THE USE OF LOCAL ANESTHETICS

IN ANESTHESIA CLINICAL SETTINGS

M. Andy Prihartono
Departement of Anesthesiologist and Intensive Therapy
Padjadjaran University of Medicine
Hasan Sadikin General Hospital Bandung
 Local Anesthetics (LA)
Menyebabkan hilangnya sensasi di area tubuh yang
terbatas
Pasien sadar, mungkin dapat merasakan penekanan tapi
tidak merasakan sakit di area yang dibius.
Digunakan untuk prosedur invasif atau bedah.

Durasi berkisar 30mnt s/d ≥12 jam.

Durasi tergantung: lokasi blok, jenis LA, & persiapannya.

Garmon EH, Huecker MR. Topical, Local, and Regional Anesthesia and Anesthetics. [Updated 2022 May 3]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430894/?report=classic
Jaan et al. Local Anesthesia - Solution to Pain : An Overview. Journal of Current Medical Resaearch and Opinion. 2020
 Sejarah Perkembangan LA

• Diawali penemuan kokain oleh Albert Nieman (1860).

• Schraff (1862): menemukan efek lokalnya pada lidah.
• Koller dan Gartner (1884): berhasil memproduksi anestesi kokain
topikal mata pada katak, kelinci, anjing, & manusia → lahirnya
anestesi lokal dan regional.
• William Halsted Steward (1884): melakukan blok saraf gigi inferior
pertama degan kokain.
• Alfred Einhorn (1904-1905): melakukan esterifikasi basa alkohol
dengan asam benzoat untuk mensintesis prokain.
• Lofgren (1943): mensintesis Lidokain dari turunan anilin.

Butterworth IV, Clinical Pharmacology of Local Anesthetics. Available from

https://www.nysora.com/topics/pharmacology/clinical-pharmacology-local-anesthetics/#toc_INTRODUCTION
Jaan et al. Local Anesthesia - Solution to Pain : An Overview. Journal of Current Medical Resaearch and Opinion. 2020
Yu et al. The development of local anesthetics and Their Applications Beyond Anesthesia. Int J Clin Exp Med. 2019
 Sejarah Perkembangan LA

Yu et al. The development of local anesthetics and Their Applications Beyond Anesthesia. Int J Clin Exp Med. 2019
LA mencegah pembentukan dan konduksi impuls saraf dengan
menghalangi masuknya ion NA+ melalui kanal NA dan
mencegah transmisi gelombang polarisasi di sepanjang saraf
xAdapted from https://www.nysora.com/topics/pharmacology/clinical-pharmacology-local-anesthetics/#toc_INTRODUCTION
 Prosedur yang Umum Menggunakan LA

Biopsi, Eksisi,
Prosedur Operasi
bedah minor
Dental Podiatri
lainnya

Prosedur
Cataract Diagnostik
Cysctoscopy
Removal (pungsi lumbal,
dll)

Manajemen
DLL
Nyeri Post Op

Torpy et al. Local Anesthesia. JAMA, September 28, 2011—Vol 306, No. 12
 Jenis Obat LA yang Sering Digunakan

Amino Amides Amino Esters Quinolone

• Mepivacaine • Procaine • Centbucridine
• Lidocaine • Cocaine
• Etidocaine • Chloroprocaine
• Bupivacaine • Tetracaine
• Levobupivacaine • Benzocaine
• Ropivacaine

Garmon EH, Huecker MR. Topical, Local, and Regional Anesthesia and Anesthetics. [Updated 2022 May 3]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430894/?report=classic
Jaan et al. Local Anesthesia - Solution to Pain : An Overview. Journal of Current Medical Resaearch and Opinion. 2020
 Potensi Obat LA

Low potency, • Procaine

short duration • Chloroprocaine

Intermediate • Lidocaine
potency &
• Prilocaine.
duration
High potency • Bupivacaine
& long
• Tetracaine.
duration

Jaan et al. Local Anesthesia - Solution to Pain : An Overview. Journal of Current Medical Resaearch and Opinion. 2020
 Cara Pemberian LA

Topikal Oral/Gargle

Infiltrasi/
Intravena
Subkutan

Garmon EH, Huecker MR. Topical, Local, and Regional Anesthesia and Anesthetics. [Updated 2022 May 3]. In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430894/?report=classic
 Clinical Use of LA
Neuraxial Anesthesia

Spinal

Epidural

Caudal

Combined Spinal-Epidural
Anesthesia (CSE)

Rehatta et al., Anestesiologi dan Terapi Intensif Buku Teks KATI-PERDATIN, Ed 1. 2019
 Anestesi Spinal

Paling sering digunakan

Tingkat kepuasan pasien tinggi

Kesuksesan dipengaruhi pengalaman

dokter, karakteristik pasien, jenis dan
dosis obat yang digunakan.

Tingkat kegagalan rendah

Yüksek A, Miniksar Ö, H, Honca M, Öz H: Incidence and Causes of Failed Spinal Anesthesia. Dubai Med J 2020;3:50-54. doi: 10.1159/000508837
 Clinical Use of LA
Peripheral Nerve Block
Upper Extremity Block Lower Extremity Block
• Brachial Plexus • Femoral
• Supraclavicular • Obturator
• Interschalenus • Adductor Canal Block
• Infraclavicula • Sciatic
• Axillaris • Popliteal
• Terminal Nerve • Lumbar Plexus
• Ankle
• Dll
Rehatta et al., Anestesiologi dan Terapi Intensif Buku Teks KATI-PERDATIN, Ed 1. 2019
 Clinical Use of LA
Trunchal Block

Blok
Blok Blok Saraf
Transversus
Paravertebral Pectoralis
Abdominal
Toraks (PECS)
Plane (TAP)

Rehatta et al., Anestesiologi dan Terapi Intensif Buku Teks KATI-PERDATIN, Ed 1. 2019
Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
 Clinical Use of LA

Peripheral Nerve Block

• Jenis dan konsentrasinya dipilih sesuai tujuan blok (anestesi
bedah dan/ analgesia postop), derajat blok motorik, toksisitas,
& durasi blok yang diinginkan.

Intravenous Regional Anesthesia (IVRA)

• Di AS: lidokain paling sering digunakan.
• Prilocaine digunakan secara umum di tempat lain, tapi
cenderung menyebabkan efek samping SSP.

Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
 Clinical Use of LA

Infiltrasi
• Infiltrasi jaringan
• Subkutan

Anestesi Topikal
• Kulit dan membran mukosa
• Salep, gel, larutan untuk nebulisasi, spray, gargle, dll.
• Paling sering digunakan untuk laringoskopi sadar dan
intubasi.

Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
 …Anestesi Topikal

Lidokain
• Sediaan: larutan 2% & 4%, gel 2% & 4%, dan salep 5%.
• Pada mukosa: onset bbrp menit, durasi bervariasi (min
30mnt).
• Dosis maks: 4,5 mg/kg, tidak melebihi 300 mg/dosis.
• Lidokain untuk anestesi orofaringeal diserap melalui mukosa
dan saluran pencernaan saat tertelan.

Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
 …Anestesi Topikal

Benzokain
• Cocok untuk anestesi topikal pada membran mukosa.
• Sediaan: gel, cairan, salep, dan spray.
• Spray 20% paling sering digunakan untuk anestesi jalan napas.
• Dosis spray sulit ditentukan, maks. 200 mg.
• Diserap cepat, terutama jika mukosa tidak utuh.
• Benzokain untuk endoskopi dikaitkan dengan derajat
methemoglobinemia yang berat → diganti dengan lidokain.

Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
 Clinical Use of LA
Systemic Local Anesthetic Administration
• Lidokain:
• Diberikan secara iv (bolus/infus).
• Penanganan aritmia ventrikel yang mengancam jiwa.
• Untuk ↓rasa sakit yang terkait dengan injeksi propofol,
ajuvan selama induksi anestesi, & menumpulkan respons
simpatik terhadap manipulasi jalan napas.
• Untuk ↑analgesia setelah prosedur bedah (infus iv intraop &
postop)

Butterworth J et al. Clinical use of local anesthetics in anesthesia. [Updated 2022 April 18]. In: UpToDate [Internet]. MediMedia. Publishing; 2022 Jun.
Available from: https://www.medilib.ir/uptodate/show/14929#top
TERIMA KASIH