Infiltration Anaesthesia [Dr S Sen]

Infiltration anesthesia is the injection of local anesthetic directly into tissue without
taking into consideration the course of cutaneous nerves. Infiltration anesthesia can be so
superficial as to include only the skin. It also can include deeper structures, including intra-
abdominal organs, when these too are infiltrated.
The duration of infiltration anesthesia can be approximately doubled by the addition of
epinephrine (5μg/mL) to the injection solution. Epinephrine-containing solutions should
not, however, be injected into tissues supplied by end arteries (e.g., fingers and toes, ears, the
nose, and the penis). The resulting vasoconstriction may cause gangrene.
The local anesthetics used most frequently for infiltration anesthesia are lidocaine (0.5-1%),
procaine (0.5-1%), and bupivacaine (0.125-0.25%). When used without epinephrine, up to
4.5 mg/kg of lidocaine, 7 mg/kg of procaine, or 2 mg/kg of bupivacaine can be employed in
adults. When epinephrine is added, these amounts can be increased by one-third.
The advantage of infiltration anesthesia and other regional anesthetic techniques is that it
can provide satisfactory anesthesia without disrupting normal bodily functions.
The chief disadvantage of infiltration anesthesia is that relatively large amounts of drug
must be used to anesthetize relatively small areas.
Mechanism of action
Local anesthetics reversibly block nerve conduction near their site of administration,
thereby producing temporary loss of sensation in a limited area. Nerve impulse conduction
is blocked by inhibition of sodium channels at the nerve endings and along the axon. This
causes a decrease in nerve cell membrane permeability to sodium ions, possibly by
competing with calcium-binding sites that control sodium permeability. This change in
permeability results in decreased depolarization and an increased excitability threshold that
ultimately prevents the nerve action potential from forming.
Indications
Local anesthetics are used for infiltration and nerve block anesthesia. Because of
variation in systemic absorption and toxicity, the ideal choice of local anesthetic and
concentration depends on the intended procedure. Infiltration anesthesia is often used for
minor surgical and dental procedures. Nerve block anesthesia is used for surgical, dental, and
diagnostic procedures and for pain management.
Uses for infiltrative anesthetics are as follows:
• Subcutaneous infiltration (IV placement, superficial/shave biopsy, suturing)
 • Submucosal infiltration (dental procedures, laceration repairs)
• Wound infiltration (postoperative pain control at incision site)
• Intraarticular injections (postsurgical pain control, arthritic joint pain control)
• Infiltrative nerve blocks (ankle block, scalp block, digit block)
Infiltration anesthesia is accomplished with administration of the local anesthetic solution
intradermally (ID), subcutaneously (SC), or submucosally across the nerve path that supplies
the area of the body that requires anesthesia.
Adverse effects
Adverse effects are usually caused by high plasma concentrations of a local anesthetic
drug that result from inadvertent intravascular injection, excessive dose or rate of injection,
delayed drug clearance, or administration into tissues with high rates of clearance. Possible
adverse effects include the following:
CNS: High plasma concentration initially produces CNS stimulation (including seizures),
followed by CNS depression (including respiratory arrest). The CNS stimulatory effect may
be absent in some patients, particularly when amides are administered. Solutions that contain
epinephrine may add to the CNS stimulatory effect.
Cardiovascular: High plasma levels typically depress the heart and may result
in bradycardia, arrhythmias, hypotension, cardiovascular collapse, and cardiac arrest. Local
anesthetics that contain epinephrine may cause opposite effects,
including hypertension, tachycardia, and angina.
Other body systems can also experience adverse effects
• Transient burning sensation
• Skin discoloration
• Swelling
• Neuritis
• Tissue necrosis and sloughing
• Methemoglobinemia (with prilocaine)