Local anesthesia
Summary
Local anesthesia refers to the reversible numbing of pain conduction by blocking nerve
endings at and around the site of administration. It is commonly used in both adults and
children for minor procedures and wound repair and is further subdivided into topical
anesthesia and infiltration anesthesia, which is the loss of sensation in a
localized superficial area via injection of a local anesthetic agent into subcutaneous
or submucosal tissue. Contraindications include allergy to the class of anesthetic agent. The
preparation consists of performing a baseline neurovascular examination and selecting the
appropriate local anesthetic. Complications are rare.
See also “Regional anesthesia” and “Local anesthetic agents.”
Indications
Local anesthesia is used to decrease the pain associated with minor procedures. [2]
• Single point infiltration : localized painful procedures (e.g., lumbar puncture, incision
and drainage)
• Local anesthesia for wound repair : larger lacerations (i.e., requiring more than
one anesthetic injection)
Topical anesthesia may help reduce pain and anxiety in children before minor invasive
procedures (e.g., IV placement, wound repair). [3]
Contraindications
• Absolute: medication allergy to an anesthetic class [4]
o Ester anesthetics and amine anesthetics are chemically different and rarely cross-react.
o Use a local anesthetic agent of the alternative class, if an allergy is present.
• Relative: injecting through inflamed tissue (e.g., cellulitis) at planned procedure site, if
contraindicated by planned procedure [2]
We list the most important contraindications. The selection is not exhaustive.
Preparation
Physical examination
• Perform a neurovascular examination prior to anesthetic infiltration to establish baseline
function.
Medication selection
• Commonly used agents: lidocaine, bupivacaine (see “Overview of local anesthetics” for
additional agents)
• Dosage: varies depending on the area and sensitivity of the tissue requiring anesthesia
and the individual's pain threshold
Local anesthetic with epinephrine should be used with caution in areas supplied by end
arteries (e.g., digits, penis) because of the risk of tissue ischemia. [6][7][8]
Calculate the maximum dose of local anesthetic, especially in pediatric patients, to
avoid local anesthetic systemic toxicity.
Complications
Complications are rare; see “Adverse effects of local anesthetic agents.”
We list the most important complications. The selection is not exhaustive.
NOTES
FEEDBACK
Topical anesthesia
• Definition: the loss of sensation to skin or mucosa by direct application of a local
anesthetic agent (e.g., in the form of a gel, ointment, spray, or patch) [2]
• Indications: typically used for superficial and localized procedures, particularly in
children
o Good for anesthetizing small lacerations, intact skin, or mucus membranes
o Common applications include minor wound repair, peripheral IV placement, and foley
catheter placement
• Choice of agent is based on the intended location, e.g.: [2]
o Skin: eutectic mixture of local anesthetic (EMLA)
cream, lidocaine/epinephrine/tetracaine (LET) gel
o Ophthalmic: tetracaine, proparacaine
o Oropharyngeal: benzocaine spray, viscous lidocaine
o Genitourinary: viscous lidocaine
Tips and Links
• 2016 American Academy of Dermatology Guidelines for the use of local anesthesia in
office-based dermatologic surgery
• CME Program Overview
• CME/MOC Accreditation Statements
• Redeeming CME Credits
References
1.
Contributor Disclosures - Local anesthesia. None of the individuals in control of the content
for this article reported relevant financial relationships with ineligible companies. For
details, please review our full conflict of interest (COI)
policy:. url: https://go.amboss.com/conflict-of-interest-policy Accessed: June 5, 2023.
2.
Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute
Care. Elsevier; 2018
3.
Mace SE, Whiteman P, Avarello JT, et al. Local and Topical Anesthetics for Pediatric Patients
in the Emergency Department. Pediatr Emerg Care. 2020; 36(12): p.593-
601. doi: 10.1097/pec.0000000000002285.| Open in Read by QxMD
4.
Achar S, Kundu S. Principles of office anesthesia: part I. Infiltrative anesthesia.. Am Fam
Physician. 2002; 66(1): p.91-4. pmid: 12126036. | Open in Read by QxMD
5.
El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current
perspectives. Local Reg Anesth. 2018; Volume 11: p.35-44. doi: 10.2147/lra.s154512.| Open
in Read by QxMD
6.
Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-
based dermatologic surgery. J Am Acad Dermatol. 2016; 74(6): p.1201-
1219. doi: 10.1016/j.jaad.2016.01.022.| Open in Read by QxMD
7.
Prabhakar H, Rath S, Kalaivani M, Bhanderi N. Adrenaline with lidocaine for digital nerve
blocks. Cochrane Database Syst Rev. 2015;
2020(11). doi: 10.1002/14651858.cd010645.pub2.| Open in Read by QxMD
8.
Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine
10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences; 2022
9.
Strazar AR, Leynes PG, Lalonde DH. Minimizing the Pain of Local Anesthesia Injection. Plast
Reconstr Surg. 2013; 132(3): p.675-684. doi: 10.1097/prs.0b013e31829ad1e2.| Open in Read
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