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Anestesi Lokal pada Lesi Superfisial

Huntal Napoleon
Local Anesthesia
Local anesthetics work by
producing nerve conduction
blockade at the level of nerve
membrane receptors.


Routes of Local Anesthetic
Local anaesthetic drugs can reach their target by one
of a number of routes:
1.infiltrationdiffusion to sensory receptors
and the finest nerve branches (a similar
retrograde diffusion occurs during intravenous
regional analgesia);
2.injection close to (preferably not into) a
nerve trunk;
3.injection into a plane or compartment
through which a nerve runs (e.g. axillary sheath,
epidural and subarachnoid spaces).

Indications
a. Anesthesia for surgical procedures
b. Anesthesia for wounds that require
irrigation, debridement, and/or
repair

Advantage
The patient can remain conscious, and by
doing so provides assurance of a safe airway
and avoids complications caused by
anaesthetic interference with breathing
function. In contrast, most techniques for
general anaesthesia interfere with the control
of at least three major systems:
consciousness, cardiovascular and
respiratory function. For many patients it is
the loss of control of these functions that
causes them the greatest anxiety in relation
to surgery.
Contraindications
a. None when using local anesthetics
without epinephrine.
b. Epinephrine should not be used at
anatomic sites supplied by end-
arteries (fingers, toes, nose, ears,
penis) or in infection-prone wounds
(animal/human bites, contaminated
wounds).
Local Anesthesi
Choose from the above chart and tailor
choice to individual patient based on the
duration of procedure; time to onset;
and location, type, and extent of wound.
Long-and short-acting anesthetics can
be mixed in a 50:50 ratio to achieve
benefits of both.
Local Anesthesia
No. Local Anesthetic Onset Maximum Dose mg/Kg) Durations of Actions (hrs)

plain With epi plain With epi

1. Bupivacaine (Marcaine) slow 2.5 3.5 2.0-4.0 4.0-6.0
2. Lidocaine (Xylocaine) rapid 5.0 7.0 0.5-2.0 1.0-4.0
3. Procaine (Novocaine) slow 6.0 9.0 0.25-0.5 0.5-1.0
4. Tetracaine (Pontocaine) slow 1.5 2.5 2.0-3.0 2.0-4.0

Equipment and Positioning
Equipment:
a.Sterile prep solution
b.Sterile gloves and towels
c.25-gauge needle
d.10-ml syringe

Positioning:
Varies with location of wound
Technique
Technique:
a. Sterile prep wound with antiseptic such as
Betadine, cleanse with alcohol swab.
b. Stretch skin taut to facilitate penetration,
and directly infiltrate local anesthetic
through wound edges and inside wound
with a long 25 gauge needle; minimize
needle sticks by orienting needle
longitudinally along axis of wound and
injecting beneath skin edges
c. Inject the anesthetic slowly
Complications and Management
Complications and Management overdose :

Initial signs of toxicity include dizziness, restlessness,
paresthesias, and twitching, and may lead to
generalized seizures, hypotension, bradycardia, and
cardiovascular collapse. Complications are generally
self-limited but may require supportive care until
effects wear off.
Stop the local anesthetic and hyperventilate with
100% O2.
Use IV diazepam (0.10.3 mg/kg) for seizures.
Initiate ACLS protocols if necessary. Trendelenburg
for hypotension and bradycardia. Prolonged CPR is
indicated because the effects of the anesthetic will
subside as the drug redistributes.
TERIMAKASIH