y Are the second class of anaesthetics.

They are also called regional anaesthetics because they render a specific portion of the body insensitive to pain without major reduction of CNS function and level of consciousness. y The most local anaesthetics belong to one of two major groups of organic compounds, esters and amides, and are classified as either topical and parenteral (injectable) anaesthetics. Topical anaesthetics are applied directly to the skin and mucous membrane. They are available in the form of solutions, gel, cream or powder y Parenteral anaesthetics can be administered intravenously or by various spinal injection techniques

y Short-acting- last for 30 minutes to one hour.

Ex. Chloroprocaine, procaine(novocaine) y Moderate-acting- one to three hours duration of Action Ex. Lidocaine(xylocaine) y Long-acting-last for three to ten hours Ex. Bupivacaine(sensorcaine), tetracaine HCI (pontocaine)

y Generic Name: Nesacaine

Brand Name: (chloroprocaine HCl) Injection, USP y Nesacaine-MPF (chloroprocaine HCl) Injection, USP
y INDICATIONS y Nesacaine (chloroprocaine) 1% and 2% Injections, in multidose vials

with methylparaben as preservative, are indicated for the production of local anesthesia by infiltration and peripheral nerve block. They are not to be used for lumbar or caudal epidural anesthesia. y Nesacaine (chloroprocaine) -MPF 2% and 3% Injections, in single dose vials without preservative and without EDTA, are indicated for the production of local anesthesia by infiltration, peripheral and central nerve block, including lumbar and caudal epidural blocks. y Nesacaine (chloroprocaine) and Nesacaine (chloroprocaine) -MPF Injections are not to be used for subarachnoid administration.

y DOSAGE AND ADMINISTRATION y Administered as a single injection or continuously through an

indwelling catheter. As with all local anesthetics, the dose administered varies with the anesthetic procedure, the vascularity of the tissues, the depth of anesthesia and degree of muscle relaxation required, the duration of anesthesia desired, and the physical condition of the patient. The smallest dose and concentration required to produce the desired result should be used. Dosage should be reduced for children, elderly and debilitated patients and patients with cardiac and/or liver disease. y Caudal and Lumbar Epidural Block: In order to guard against adverse experiences sometimes noted following unintended penetration of the subarachnoid space, the following procedure modifications are recommended:

y Use an adequate test dose (3 mL of Nesacaine

(chloroprocaine) -MPF 3% Injection or 5 mL of Nesacaine (chloroprocaine) -MPF 2% Injection) prior to induction of complete block. This test dose should be repeated if the patient is moved in such a fashion as to have displaced the epidural catheter. Allow adequate time for onset of anesthesia following administration of each test dose. y Avoid the rapid injection of a large volume of local anesthetic injection through the catheter. Consider fractional doses, when feasible.

y Pediatric Dosage: It is difficult to recommend a maximum dose of any drug for children, since this varies as a function of age and weight. For children over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child's age and weight and should not exceed 11 mg/kg (5 mg/lb). For example, in a child of 5 years weighing 50 lbs (23 kg), the dose of chloroprocaine HCl without epinephrine would be 250 mg. Concentrations of 0.5-1% are suggested for infiltration and 1-1.5% for nerve block. In order to guard against systemic toxicity, the lowest effective concentration and lowest effective dose should be used at all times.

y SIDE EFFECTS y Central Nervous System Reactions: These are characterized by

excitation and/or depression. Restlessness, anxiety, dizziness, tinnitus, blurred vision or tremors may occur, possibly proceeding to convulsions. y Cardiovascular System Reactions: High doses, or unintended intravascular injection, may lead to high plasma levels and related depression of the myocardium, hypotension,bradycardia, and, possibly, cardiac arrest. Allergic: Allergic type reactions are rare and may occur as a result of sensitivity to the local anesthetic or to other formulation ingredients, such as the antimicrobial preservative methylparaben, contained in multiple dose vials. These reactions are characterized by signs such as tachycardia, sneezing, nausea, vomiting, dizziness,excessive sweating, elevated temperature, and possibly,(including severe hypotension).

y Pharmacokinetics y The rate of systemic absorption of local anesthetic drugs is dependent upon the total dose and concentration of drug administered, the route of administration, the vascularity of the administration site, and the presence or absence of epinephrine in the anesthetic injection. Epinephrine usually reduces the rate of absorption and plasma concentration of local anesthetics and is sometimes added to local anesthetic injections in order to prolong the duration of action. y The onset of action with chloroprocaine is rapid (usually within 6 to 12 minutes), and the duration of anesthesia, depending upon the amount used and the route of administration, may be up to 60 minutes.

Novocain
y y y y

Generic Name:Procaine Brand Name: Novocain Description It is a white crystalline, odorless powder that is freely soluble in water, but less soluble in alcohol. Each mL contains 100 mg procaine hydrochloride and 4 mg acetone sodium bisulfite as antioxidant

y Clinical Pharmacology y Novocain stabilizes the neuronal membrane and prevents the initiation

and transmission of nerve impulses, thereby effecting local anesthesia. Novocain lacks surface anesthetic activity. The onset of action is rapid (2 to 5 minutes) and the duration of action is relatively short (average 1 to 1 hours), depending upon the anesthetic technique, the type of block, the concentration, and the individual patient.

y Indications and Usage for Novocain y Novocain is indicated for spinal anesthesia. y Contraindications y Spinal anesthesia with Novocain is contraindicated in

patients with generalized septicemia: sepsis at the proposed injection site; certain diseases of the cerebrospinal system, meningitis, syphilis; and a known hypersensitivity to the drug.

y Adverse Reactions y Use of inappropriate doses or techniques may result in extensive spinal y y

y y

blockade leading to hypotension and respiratory arrest. A small number of reactions may result from hypersensitivity, diminished tolerance to normal dosage. CNS effects (nervousness, dizziness, blurred vision, tremors) commonly represent the initial signs of local anesthetic systemic toxicity. However, these reactions may be very brief or absent in some patients in which case the first manifestation of toxicity may be drowsiness or convulsions merging into unconsciousness and respiratory arrest. Cardiovascular system reactions include depression of the myocardium, hypotension (or sometimes hypertension), bradycardia, and even cardiac arrest. Allergic reactions are characterized by cutaneous lesions of delayed onset,edema, and other manifestations of allergy.

Generic Name: Lidocaine hydrochloride Brand Name: Xylocaine

y Indications and Usage for Lidocaine y Lidocaine Hydrochloride Injection, is indicated for production of local or regional anesthesia by infiltration techniques such as percutaneous injection and intravenous regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques. y Dosages y ADULTS:50-100mg(1 to 1.5mg/kg)by I.V. Bolus at 25-50 mg/minute. y CHILDREN: 1 mg/kg by I.V. Bolus. y Elderly pt.: reduce dosage and rate of infusion by 50%. y Administration y Injection(addictive syringes and single use vials)containing 40, 100, or 200mg/ml are for the preparation of I.V. Infusion solutions only and must be diluted before use. y Use a more concentrated solution of up to 8mg/ml if pt. Is fluid restricted. y Avoid giving injections containing preservative

y Adverse Reactions y CNS: confusion, restlessness, tremor, lethargy, anxiety, y y y y

hallucinations, nervousness, seizures. CV: hypotension, bradycardia, cardiac arrest. GI: vomiting. Respiratory: respiratory depression and arrest. SKIN: soreness and injection site

y CONTRAINDICATIONS & CAUTIONS y Contraindicated in pt. Hypersensitive to the amide type of local

anesthetics. y Use cautiously and at reduced dosages in pt. With complete or second degree heart block, in elderly pt. , in those with heart failure or renal or hepatic disease, and in those weighing less than 50kg(110 lb.)
y y y y

NURSING CONSIDERATIONS Give I.M. Injections in the deltoid muscle only. Monitor drug level. Therapeutic levels are 2-5 mcg/ml. Monitor patient s response, especially blood pressure and electrolytes. Notify prescriber promptly if abnormalities develop.

Generic Name: Bupivacaine Brand Name: sensorcaine

y Indication y Bupivacaine Spinal is indicated for the production of

subarachnoid block (spinal anesthesia).

y Contraindications y contraindicated in patients with a known hypersensitivity to it or

to any local anesthetic agent of the amide-type.

y The following conditions preiclude the use of spinal anesthesia: y Severe hemorrhage, severe hypotension or shock and such as

complete heart block, which severely restrict cardiac output. y Local infection at the site of proposed lumbar puncture. y Septicemia.

y Adverse Reactions y Respiratory System: Respiratory paralysis or underventilation may be noted as

a result of upward extension of the level of spinal anesthesia and may lead to secondary hypoxic cardiac arrest if untreated. Preanesthetic medication, intraoperative analgesics and sedatives, as well as surgical manipulation, may contribute to underventilation. y Cardiovascular System: Hypotension due to loss of sympathetic tone is a commonly encountered extension of the clinical pharmacology of spinal anesthesia. Nausea and vomiting are frequently associated with hypotensive episodes following the administration of spinal anesthesia. High doses, or inadvertent intravascular injection, may lead to high plasma levels and related depression of the myocardium, decreased cardiac output, bradycardia, heart block, and, possibly, cardiac arrest. y High doses or inadvertent intravascular injection may lead to high plasma levels and related central nervous system toxicity characterized by excitement and/or depression. Restlessness, anxiety, dizziness,blurred vision or tremors may occur, possibly proceeding to convulsions. y Nausea and vomiting may occur during spinal anesthesia.

y Management of Local Anesthetic Emergencies: The

first consideration is prevention, best accomplished by careful and constant monitoring of cardiovascular and respiratory vital signs and the patient s state of consciousness after each local anesthetic injection. At the first sign of change, oxygen should be administered.

y Bupivacaine Dosage and Administration y The dose of any local anesthetic administered varies with the

anesthetic procedure, the area to be anesthetized, the vascularity of the tissues, the number of neuronal segments to be blocked, the depth of anesthesia and degree of muscle relaxation required, the duration of anesthesia desired, individual tolerance, and the physical condition of the patient. The smallest dose and concentration required to produce the desired result should be administered. Dosages of Bupivacaine Spinal (Bupivacaine in Dextrose Injection,) should be reduced for elderly and debilitated patients and patients with cardiac and/or liver disease. y Obstetrical Use: Doses as low as 6 mg Bupivacaine hydrochloride have been used for vaginal delivery under spinal anesthesia. The dose range of 7.5 mg to 10.5 mg (1 mL to 1.4 mL) Bupivacaine hydrochloride has been used for Cesarean section under spinal anesthesia.

Generic Name: tetracaine HCI Brand Name: Pontocaine

y Tetracaine is a local anesthetic (numbing medication).

It works by blocking nerve signals in your body. y Tetracaine topical cream or ointment is used to reduce pain or discomfort caused by minor skin irritations, cold sores or fever blisters, sunburn or other minor burns, insect bites or stings, and many other sources of minor pain on a surface of the body.

y Important information y An overdose of numbing medications can cause fatal side effects if too much of

the medicine is absorbed through your skin and into your blood. This is more likely to occur when using a numbing medicine without the advice of a medical doctor (such as during a cosmetic procedure like laser hair removal). Overdose symptoms may include uneven heartbeats, seizure (convulsions), coma, slowed breathing, or respiratory failure (breathing stops). Your body may absorb more of this medication if you use too much, if you apply it over large skin areas, or if you apply heat, bandages, or plastic wrap to treated skin areas. Skin that is cut or irritated may also absorb more topical medication than healthy skin. y Use the smallest amount of this medication needed to numb the skin or relieve pain. Do not use large amounts of tetracaine topical, or cover treated skin areas with a bandage or plastic wrap without medical advice. Be aware that many cosmetic procedures are performed without a medical doctor present. y Do not use this medication if you are allergic to tetracaine or other numbing medicines such as lidocaine, benzocaine, or prilocaine.

y Indications and dosage y Do not use the medication in larger or smaller amounts, or use it for longer than recommended. y Your body may absorb more of this medication if you use too much, if you apply it over large skin areas, or if you apply heat, bandages, or plastic wrap to treated skin areas. Skin that is cut or irritated may also absorb more topical medication than healthy skin. y Use the smallest amount of medicine needed to numb the skin or relieve pain. Do not use large amounts of tetracaine topical, or cover treated skin areas with a bandage or plastic wrap without medical advice. Be aware that many cosmetic procedures are performed without a medical doctor present. y This medication comes with instructions for safe and effective application. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. y To treat minor skin conditions, apply a thin layer of tetracaine topical to the affected area up to 4 times per day. y Do not use tetracaine topical to treat large skin areas or deep puncture wounds. Avoid using the medicine on skin that is raw or blistered, such as a severe burn or abrasion.

y side effects y Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using tetracaine topical and call your doctor at once if you have any of these serious side effects: y severe burning, stinging, or sensitivity where the medicine is applied; y swelling, warmth, or redness; y oozing, blistering, or any signs of infection; or y eye irritation, watering, or increased sensitivity to light. y Rare but serious side effects may include: y nervousness, dizziness, blurred vision; y drowsiness, feeling like you might pass out; y breathing problems; y fast or slow heart rate; and y weak pulse, fainting, slow breathing (breathing may stop). y Less serious side effects may include: y mild stinging, burning, or itching where the medicine is applied; y skin tenderness or redness; or y dry white flakes where the medicine was applied.

y Administration y Use this medication exactly as directed on the label, or as it has been prescribed by your doctor. Do not use the medication in larger or smaller amounts, or use it for longer than recommended. y Your body may absorb more of this medication if you use too much, if you apply it over large skin areas, or if you apply heat, bandages, or plastic wrap to treated skin areas. Skin that is cut or irritated may also absorb more topical medication than healthy skin. y Use the smallest amount of medicine needed to numb the skin or relieve pain. Do not use large amounts of tetracaine topical, or cover treated skin areas with a bandage or plastic wrap without medical advice. Be aware that many cosmetic procedures are performed without a medical doctor present. y This medication comes with instructions for safe and effective application. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. y To treat minor skin conditions, apply a thin layer of tetracaine topical to the affected area up to 4 times per day. y Do not use tetracaine topical to treat large skin areas or deep puncture wounds. Avoid using the medicine on skin that is raw or blistered, such as a severe burn or abrasion.