Local Anesthetic

Feb 17, 2023

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The choice of local anesthetic is primarily based on its pharmacokinetics. The site of administration and route of administration can affect the properties of the drug. Most local anesthetics act rapidly when given parenterally for infiltration anesthesia, the fastest being lidocaine (0.5-1 min), followed by prilocaine (1-2 min). The average onset time for the remaining proxies is 3-5 minutes. Except for tetracaine, which may take up to 15 minutes. Epidurals take longer to work, with most local anesthetics taking an average of about 5-15 minutes to work. Procaine (15-25 minutes), tetracaine (20-30 minutes), and bupivacaine (10-20 minutes) are all slightly slower to act when given epidurally than the other drugs.

The duration of action of injectable anesthetics is important in their selection for use in various procedures. Procaine and chloroprocaine were the drugs with the shortest onset of action (0.25-0.5 hours), followed by lidocaine, mepivacaine, and prilocaine, which had a slightly longer duration of action (0.5-1.5 hours ). Long-acting medications include tetracaine (2-3 hours), bupivacaine (2-4 hours), etidocaine (2-3 hours), and ropivacaine. Ropivacaine has a duration of 8-13 hours when used for peripheral nerve blocks, but only 2.5-6 hours for effective analgesia when given epidurally.

When applied topically, local anesthetics reach their peak effect at various times when applied to the mucous membranes. Benzocaine was fastest (1 minute), followed by lidocaine = cocaine < pramoxine < tetracaine < dyclonine and < dibucaine. The duration of action for all topical products ranges from approximately 30 minutes to an hour. The effects of cocaine can last up to 2 hours after topical application, while the effects of dibucaine last the longest at 3-4 hours.