The Science of Local Anesthesia: Basic Research, Clinical Application, and Future Directions.

Abstract:

:Local anesthetics have been used clinically for more than a century, but new insights into their mechanisms of action and their interaction with biological systems continue to surprise researchers and clinicians alike. Next to their classic action on voltage-gated sodium channels, local anesthetics interact with calcium, potassium, and hyperpolarization-gated ion channels, ligand-gated channels, and G protein-coupled receptors. They activate numerous downstream pathways in neurons, and affect the structure and function of many types of membranes. Local anesthetics must traverse several tissue barriers to reach their site of action on neuronal membranes. In particular, the perineurium is a major rate-limiting step. Allergy to local anesthetics is rare, while the variation in individual patient's response to local anesthetics is probably larger than previously assumed. Several adjuncts are available to prolong sensory block, but these typically also prolong motor block. The 2 main research avenues being followed to improve action of local anesthetics are to prolong duration of block, by slow-release formulations and on-demand release, and to develop compounds and combinations that elicit a nociception-selective blockade.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Lirk P,Hollmann MW,Strichartz G

doi

10.1213/ANE.0000000000002665

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

1381-1392

issue

4

eissn

0003-2999

issn

1526-7598

journal_volume

126

pub_type

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