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Local Anaesthetic – Effects, Uses & Active Substances

A local anaesthetic is a medication that temporarily blocks pain in a specific area of the body without affecting consciousness or general awareness.

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Things worth knowing about "Local Anaesthetic"

A local anaesthetic is a medication that temporarily blocks pain in a specific area of the body without affecting consciousness or general awareness.

What is a Local Anaesthetic?

A local anaesthetic is a medication that temporarily numbs a defined area of the body, eliminating pain sensation without causing loss of consciousness. Unlike general anaesthesia, the patient remains fully awake and alert throughout the procedure. Local anaesthetics are widely used in medicine, dentistry, and surgery to enable pain-free interventions.

Mechanism of Action

Local anaesthetics work by blocking sodium channels in the membranes of nerve cells. This prevents the transmission of pain signals along the nerve to the brain. As a result, the patient feels no pain in the treated area. The effect is fully reversible: once the substance is metabolised, normal sensation returns gradually.

Indications and Uses

Local anaesthetics are used across a wide range of medical specialties:

Dentistry: Numbing the mouth for tooth extractions, fillings, or root canal treatments
Surgery: Minor procedures on the skin and soft tissues
Regional anaesthesia: Blocking larger nerve regions, e.g., epidural anaesthesia during childbirth
Emergency medicine: Rapid pain relief following injuries
Dermatology: Numbing before skin biopsies or removal of skin lesions

Common Active Substances

The most frequently used local anaesthetics include:

Lidocaine: The most widely used local anaesthetic, fast-acting and commonly used in dentistry and emergency medicine
Articaine: Widely used in dentistry due to its excellent tissue penetration
Bupivacaine: A long-acting agent frequently used for epidural anaesthesia
Ropivacaine: Also long-acting, often used for nerve blocks
Mepivacaine: Commonly used in dentistry and peripheral nerve blocks

Forms of Administration

Local anaesthetics can be administered in several ways:

Injection: Directly into the tissue or near a specific nerve
Topical application: As a cream, gel, or spray applied to the skin or mucous membranes (e.g., EMLA cream)
Epidural or spinal anaesthesia: Injection into the spinal canal to numb larger areas of the body

Dosage and Treatment Context

The appropriate dosage depends on the type of procedure, the specific agent used, the body weight of the patient, and the area to be anaesthetised. Administration must always be carried out by trained medical professionals. Some formulations also contain adrenaline (epinephrine), which constricts blood vessels, prolongs the duration of action, and slows systemic absorption of the anaesthetic.

Side Effects and Risks

When used correctly, local anaesthetics are generally well tolerated. Possible side effects include:

Local reactions: redness, swelling, or burning at the injection site
Systemic toxicity: If accidentally injected into a blood vessel, cardiovascular disturbances or seizures may occur
Allergic reactions (rare, more common with older ester-type agents such as procaine)
Nerve damage (very rare)

Special caution is needed in patients with cardiac arrhythmias, liver disease, or a known allergy to local anaesthetics.

References

Butterworth J.F., Mackey D.C., Wasnick J.D. - Morgan & Mikhail's Clinical Anesthesiology. 6th edition. McGraw-Hill Education (2018).
Rang H.P., Ritter J.M., Flower R.J., Henderson G. - Rang & Dale's Pharmacology. 9th edition. Elsevier (2020).
World Health Organization (WHO) - WHO Model Formulary. Geneva: WHO Press (2008). Available at: https://www.who.int

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