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Local anesthetics allow an animal in severe pain e. Large animal practitioners often perform standing surgeries with only local anesthetics on board.

Because local anesthetics are so powerful, we are able to lower the overall use of systemic analgesics and gas anesthetics that may otherwise cause more concern, particularly in critical patients, by not causing sedation or by causing such adverse effects as excessive panting or hyperthermia.

Emerging research has also found some local anesthetics to be anti-inflammatory and even anti-proliferative for certain cancers, suggesting more serious consideration for most, if not all, surgical cases and trauma.

Depending on the type of local anesthetic used and the dose administered, the duration of action can range from 2 to 6 hours.

Obviously, most patients will feel pain for longer than this length of time, leaving us to explore methods of extending the local anesthetic if possible.

Acute pain, such as from surgery or trauma, and the inflammatory processes that result are at their peak for the first 72 to 96 hours from outset.

This does not mean analgesics should not be used past this hour mark; rather, it should trigger us to focus on this acute pain period for better outcomes down the road.

Doing so may even prevent chronic or neuropathic pain states from poorly controlled periods of pain. With topical or surface anesthesia , sodium channel—blocking agents in creams or solutions are administered on the skin or mucous membrane to provide some relief.

Unfortunately, many of the agents used in veterinary medicine are not readily absorbed through the skin and must be left on for quite sometime to achieve their effect.

The use of lidocaine patches over wounds or incisions has also been described 5,6 but has not been found to alleviate the need for other analgesic medications.

I have found the effects of lidocaine patches on myself and on patients to be lackluster. Splash blocks, which are local anesthetics sprayed on incised or exposed fleshy tissue, are short-lived or have no meaningful effect.

It is important to note this is different than instilling the blocking agent into a body cavity or on mucous membranes. Local infiltration is a less precise, yet still effective, means of administering a blocking agent.

Basically, a local blocking agent is infiltrated into the area where the surgeon plans to incise the skin and manipulate tissues. There are many positive studies on the efficacy of using this technique for surgical patients.

Regional or nerve blocking techniques are a bit more precise and require thorough knowledge of the nervous system anatomy.

To administer a regional block, anatomic landmarks, palpation, or devices are used to infiltrate the blocking solution within millimeters of a nerve.

It is important not to pierce or infiltrate the nerve itself, as is commonly done during leg amputations. Recent research has shown that infiltrating the nerve stretches the nerve fibers or can create a creeping nerve toxicity that can sensitize the remaining nerve component adversely.

A few techniques in veterinary practice can reduce the sting of blocking agents, but is it necessary?

Adding sodium bicarbonate to the blocking agent alkalinizes the agent for a less dramatic sting in awake patients, but doing so decreases the duration of the block.

This technique should not be used in anesthetized patients. If a greater volume of blocking agent is needed, reach for regular saline instead.

Mixing the local anesthetic with saline in a ratio will increase volume without compromising efficacy. In addition, there is some suggestion that adding saline to the mixture will better facilitate tissue distribution of the blocking agents.

The longstanding practice of mixing two local blocking agents, one with a quicker onset lidocaine and one with a longer onset but longer duration bupivacaine , has been largely disproven, with a growing body of evidence showing that this mixture can be inferior to bupivacaine alone.

There are also a handful of veterinary studies and multiple human studies showing no added benefit to this technique. Interestingly, bupivacaine was found in a study 21 to have some effect on the N-methyl-D-aspartate NMDA receptor by its ability to access the sodium ion channel ubiquitously and suppress transmission currents to the dorsal horn.

This receptor is critical in the complex physiology of chronic pain. Because local anesthetics are vasodilators, some practitioners add epinephrine to their anesthetic cocktail to produce local vasoconstriction and thus allow the block to last longer.

This is contraindicated in animals with cardiovascular disease, 22 however, and not a technique I recommend. Instead, micro doses of dexmedetomidine can be added for this same effect, a longer duration of action, and potentially better analgesia.

In a human meta-analysis study, 23 the authors noted no more than a minute prolongation of the local anesthetic when epinephrine was added, again suggesting the superiority of using dexmedetomidine instead.

Dosing recommendations for lidocaine and bupivacaine vary. Doses can be increased further if necessary and referenced appropriately.

If there are concerns about toxicity, the addition of an adjunctive medication allows for a decrease in local anesthetic dose while still prolonging the block Table.

These blocking cocktails can be re-administered after the initial block has worn off. With the release of Nocita bupivacaine liposome injectable suspension — Elanco in , being a creative mixologist became a lot less … experimental.

Nocita is labeled for specific canine and feline surgeries but, like many drugs in veterinary medicine, has been used extensively off label.

With a duration of 72 hours and, in one animal study, a bit longer 37,38 , it is truly one of my favorite anesthetics to use.

However, proper technique is critical for full success with this product. Limiting factors for Nocita appear to be its cost and shelf-life after initial puncture of the or ml bottle.

New research published this year has shown product stability even 4 days after the initial puncture.

In light of the fewer number of pain medications required when Nocita is on board, elimination of the need for opioid constant-rate infusions, and getting the animal out of the hospital sooner, use of Nocita may save on costs.

He became one of the first veterinary cannabis counselors and a certified veterinary pain practitioner through the International Veterinary Academy of Pain Management.

By Role. I like big blocks and I cannot lie July 23, Relevant Topics. Efficacy of local anesthetics Local anesthetics allow an animal in severe pain e.

Administering local anesthesia With topical or surface anesthesia , sodium channel—blocking agents in creams or solutions are administered on the skin or mucous membrane to provide some relief.

Mixology A few techniques in veterinary practice can reduce the sting of blocking agents, but is it necessary?

Adjunctive medications If there are concerns about toxicity, the addition of an adjunctive medication allows for a decrease in local anesthetic dose while still prolonging the block Table.

The use of lidocaine as an anti-inflammatory substance: A systematic review. J Dent. Effects of local anesthetics on breast cancer cell viability and migration.

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