About The Location Of The Local Anesthetic

Common local anesthesia includes topical anesthesia, local infiltration anesthesia, regional block and nerve block. The latter can be divided into nerve block, epidural block and spinal anesthesia. Intravenous local anesthesia is another form of local anesthesia [1].

1. Topical anesthesia

(1) It is defined as the painless state produced by contacting the local mucosa with a strong osmotic anesthetic to block the superficial nerve endings through the mucosa. It is called topical anesthesia. The local anesthetics used in topical anesthesia are difficult to achieve the nociceptor under the epithelium, which can only relieve the discomfort caused by mucosa. Can be used for cornea, nasal cavity, throat, trachea and bronchus surface anesthesia.

(2) Precautions ① Before the cotton tablets impregnated with local anesthetics are filled on the mucosal surface, the excess liquid should be squeezed to prevent excessive absorption and toxic reaction. The padding should be done under a headlamp or laryngoscope to facilitate proper placement [2]. ② The absorption rate of local anesthetics is different in different parts of mucosa. Generally speaking, the application of high concentration and large dose of local anesthetics on a large area of mucosa is prone to toxic reactions, severe enough to be fatal. The speed of mucosal absorption of local anesthetics is equal to that of intravenous injection, especially with tracheal and bronchial spray method, local anesthetics absorption is the fastest, so the dose should be strictly controlled, otherwise a large amount of local anesthetics absorption can inhibit the myocardium, the patient quickly collapse, so resuscitation equipment and drugs should be prepared in advance. (3) Atropine must be injected before topical anesthesia to dry the mucosa and avoid saliva or secretions to interfere with the contact between local anesthetics and mucosa. (4) The local anesthetic ointment applied on the outer wall of the endotracheal tube should be water-soluble. It should be noted that the anesthetic effect time of the endotracheal tube should be at least 1 minute. Therefore, it is not expected that the endotracheal tube can prevent cough once inserted.

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