Editing Local anesthetic (section)

== Medical uses ==
Local anesthetics may be used to prevent and/or treat acute pain, to treat chronic pain, and as a supplement to general anesthesia.

They are used in various techniques of [[local anesthesia]] such as:
* [[Topical anesthesia]] (surface anesthesia)
* Topical administration of cream, gel, ointment, liquid, or spray of anesthetic dissolved in [[DMSO]] or other solvents/carriers for deeper absorption
* [[Infiltration (medical)|Infiltration]]
* [[Brachial plexus block]]
* [[Epidural|Epidural block]] (extradural)
* [[Spinal anaesthesia|Spinal anesthesia]] (subarachnoid block)
* [[Iontophoresis]]
* Diagnostic purposes (e.g. [[dibucaine]])
*[[Anti-arrhythmic]] agents (e.g. lidocaine).<ref name="Heavner2017">{{cite book |last=Heavner |first=James E. |title=Local Anesthetics |date=2017 |url=http://accessanesthesiology.mhmedical.com/content.aspx?aid=1144119460 |work=Anesthesiology |editor-last=Longnecker |editor-first=David E. |access-date=2023-04-10 |edition=3 |place=New York, NY |publisher=McGraw-Hill Education |editor2-last=Mackey |editor2-first=Sean C. |editor3-last=Newman |editor3-first=Mark F. |editor4-last=Sandberg |editor4-first=Warren S.}}</ref>

===Acute pain===
Even though [[acute pain]] can be managed using [[analgesic]]s, conduction anesthesia may be preferable because of superior pain control and fewer side effects.{{citation needed|date=January 2023}} For purposes of pain therapy, LA drugs are often given by repeated injection or continuous infusion through a catheter. LA drugs are also often combined with other agents such as opioids for synergistic analgesic action.<ref>{{cite journal | vauthors = Ryan T, Hodge A, Holyoak R, Vlok R, Melhuish T, Binks M, Hurtado G, White L | display-authors = 6 | title = Tramadol as an adjunct to intra-articular local anesthetic infiltration in knee arthroscopy: a systematic review and meta-analysis | journal = ANZ Journal of Surgery | volume = 89 | issue = 7–8 | pages = 827–832 | date = July 2019 | pmid = 30684306 | doi = 10.1111/ans.14920 | s2cid = 59275648 }}</ref>  Low doses of LA drugs can be sufficient so that muscle weakness does not occur and patients may be mobilized.{{citation needed|date=February 2022}}

Some typical uses of conduction anesthesia for acute pain are:
{| {{table}}
! Type of pain 
! Possible treatments
|-
|[[Labor pain]]
|[[Epidural anesthesia]], [[Pudendal nerve block]]s
|-
|[[Postoperative pain]] 
|[[Peripheral nerve block]]s, epidural anesthesia
|-
|[[Injury|Trauma]]
|Peripheral nerve blocks, [[intravenous regional anesthesia]], epidural anesthesia
|}

===Chronic pain===

[[Chronic pain]] is a complex and often serious condition that requires diagnosis and treatment by an expert in pain medicine. LAs can be applied repeatedly or continuously for prolonged periods to relieve chronic pain, usually in combination with medication such as [[opioid]]s, [[NSAID]]s, and [[anticonvulsant]]s. Though it can be easily performed, repeated local anesthetic blocks in chronic pain conditions are not recommended as there is no evidence of long-term benefits.<ref>{{cite journal | vauthors =  | title = Current world literature. Drugs in anaesthesia | journal = Current Opinion in Anesthesiology | volume = 16 | issue = 4 | pages = 429–436 | date = August 2003 | pmid = 17021493 | doi = 10.1097/00001503-200308000-00010 }}</ref>

=== Surgery ===
Virtually every part of the body can be anesthetized using conduction anesthesia. However, only a limited number of techniques are in common clinical use. Sometimes, conduction anesthesia is combined with [[general anesthesia]] or [[sedation]] for the patient's comfort and ease of surgery. However, many anesthetists, surgeons, patients and nurses believe that it is safer to perform major surgeries under local anesthesia than general anesthesia.<ref name="pmid19918020">{{cite journal | vauthors = Bodenham AR, Howell SJ | title = General anaesthesia vs local anaesthesia: an ongoing story | journal = British Journal of Anaesthesia | volume = 103 | issue = 6 | pages = 785–789 | date = December 2009 | pmid = 19918020 | doi = 10.1093/bja/aep310 | doi-access = free }}</ref> Typical operations performed under conduction anesthesia include:
{| {{table}}
! Type of surgery
! Purposes or procedures
|-
|[[Dentistry]]
|[[topical anesthesia]] (surface anesthesia), [[infiltration anesthesia]] and [[intraligamentary anesthesia]] during restorative operations such as fillings, crowns, and root canals,<ref name="Torpy2011">{{cite journal | vauthors = Torpy JM, Lynm C, Golub RM | title = JAMA patient page. Local anesthesia | journal = JAMA | volume = 306 | issue = 12 | pages = 1395 | date = September 2011 | pmid = 21954483 | doi = 10.1001/jama.306.12.1395 | doi-access = free}}</ref> or extractions, and regional nerve blocks during extractions and surgeries
|-
|[[Podiatry]]<br>(surgery of feet, ankles, and legs)
|[[cutaneous anesthesia]], [[nail avulsion]]s, [[matricectomy]], [[bunionectomy]], [[hammertoe repair]]<ref name="Torpy2011" /> and various other podiatric procedures
|-
|[[Eye surgery]]
|surface anesthesia with [[topical anesthetic]]s or [[retrobulbar block]] during cataract removal or other ophthalmic procedures<ref name="Torpy2011" />
|-
|[[Head and neck surgery]]<br>(ENT operations)
|infiltration anesthesia, field blocks, or peripheral nerve blocks, [[plexus anesthesia]]
|-
|[[Shoulder surgery]]<br>[[Arm surgery]]
|plexus anesthesia or intravenous regional anesthesia<ref>{{cite journal | vauthors = Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU | title = Interscalene block for shoulder arthroscopy: comparison with general anesthesia | journal = Arthroscopy | volume = 9 | issue = 3 | pages = 295–300 | year = 1993 | pmid = 8323615 | doi = 10.1016/S0749-8063(05)80425-6 }}</ref>
|-
|[[Cardiac surgery]] (heart surgery)<br>[[Pulmonary surgery]] (lung surgery)
|epidural anesthesia combined with general anesthesia
|-
|[[Abdominal surgery]]
|epidural anesthesia or [[spinal anesthesia]], often combined with general anesthesia during inguinal hernia repair or other abdominal surgery<ref name="Torpy2011" />
|-
|[[Gynecological surgery]]<br>[[Obstetric surgery]]<br>[[Urological surgery]] 
|spinal anesthesia or epidural anesthesia
|-
|[[Bone surgery]] and [[joint surgery]] of the [[pelvis]], [[hip]], and [[leg]] 
|spinal anaesthesia or epidural anesthesia, peripheral nerve blocks, or intravenous regional anesthesia
|-
|[[Skin surgery]] and [[peripheral vascular surgery]]
|[[topical anesthesia]], [[field block]]s, peripheral nerve blocks, spinal anesthesia or epidural anesthesia<ref>{{Cite journal |last1=Flaherty |first1=James |last2=Horn |first2=Jean-Louis |last3=Derby |first3=Ryan |date=September 2014 |title=Regional anesthesia for vascular surgery |url=https://pubmed.ncbi.nlm.nih.gov/25113725/ |journal=Anesthesiology Clinics |volume=32 |issue=3 |pages=639–659 |doi=10.1016/j.anclin.2014.05.002 |issn=1932-2275 |pmid=25113725}}</ref>
|}

=== Diagnostic tests ===
Diagnostic tests such as bone marrow aspiration, lumbar puncture (spinal tap) and aspiration of cysts or other structures are made to be less painful upon administration of local anesthetic before insertion of larger needles.<ref name="Torpy2011" />

=== Other uses ===
Local anesthesia is also used during insertion of IV devices, such as pacemakers and implantable defibrillators, ports used for giving chemotherapy medications and hemodialysis access catheters.<ref name="Torpy2011" />

Topical anesthesia, in the form of [[lidocaine/prilocaine]] (EMLA) is most commonly used to enable relatively painless [[venipuncture]] ([[blood]] collection) and placement of [[Peripheral venous catheter|intravenous cannula]]e. It may also be suitable for other kinds of punctures such as [[ascites]] drainage and [[amniocentesis]].

Surface anesthesia also facilitates some [[endoscopy|endoscopic]] procedures such as [[bronchoscopy]] (visualization of the lower airways) or [[cystoscopy]] (visualization of the inner surface of the bladder)