Chapter 1 Basic Principles of Analgesia

Overview

Review of Local Anesthetics

1. The two most commonly used local anesthetics are lidocaine (Xylocaine) and bupivacaine (Marcaine, Sensorcaine) (Table 1-1).

a. Recent studies have suggested that bupivacaine may be toxic to chondrocytes.

b. Ropivacaine (Naropin) has been found to be significantly less toxic to chondrocytes.

c. Whenever possible, ropivacaine should be used instead of bupivacaine when performing an intraarticular injection. Unfortunately, ropivacaine is not routinely available in hospital emergency departments.

2. Epinephrine is a vasoconstrictor and is often added to the local anesthetic.

a. Epinephrine improves onset of action, decreases drug uptake, and prolongs action.

b. An epinephrine concentration of 1:200,000 is typically used.

c. Because it is a vasoconstrictor, epinephrine should not be used in the distal extremities. The following well-known mnemonic is often used to recall the areas where epinephrine should not be used: nose, hose (penis), digits, toes.

Table 1-1 Local Anesthetics

Types of Local Orthopaedic Analgesia

1. In general, three different techniques are used to achieve local analgesia:

a. Intra-articular injection

b. Hematoma block

(1) A hematoma block involves injection of anesthetic directly into the fracture hematoma.

c. Nerve block

(1) A nerve block may be of a specific nerve or of a group of nerves crossing a joint.

(2) For example, a “wrist block” involves nerve blocks of the radial, median, and ulnar nerves.

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