Infiltrasi Anestesia

Dr. Imai Indra, SpAn

History of Local Anesthetics

Cocaine isolated 1856 1884 cocaine used in occular surgery 1880s Regional anesthesia plexus 1898 cocaine used in spinal anesthesia 1905 1st synthetic LA (procaine) introduced 1943 lidocaine synthesized Mepivacaine (1957), Bupiv (63), Ropiv (96)

Infiltration Anesthesia/Analgesia
Most local anesthetics can be used for infiltration anesthesia Immediate onset for intradermal or subcutaneous administration Epinephrine will prolong duration of action of all local anesthetics Pain with injection is noted due to the acidic nature of local anesthetic solutions

Local Anesthetic

Concentration in %

Maximum Dose Total

Maximum Dose mg/kg

Duration of Action

Lidocaine

0.5-1

300

4.5

30-60 minutes Moderate duration 45-90 minutes Moderate duration 120-240 minutes Long duration 120-360 minutes Long duration

Mepivacaine

0.5-1

300

4.5

Bupivacaine

0.25-0.5

175

2.5

Ropivacaine

0.1-2

200

Maximum Dose with Epinephrine

Local Anesthetic Lidocaine Concentratio n in % 0.5-1 Maximum Dose Total 500 Maximum Dose mg/kg 7 Duration of Action 120-360 minutes Moderate duration

Mepivacaine

0.5-1

500

120-360 minutes Moderate duration

Bupivacaine

0.25-0.5

225

180-420 minutes Long duration

Injection Technique

Lowest concentration effective Prep wound first if possible Smallest needle available (27g) Use wound margin Subdermal injection Insert, then inject

Injectio n
Injection should be subdermal Bury the hub and inject as you withdraw Through wound edge

Injection Technique

Warming No change in efficacy Less pain of injection Probably synergistic with buffering

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