Chapter

Peripheral nerve and local anaesthetic drugs

Cameron Weir and Gary Strichartz

in Principles and Practice of Regional Anaesthesia

Fourth edition

Published on behalf of Oxford University Press

Published in print November 2012 | ISBN: 9780199586691
Published online November 2012 | e-ISBN: 9780191755507 | DOI: http://dx.doi.org/10.1093/med/9780199586691.003.0006

Series: Oxford Textbooks in Anaesthesia

Peripheral nerve and local anaesthetic drugs

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Local anaesthetics are drugs which block reversibly the conduction of impulses in the peripheral nervous system. The fundamental mode of action is far from unique to peripheral nerves, explaining both the systemic toxicity of these drugs and their other clinical uses (e.g. cardiac arrhythmias and refractory epilepsy). However, this chapter will focus on their actions in blocking both afferent and efferent nerve impulses as a component of surgical anaesthesia. ‘Local’ anaesthesia may be achieved by simple surgical site infiltration, selective peripheral nerve block, or central neuraxial block. Whatever method is employed, optimal operating conditions and postoperative analgesia can only be provided if the clinician has a clear understanding of the anatomical, neurophysiological, and pharmacological aspects of neuronal function and local anaesthetic activity. For example, the anatomical arrangement of the nerves governs the distribution of a local anaesthetic block once an agent has been applied at a particular site, with this impulse block having the same functional significance whatever factor (drug, temperature, surgery, etc.) is used to produce it. By contrast, micro-anatomical, in addition to neurophysiological and pharmacokinetic factors, affect the action of drugs, because they must be able to penetrate the often considerable coverings of a nerve before its function can be interrupted.

Chapter.  8395 words.  Illustrated.

Subjects: Anaesthetics ; Clinical Pharmacology and Therapeutics

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