Intravenous Local Anesthetics

The effect of intravenously administrated local anesthetics on postoperative pain and endocrine metabolic responses is minimal.13

PERIPHERAL INFILTRATION/INSTILLATION OF LOCAL ANESTHETICS IN THE WOUND

Application of local anesthetics at the wound site may modify the injury response by a dual mechanism: inhibition of an afferent neural stimulus and a reduction in afferent firing because of the anti-inflammatory effects of local anesthetics.13 Although instillation or infiltration of the wound with local anesthetics may provide a variable degree of pain relief, only a few studies

Figure 23-2 Neural blockade techniques that may influence the response to surgical injury. (From Kehlet H: Endocrine-metabolic effects. In Raj PP [ed]: Clinical Practice of Regional Anesthesia. New York, Churchill Livingstone, 1991, p 188.)

have looked at the effect on the stress response. Incisional application of lidocaine with an aerosol provides long-lasting pain relief as well as inhibition of the P-endorphin response."1 Incisional infiltration with bupivacaine may prevent the cortisol and glucose response to herniotomy but may not modify the leukocytic or acute phase response, even in patients whose wounds are cooled to about 15°C.13 No studies are available concerning the use of local anesthetic creams on the wound postoperatively. In summary, the limited data suggest modification of some aspects of the stress response by application of local anesthetics to the wound. However, the effect is small and short-lasting comparable to the short-lasting pain duration.

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