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Local anesthesia in surgery. What is it, drugs, indications and contraindications

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Local anesthesia or analgesia - type of anesthesia at which impulses are blocked pain emanating from the site of surgery. Wherein the transmission of impulses along nerve network is cut off by the action of the administered drug. More than half of all operations in the surgery currently performed under local anesthesia.

The content of the article:

  • 1 Application area
  • 2 Types of surgery
    • 2.1 terminal
    • 2.2 regional
      • 2.2.1 Spine
      • 2.2.2 epidural
      • 2.2.3 conductor
    • 2.3 According to A. AT. Wisniewski
    • 2.4 pudendal
    • 2.5 when blepharoplasty
    • 2.6 In dentistry
  • 3 Most drugs
    • 3.1 lidocaine
    • 3.2 Novocaine
    • 3.3 Trimekain
    • 3.4 Anekain
    • 3.5 dicain
    • 3.6 chloroethyl
    • 3.7 other analgesics
  • 4 testimony
  • 5 Contraindications, side effects
  • 6 Doctors about preparations
  • 7 Video of local anesthesia

Application area

Local anesthesia in surgery is used in almost all branches of medicine:

  • in dental practice - in removing dental treatment of their dentures and installation;Local anesthesia in surgery. What is it, drugs, indications, contraindications
  • during interventions on the hands or feet, as well as the operations in the lower abdomen;
  • insta story viewer
  • at autopsy pustules;
  • Urology - in surgical interventions on the kidney, prostate removal, holding urography;
  • in gynecology and obstetrics, local anesthesia is indispensable for operations on the female reproductive organs, pain relief during labor and caesarean section;
  • virtually all operations for injuries;
  • at different operations in proctology;
  • during gastroscopy and sensing;
  • ENT-operations;
  • in ophthalmic practice.

Types of surgery

different types of anesthesia used for high-quality analgesia. Each of them has its scope.

terminal

It has other names - completed application or surface. The most commonly used in dentistry and gastroenterology, as well as carrying out some small interventions proctologic practice. Terminal anesthesia different way of performing. Anesthetic agent is applied to the surface of the skin or mucosa.

Terminal anesthesia is indispensable during the proctology examination. This unpleasant procedure is associated with painful sensations, and the introduction of the anesthetic allows for viewing with the greatest comfort for the patient.

Intraoral anesthesia is indispensable for:

  • latex variceal ligation hemorrhoids;
  • sclerotherapy;
  • biopsy of the rectum.

regional

This type of anesthesia, wherein the anesthetic is injected into the desired body region by injection. Anesthesia of the operated part can last up to 8 hours, which is very important in the prevention of post-operative pain. Administration of the anesthetic procedure is painless.

Regional anesthesia is not carried out if the patient is taking anticoagulants, since these reduce blood clotting.

Injection is also being done at:

  • inflammation around the affected area;
  • multiple sclerosis;
  • if within a year the patient was ill with meningitis, encephalitis.

The following types of regional anesthesia:

Spine

Another name for this anesthesia - cerebrospinal. Anesthetic agent is injected into the subarachnoid space via lumbar puncture. Blocking nerve impulse occurs at the level of the spinal nerve roots.

Local anesthesia in surgery. What is it, drugs, indications, contraindications
Local spinal anesthesia in surgery is inserted between the vertebrae 3 and 4

The advantages of spinal anesthesia:

  • the patient does not need postanesthesia observation;
  • it is not necessary to use respiratory equipment;
  • It has no effect on consciousness.

epidural

In epidural anesthesia drugs are injected into the epidural space of the spine via the catheter. Blocking pain occurs as a result of the impact on the spinal nerve roots.

Epidural analgesia does not lead to a relaxation of muscles. Therefore, it is used in childbirth. It is effective in relieving pain and after surgery.

conductor

So it called blocking the transmission of nerve impulse along nerve plexus or node by administering topically anesthetic near the nerve fiber.

This modern way of anesthesia for the surgical treatment of injuries. The blockade is used to relieve pain in patients with pain syndrome on the background of sciatica, trigeminal nerve, herniated disc and other pathologies.

According to A. AT. Wisniewski

Local anesthesia in surgery widely used AV Vishnevsky. His technique has remained unchanged to this day. With this type of anesthesia used novocaine solution. The mechanism of it is in contact with the active substance nerve endings.

Infiltrated separately peritoneum, fascial area aponeurosis and pleura. With a single needle injection solution is pumped under pressure. It spreads along fascial space.

Solution according Wisniewski injected intradermally. When properly administered medication, a so-called lemon crust. The same peel created in the course of the incision. The drug is injected under the skin gradually, in the fascia, in subgaleal space. Novocaine "indulges" in the most remote area.

Anesthesia for Wisniewski is not applicable during long surgical procedures and operations that require connection ventilation. The only contraindication to surgery - this is the increased sensitivity of the human body to novocaine. In this regard, diagnostic tests done before the use of large doses of novocaine.

pudendal

This type of anesthesia is used for pain relief in labor. When pudendal anesthetic pudendal nerve is blocked. Anesthetic solution is injected into ischiorectal region. It occurs branching of nerve. The advantages of this type of anesthesia is that it does not disconnect the mind, not muscle relaxant, and a woman in labor can push yourself.Local anesthesia in surgery. What is it, drugs, indications, contraindications

At the same time, there are certain disadvantages of the method:

  • relatively low efficiency;
  • at the injection site bruising can be formed;
  • there is a risk of infection of soft tissues of the perineum.

when blepharoplasty

Blepharoplasty - surgery is about changing the shape of the eyelids, eye size. In this case, the skin is excised at the top and bottom of the eye, removes fat herniation.

The operation is performed under local anesthesia combined with intravenous sedation. Sedation eliminates the too frequent blinking, which favorably affects the prosperous during the intervention and its outcome.

In dentistry

Surgical procedures in dentistry in most cases carried out under local anesthesia. Type of anesthesia is determined by the attending physician depending on the indication and the type of intervention.

For anesthesia mucosa Use application anesthesia. Typically, this is done with small interventions, for example, to painlessly inject the needle.
To "turn off" the teeth, periosteum, mucosal using infiltration anesthesia
chewing teeth Anesthetize conduction anesthesia. Depot anesthetic near a nerve creates.
The circular ligament tooth For every tooth made from 2 to 4 injections.
After opening the pulp chamber The anesthetic is administered in the dental cavity. The effect occurs immediately after a few seconds.
The bone spongy tissue This is done at the time of perforation.
Local anesthesia in surgery. What is it, drugs, indications, contraindications

Anesthesia necessarily used in dental practice in:

  • treatment of caries, pulpitis, and other lesions of teeth;
  • curettage;
  • Gingivoplasty;
  • prosthetic tooth crowns and other structures;
  • removal of teeth;
  • implant placement.

Most drugs

Local anesthesia in surgery carried out using special drugs. The spectrum of drugs and a sufficiently wide range in each case makes the surgeon.

lidocaine

The active substance is blocking sodium channels. This effect is well relieves nerve ability to conduct pain impulses. The desired effect occurs very quickly. Its duration depends on the amount of substance administered.

It is indicated for the terminal, infiltration, conduction anesthesia during operations in ophthalmic and ENT practice dentistry. It is irreplaceable and small surgical procedures. When administered cephalosporin antibiotics used as solvent.

This drug is not indicated for:

  • cardiomyopathy;
  • increased blood pressure;
  • migraine;
  • diabetes;
  • violation of the thyroid gland works;
  • vascular pathologies.

Novocaine

This compound also inhibits sodium channels, which ultimately inhibits the generation process of nerve pain impulses. The drug reduces smooth muscle spasm.Local anesthesia in surgery. What is it, drugs, indications, contraindications

This substance is used as a basis for different types of anesthesia in surgery, urology, ophthalmology procedures. When the herniated disc, sciatica and neuralgia is used as a blockade.

Novocaine not used when pronounced fall in blood pressure, cardiogenic shock, severe bradycardia, hypovolemia and bleeding. The maximum total dose - no more than 800 mg.

Trimekain

It is a powder, highly soluble in alcohol and in water. Penetrates through the nerve membrane, it binds to the receptors responsible for the occurrence of pain, blocks impulse conduction mechanisms.

It is applied at the surface, wire, infiltration, spinal anesthesia. To stabilize the state of cardiac patients indicated for tachycardia and ventricular arrhythmia. It does not apply to single arrythmia.

Local anesthesia in surgery using Trimekain not assigned at elevated sensitivity of the patient to the drug, bradycardia, liver disease states.

Side effects that can cause Trimekain in some cases, are as follows:

  • dizziness;
  • drowsiness;
  • expressed concern;
  • numbness of the oral cavity mucous membranes;
  • convulsions;
  • visual impairment.

The use of vasoconstrictors Trimekain enhances the effect.

Anekain

The substance prevents holding the pain impulse. When spinal anesthesia relaxes the muscles of the legs; the duration of this effect - about 2 hours. The effect of the intercostal blockade can store up to 14 hours. When blockade musculature desired effect lasts for about an hour.Local anesthesia in surgery. What is it, drugs, indications, contraindications

"Disable" pain sensitivity occurs after about 5 - 10 minutes. Pronounced analgesic effect is maintained even after the operation. This reduces the patient's need for pain medication. Anekain effectively used for the treatment of sprains.

dicain

This is an effective means for the terminal anesthesia. Inhibits pulse formation mechanism in nerve endings, inhibits conduction of impulses along nerve fibers. The desired analgesic effect occurs already after 30 seconds - fifteen minutes after application to the mucosa. Its length varies between 15 and 20 minutes.

Dikain available in powder, eye films. The drug is indispensable for carrying out minor surgical interventions and manipulations in ophthalmic practice.

Dikain banned for use in mechanical damage to the mucous membranes. It is given to a patient under the age of 10 years.

chloroethyl

This local facility for short-term pain relief and the surface of the skin integument. Its sensitivity is lowered due to the cooling provided extremely rapid evaporation of the substance.

Currently, this medicine is not used for anesthesia. Its scope - the local agent for a brief anesthesia. Getting on the skin, it cools the surface. Thereby causing its ischemia and significant decrease in sensitivity. This property of ethyl chloride is used during the skin incisions.Local anesthesia in surgery. What is it, drugs, indications, contraindications

The use of ethyl chloride is justified for the treatment of:

  • itching;
  • neuralgia;
  • burns;
  • warty red lichen.

Insensitive tissue appears even after the skin was made by characteristic "frost". The drug is used with caution, because possible reddening of the skin and maceration. Chloroethyl not used in the breakage of the skin integument, varicosity and vasospasms.

other analgesics

Local anesthesia in surgery carried out with other preparations using:

  • artikaina;
  • benzocaine;
  • ultrakain;
  • Dentispreya;
  • Anilokaina;
  • Buvanestina;
  • Leokaina;
  • levobupivacaine;
  • mepivacaine;
  • oxibuprocaine;
  • Pramokaina;
  • prilocaine;
  • tetracaine;
  • Ropivacaine.

testimony

Local anesthesia in surgery and therapy is shown in the following cases:

  1. Peripheral Nerve Blocks in interventions on the hands and feet, short interventions.
  2. Of spinal anesthesia during surgery in the pelvic area, the pelvic bones and leg bones, vessels of the legs.
  3. Pain relief during childbirth.Local anesthesia in surgery. What is it, drugs, indications, contraindications
  4. Surgery on the abdominal cavity, chest organs.
  5. Prolonged analgesia in postoperative and cancer patients.
  6. Surgical intervention conducted on an outpatient basis.
  7. Situations where there is a history of post-operative nausea syndrome.
  8. Situation, when the patient wishes to be awake during the surgery.

Contraindications, side effects

For the application of local anesthesia, there are a number of contraindications:

  1. Prolonged operation during obesity.
  2. Operations requiring controlled breathing.
  3. Intolerance preparations.
  4. Inability to establish contact with the patient as a result of deaf-mutism, intoxication;
  5. Epilepsy.
  6. Infection of tissues in the administration of the drug.
  7. Age up to 10 years.
  8. Anticoagulant treatment.
  9. Sharp anemia, cachexia, hypovolemia.
  10. Heart block:
  • allergic reactions;
  • expressed reaction of the nervous system;
  • nausea, vomiting;
  • nervousness;
  • dizziness, in severe cases - loss of consciousness.

Doctors about preparations

Trauma from the city Moscow writes about the successful use of lidocaine for local anesthesia during a simple surgical interventions. The comment indicates that the drug comes very quickly. It saves all the time needed to carry out the intervention. Side effects did not occur.

The surgeon from the city of St. Petersburg indicates that small manipulation is most commonly used anesthesia on the basis of lidocaine or Novocain. Under their action comes fast analgesic effect. The dosage is chosen according to the place of intervention and its complexity.

Trauma from Omsk writes that, if necessary, to hold sutures or other small intervention applies Chloroethyl. He quickly relieve your skin or mucous cover and gives the opportunity to complete the procedure.

The use of local anesthesia in surgery has many advantages. First of all, it is the rapid onset of the desired effect, a small number of adverse events. This kind of pain relief has far less negative impact on the body and allows for a faster recovery.

Registration of the article: Vladimir the Great

Video of local anesthesia

The surgeon will speak about local anesthesia:

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