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IDEAL REQUIREMENTS
AND COMPOSITION OF
LOCAL ANAESTHESIA
Dr.Shabana Shaikh
B.D.S.Lecturer, Dept of Oral & Maxillofacial
Surgery,
M.M.N.G.H Institute of Dental Sciences,
Belgaum.
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DEFINITIONDEFINITION
LOCAL ANAESTHESIALOCAL ANAESTHESIA
Local anaesthesia is the loss of sensation in aLocal anaesthesia is the loss of sensation in acircumscribed area of the body caused by acircumscribed area of the body caused by a
depression of excitation in nerve endings or andepression of excitation in nerve endings or an
inhibition of the conduction process in peripheralinhibition of the conduction process in peripheral
nerves.nerves.
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LOCAL ANAESTHETICSLOCAL ANAESTHETICS
Local anaesthetics are drugs that have little orLocal anaesthetics are drugs that have little or
no irritating effects when injected into the tissuesno irritating effects when injected into the tissues
and that will temporarily interrupt conductionand that will temporarily interrupt conduction
when absorbed into the nerves.when absorbed into the nerves.
eg. : Lignocaine, Procaine, Xylocaineeg. : Lignocaine, Procaine, Xylocaine
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IDEAL REQUIREMENTS OFIDEAL REQUIREMENTS OF
LOCAL ANAESTHESIALOCAL ANAESTHESIA
The action must be reversible.The action must be reversible.
NonNon--irritating to the tissues.irritating to the tissues.
No secondary local reactions.No secondary local reactions.
Low degree of systemic toxicity.Low degree of systemic toxicity.
Rapid onset & sufficient duration of action.Rapid onset & sufficient duration of action.
Potency sufficient to render complete anesthesia.Potency sufficient to render complete anesthesia.
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IDEAL REQUIREMENTS OFIDEAL REQUIREMENTS OF
LOCAL ANAESTHESIALOCAL ANAESTHESIA (cont)(cont)
Potency sufficient to render complete anesthesia.Potency sufficient to render complete anesthesia.
Sufficient penetrating properties.Sufficient penetrating properties. NonNon--allergenic.allergenic.
Stable in solution.Stable in solution.
Undergo biotransformation readily in the body.Undergo biotransformation readily in the body.
Sterile.Sterile.
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CLASSIFICATION OFCLASSIFICATION OF
LOCAL ANAESTHESIALOCAL ANAESTHESIA
( I ) BASED ON CHEMICAL COMPOSITION( I ) BASED ON CHEMICAL COMPOSITION
( A ) ESTER GROUP( A ) ESTER GROUP
( B ) NON ESTER GROUP( B ) NON ESTER GROUP
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ESTER GROUPESTER GROUP
A.Benzoic acid esters :A.Benzoic acid esters :
1.Cocaine(topical only).1.Cocaine(topical only).
2.Benzocaine(topical).2.Benzocaine(topical).B.ParaB.Para--aminobenzoic acid esters :aminobenzoic acid esters :
1. Procaine.1. Procaine.
2. Tetracaine.2. Tetracaine.3. Propoxycaine.3. Propoxycaine.
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NON ESTER GROUPNON ESTER GROUP
AMIDESAMIDES
*Atricaine*Atricaine
*Lignocaine*Lignocaine*Bupivacaine*Bupivacaine
*Prilocaine*Prilocaine
QUINOLONESQUINOLONES*Centbucridine*Centbucridine
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Based on duration of actionBased on duration of action
1) Short duration (apprx.30 minutes)1) Short duration (apprx.30 minutes)
Lignocaine HCl 2%Lignocaine HCl 2%Mepivacaine HCl 2%Mepivacaine HCl 2%
Prilocaine HCl 4%Prilocaine HCl 4%
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Based on duration of actionBased on duration of action
Intermediate duration (apprx.60 minutes)Intermediate duration (apprx.60 minutes)
*Lidocaine HCL 2% + Epinephrine 1:100000*Lidocaine HCL 2% + Epinephrine 1:100000
*Atricaine HCl 4% + Epinephrine 1:200000*Atricaine HCl 4% + Epinephrine 1:200000
*Prilocaine HCl 4% + Epinephrine 1:200000*Prilocaine HCl 4% + Epinephrine 1:200000
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Based on duration of actionBased on duration of action
Long duration (apprx. 90+minutes)Long duration (apprx. 90+minutes)
Bupivacaine HCl 0.5%+EpinephrineBupivacaine HCl 0.5%+Epinephrine
1:2000001:200000
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(III ) BASED ON BIOLOGICAL(III ) BASED ON BIOLOGICAL
SITE AND MODE OF ACTIONSITE AND MODE OF ACTIONClass AClass A
Acting at receptor site on external surface of nerveActing at receptor site on external surface of nervemembranemembrane
eg. : Biotoxinseg. : Biotoxins
Class BClass BActing at receptor site on internal surface of nerveActing at receptor site on internal surface of nerve
membranemembraneeg. : Scorpion venom,Quaternary ammonium analogues ofeg. : Scorpion venom,Quaternary ammonium analogues oflidocainelidocaine
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(III) BASED ON BIOLOGICAL SITE(III) BASED ON BIOLOGICAL SITE
AND MODE OF ACTIONAND MODE OF ACTIONClass CClass C
Acting by a receptorActing by a receptor--independent physiochemicalindependent physiochemical
mechanismmechanismeg. : Benzocaineeg. : Benzocaine
Class DClass D
Acting by combination of receptor and receptorActing by combination of receptor and receptorindependent mechanismsindependent mechanisms
eg. : Articaine, Lidocaine, Prilocaineeg. : Articaine, Lidocaine, Prilocaine
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LOCAL ANAESTHETICSLOCAL ANAESTHETICS
May be an amide or an ester.May be an amide or an ester.
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VASOCONSTRICTORVASOCONSTRICTOR
Epinephrine is used as a vasoconstrictorEpinephrine is used as a vasoconstrictor
-- Causes vasoconstriction and preventsCauses vasoconstriction and prevents
rapid absorption.rapid absorption.-- It produces desired effect at lowerIt produces desired effect at lower
dose of L.A.dose of L.A.
-- It reduces systemic toxicity.It reduces systemic toxicity.
-- It also causes hemostasis.It also causes hemostasis.
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ANTIOXIDANTANTIOXIDANT
Sodium metabisulphiteSodium metabisulphite
It delays rapid oxidation of vasoconstrictorIt delays rapid oxidation of vasoconstrictorand prolongs the shelf life of the solutionand prolongs the shelf life of the solution
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PRESERVATIVEPRESERVATIVE
Methyl parabenMethyl paraben
FUNGICIDEFUNGICIDE
ThymolThymol
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SALTSALT
Bicarbonate is added to make the solutionBicarbonate is added to make the solution
isotonicisotonic
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VEHICLEVEHICLE
Distilled water or ringer lactate solutionDistilled water or ringer lactate solution
Helps to dissolve the content of L.A toHelps to dissolve the content of L.A tomake it injectible.make it injectible.
Also reduces the concentration of the drugAlso reduces the concentration of the drug
which provides additional volume forwhich provides additional volume forinjection.injection.
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EACH ML CONTAINSEACH ML CONTAINS
Lignocaine HCl 21.33Lignocaine HCl 21.33
Adrenaline Bititrate 0.0225 mgAdrenaline Bititrate 0.0225 mg
Sodium Chloride Sodium Chloride Sodium Metabisulphite 0.5 mgSodium Metabisulphite 0.5 mg
Methyl Paraben Methyl Paraben
Water for injection q.sWater for injection q.s
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