Individual differences |
Methods | Statistics | Clinical | Educational | Industrial | Professional items | World psychology |
Biological: Behavioural genetics · Evolutionary psychology · Neuroanatomy · Neurochemistry · Neuroendocrinology · Neuroscience · Psychoneuroimmunology · Physiological Psychology · Psychopharmacology (Index, Outline)
- Main article: Local anesthesia
A local anesthetic is a drug that reversibly inhibits the propagation of signals along nerves. 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 sympathoadrenergic system, i.e. they do not produce hypertension or local vasoconstriction, with the exception of Ropivacaine and Mepivacaine that do produce weak vasoconstriction.
- Topical anesthesia (surface)
- Plexus block
- Epidural (extradural) block
- Spinal anesthesia (subarachnoid block)
Mechanism of action
All local anesthetics are membrane stabilizing drugs, they reversibly decrease the rate of depolarization and repolarization of excitable membranes (like neurons). Though many other drugs also have membrane stabilizing properties, all are not used as local anesthetics, for example propranolol. Local anesthetic drugs act mainly by inhibiting sodium influx through sodium-specific ion channels in the neuronal cell membrane, in particular the so-called voltage-gated sodium channels. When the influx of sodium is interrupted, an action potential cannot arise and signal conduction is inhibited. The receptor site is thought to be located at the cytoplasmic (inner) portion of the sodium channel. Local anesthetic drugs bind more readily to "open" sodium channels, thus onset of neuronal blockade is faster in neurons that are rapidly firing. This is referred to as state dependent blockade.
Local anesthetics are weak bases and are usually formulated as the hydrochloride salt to render them water-soluble. At the chemical's pKa the protonated (ionised) and unprotonated (unionised) forms of the molecule exist in an equilibrium but only the unprotonated molecule diffuses readily across cell membranes. Once inside the cell the local anesthetic will be in equilibrium, with the formation of the protonated (ionised form), which does not readily pass back out of the cell. This is referred to as "ion-trapping". In the protonated form, the molecule binds to the local anaesthetic binding site on the inside of the ion channel near the cytoplasmic end.
Acidosis such as caused by inflammation at a wound partly reduces the action of local anesthetics. This is partly because most of the anaesthetic is ionised and therefore unable to cross the cell membrane to reach its cytoplasmic-facing site of action on the sodium channel.
Localized Adverse Effects
The local adverse effects of anesthetic agents include neurovascular manifestations such as prolonged anesthesia (numbness) and paresthesia (tingling, feeling of "pins and needles", or strange sensations). These are symptoms of localized nerve impairment or nerve damage.
Permanent nerve damage after a peripheral nerve block is rare. Symptoms are very likely to resolve within a few weeks. The vast majority of those affected (92–97%), recover within four to six weeks. 99% of these people have recovered within a year. It is estimated that between 1 in 5,000 and 1 in 30,000 nerve blocks result in some degree of permanent persistent nerve damage .
It is suggested that symptoms may continue to improve for up to 18 months following injury.
Causes of localized symptoms include:
- neurotoxicity due to allergenic reaction,
- excessive fluid pressure in a confined space,
- severing of nerve fibers or support tissue with the syringe/catheter,
- injection-site [Hematoma] that puts pressure on the nerve, or
- injection-site infection that produces inflammatory pressure on the nerve and/or necrosis.
General Adverse Effects
(See also local anesthetic toxicity)
General systemic adverse affects are due to the pharmacological effects of the anesthetic agents used. The conduction of electric impulses follows a similar mechanism in peripheral nerves, the central nervous system, and the heart. The effects of local anesthetics are therefore not specific for the signal conduction in peripheral nerves. Side effects on the central nervous system and the heart may be severe and potentially fatal. However, toxicity usually occurs only at plasma levels which are rarely reached if proper anesthetic techniques are adhered to. Additionally, persons may exhibit allergenic reactions to the anesthetic compounds and may also exhibit cyanosis due to methemoglobinemia.
Central nervous system
Depending on local tissue concentrations of local anesthetics, there may be excitatory or depressant effects on the central nervous system. At lower concentrations, a relatively selective depression of inhibitory neurons results in cerebral excitation, which may lead to generalized convulsions. A profound depression of brain functions occurs at higher concentrations which may lead to coma, respiratory arrest and death. Such tissue concentrations may be due to very high plasma levels after intravenous injection of a large dose. Another possibility is direct exposure of the central nervous system through the CSF, i.e. overdose in spinal anesthesia or accidental injection into the subarachnoid space in epidural anesthesia.
The conductive system of the heart is quite sensitive to the action of local anesthetics. Lidocaine is often used as an antiarrhythmic drug and has been studied extensively, but the effects of other local anesthetics are probably similar to those of Lidocaine. Lidocaine acts by blocking sodium channels, leading to slowed conduction of impulses. This may obviously result in bradycardia, but tachyarrhythmia can also occur. With high plasma levels of lidocaine there may be higher-degree atrioventricular block and severe bradycardia, leading to coma and possibly death.
Treatment of overdose: "Lipid rescue"
There is evidence that Intralipid, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anaesthetic overdose, including human case reports of successful use in this way ('lipid rescue'). 
Adverse reactions to local anesthetics (especially the esters) are not uncommon, but true allergy is very rare. Allergic reactions to the esters is usually due to a sensitivity to their metabolite, para-aminobenzoic acid (PABA), and does not result in cross-allergy to amides. Therefore, amides can be used as alternatives in those patients. Non-allergic reactions may resemble allergy in their manifestations. In some cases, skin tests and provocative challenge may be necessary to establish a diagnosis of allergy. There are also cases of allergy to paraben derivatives, which are often added as preservatives to local anesthetic solutions.
The systemic toxicity of prilocaine is comparatively low, however its metabolite, o-toluidine, is known to cause methemoglobinemia. As methemoglobinemia reduces the amount of hemoglobin that is available for oxygen transport, this side effect is potentially life-threatening. Therefore dose limits for prilocaine should be strictly observed. Prilocaine is not recommended for use in infants.
Local anesthetics in clinical use
- Amino esters
- Amino amides
Esters are prone to producing allergic reactions, which may necessitate the use of an Amide. The names of Amides contain an "i" somewhere before the -aine. Esters do not.
- Lidocaine/prilocaine (EMLA)
Natural local anesthetics
Naturally occurring local anesthetics not derived from cocaine are usually neurotoxins, and have the suffix -toxin in their names.  Unlike cocaine produced local anesthetics which are intracellular in effect, saxitoxin & tetrodotoxin bind to the extracellular side of sodium channels.
- ↑ The Royal College of Anaesthetists, Nerve Damage Associated with Peripheral Nerve Block (2006)
- ↑ The Royal College of Anaesthetists, Nerve Damage Associated with Peripheral Nerve Block (2006)
- ↑ Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology 1998; 88: 1071-5.
- ↑ Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity. Regional Anesthesia and Pain Medicine 2003; 28: 198-202..
- ↑ Picard J, Meek T. Lipid emulsion to treat overdose of local anaesthetic: the gift of the glob. Anaesthesia 2006;61:107-9. PMID 16430560
- ↑ Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB. Successful Use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology 2006;105:217-8. PMID 16810015
- ↑ Litz, RJ, Popp M, Stehr S N, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia 2006;61:800-1.
"Nerve damage associated with peripheral nerve block", Risks associated with your anaesthetic, (The Royal College of Anaesthetists) Section 12, January 2006, http://www.rcoa.ac.uk/docs/nerve-peripheral.pdf, retrieved on 10 Oct 2007
- Acharya, R. (2004). Chronic subdural haematoma complicating spinal anaesthesia: Neurological Sciences Vol 25(6) Feb 2004, 348-350.
- Ackerman, C. A. (1989). The emotional and physiological responses of dentists and their patients during administration of a local anaesthetic: Dissertation Abstracts International.
- Ackerman, W. E., Phero, J. C., & Juneja, M. M. (1989). Panic disorder following 2-chloroprocaine: American Journal of Psychiatry Vol 146(7) Jul 1989, 940-941.
- Albaladejo, P., Bouaziz, H., & Benhamou, D. (1998). Epidural analgesics: How can safety and efficacy be improved? : CNS Drugs Vol 10(2) Aug 1998, 91-104.
- Atanassoff, P. G., Brull, S. J., Zhang, J., Greenquist, K., Silverman, D. G., & LaMotte, R. H. (1999). Enhancement of experimental pruritus and mechanically evoked dysesthesiae with local anesthesia: Somatosensory & Motor Research Vol 16(4) 1999, 291-298.
- Backonja, M.-M. (1994). Local anesthetics as adjuvant analgesics: Journal of Pain and Symptom Management Vol 9(8) Nov 1994, 491-499.
- Barnsley, L., Lord, S. M., Wallis, B. J., & Bogduk, N. (1994). Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints: New England Journal of Medicine Vol 330(15) Apr 1994, 1047-1050.
- Beekwilder, J. P., O'Leary, M. E., Van den Broek, L. P., Van Kempen, G. T. H., Ypey, D. L., & Van den Berg, R. J. (2003). Kv1.1 channels of dorsal root ganglion nerves are inhibited by n-butyl-p-aminobenzoate, a promising anesthetic for the treatment of chronic pain: Journal of Pharmacology and Experimental Therapeutics Vol 304(2) Feb 2003, 531-538.
- Benini, F., Gobber, D., Lago, P., Agosto, C., Carli, G., & Zacchello, F. (1998). Pain management of arteriovenous fistula cannulation in haemodialysis children: Efficacy of EMLA anaesthetic cream: European Journal of Pain Vol 2(2) 1998, 109-113.
- Bogduk, N. (2004). Diagnostic Blocks: A Truth Serum for Malingering: Clinical Journal of Pain Vol 20(6) Nov 2004, 409-414.
- Brackbill, Y. (1977). Long-term effects of obstetrical anesthesia on infant autonomic function: Developmental Psychobiology Vol 10(6) Nov 1977, 529-535.
- Champoux, R., & Upton, L. G. (1974). Oral motor nerve block: Some implications for research in speech: Journal of Speech & Hearing Disorders Vol 39(3) Aug 1974, 344-349.
- Chapman, S. L., & Brena, S. F. (1982). Learned helplessness and responses to nerve blocks in chronic low back pain patients: Pain Vol 14(4) Dec 1982, 355-364.
- Chen, Y.-W., Huang, K.-L., Liu, S.-Y., Tzeng, J.-I., Chu, K.-S., Lin, M.-T., et al. (2004). Intrathecal tri-cyclic antidepressants produce spinal anesthesia: Pain Vol 112(1-2) Nov 2004, 106-112.
- Chong, S. F., Bretscher, M. E., Mailliard, J. A., Tschetter, L. K., & et al. (1997). Pilot study evaluating local anesthetics administered systemically for treatment of pain in patients with advanced cancer: Journal of Pain and Symptom Management Vol 13(2) Feb 1997, 112-117.
- Clerc, S., Vuilleumier, H., Frascarolo, P., Spahn, D. R., & Gardaz, J.-P. (2005). Is the Effect of Inguinal Field Block With 0.5% Bupivacaine on Postoperative Pain After Hernia Repair Enhanced by Addition of Ketorolac or S(+) Ketamine? : Clinical Journal of Pain Vol 21(1) Jan 2005, 101-105.
- Clifton, P. A., Shaughnessy, A. F., & Andrews, S. (1998). Ineffectiveness of topical benzocaine spray during colposcopy: The Journal of Family Practice Vol 46(3) Mar 1998, 242-246.
- Colburn, R. W., DeLeo, J. A., Rickman, A. J., Yeager, M. P., Kwon, P., & Hickey, W. F. (1997). Dissociation of microglial activation and neuropathic pain behaviors following peripheral nerve injury in the rat: Journal of Neuroimmunology Vol 79(2) Nov 1997, 163-175.
- Copstick, S. M., Taylor, K. E., Hayes, R., & Morris, N. (1986). Partner support and the use of coping techniques in labour: Journal of Psychosomatic Research Vol 30(4) 1986, 497-503.
- Coyne, P. J., Hansen, L. A., Laird, J., Buster, P., & Smith, T. J. (2004). Massive Hydromorphone Dose Delivered Subcutaneously Instead of Intrathecally: Guidelines for Prevention and Management of Opioid, Local Anesthetic, and Clonidine Overdose: Journal of Pain and Symptom Management Vol 28(3) Sep 2004, 273-276.
- Cummings, S. B., Jr. (1938). The effect of local anesthesia on tactile and vibratory thresholds: Journal of Experimental Psychology Vol 23(4) Oct 1938, 321-338.
- Danek, G. D. (1999). Effect of local anesthetic on stress response of infants undergoing peripherally inserted central catheter placement. Dissertation Abstracts International: Section B: The Sciences and Engineering.
- Daniloff, R., Bishop, M., & Ringel, R. (1977). Alteration of children's articulation by application of oral anesthesia: Journal of Phonetics Vol 5(3) Jul 1977, 285-298.
- Davidson, E. M., & Carlton, S. M. (1998). Intraplantar injection of dextrorphan, ketamine or memantine attenuates formalin-induced behaviors: Brain Research Vol 785(1) Feb 1998, 136-142.
- Dierks-Ventling, C., Gerhard, U., & Hobi, V. (1989). The effects of total- and local anesthesia on concentration and memory: Schweizersche Zeitschrift fur Psychologie/ Revue suisse de psychologie Vol 48(2) 1989, 112-120.
- Doty, R. L., & Anisko, J. J. (1973). Procaine hydrochloride olfactory block eliminates mounting in the male golden hamster: Physiology & Behavior Vol 10(2) Feb 1973, 395-397.
- Duncan, P. M., & Copeland, M. (1975). Asymmetrical state dependency from temporary septal area dysfunction in rats: Journal of Comparative and Physiological Psychology Vol 89(6) Aug 1975, 537-545.
- Duque, J., Vandermeeren, Y., Lejeune, T. M., Thonnard, J.-L., Smith, A. M., & Olivier, E. (2005). Paradoxical effect of digital anaesthesia on force and corticospinal excitability: Neuroreport: For Rapid Communication of Neuroscience Research Vol 16(3) Feb 2005, 259-262.
- Ekblom, A., Hansson, P., Lindblom, U., & Olofsson, C. (1992). Does a regional nerve block change cutaneous perception thresholds outside the anaesthetic area? Implications for the interpretation of diagnostic blocks: Pain Vol 50(2) Aug 1992, 163-167.
- Emory, E. K., Schlackman, L. J., & Fiano, K. (1996). Drug-hormone interactions on neurobehavioral responses in human neonates: Infant Behavior & Development Vol 19(2) Apr-Jun 1996, 213-220.
- Faller, H., Lippelt, A., Nagele, S., & Klein, C. E. (1999). Emotional state, physical complaints and doctor-patient relationship in patients with allergies to local anesthetics: Signs of somatization? A controlled cross-section study: Zeitschrift fur Klinische Psychologie, Psychiatrie und Psychotherapie Vol 47(3) 1999, 316-332.
- Fanurik, D., Koh, J. L., & Schmitz, M. L. (2000). Distraction techniques combined with EMLA: Effects on IV insertion pain and distress in children: Children's Health Care Vol 29(2) Spr 2000, 87-101.
- Fischer, A. A. (1999). Treatment of myofascial pain: Journal of Musculoskeletal Pain Vol 7(1-2) 1999, 131-142.
- Fontaine, P., Dittberner, D., & Scheltema, K. E. (1994). The safety of dorsal penile nerve block for neonatal circumcision: The Journal of Family Practice Vol 39(3) Sep 1994, 243-248.
- Fraser, L. S. M., Vincent, C., Oakley, D. A., Pearce, S., & et al. (1996). Pain perception during surgery performed under adequate general anaesthesia. Assen, Netherlands: Van Gorcum & Co.
- Galer, B. S., Harle, J., & Rowbotham, M. C. (1996). Response to intravenous lidocaine infusion predicts subsequent response to oral mexiletine: A prospective study: Journal of Pain and Symptom Management Vol 12(3) Sep 1996, 161-167.
- Glazer, S., & Portenoy, R. K. (1991). Systemic local anesthetics in pain control: Journal of Pain and Symptom Management Vol 6(1) Jan 1991, 30-39.
- Golub, M. S. (1996). Labor analgesia and infant brain development: Pharmacology, Biochemistry and Behavior Vol 55(4) Dec 1996, 619-628.
- Graboski, C. L., Gray, D. S., & Burnham, R. S. (2005). Botulinum toxin a versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: A randomised double blind crossover study: Pain Vol 118(1-2) Nov 2005, 170-175.
- Graham, J. H. (1993). Cocaine-like drugs and local anesthetics: Correlation of neurochemistry and behavior: Dissertation Abstracts International.
- Graham, J. H., Maher, J. R., & Robinson, S. E. (1995). The effect of cocaine and other local anesthetics on central dopaminergic neurotransmission: Journal of Pharmacology and Experimental Therapeutics Vol 274(2) Aug 1995, 707-717.
- Gross, D. (1982). Contralateral local anaesthesia in the treatment of phantom limb and stump pain: Pain Vol 13(3) Jul 1982, 313-320.
- Guler, G., Erdogan, F., Golgeli, A., Akin, A., & Boyaci, A. (2005). Ketamine Reduces Lidocaine-Induced Seizures In Mice: International Journal of Neuroscience Vol 115(8) Aug 2005, 1239-1244.
- Harper, D. M., Walstatter, B. S., & Lofton, B. J. (1994). Anesthetic blocks for loop electrosurgical excision procedure: The Journal of Family Practice Vol 39(3) Sep 1994, 249-256.
- Hayek, S. M., Paige, B., Girgis, G., Kapural, L., Fattouh, M., Xu, M., et al. (2006). Tunneled Epidural Catheter Infections in Noncancer Pain: Increased Risk in Patients With Neuropathic Pain/Complex Regional Pain Syndrome: Clinical Journal of Pain Vol 22(1) Jan 2006, 82-89.
- Hendler, N., Fink, H., & Long, D. M. (1983). Myofascial syndrome: Response to trigger-point injections: Psychosomatics: Journal of Consultation Liaison Psychiatry Vol 24(11) Nov 1983, 990-999.
- Jaffe, R. A. (1996). Comments on Sotgiu et al: Pain Vol 65(2-3) May-Jun 1996, 286-287.
- Jaffe, R. A., & Rowe, M. A. (1995). Subanesthetic concentrations of lidocaine selectively inhibit a nociceptive response in the isolated rat spinal cord: Pain Vol 60(2) Feb 1995, 167-174.
- Johanson, C. E. (1980). The reinforcing properties of procaine, chloroprocaine and proparacaine in rhesus monkeys: Psychopharmacology Vol 67(2) Feb 1980, 189-194.
- Johansson, A., & Sjolund, B. (1996). Nerve blocks with local anesthetics and corticosteroids in chronic pain: A clinical follow-up study: Journal of Pain and Symptom Management Vol 11(3) Apr 1996, 181-187.
- Katz, J. (1996). Comments on Luo & Wiesenfeld-Hallin: Pain Vol 67(1) Sep 1996, 212-213.
- Kemble, E. D., & Nagel, J. A. (1976). Effect of vibrissal amputation or anesthesia on rearing behavior in rats: Bulletin of the Psychonomic Society Vol 7(4) Apr 1976, 405-406.
- Kosek, E., & Ekholm, J. (1995). Modulation of pressure pain thresholds during and following isometric contraction: Pain Vol 61(3) Jun 1995, 481-486.
- Kosek, E., & Ekholm, J. (1996). "Modulation of pressure pain thresholds during and following isometric contraction": Erratum: Pain Vol 64(3) Mar 1996, 603.
- Kosek, E., Ekholm, J., & Hansson, P. (1995). Increased pressure pain sensibility in fibromyalgia patients is located deep to the skin but not restricted to muscle tissue: Pain Vol 63(3) Dec 1995, 335-339.
- Lindh, V., Wiklund, U., & Hakansson, S. (2000). Assessment of the effect of EMLA during venipuncture in the newborn by analysis of heart rate variability: Pain Vol 86(3) Jun 2000, 247-254.
- Liossi, C., White, P., & Hatira, P. (2006). Randomized Clinical Trial of Local Anesthetic Versus a Combination of Local Anesthetic With Self-Hypnosis in the Management of Pediatric Procedure-Related Pain: Health Psychology Vol 25(3) May 2006, 307-315.
- Lord, S. M., Barnsley, L., & Bogduk, N. (1995). The utility of comparative local anesthetic blocks versus placebo-controlled blocks for the diagnosis of cervical zygapophysial joint pain: Clinical Journal of Pain Vol 11(3) Sep 1995, 208-213.
- Luo, L., & Wiesenfeld-Hallin, Z. (1995). Effects of intrathecal local anesthetics on spinal excitability and on the development of autotomy: Pain Vol 63(2) Nov 1995, 173-179.
- Lyle, W. M., & Page, C. (1975). Possible adverse effects from local anesthetics and the treatment of these reactions: American Journal of Optometry & Physiological Optics Vol 52(11) Nov 1975, 736-744.
- Manabe, H., Dan, K., & Higa, K. (1995). Continuous epidural infusion of local anesthetics and shorter duration of acute zoster-associated pain: Clinical Journal of Pain Vol 11(3) Sep 1995, 220-228.
- Manabe, H., Dan, K., Hirata, K., Hori, K., Shono, S., Tateshi, S., et al. (2004). Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain: Clinical Journal of Pain Vol 20(5) Sep-Oct 2004, 302-308.
- Mao, J., Price, D. D., Hayes, R. L., Lu, J., & et al. (1992). Intrathecal GM1 ganglioside and local nerve anesthesia reduce nonciceptive behaviors in rats with experimental peripheral mononeuropathy: Brain Research Vol 584(1-2) Jul 1992, 28-35.
- Marchal, J. M., Delgado-Martinez, A. D., Poncela, M., Valenzuela, J., & de Dios Luna, J. (2003). Does the type of arthroscopic surgery modify the analgesic effect of intraarticular morphine and bupivacaine? A preliminary study: Clinical Journal of Pain Vol 19(4) Jul-Aug 2003, 240-246.
- Marcus, N. J., & Padawer, W. J. (1991). Re-experienced sexual abuse as "side effect" or cure following intravenous 2-chloroprocaine: Comments on Phero et al., Pain, 43 (1990) 349-352: Pain Vol 47(1) Oct 1991, 122-123.
- Marini, I., Fairplay, T., Vecchiet, F., & Checchi, L. (1999). The treatment of trigger points in the cervical and facial area: Journal of Musculoskeletal Pain Vol 7(1-2) 1999, 239-245.
- Mauleon, A. L., Palo-Bengtsson, L., & Ekman, S.-L. (2007). Patients experiencing local anaesthesia and hip surgery: Journal of Clinical Nursing Vol 16(5) May 2007, 892-899.
- McGargill, R. L., Egan, J. J., & Babbitt, D. C. (1977). Pseudoauditory air conduction thresholds in the deaf: Audiology Vol 16(1) 1977, 55-60.
- Mendonca, M. T., Daniels, D., Faro, C., & Crews, D. (2003). Differential effects of courtship and mating on receptivity and brain metabolism in female red-sided garter snakes (Thamnophis sirtalis pareitalis): Behavioral Neuroscience Vol 117(1) Feb 2003, 144-149.
- Middaugh, L. D., McGroarty, K. K., Groseclose, C. H., & Adinoff, B. (1998). Cocaine discrimination: Relationship to local anesthetics and monoamine uptake inhibitors in C57BL/6 mice: Psychopharmacology Vol 136(1) Mar 1998, 44-49.
- Modzelewska, M., Wolowicka, L., & Admiraal, P. (1985). Research into the dynamics of operation anxiety: Przeglad Psychologiczny Vol 28(4) 1985, 1103-1110.
- Morse, D. R., & et al. (1981). Stress, relaxation and saliva: A follow-up study involving clinical endodontic patients: Journal of Human Stress Vol 7(3) Sep 1981, 19-26.
- Nahum, Y., Tenenbaum, A., Isaiah, W., & Levy-Khademi, F. (2007). Effect of eutectic mixture of local anesthetics (EMLA) for pain relief during suprapubic aspiration in young infants: A randomized, controlled trial: Clinical Journal of Pain Vol 23(9) Nov-Dec 2007, 756-759.
- Naja, Z. M., Al-Tannir, M. A., Zeidan, A., El-Rajab, M., Ziade, F., & Baraka, A. (2007). Nerve stimulator-guided repetitive paravertebral block for thoracic myofascial pain syndrome: Pain Practice Vol 7(4) Dec 2007, 348-351.
- Nikels, K. W., & Hendricks, S. E. (1981). Perinatal hormones and genital anesthetization: Effects on masculine sexual behavior of rats: Physiological Psychology Vol 9(3) Sep 1981, 288-292.
- Noble, R. G. (1980). Sex responses of the female hamster: Effects on male performance: Physiology & Behavior Vol 24(2) Feb 1980, 237-242.
- Pasqualucci, A., Varrassi, G., Braschi, A., Peduto, V. A., Brunelli, A., Marinangeli, F., et al. (2007). Epidural local anesthetic plus corticosteroid for the treatment of cervical brachial radicular pain: Single injection versus continuous infusion: Clinical Journal of Pain Vol 23(7) Sep 2007, 551-557.
- Phero, J. C., Ackerman, W. E., & Wulsin, L. R. (1990). A brief psychotic reaction during the administration of intravenous 2-chloroprocaine for the treatment of chronic pain: Pain Vol 43(3) Dec 1990, 349-352.
- Pober, Z., & Calhoun, W. K. (1975). Effect of oxethazaine HCl on control of food and water intake in the rat: Pharmacology, Biochemistry and Behavior Vol 3(1) Jan-Feb 1975, 69-74.
- Post, R. M., Weiss, S. R. B., Pert, A., & Uhde, T. W. (1987). Chronic cocaine administration: Sensitization and kindling effects. New York, NY: Oxford University Press.
- Price, D. D., Long, S., Wilsey, B., & Rafii, A. (1998). Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients: Clinical Journal of Pain Vol 14(3) Sep 1998, 216-226.
- Price, K. R. (1991). Memory and mental processing speed following regional and general anesthesia in the elderly: Dissertation Abstracts International.
- Ragozzino, M. E., Jih, J., & Tzavos, A. (2002). Involvement of the dorsomedial striatum in behavioral flexibility: Role of muscarinic cholinergic receptors: Brain Research Vol 953(1-2) Oct 2002, 205-214.
- Richelson, E., Prendergast, F. G., & Divinetz-Romero, S. (1978). Muscarinic receptor-mediated cyclic GMP formation by cultured nerve cells: Ionic dependence and effects of local anesthetics: Biochemical Pharmacology Vol 27(16) 1978, 2039-2048.
- Rigon, A., & Takahashi, R. N. (1996). Stimulant activities of dimethocaine in mice: Reinforcing and anxiogenic effects: Psychopharmacology Vol 127(4) Oct 1996, 323-327.
- Robleto, K., Poulos, A. M., & Thompson, R. F. (2004). Effects of a Corneal Anesthetic on Extinction of the Classically Conditioned Nictitating Membrane Response in the Rabbit (Oryctolagus cuniculus): Behavioral Neuroscience Vol 118(6) Dec 2004, 1433-1438.
- Rowbotham, M. C. (1994). Managing post-herpetic neuralgia with opioids and local anesthetics: Annals of Neurology Vol 35(Suppl) 1994, S46-S49.
- Sasmaz, I., Birbicer, H., Antmen, B., Ozbek, H., & Kilinc, Y. (2004). The usage of remifentanil and alfentanil in alleviating pain and anxiety during bone marrow aspiration in pediatric patients: The Pain Clinic Vol 16(4) 2004, 421-426.
- Scholz, A., & Vogel, W. (2000). Tetrodotoxin-resistant action potentials in dorsal root ganglion neurons are blocked by local anesthetics: Pain Vol 89(1) Dec 2000, 47-52.
- Siegel, G. M., & et al. (1977). The effect of task variables on speech during oral anesthesia: Journal of Communication Disorders Vol 10(3) Sep 1977, 253-265.
- Silverman, P. B. (1990). Cocaine and local anesthetics: Stimulant activity in rats with nigral lesions: Psychopharmacology Vol 102(2) Oct 1990, 269-272.
- Smith, F. L., & Lindsay, R. (2007). Enhancement of bupivacaine local anesthesia with the potassium channel blocker ibutilide: European Journal of Pain Vol 11(5) Jul 2007, 551-556.
- Smith, R. F., Wharton, G. G., Kurtz, S. L., Mattran, K. M., & et al. (1986). Behavioral effects of mid-pregnancy administration of lidocaine and mepivacaine in the rat: Neurobehavioral Toxicology & Teratology Vol 8(1) Jan 1986, 61-68.
- Stevens, J. K., & et al. (1976). Paralysis of the awake human: Visual perceptions: Vision Research Vol 16(1) Jan 1976, 93-98.
- Stowell, H., & Yuasa, H. (1974). The somatosensory evoked response to finger-tapping: How local is the stimulus? : Activitas Nervosa Superior Vol 16(1) Mar 1974, 10-16.
- Sudoh, Y., Gaboon, E. E., Gerner, P., & Wang, G. K. (2003). Tricyclic antidepressants as long-acting local anesthetics: Pain Vol 103(1-2) May 2003, 49-55.
- Themistocleous, A., Kamerman, P., & Mitchell, D. (2007). Pre-Emptive Ring-Block With Bupivacaine Prevents the Development of Thermal Hyperalgesia, but not Sustained Mechanical Hyperalgesia, in Rat Tails Exposed to Ultraviolet A Light: The Journal of Pain Vol 8(3) Mar 2007, 208-214.
- Umino, M., Kohase, H., Ideguchi, S., & Sakurai, N. (2002). Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve: Clinical Journal of Pain Vol 18(3) May-Jun 2002, 196-199.
- Vale, N. B., & Leite, J. R. (1988). Decreased susceptibility to local anesthetics-induced convulsions after paradoxical sleep deprivation: Psychopharmacology Vol 94(1) Jan 1988, 138-140.
- van Dongen, R. T. M., van Ee, R., & Crul, B. J. P. (1997). Neurological impairment during long-term intrathecal infusion of bupivacaine in cancer patients: A sign of spinal cord compression: Pain Vol 69(1-2) Jan 1997, 205-209.
- Van Howe, R. S. (1997). Anesthesia for neonatal circumcision: Who benefits? : Journal of Prenatal & Perinatal Psychology & Health Vol 12(1) Fal 1997, 3-18.
- Vardaris, R. M., Weisz, D. J., & Teyler, T. J. (1977). !D-9-tetrahydrocannabinol and the hippocampus: Effects on CA1 field potentials in rats: Brain Research Bulletin Vol 2(3) May-Jun 1977, 181-187.
- Wiesenfeld-Hallin, Z. (1996). Response to comments by Katz: Pain Vol 67(1) Sep 1996, 214.
- Wiesenfeld-Hallin, Z., & Lindblom, U. (1985). The effect of systemic tocainide, lidocaine and bupivacaine on nociception in the rat: Pain Vol 23(4) Dec 1985, 357-360.
- Wilcox, K. M., Paul, I. A., Ordway, G. A., & Woolverton, W. L. (2001). Role of the dopamine transporter and the sodium channel in the cocaine-like discriminative stimulus effects of local anesthetics in rats: Psychopharmacology Vol 157(3) 2001, 260-268.
- Wilcox, K. M., Rowlett, J. K., Paul, I. A., Ordway, G. A., & Woolverton, W. L. (2000). On the relationship between the dopamine transporter and the reinforcing effects of local anesthetics in rhesus monkeys: Practical and theoretical concerns: Psychopharmacology Vol 153(1) Dec 2000, 139-147.
- Woolverton, W. L., & Balster, R. L. (1982). Behavioral pharmacology of local anesthetics: Reinforcing and discriminative stimulus effects: Pharmacology, Biochemistry and Behavior Vol 16(3) Mar 1982, 491-500.
- Woolverton, W. L., & Balster, R. L. (1983). Effects of local anesthetics on fixed-interval responding in rhesus monkeys: Pharmacology, Biochemistry and Behavior Vol 18(3) Mar 1983, 383-387.
Anesthetics: Local anesthetics (N01B)
|Esters of aminobenzoic acid|
|Esters of benzoic acid|
|This page uses Creative Commons Licensed content from Wikipedia (view authors).|