Editing Local anesthesia

{{short description|Technique to induce the absence of sensation in a specific part of the body}}
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'''Local anesthesia''' is any technique to induce the absence of [[sense|sensation]] in a specific part of the body,<ref>[http://medical-dictionary.thefreedictionary.com/local+anesthesia thefreedictionary.com > local anesthesia] In turn citing: Mosby's Medical Dictionary, 8th edition. Copyright 2009</ref> generally for the aim of inducing '''local analgesia''', i.e. local insensitivity to [[pain]], although other local senses may be affected as well. It allows patients to undergo surgical and [[dentistry|dental]] procedures with reduced pain and distress. In many situations, such as [[caesarean section|cesarean section]], it is safer and therefore superior to [[general anesthesia]].<ref name=anest>{{cite journal |author1=Sukhminder Jit Singh Bajwa |author2=Ashish Kulshrestha |title=Anaesthesia for laparoscopic surgery: General vs regional anaesthesia |date=2016 |journal=J Minim Access Surg |volume=12 |issue=1 |pages=4–9 |doi=10.4103/0972-9941.169952 |pmid=26917912|pmc=4746973 |doi-access=free }}</ref>

The following terms are often used interchangeably:
* ''Local anesthesia'', in a strict sense, is [[anesthesia]] of a small part of the body such as a tooth or an area of skin.
* ''Regional anesthesia'' is aimed at anesthetizing a larger part of the body such as a leg or arm.
* ''Conduction anesthesia'' encompasses a great variety of local and regional anesthetic techniques.

==Medical==
{{Main|Local anesthetic}}
A local anesthetic is a [[medication|drug]] that causes reversible local anesthesia and a loss of [[nociception]]. When it is used on specific nerve pathways ([[nerve block]]), effects such as [[analgesia]] (loss of [[pain]] sensation) and [[paralysis]] (loss of [[muscle]] power) can be achieved. Clinical local anesthetics belong to one of two classes: aminoamide and aminoester local anesthetics. Synthetic local anesthetics are structurally related to [[cocaine]]. They differ from cocaine mainly in that they have no abuse potential and do not act on the [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2278837/ sympathoadrenergic system], i.e. they do not produce [[hypertension]] or local [[vasoconstriction]], with the exception of [[Ropivacaine]] and [[Mepivacaine]] that do produce weak vasoconstriction. Unlike other forms of anesthesia, a local can be used for a minor procedure in a surgeon's office as it does not put one into a state of unconsciousness. However, the physician should have a sterile environment available before doing a procedure in their office. Local anesthetics work primarily by reversibly blocking voltage-gated sodium channels in neuronal membranes, which prevents the initiation and propagation of action potentials along sensory nerves. This blocks nociceptive signals from reaching the brain.

Local anesthetics vary in their [[pharmacology|pharmacological]] properties and they are used in various techniques of local anesthesia such as:
* [[Topical anesthetic|Topical anesthesia]] (surface) - Surface application on mucous membranes or skin.
* [[Infiltration (medical)|Infiltration]] anesthesia: Direct injection into tissue near the site of the procedure.
* Peripheral nerve blocks: Injection near specific nerves or plexuses (e.g., brachial, femoral).
* Neuraxial anesthesia: Includes spinal and epidural techniques, which anesthetize broader regions through nerve root blockade.
Adverse effects depend on the [[local anesthetic]] method and site of administration discussed in depth in the [[local anesthetic]] sub-article, but overall, adverse effects can be:
# localized prolonged [[anesthesia]] or [[paresthesia]] due to infection, [[hematoma]], excessive fluid pressure in a confined cavity, and severing of nerves & support tissue during injection.<ref>{{Cite journal|journal=Risks Associated with Your Anaesthetic|title=Nerve damage associated with peripheral nerve block|volume=Section 12|publisher=The Royal College of Anaesthetists|date=January 2006|url=http://www.rcoa.ac.uk/docs/nerve-peripheral.pdf|access-date=2007-10-10|archive-url=https://web.archive.org/web/20071009110706/http://www.rcoa.ac.uk/docs/nerve-peripheral.pdf|archive-date=2007-10-09|url-status=dead}}</ref>
# systemic reactions such as depressed [[central nervous system|CNS]] syndrome, allergic reaction, [[vasovagal episode]], and [[cyanosis]] due to [[local anesthetic toxicity]].
# lack of anesthetic effect due to infectious pus such as an [[abscess]].

==Non-medical local anesthetic techniques==
Local [[pain management]] that uses other techniques than [[analgesic]] medication include:
* [[Transcutaneous electrical nerve stimulation]], which has been found to be ineffective for [[lower back pain]]{{Citation needed|date=November 2016}}, however, it might help with [[diabetic neuropathy]].<ref name=pmid20042705>{{Cite journal |vauthors=Dubinsky RM, Miyasaki J |title=Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology |journal=Neurology |volume=74 |issue=2 |pages=173–6 |date=January 2010|pmid=20042705 |doi=10.1212/WNL.0b013e3181c918fc |url=http://www.neurology.org/content/74/2/173.full.pdf|doi-access=free }}</ref>
* [[Pulsed radiofrequency]], [[Neuromodulation (medicine)|neuromodulation]], direct introduction of medication and nerve [[ablation]] may be used to target either the tissue structures and organ/systems responsible for persistent [[nociception]] or the [[nociceptors]] from the structures implicated as the source of chronic pain.<ref name="Varrassi G, Paladini A">{{cite journal |vauthors=Varrassi G, Paladini A, Marinangeli F, Racz G |title=Neural modulation by blocks and infusions |journal=Pain Practice |volume=6 |issue=1 |pages=34–8 |year=2006 |pmid=17309707 |doi=10.1111/j.1533-2500.2006.00056.x|s2cid=22767485 }}</ref><ref name="Meglio M.">{{cite journal |author=Meglio M |title=Spinal cord stimulation in chronic pain management |journal=Neurosurg. Clin. N. Am. |volume=15 |issue=3 |pages=297–306 |year=2004 |pmid=15246338 |doi=10.1016/j.nec.2004.02.012}}</ref><ref>{{cite journal |vauthors=Rasche D, Ruppolt M, Stippich C, Unterberg A, Tronnier VM |title=Motor cortex stimulation for long-term relief of chronic neuropathic pain: a 10 year experience |journal=Pain |volume=121 |issue=1–2 |pages=43–52 |year=2006 |pmid=16480828 |doi=10.1016/j.pain.2005.12.006|s2cid=24552444 }}</ref><ref name="Boswell MV, Trescott AM">{{cite journal |vauthors=Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L |title=Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain |journal=Pain Physician |volume=10 |issue=1 |pages=7–111 |year=2007 |pmid=17256025 |url=http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf?PHPSESSID=ea188711febadee5420f1c9061ebd249 |archive-url=https://web.archive.org/web/20080828141204/http://www.painphysicianjournal.com/2007/january/2007;10;7-111.pdf |url-status=dead |archive-date=August 28, 2008 |format=PDF }}</ref><ref name="Romanelli P, Esposito V">{{cite journal |vauthors=Romanelli P, Esposito V, Adler J |title=Ablative procedures for chronic pain |journal=Neurosurg. Clin. N. Am. |volume=15 |issue=3 |pages=335–42 |year=2004 |pmid=15246341 |doi=10.1016/j.nec.2004.02.009}}</ref>

==See also==
{{Portal|Medicine}}
* [[Continuous wound infiltration]]

==References==
{{Reflist}}

==External links==
* [https://www.nysora.com/ New York School of Regional Anesthesia]
* {{usurped|1=[https://web.archive.org/web/20191230204621/http://medical.freeonlinebookstore.org/ShowBook.php?subcategoryid=48 Anesthesia Books]}}
* [https://web.archive.org/web/20080701094503/http://www.nerveblocks.net/ General information and tutorials in peripheral regional anesthesia]
* [https://web.archive.org/web/20080610062910/http://www.worldanaesthesia.org/ worldanaesthesia.org] Free online manual of regional anaesthesia - John Hyndman
* [https://web.archive.org/web/20110713204255/http://www.life-tech.com/anesthesia/educ/neuro.shtml Clinical Use of Peripheral Nerve Stimulators and The Neuromuscular Junction]
* [https://web.archive.org/web/20181201073906/https://esra.kenes.com/ ESRA - The European Society for Regional Anaesthesia Congress]

{{Anesthesia}}
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[[Category:Anesthesia]]