
Mixtures.
Available
at
https://clinicaltrials.gov/ct2/show/study/NCT01243112.
Heavner, J.E. (2008). Pharmacology of local anesthetics. In D.E. Longnecker et
al (eds) Anesthesiology. New York: McGraw-Hill Medical.
Joyce, J.A. (2002). A pathway toward safer anesthesia: stereochemical advances.
AANAJournal, 70, 63-67.
Katzung, B.G. (1992). Section 1: basic principles. In B.G. Katzung Basic &
clinicalpharmacology, 5thedition. Norwalk, Connecticut: Appleton and
Lange.
Keneeth, L. R., Becker, D. E. 2006. Essentials of Local Anesthetic Pharmacology.
Anesth Prog 53:98109.
Longnecker, D. E., Brown, D. L., Newman, M. F., Zappol, W. M. 2008.
Pharmacologic of Local Anesthesi at Anesthesiology. New York:
McGraw-Hill Companies (E-Book).
Morgan, G.E., Mikhail, M.S., Murray, M.J. (2006). Local Anesthetics. In G.E.
Morgan et al
Morgan, G.E., Mikhail, M.S., Murray, M.J. 2006. Local Anesthetics. In G.E.
Morgan et al Clinical Anesthesiology, 4th edition. New York: Lange
Medical Books (E-Book).
Spivey, W.H, McNamar, R.M, MacKenzie, R.S., Bhat, S., and Burdick, W.P.,
1987. A Clinical Comparison of Lidocain and Bupivacaine, Annual
Emergency Medicine Jul; 16(7): 752-7
Stoelting, R.K. & Hillier, S.C. (2006). Pharmacology and pharmacodynamics of
injected and inhaled drugs. In R.K. Stoelting & S.C. Hillier (eds)
Pharmacology & Physiology in AnestheticPractice, 4thedition.
Philadelphia: Lippincott Williams & Wilkins.
Strichartz, G.R. & Berde, C.B. (2005). Local Anesthetics. In R.D. Miller
Millers Anesthesia,6th edition. Philadelphia: Elsevier Churchill
Livingstone.
Thomson, C. J., Lalonde, D. 2006. Randomized Double-Blind Comparison of
Duration of Anesthesia among Three Commonly Used Agents in Digital
Nerve Block. Plastic and Reconstructive Surgery 118(2): 429-432.
Valvano, M. N., Stephen, L. 1996. Comparison of Bupivacaine and
Lidocaine/Bupivacaine for Local Anesthesia/Digital Nerve Block.
Annals of Emergency Medicine 27(4): 490-492.
Vinycomb, T. I., Sahhar, L. J. 2014. Comparison of Local Anesthetics for Digital
Nerve Blocks: A Systematic Review. Journal of Hands Surgery. 39(4):
744-751.