Local Skin Anesthesia

Aka: Local Skin Anesthesia, Local Anesthesia, Local Anesthetic, Local Infiltrative Anesthesia, Infiltration Anesthesia, Mepivacaine, Carbocaine, Bupivacaine, Ropivacaine, Marcaine, Sensorcaine, Prilocaine, Citanest, Etidocaine, Duranest, Topical Anesthetic

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II. Indications: Local Anesthetic

  1. Infiltration Anesthesia (skin procedures)
  2. Regional Anesthesia or Nerve Block (e.g. Digital Block)
  3. Topical Anesthetic (e.g. tetracaine for ocular procedures)
  4. Spinal Anesthesia
  5. Epidural Anesthesia

III. Mechanism

  1. Cocaine was the first Local Anesthetic, with subsequent synthetic agents with similar activity
  2. Local Anesthetics Inhibit Nerve Conduction
    1. Decrease the Neuron's membrane permeability to Sodium
    2. Without Sodium influx when Neurons are activated (depolarization), Action Potentials cannot be generated
  3. Small nerve fibers are most susceptible to penetration and blockade
    1. Pain and Temperature sense (A-Delta and C Nerve Fibers) are most susceptible to Local Anesthetic
    2. Touch and proprioception are less susceptible
    3. Skeletal Muscle innervating Neurons are least susceptible to Local Anesthetic
  4. Images
    1. localAnesthetics.png
  5. All synthetic Local Anesthetics have a common structure
    1. Hydrophobic region (aromatic ring structure)
    2. Linker region (alkyl chain containing either an amide or ester bond)
    3. Hydrophilic region (substituted amines)
  6. Synthetic Local Anesthetics are of 2 classes (differentiated by their linker alkyl chain bond)
    1. Amides (e.g. Lidocaine)
      1. Less susceptible to enzymatic degradation, clearing more slowly than esters, with longer duration of activity
    2. Esters (e.g. Procaine)
      1. Easily hydrolyzed by plasma esterases, resulting in more rapid breakdown, and shorter duration of activity
  7. Adjunctive Agents
    1. Bicarbonate
      1. Added to Local Anesthetic to increase the percentage of non-ionized Anesthetic
      2. Nonionized Anesthetic reduces the burning Sensation on injection
      3. Nonionized Anesthetic more easily penetrates the nerve sheath, increasing its Anesthetic activity
        1. Within the Neuron, the Anesthetic re-ionizes to its active form
    2. Epinephrine
      1. Epinephrine induces local Vasoconstriction and Hemostasis, keeping Local Anesthetic within the injected region
      2. Epinephrine is added to Local Anesthetic to prolong Anesthetic activity
      3. Epinephrine also reduces systemic absorption (LAST Reaction risk) when added to Local Anesthetic
        1. Maximum safe Anesthetic total dosages are higher when Epinephrine is added

IV. Technique: Helpful hints to make Local Anesthetic more comfortable

  1. Use smaller gauge needles (higher numbers)
    1. Elective procedures: 27 to 30 gauge needle
    2. Avoid using anything larger than a 25 gauge needle
  2. Prepare the injection solution
    1. Warm Lidocaine (Xylocaine) to Body Temperature
    2. Use Buffered Lidocaine
      1. Bicarbonate 1 part to Xylocaine 9 part ratio
      2. Stable at room temp for one week
  3. Prepare the site
    1. Cool skin before injection
      1. Ice
      2. Quick spray of Liquid Nitrogen, ethyl chloride or frigiderm
      3. Avoid ethyl chloride when using electrocautery
    2. Consider Topical Anesthetic use before injection
      1. See topical pre-Anesthetics below
  4. Employ a less painful injection technique
    1. Rapidly insert needle (do not allow to needle to linger on surface)
    2. Infiltrate skin slowly and steadily while withdrawing
    3. Inject through wound edge if possible
    4. Inject into subcutaneous tissue (equivalent efficacy to injecting into skin, and less painful)
    5. Be generous with Local Anesthetic
      1. However, may distort wound edges
  5. Employ distraction techniques
    1. Patient lifts their own leg (Gate theory of pain)
    2. Vibrate skin or pinch skin as you inject
    3. Have patient keep eyes open (analgous to Lamaze birth)
    4. Talk calmly to patient
  6. Mixing Anesthetics offers no benefit
    1. Lidocaine (1 hour duration) and Bupivicaine (2-4 duration) have very similar onset of action (3 minutes)
    2. Select one agent for Local Anesthetic based on desired duration of Anesthesia
    3. Ribotsky (1996) J Am Podiatr Med Assoc 86(10): 487-91 [PubMed]
    4. Alhelail (2009) Emerg Med J 26(5): 347-50 [PubMed]

V. Pharmacokinetics

  1. Amide and Ester Anesthetic metabolism and excretion
    1. Metabolized by liver
    2. Excreted by Kidney
  2. Dose calculations
    1. Solution of 0.5%: 5 mg/ml
    2. Solution of 1%: 10 mg/ml
    3. Solution of 2%: 20 mg/ml

VI. Preparations: Topical pre-Anesthetics

  1. Ethyl Chloride Spray
    1. Do not use with electrocautery
    2. Site sprayed for 1-2 seconds
    3. Offers 1-2 seconds of Anesthesia
  2. Lidocaine-Epinephrine-Tetracaine (LET)
    1. Replaces Tetracaine, Adrenaline, Cocaine (TAC)
    2. Indicated for open wound
    3. May be especially useful in children
  3. EMLA cream (Eutactic Mixture of Local Anesthetic - Lidocaine 2.5%, Prilocaine 2.5%)
    1. Indicated in closed wounds
    2. Apply ointment under Occlusion
    3. EMLA creamAnesthesia reaches a depth of 3 mm at 1 hour, and 5 mm at 1.5 to 2 hours
    4. Use 90 minutes prior to injection
    5. ELA-Max (OTC) may offer similar effect (see below)
  4. Iontophoresis
    1. Lidocaine sponges applied to intact skin
    2. DC current applied to electrodes over Anesthetic
    3. Onset within 10 minutes and duration of 15 minutes
    4. Penetration depth of 1-2 cm
    5. As effective as EMLA cream
  5. Lidocaine 4% in liposomal matrix (LMX or ELA-Max)
    1. Apply to skin and occlude for 30 minutes (much faster onset than EMLA cream)
  6. J-Tip (transdermal Lidocaine device)
    1. Creates eraser sized wheel of Lidocaine that has been shot through the skin without needle
    2. Onset of Anesthesia within 3 minutes of use
    3. May also be used for Lumbar Puncture
  7. Buzzy Bee Vibrating Device (effective in ages 3-18 years; not effective in infants)
    1. Wings of device are stored in the freezer (use within 10 minutes of removing from freezer)
    2. Device and wings are placed on skin 5 cm proximal to venipuncture site (or Immunization site)
    3. Cold and vibration prevents pain fibers from transmitting painful stimuli (gate theory)
    4. Apply to skin for 1 minute before procedure
  8. Other measures with unknown efficacy in procedures
    1. AnestheticPatch (Lidoderm)

VII. Preparations: Local Anesthetics - Short acting Amide Anesthetics

  1. Local Lidocaine or Xylocaine (0.5%=5 mg/ml, 1%=10 mg/ml, 2%=20 mg/ml)
    1. Onset: 2 to 5 minutes
    2. Duration: 1 hour (up to 1.5 to 3 hours in some cases)
    3. Max dose: 4 mg/kg to 300 mg/dose (up to 15 ml 2%, 30 ml 1% or 60 ml 0.5%)
      1. Epinephrine increases Lidocaine duration or activity and maximal safe dose to 7 mg/kg (see below)
  2. Mepivacaine (Carbocaine) 1%
    1. Onset: 3 to 5 minutes
    2. Duration: 1.5 to 2 hours
    3. Max dose: 4 mg/kg up to 280 mg/dose (28 ml))
  3. Prilocaine (Citanest) 1%
    1. Onset: 2 minutes
    2. Duration: 1 hour
    3. Max dose: 7 mg/kg up to 500 mg/dose (50 ml)

VIII. Preparations: Local Anesthetics - Long acting Amide Anesthetics

  1. Lidocaine with Epinephrine 1:100,000 or 1:200,000
    1. Onset: 2 minutes
    2. Duration: 2 to 6 hours
    3. Max dose: 7 mg/kg to 500 mg (up to 25 ml 2%, 50 ml 1%)
    4. Epinephrine increases Lidocaine's duration of action and maximal safe dose (decreases systemic absorption)
  2. Bupivacaine or Marcaine or Sensorcaine (0.25%=2.5 mg/ml, or 0.5%=5 mg/ml)
    1. Onset: 5 minutes (up to 15-30 minutes)
    2. Duration: 2 to 4 hours (up to 6 hours, esp. when combined with Epinephrine)
    3. Max bolus dose: 2 mg/kg (some guidelines use maximum of 2.5 mg/kg)
      1. Weight >=75 kg (165 lb): 60 ml of 0.25% (2.5 mg/ml) or 30 ml of 0.5% (5 mg/ml)
    4. Avoid in pregnancy (increased Bioavailability, crosses placenta)
    5. Always confirm not intravascular (withdraw first) as risk of lethal Arrhythmias (Ventricular Fibrillation)
      1. See LAST Reaction
      2. Less risk of systemic absorption when combined with Epinephrine
  3. Etidocaine (Duranest) 0.5% or 1%
    1. Max dose: 4 mg/kg to 280 mg/dose (25 ml 1%, 50 ml 0.5%)
  4. Ropivacaine 0.2 to 0.5%
    1. Preferred agent in Regional Anesthesia (decreased LAST toxicity risk)
    2. Decrease dose in liver disease, malnourishment, Critical Illness
    3. Single bolus
      1. Onset: 10-20 minutes
      2. Duration: 6 to 14 hours
      3. Maximum Dose: 3 mg/kg of 0.5 % (5 mg/ml)
        1. Weight 50 kg (110 lb): Maximum 30 ml of 0.5% (1 bottle of Ropivacaine)
        2. Weight 60 kg (132 lb): Maximum 36 ml of 0.5%
        3. Weight 70 kg (154 lb): Maximum 42 ml of 0.5%
        4. Weight 80 kg (176 lb): Maximum 45-48 ml of 0.5%
        5. Weight 90 kg (198 lb): Maximum 45-54 ml of 0.5%
        6. Weight >=100 kg (220 lb): Maximum 45-60 ml of 0.5% (up to 2 bottles of Ropivacaine)
    4. Continuous infusion
      1. Maximum: 0.5 mg/kg/h of 0.2% (2 mg/ml)
        1. Weight 40 kg: Maximum 10 ml/h of 0.2% (2 mg/ml)
        2. Weight 50 kg: Maximum 12 ml/h of 0.2% (2 mg/ml)
        3. Weight >=56 kg: Maximum 14 ml/h of 0.2% (2 mg/ml)
    5. References
      1. Reardon and Martel (2020) Regional Anesthesia for Acute Care Conference, attended 12/11/2020
        1. https://stabroom.com/

IX. Preparations: Local Anesthetics - Esters

  1. Background: Mnemonic to distinguish the Ester Anesthetics from the Amide Anesthetics
    1. Amides have two "i"
    2. Esters have one "i"
  2. Chloroprocaine (Nesacaine)
  3. Procaine (Novocain) 1%, 2%
    1. Onset: 2-5 minutes
    2. Duration: 15 to 60 minutes
    3. Max Dose: 7 mg/kg up to 600 mg/dose (30 ml 2%, 60 ml 1%)
  4. Tetracaine (Pontocaine) 0.5%
    1. Onset: 5-10 minutes
    2. Duration: 2-3 hours
    3. Max Dose: 1.4 mg/kg up to 120 mg/dose (24 ml 0.5%)

X. Adverse Effects: LAST Reaction

  1. See Local Anesthetic Systemic Toxicity (LAST Reaction)
  2. Prevention
    1. Exercise caution to avoid intravascular injection of Local Anesthetic
    2. Limit total Anesthetic dose to weight-based maximums established for each agent

XI. Adverse Effects: Allergy to Local Anesthesia

  1. True amide Anesthetic is rare
    1. Usually a reaction to preservative methylparaben
  2. Novocaine allergy does not predict Lidocaine allergy
    1. Lidocaine is an amide and novocaine an ester
    2. Lidocaine may be used if novocain allergy
  3. Options if history of Lidocaine allergy
    1. Preservative-free Lidocaine (single use bottles)
    2. Select an ester Anesthetic (e.g. Nesacaine, Procaine, Tetracaine)
    3. Diphenhydramine Hydrochloride 1%
      1. Dilute 50 mg (1 ml) in 4 ml Normal Saline
      2. Equivalent to Lidocaine 1% activity
      3. Avoid use in Peripheral Nerve Block

XII. Resources

  1. Local Anesthetics: Clinical Pharmacology and Rational Selection
    1. http://www.nysora.com/regional-anesthesia/foundations-of-ra/3492-local-anesthetics-clinical-pharmacology-and-rational-selection.html

XIII. References

  1. Acker, Koval and Leeper (2017) Crit Dec Emerg Med 31(4): 3-13
  2. Pfenninger (1994) Procedures, Mosby, p. 135-155
  3. Mortiere (1996) Wound Management, p. 27-39
  4. Achar (2002) Am Fam Physician 66(1):91-4 [PubMed]
  5. Latham (2014) Am Fam Physician 89(12): 956-62 [PubMed]

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Related Studies

Ontology: Local anesthesia (C0002921)

Definition (NCI) The temporary suppression of sensation at a specific region of the body by pharmacological intervention. This type of anesthesia does not induce unconsciousness in the patient.
Definition (NCI_NCI-GLOSS) A temporary loss of feeling in one small area of the body caused by special drugs or other substances called anesthetics. The patient stays awake but has no feeling in the area of the body treated with the anesthetic.
Definition (CSP) blocking of nerve conduction to a specific area by an injection of an anesthetic agent.
Definition (MSH) A blocking of nerve conduction to a specific area by an injection of an anesthetic agent.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D000772
SnomedCT 180897007, 20653004, 386761002
English Local anesthesia, Anesthesia, Local, Local anaesthetic NOS, Local anesthetic NOS, local anesthetics (medication), local anesthetics, Anaesthesia local, Anesthesia local, LA, Local Anesthesia Procedure, anesthetic local techniques, local anesthesia, anesthetic local procedure, laing, anaesthetic local, anaesthesia local, local anesthetic technique, anesthesia local, anaesthetics local, anesthetic local, local anaesthesia, local anesthesia in conjunction with operative or surgical procedures, Local anesthetic NOS (procedure), Local anesthesia in conjunction with operative or surgical procedures, Local anesthetic, Local anaesthesia, Local anaesthetic technique, Local anesthetic technique, Local anaesthetic, Local anesthesia (procedure), Local anesthesia, NOS, Local Anesthesia, local anesthetic, local anaesthetic
Dutch LA, anesthesie lokaal, lokaal anestheticum, lokale anesthesie, Anesthesie, lokale, Lokale anesthesie
French AL, Anesthésique local, Anesthésie locale
German LA, lokales Anaesthetikum, Anaesthesie lokal, Lokalanaesthesie, Anästhesie, Lokal-, Betäubung, örtliche
Italian Atrio sinistro, Anestetico locale, Anestesia locale
Portuguese Anestésico local, Anestesia local, Anestesia Local
Spanish Anestésico local, AL, anestesia local, SAI, anestesia local, SAI (procedimiento), anestesia local, anestesia local (procedimiento), Anestesia local, Anestesia Local
Japanese 局所麻酔, ｷｮｸｼｮﾏｽｲ, 麻酔-浸潤, 麻酔-局所浸潤, 局所麻酔-浸潤, 浸潤麻酔法, 局所浸潤麻酔法, 浸潤麻酔, 局所浸潤麻酔
Swedish Lokalbedövning
Czech anestézie lokální, Místní anestezie, LA, Lokální anestetikum, Lokální anestezie, lokální anestezie, regionální anestézie
Finnish Paikallispuudutus
Russian ANESTEZIIA MESTNAIA, ANESTEZIIA INFIL'TRATSIONNAIA, АНЕСТЕЗИЯ ИНФИЛЬТРАЦИОННАЯ, АНЕСТЕЗИЯ МЕСТНАЯ
Croatian ANESTEZIJA, LOKALNA
Polish Znieczulenie miejscowe
Hungarian LA, Helyi érzéstelenítés, Helyi érzéstelenítő
Norwegian Lokalbedøvelse, Lokalanestesi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Local Anesthetics (C0002934)

Definition (MSH) Drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations. They act on any part of the nervous system and on every type of nerve fiber. In contact with a nerve trunk, these anesthetics can cause both sensory and motor paralysis in the innervated area. Their action is completely reversible. (From Gilman AG, et. al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed) Nearly all local anesthetics act by reducing the tendency of voltage-dependent sodium channels to activate.
Definition (CSP) drugs that block nerve conduction when applied locally to nerve tissue in appropriate concentrations; they act on any part of the nervous system and on every type of nerve fiber; their action is completely reversible.
Concepts Pharmacologic Substance (T121)
MSH D000779
SnomedCT 334109006, 20653004, 261379008, 27548001, 373477003
LNC LP31442-4
English Local anesthesia, Local Anesthetics, Anesthetics, Conduction Blocking, Anesthetics, Local, Conduction Blocking Anesthetics, Anesthetics, Conduction-Blocking, Conduction-Blocking Anesthetics, Local anaesthesia, Local anaesthetic drugs, Local anesthetic drugs, ANESTHETICS CONDUCTION BLOCK, CONDUCTION BLOCK ANESTHETICS, anesthetic, local, Local anesthetics, anesthetic local, anesthetics local, anaesthetic local, anaesthetics local, local anesthetic, local anesthetics, local anaesthetic, LOCAL ANESTHETICS, ANESTHETICS, LOCAL, Local anaesthesia product, Local anesthesia product, Local anesthesia product (substance), Local anaesthetic drugs (substance), Local anesthetic, LA - Local anaesthetic drug, LA - Local anesthetic drug, Local anaesthetic, Local anesthetic (product), Local anesthetic (substance), Local anesthetic, NOS
Swedish Lokalbedövningsmedel
Czech anestetika lokální
Finnish Paikallispuudutteet
Russian PROVODIMOST' BLOKIRUIUSHCHIE ANESTETIKI, ANESTETIKI, BLOKIRUIUSHCHIE PROVODIMOST', ANESTETIKI LOKAL'NYE, ANESTEZIRUIUSHCHIE SREDSTVA MESTNYE, MESTNOANESTEZIRUIUSHCHIE SREDSTVA, АНЕСТЕЗИРУЮЩИЕ СРЕДСТВА МЕСТНЫЕ, АНЕСТЕТИКИ, БЛОКИРУЮЩИЕ ПРОВОДИМОСТЬ, АНЕСТЕТИКИ ЛОКАЛЬНЫЕ, МЕСТНОАНЕСТЕЗИРУЮЩИЕ СРЕДСТВА, ПРОВОДИМОСТЬ БЛОКИРУЮЩИЕ АНЕСТЕТИКИ
Japanese 局所麻酔剤, 伝導ブロック麻酔薬, 局所麻酔薬, 麻酔剤-局所, 麻酔薬-局所
Croatian ANESTETICI, LOKALNI
Polish Środki znieczulające miejscowo i przewodowo, Leki znieczulające miejscowo, Anestetyki lokalne
Spanish anestésico local (producto), anestésico local (sustancia), anestésico local, Anestésicos Bloqueantes de Condución, Anestésicos Locales
French Anesthésiques locaux, Anesthésique local, Anesthésiques bloquant la conduction nerveuse
German Anästhetika, leitungsblockierende, Leitungsblockierende Anästhetika, Lokalanästhetika
Italian Anestetici locali
Portuguese Anestésicos Bloqueadores de Condução, Anestésicos Locais
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bupivacaine (C0006400)

Definition (NCI_NCI-GLOSS) A drug used to relieve pain by blocking signals at nerve endings. It is being studied in the relief of pain following surgery for cancer. It is a type of local anesthetic.
Definition (NCI) An amide-type, long-acting local anesthetic. Bupivicaine reversibly binds to specific sodium ion channels in the neuronal membrane, resulting in a decrease in the voltage-dependent membrane permeability to sodium ions and membrane stabilization; inhibition of depolarization and nerve impulse conduction; and a reversible loss of sensation.
Definition (MSH) A widely used local anesthetic agent.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002045
SnomedCT 27196008, 387150008
LNC LP16053-8, MTHU014869
English Bupivacaine, 2-Piperidinecarboxamide, 1-butyl-N-(2,6-dimethylphenyl)-, 1-Butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide, Bupivacaine [Chemical/Ingredient], BUPIVACAINE, 1-Butyl-2',6'-pipecoloxylidide, local anesthetics bupivacaine (medication), local anesthetics bupivacaine, bupivacaine, Bupivacaine (product), Bupivacaine (substance), Bupivicaine
Swedish Bupivakain
Czech bupivakain
Finnish Bubivakaiini
Russian BUPIVAKAIN, БУПИВАКАИН
Japanese ブピバカイン
Polish Bupiwakaina
Croatian BUPIVAKAIN
Spanish bupivacaína (producto), bupivacaína (sustancia), bupivacaína, Bupivacaína
French Bupivacaïne
German Bupivacain
Italian Bupivacaina
Portuguese Bupivacaína
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Carbocaine (C0006987)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008619
Portuguese Carbocaína
Spanish Carbocaína
German Carbocain
French Carbocaïne
English carbocaine, Carbocaine, Scandicaine, Astra Brand of Mepivacaine Hydrochloride, AstraZeneca Brand of Mepivacaine Hydrochloride, Sanofi Brand of Mepivacaine Hydrochloride, Scandicain, Abbott Brand of Mepivacaine Hydrochloride, Carbocaïne
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Etidocaine (C0015120)

Definition (MSH) A local anesthetic with rapid onset and long action, similar to BUPIVACAINE.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D005041
SnomedCT 88485001, 370282009
English Etidocaine, Butanamide, N-(2,6-dimethylphenyl)-2-(ethylpropylamino)-, (+-)-, 2-(Ethylpropylamino)-2',6'-butyroxylidide, etidocaine, Etidocaine [Chemical/Ingredient], Etidocaine (substance), Etidocaine product (product), Etidocaine product, ETIDOCAINE
Swedish Etidokain
Czech etidokain
Finnish Etidokaiini
Italian 2-(Etilpropilamino)-2,6-butir-xilidide, Etidocaina
Russian ETIDOKAIN, ЭТИДОКАИН
Japanese エチドカイン, ズラネスト
Spanish etidocaína (producto), producto con etidocaína (producto), producto con etidocaína, etidocaína (sustancia), etidocaína, Etidocaína
Polish Etidokaina
French Étidocaïne
German Etidocain
Portuguese Etidocaína
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Mepivacaine (C0025384)

Definition (NCI) An amide-type local anesthetic agent. At the injection site, mepivacaine binds to specific voltage-gated sodium ion channels in neuronal cell membranes, which inhibits both sodium influx and membrane depolarization. This leads to a blockage of nerve impulse initiation and conduction and results in a reversible loss of sensation. Compared to other local anesthetics, this agent has a more rapid onset and moderate duration of action.
Definition (MSH) A local anesthetic that is chemically related to BUPIVACAINE but pharmacologically related to LIDOCAINE. It is indicated for infiltration, nerve block, and epidural anesthesia. Mepivacaine is effective topically only in large doses and therefore should not be used by this route. (From AMA Drug Evaluations, 1994, p168)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008619
SnomedCT 370291008, 59560006, 391673008
LNC LP14721-2, MTHU001813
English Mepivacaine, 2-Piperidinecarboxamide, N-(2,6-dimethylphenyl)-1-methyl-, Mepivacaine [Chemical/Ingredient], Mepivacaine product (product), mepivacaine, MEPIVACAINE, Mepivacaine (substance), Mepivacaine product, Mepivacaine (product)
Swedish Mepivakain
Czech mepivakain
Finnish Mepivakaini
Russian KARBOKAIN, MEPIVAKAIN, КАРБОКАИН, МЕПИВАКАИН
Japanese カルボカイン, 塩酸メピバカイン, メピバカイン
Polish Mepiwakaina, Karbokaina
Spanish producto con mepivacaína, producto con mepivacaína (producto), mepivacaína (sustancia), mepivacaína, mepivacaína (producto), Mepivacaína
French Mépivacaïne
German Mepivacain
Italian Mepivacaina
Portuguese Mepivacaína
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Prilocaine (C0033124)

Definition (MSH) A local anesthetic that is similar pharmacologically to LIDOCAINE. Currently, it is used most often for infiltration anesthesia in dentistry.
Definition (NCI) A toluidine derivative and intermediate-acting amino amide with local anesthetic property. Prilocaine stabilizes the neuronal membrane by preferential binding to and inhibiting depolarization of the voltage-gated sodium channel. This results in a decrease in membrane permeability and subsequent inhibition of the ionic sodium influx required for the initiation and conduction of impulses.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011318
SnomedCT 19232009, 387107003
LNC LP32686-5, MTHU016255
English Propitocaine, Propanamide, N-(2-methylphenyl)-2-(propylamino)-, o-Methyl-alpha-propylaminopropionanilide, o-Propionotoluidide, 2-(propylamino)-, 6,7-Epoxytropine Tropate, Propanamide, N-(2-methylphenyl)-2-(propylamino)-(9CI), Prilocaine, prilocaine, PRILOCAINE, Prilocaine [Chemical/Ingredient], Prilocaine (product), Prilocaine (substance)
Swedish Prilokain
Czech prilokain
Finnish Prilokaiini
Russian TSITANEST, PROPITOKAIN, PRILOKAIN, ПРИЛОКАИН, ПРОПИТОКАИН, ЦИТАНЕСТ
Japanese プロピトカイン, プリロカイン
Italian Propitocaina, Prilocaina
Polish Prilokaina
Spanish prilocaína (producto), prilocaína (sustancia), prilocaína, propitocaína, Propitocaína, Prilocaína
French Prilocaïne
German Prilocain, Propitocain
Portuguese Prilocaína, Propiocaína
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Topical anesthetic (C0040464)

Definition (MSH) Anesthetic applied on a specific site of body.
Concepts Pharmacologic Substance (T121)
MSH D000779
SnomedCT 373520001, 67585005
English topical anesthetics (medication), topical anesthetics, anesthetic topical, topical anesthetic, anaesthetics topical, topical anaesthetic, anesthetics topical, Anesthetics, Topical, Topical Anesthetic (Obsolete), Topical anaesthetic, Topical anesthetic (product), Topical anesthetic (substance), Topical anesthetic, NOS, Topical anesthetic
Spanish anestésico tópico (producto), anestésico tópico (sustancia), anestésico tópico
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: ropivacaine (C0073571)

Definition (NCI_NCI-GLOSS) A drug used to control pain and to cause a temporary loss of feeling in one part of the body, during and after surgery. It is also being studied for pain control after cancer surgery. It is a type of local anesthetic.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C037663
SnomedCT 109094008, 386969005
LNC LP66071-9, MTHU027086
English ropivacaine, 1-propyl-2',6'-pipecoloxylidide, ropivacaine [Chemical/Ingredient], (-)-1-Propyl-2',6'-pipecoloxylidide, (-)-1-Propyl-2',6'-dimethyl-2-piperidylcarboxyanilid, ROPIVACAINE, Ropivacaine, Ropivacaine (product), Ropivacaine (substance)
Spanish ropivacaína (producto), ropivacaína (sustancia), ropivacaína
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Local anesthesia, by infiltration (C0198813)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 92501-01
SnomedCT 44596000
English Local infiltration anaesthesia, Local infiltration anesthesia, Local anesthesia, by infiltration, Local anaesthesia, by infiltration, Local anaesthetic infiltration, Local anesthetic infiltration, Local anesthesia, by infiltration (procedure)
Spanish anestesia local, por infiltración (procedimiento), anestesia local, por infiltración
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Anesthesia, Infiltration (C0234945)

Concepts Therapeutic or Preventive Procedure (T061)
MSH D000772
English INFILTRATION ANAESTHESIA, INFILTRATION ANESTHESIA, Infiltration Anesthesia, Infiltration anaesthesia, Infiltration anesthesia, infiltration anaesthesia, infiltration anesthesia, Anesthesia, Infiltration
Spanish ANESTESIA POR INFILTRACION, Anestesia por Infiltración, Anestesia por infiltración
Dutch infiltratie anesthesie, infiltratieanesthesie, Infiltratie-anesthesie
French Anesthésie d'infiltration, Anesthésie locale par infiltration, ANESTHESIE PAR INFILTRATION, Anesthésie par infiltration, Anesthésie par infiltration locale
Japanese 浸潤麻酔, ｼﾝｼﾞｭﾝﾏｽｲ
Portuguese Anestesia de Infiltração, ANESTESIA POR INFILTRACAO, Anestesia de infiltração
German Infiltrationsanästhesie, INFILTRATIONSANAESTHESIE, Infiltrationsanaesthesie
Czech Infiltrační anestezie, infiltrační anestézie
Hungarian Infiltrációs érzéstelenítés
Italian Anestesia d'infiltrazione, Anestesia per infiltrazione
Norwegian Infiltrasjonsanestesi
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Skin infiltration of local anesthetic (C0472454)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 231306007
English Skin infiltration LA, Skin infiltration of local anaesthetic, Skin infiltration of local anesthetic, Skin infiltration of local anesthetic (procedure)
Spanish infiltración de piel con anestesia local (procedimiento), infiltración de piel con anestesia local
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Citanest (C0591261)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011318
English citanest, Citanest, Inibsa Brand of Prilocaine Hydrochloride
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Sensorcaine (C0699883)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D002045
English Carbostesin, sensorcaine, AstraZeneca Brand of Bupivacaine Hydrochloride, Sensorcaine, Astra Brand of Bupivacaine Hydrochloride
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Duranest (C0733378)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D005041
English Duranest
Derived from the NIH UMLS (Unified Medical Language System)

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