Local Anesthetics

BACKGROUND Dermatology is dependent upon the effects of local anesthetics for diagnostic and therapeutic interventions. A working knowledge of the drugs’actions and interactions is necessary for anyone aspiring to optimize the benefits derived from the use local anesthetic agents. OBJECTIVE This article reviews nerve physiology, pharmacology, classification of local anesthetics, adverse reactions (toxic, drug, allergic), local anesthetic use in pregnancy, alternatives to the “-caine” anesthetics, methods for reducing the pain of infiltration, and new agents under development. CONCLUSION Local anesthetics are safe and effective. With the understanding of the actions and interactions of this class of drugs, maximum patient safety and satisfaction can be achieved. LEARNING OBJECTIVES After studying this article, participant should be able to: Be familiar with general nerve structure, physiology, and local anesthetic interactions. Understand the pharmacologic properties, classification, and effects of local anesthetics. Recognize and initiate treatment for adverse reactions to local anesthetics. Be aware of techniques to minimize the pain of infiltration. Understand the alternatives to “-caine” anesthetics and new anesthetics under evaluation.