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LA General

This document summarizes key local anesthetics including lidocaine, prilocaine, bupivacaine, ropivacaine, and mepivacaine. It provides maximum dosage levels and duration of action for each. Additional details are given on additive drugs like fentanyl, epinephrine, sodium bicarbonate, and neosynephrine that can prolong local anesthetic effects or alter properties. Routes of administration and mechanisms of action are briefly explained for select drugs.

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Nicole Cardenas
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44 views2 pages

LA General

This document summarizes key local anesthetics including lidocaine, prilocaine, bupivacaine, ropivacaine, and mepivacaine. It provides maximum dosage levels and duration of action for each. Additional details are given on additive drugs like fentanyl, epinephrine, sodium bicarbonate, and neosynephrine that can prolong local anesthetic effects or alter properties. Routes of administration and mechanisms of action are briefly explained for select drugs.

Uploaded by

Nicole Cardenas
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Drug Max Doses Durations Other

Lidocaine 4mg/kg Moderate


7mg/kg w/epi

Prilocaine 8mg/kg Moderate  Metabolite is ortho-toluidine


-responsible for methemoglobin
-tx methylene bule 1-2mg/kg over 5 min

Bupivicaine 2mg/kg Long  Sensory > motor block


3mg/kg w/epi  Epi will NOT prolong DOA
 Epidural  Cardiotoxicity due to Duration
0.5-0.75%  95% protein bound- < likely to cross
placenta
Ropivacaine 3mg/kg Long  Designed to be long acting but w/o
cardiotox of bupivicaine
 Available  Exist only as S isomer
0.5/0.75/1%  Used for epidural, brach. Plex block, &
infiltration
 Vasoconstrics when inj SQ
 Metab. In liver, excreted by kidney
Mepivicaine 4mg/kg Moderate  Properties similar to Lido except:
7mg/kg w/epi o Slower onset
o DOA long than lido
o Lacks vasodilation properties ->
does not need epi for prolongation
Procaine & Chloroprocaine = short acting
Opioid Additive
Fentanyl Epidural: 1 – 2 mcq/kg  Anegesia is a function of drug diffusion to mu receptors in
cord as well as systemic absorption
Spinal: 0.1 – 0.4 mcq/kg  Opoid receptors are present in the substania gelatinosa
 The > lipid sol. Of the drug the < it remains in CSF
o Fentanyl, Sufenta < MS in terms of time in CSF
Epidural- absorbed rapidly into the blood and migrate to CSF to the brain causing analgesia

Spinal – Pre & Postsynaptic receptor in the substantia gelatinosa of the dorsal horn

Non-Opiod Additives
Drug: Dose
Epinephrine 0.2 mg  Prolongs block by 40%
Max = 500 mcq  Plasma levels _ up to 50%
 Not to be used in IV Regional – Bier Blocks
 Not to be used w/ MAOI or tricyclic antidepressants
 Not to be used w/ Uteroplacenta insuff,
 Not to be used w/ uncontrolled HTN, aginia or cardiac
dysrhymias
Sodium 1 meq to each  _ pH of LA = _ unionized fraction = more rapid onset & spread of
Bicarbonate 10cc anesthesia
Neosynephrine 2 – 5 mg  Prolongs block by 70%
 Does not significantly _ peak blood levels of LA
10% Dextrose  For hyperbaric spinal
Sterile H2O  For hypobaric spinal

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