Local anesthetics

Local anesthetics continue to be used to achieve anesthesia and analgesia via a wide range of routes of administration. This review of relevant 2010 publications covers adverse reactions after brachial plexus anesthesia, caudal, epidural, and spinal (intrathecal) anesthesia, dental anesthesia, infiltration anesthesia, ocular anesthesia, paravertebral anesthesia, and transversus abdominis plane block; there is also a special review on tumescent anesthesia. Some adverse reactions to local anesthetics are specific to certain routes of administration, while others are specific to certain compounds, such as benzocaine, bupivacaine and levobupivacaine, lidocaine, mepivacaine, prilocaine and EMLA (prilocaine + lidocaine), and ropivacaine. Typical adverse reactions related to the route of administration continue to be unintentional spread of the local anesthetic into the intrathecal space, uptake into the systemic circulation, or chondrolysis after intra-articular infusion. Typical adverse reactions related to certain individual compounds are methemoglobinemia after the use of benzocaine and prilocaine and cardiotoxicity with bupivacaine. The successful use of lipid solutions to treat systemic toxicity of local anesthetics continues to be reported. True allergic reactions to local anesthetics are rare.