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id="toc-Examples-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medical_uses" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Medical_uses"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Medical uses</span> </div> </a> <button aria-controls="toc-Medical_uses-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Medical uses subsection</span> </button> <ul id="toc-Medical_uses-sublist" class="vector-toc-list"> <li id="toc-Acute_pain" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Acute_pain"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Acute pain</span> </div> </a> <ul id="toc-Acute_pain-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chronic_pain" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chronic_pain"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Chronic pain</span> </div> </a> <ul id="toc-Chronic_pain-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Surgery</span> </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnostic_tests" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Diagnostic_tests"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Diagnostic tests</span> </div> </a> <ul id="toc-Diagnostic_tests-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_uses" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_uses"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.5</span> <span>Other uses</span> </div> </a> <ul id="toc-Other_uses-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Side_effects" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Side_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Side effects</span> </div> </a> <button aria-controls="toc-Side_effects-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Side effects subsection</span> </button> <ul id="toc-Side_effects-sublist" class="vector-toc-list"> <li id="toc-Localized_side_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Localized_side_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Localized side effects</span> </div> </a> <ul id="toc-Localized_side_effects-sublist" class="vector-toc-list"> <li id="toc-Risks" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Risks"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.1</span> <span>Risks</span> </div> </a> <ul id="toc-Risks-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Recovery" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Recovery"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.2</span> <span>Recovery</span> </div> </a> <ul id="toc-Recovery-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Potential_side_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Potential_side_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Potential side effects</span> </div> </a> <ul id="toc-Potential_side_effects-sublist" class="vector-toc-list"> <li id="toc-Emotional_reactions" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Emotional_reactions"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.1</span> <span>Emotional reactions</span> </div> </a> <ul id="toc-Emotional_reactions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Central_nervous_system" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Central_nervous_system"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.2</span> <span>Central nervous system</span> </div> </a> <ul id="toc-Central_nervous_system-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cardiovascular_system" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Cardiovascular_system"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.3</span> <span>Cardiovascular system</span> </div> </a> <ul id="toc-Cardiovascular_system-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Endocrine" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Endocrine"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.4</span> <span>Endocrine</span> </div> </a> <ul id="toc-Endocrine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunologic_allergy" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Immunologic_allergy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.5</span> <span>Immunologic allergy</span> </div> </a> <ul id="toc-Immunologic_allergy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Methemoglobinemia" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Methemoglobinemia"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.6</span> <span>Methemoglobinemia</span> </div> </a> <ul id="toc-Methemoglobinemia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Second-generation_effects" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Second-generation_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.7</span> <span>Second-generation effects</span> </div> </a> <ul id="toc-Second-generation_effects-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment_of_overdose:_"Lipid_rescue"" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Treatment_of_overdose:_"Lipid_rescue""> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2.8</span> <span>Treatment of overdose: "Lipid rescue"</span> </div> </a> <ul id="toc-Treatment_of_overdose:_"Lipid_rescue"-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Mechanism_of_action" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Mechanism_of_action"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Mechanism of action</span> </div> </a> <button aria-controls="toc-Mechanism_of_action-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Mechanism of action subsection</span> </button> <ul id="toc-Mechanism_of_action-sublist" class="vector-toc-list"> <li id="toc-Sensitivity_of_nerve_fibers_to_local_anesthetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Sensitivity_of_nerve_fibers_to_local_anesthetics"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Sensitivity of nerve fibers to local anesthetics</span> </div> </a> <ul id="toc-Sensitivity_of_nerve_fibers_to_local_anesthetics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Techniques" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Techniques"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Techniques</span> </div> </a> <button aria-controls="toc-Techniques-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Techniques subsection</span> </button> <ul id="toc-Techniques-sublist" class="vector-toc-list"> <li id="toc-Vazirani–Akinosi_technique" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Vazirani–Akinosi_technique"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Vazirani–Akinosi technique</span> </div> </a> <ul id="toc-Vazirani–Akinosi_technique-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Intraligamentary_Infiltration" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Intraligamentary_Infiltration"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Intraligamentary Infiltration</span> </div> </a> <ul id="toc-Intraligamentary_Infiltration-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Gow-Gates_Technique" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Gow-Gates_Technique"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Gow-Gates Technique</span> </div> </a> <ul id="toc-Gow-Gates_Technique-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Types" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Types"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Types</span> </div> </a> <button aria-controls="toc-Types-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Types subsection</span> </button> <ul id="toc-Types-sublist" class="vector-toc-list"> <li id="toc-Ester_group" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Ester_group"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>Ester group</span> </div> </a> <ul id="toc-Ester_group-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Amide_group" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Amide_group"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.2</span> <span>Amide group</span> </div> </a> <ul id="toc-Amide_group-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Naturally_derived" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Naturally_derived"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.3</span> <span>Naturally derived</span> </div> </a> <ul id="toc-Naturally_derived-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Local anesthetic</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 31 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-31" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">31 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%85%D8%AE%D8%AF%D8%B1_%D9%85%D9%88%D8%B6%D8%B9%D9%8A" title="مخدر موضعي – Arabic" lang="ar" hreflang="ar" data-title="مخدر موضعي" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Lokal_anestetik" title="Lokal anestetik – Azerbaijani" lang="az" hreflang="az" data-title="Lokal anestetik" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Anest%C3%A8sic_local" title="Anestèsic local – Catalan" lang="ca" hreflang="ca" data-title="Anestèsic local" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Lok%C3%A1ln%C3%AD_anestetikum" title="Lokální anestetikum – Czech" lang="cs" hreflang="cs" data-title="Lokální anestetikum" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Anesthetig_lleol" title="Anesthetig lleol – Welsh" lang="cy" hreflang="cy" data-title="Anesthetig lleol" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target"><span>Cymraeg</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Lokalan%C3%A4sthetikum" title="Lokalanästhetikum – German" lang="de" hreflang="de" data-title="Lokalanästhetikum" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Anest%C3%A9sico_local" title="Anestésico local – Spanish" lang="es" hreflang="es" data-title="Anestésico local" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Anestesiko_lokal" title="Anestesiko lokal – Basque" lang="eu" hreflang="eu" data-title="Anestesiko lokal" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A8%DB%8C%E2%80%8C%D8%AD%D8%B3%E2%80%8C%DA%A9%D9%86%D9%86%D8%AF%D9%87_%D9%85%D9%88%D8%B6%D8%B9%DB%8C" title="بی‌حس‌کننده موضعی – Persian" lang="fa" hreflang="fa" data-title="بی‌حس‌کننده موضعی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Anesth%C3%A9sique_local" title="Anesthésique local – French" lang="fr" hreflang="fr" data-title="Anesthésique local" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Ain%C3%A9ist%C3%A9isigh_%C3%A1iti%C3%BAla" title="Ainéistéisigh áitiúla – Irish" lang="ga" hreflang="ga" data-title="Ainéistéisigh áitiúla" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EA%B5%AD%EC%86%8C%EB%A7%88%EC%B7%A8%EC%A0%9C" title="국소마취제 – Korean" lang="ko" hreflang="ko" data-title="국소마취제" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8F%D5%A5%D5%B2%D5%A1%D5%B5%D5%AB%D5%B6_%D5%A1%D5%B6%D5%A6%D5%A3%D5%A1%D5%B5%D5%A1%D6%81%D5%B6%D5%B8%D5%B2%D5%B6%D5%A5%D6%80" title="Տեղային անզգայացնողներ – Armenian" lang="hy" hreflang="hy" data-title="Տեղային անզգայացնողներ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Anestesi_lokal" title="Anestesi lokal – Indonesian" lang="id" hreflang="id" data-title="Anestesi lokal" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Anestetico_locale" title="Anestetico locale – Italian" lang="it" hreflang="it" data-title="Anestetico locale" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-lij mw-list-item"><a href="https://lij.wikipedia.org/wiki/Anestetici_locali" title="Anestetici locali – Ligurian" lang="lij" hreflang="lij" data-title="Anestetici locali" data-language-autonym="Ligure" data-language-local-name="Ligurian" class="interlanguage-link-target"><span>Ligure</span></a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%B2%E0%B5%8B%E0%B4%95%E0%B5%8D%E0%B4%95%E0%B5%BD_%E0%B4%85%E0%B4%A8%E0%B4%B8%E0%B5%8D%E0%B4%A4%E0%B5%86%E0%B4%B1%E0%B5%8D%E0%B4%B1%E0%B4%BF%E0%B4%95%E0%B5%8D" title="ലോക്കൽ അനസ്തെറ്റിക് – Malayalam" lang="ml" hreflang="ml" data-title="ലോക്കൽ അനസ്തെറ്റിക്" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target"><span>മലയാളം</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Lokale_anesthetica" title="Lokale anesthetica – Dutch" lang="nl" hreflang="nl" data-title="Lokale anesthetica" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%B1%80%E6%89%80%E9%BA%BB%E9%85%94%E8%96%AC" title="局所麻酔薬 – Japanese" lang="ja" hreflang="ja" data-title="局所麻酔薬" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no badge-Q70894304 mw-list-item" title=""><a href="https://no.wikipedia.org/wiki/Lokalanestetikum" title="Lokalanestetikum – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Lokalanestetikum" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk 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id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medications to reversibly block pain</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For the novel by Günter Grass, see <a href="/wiki/Local_Anaesthetic_(novel)" title="Local Anaesthetic (novel)">Local Anaesthetic (novel)</a>.</div> <p class="mw-empty-elt"> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Local_anesthetics_general_structure.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Local_anesthetics_general_structure.svg/220px-Local_anesthetics_general_structure.svg.png" decoding="async" width="220" height="255" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Local_anesthetics_general_structure.svg/330px-Local_anesthetics_general_structure.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/fd/Local_anesthetics_general_structure.svg/440px-Local_anesthetics_general_structure.svg.png 2x" data-file-width="470" data-file-height="545" /></a><figcaption>Many local anesthetics fall into two general chemical classes, amino esters (top) and amino amides (bottom).</figcaption></figure> <p>A <b>local anesthetic</b> (<b>LA</b>) is a <a href="/wiki/Medication" title="Medication">medication</a> that causes absence of all <a href="/wiki/Sense" title="Sense">sensation</a> (including <a href="/wiki/Pain" title="Pain">pain</a>) in a specific body part without loss of consciousness,<sup id="cite_ref-nhs.uk_1-0" class="reference"><a href="#cite_note-nhs.uk-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> providing <a href="/wiki/Local_anesthesia" title="Local anesthesia">local anesthesia</a>, as opposed to a <a href="/wiki/General_anesthetic" class="mw-redirect" title="General anesthetic">general anesthetic</a>, which eliminates all sensation in the entire body and causes <a href="/wiki/Unconsciousness" title="Unconsciousness">unconsciousness</a>.<sup id="cite_ref-nhs.uk_1-1" class="reference"><a href="#cite_note-nhs.uk-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Local anesthetics are most commonly used to eliminate pain during or after surgery.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> When it is used on specific nerve pathways (<a href="/wiki/Local_anesthetic_nerve_block" class="mw-redirect" title="Local anesthetic nerve block">local anesthetic nerve block</a>), <a href="/wiki/Paralysis" title="Paralysis">paralysis</a> (loss of muscle function) also can be induced.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Classification">Classification</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=1" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>LAs are of 2 types: </p> <ul><li>Clinical LAs: <ul><li><a href="/w/index.php?title=Amino_amide&action=edit&redlink=1" class="new" title="Amino amide (page does not exist)">amino amide</a> LAs</li> <li><a href="/wiki/Amino_ester" class="mw-redirect" title="Amino ester">amino ester</a> LAs</li></ul></li> <li>Synthetic LAs <ul><li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a> derivatives</li></ul></li></ul> <p>Synthetic cocaine-derived LAs differ from cocaine because they have a much lower <a href="/wiki/Abuse_potential" class="mw-redirect" title="Abuse potential">abuse potential</a> and do not cause <a href="/wiki/Hypertension" title="Hypertension">hypertension</a> <a href="/wiki/Vasoconstriction" title="Vasoconstriction">vasoconstriction</a> (with few exceptions). </p><p>The suffix "-caine" at the ends of these medication names is derived from the word "<a href="/wiki/Cocaine" title="Cocaine">cocaine</a>", because cocaine was formerly used as a local anesthetic. </p> <div class="mw-heading mw-heading2"><h2 id="Examples">Examples</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=2" title="Edit section: Examples"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><b>Short Duration of Action and Low Potency</b> </p> <ul><li><a href="/wiki/Benzocaine" title="Benzocaine">Benzocaine</a></li> <li><a href="/wiki/Procaine" title="Procaine">Procaine</a></li> <li><a href="/wiki/Chloroprocaine" title="Chloroprocaine">Chloroprocaine</a></li></ul> <p><b>Medium Duration of Action and Medium Potency</b> </p> <ul><li><a href="/wiki/Lidocaine" title="Lidocaine">Lidocaine</a></li> <li><a href="/wiki/Prilocaine" title="Prilocaine">Prilocaine</a></li></ul> <p><b>High Duration and High Potency</b> </p> <ul><li><a href="/wiki/Tetracaine" title="Tetracaine">Tetracaine</a></li> <li><a href="/wiki/Bupivacaine" title="Bupivacaine">Bupivacaine</a></li> <li><a href="/wiki/Cinchocaine" title="Cinchocaine">Cinchocaine</a></li> <li><a href="/wiki/Ropivacaine" title="Ropivacaine">Ropivacaine</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Medical_uses">Medical uses</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=3" title="Edit section: Medical uses"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Local anesthetics may be used to prevent and/or treat acute pain, to treat chronic pain, and as a supplement to general anesthesia. </p><p>They are used in various techniques of <a href="/wiki/Local_anesthesia" title="Local anesthesia">local anesthesia</a> such as: </p> <ul><li><a href="/wiki/Topical_anesthesia" class="mw-redirect" title="Topical anesthesia">Topical anesthesia</a> (surface anesthesia)</li> <li>Topical administration of cream, gel, ointment, liquid, or spray of anesthetic dissolved in <a href="/wiki/DMSO" class="mw-redirect" title="DMSO">DMSO</a> or other solvents/carriers for deeper absorption</li> <li><a href="/wiki/Infiltration_(medical)" title="Infiltration (medical)">Infiltration</a></li> <li><a href="/wiki/Brachial_plexus_block" title="Brachial plexus block">Brachial plexus block</a></li> <li><a href="/wiki/Epidural" class="mw-redirect" title="Epidural">Epidural block</a> (extradural)</li> <li><a href="/wiki/Spinal_anaesthesia" title="Spinal anaesthesia">Spinal anesthesia</a> (subarachnoid block)</li> <li><a href="/wiki/Iontophoresis" title="Iontophoresis">Iontophoresis</a></li> <li>Diagnostic purposes (e.g. <a href="/wiki/Dibucaine" class="mw-redirect" title="Dibucaine">dibucaine</a>)</li> <li><a href="/wiki/Anti-arrhythmic" class="mw-redirect" title="Anti-arrhythmic">Anti-arrhythmic</a> agents (e.g. lidocaine).<sup id="cite_ref-Heavner2017_4-0" class="reference"><a href="#cite_note-Heavner2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Acute_pain">Acute pain</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=4" title="Edit section: Acute pain"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Even though <a href="/wiki/Acute_pain" class="mw-redirect" title="Acute pain">acute pain</a> can be managed using <a href="/wiki/Analgesic" title="Analgesic">analgesics</a>, conduction anesthesia may be preferable because of superior pain control and fewer side effects.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (January 2023)">citation needed</span></a></i>]</sup> For purposes of pain therapy, LA drugs are often given by repeated injection or continuous infusion through a catheter. LA drugs are also often combined with other agents such as opioids for synergistic analgesic action.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Low doses of LA drugs can be sufficient so that muscle weakness does not occur and patients may be mobilized.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2022)">citation needed</span></a></i>]</sup> </p><p>Some typical uses of conduction anesthesia for acute pain are: </p> <table class="wikitable"> <tbody><tr> <th>Type of pain </th> <th>Possible treatments </th></tr> <tr> <td><a href="/wiki/Labor_pain" class="mw-redirect" title="Labor pain">Labor pain</a> </td> <td><a href="/wiki/Epidural_anesthesia" class="mw-redirect" title="Epidural anesthesia">Epidural anesthesia</a>, <a href="/wiki/Pudendal_nerve_block" class="mw-redirect" title="Pudendal nerve block">Pudendal nerve blocks</a> </td></tr> <tr> <td><a href="/wiki/Postoperative_pain" class="mw-redirect" title="Postoperative pain">Postoperative pain</a> </td> <td><a href="/wiki/Peripheral_nerve_block" class="mw-redirect" title="Peripheral nerve block">Peripheral nerve blocks</a>, epidural anesthesia </td></tr> <tr> <td><a href="/wiki/Injury" title="Injury">Trauma</a> </td> <td>Peripheral nerve blocks, <a href="/wiki/Intravenous_regional_anesthesia" title="Intravenous regional anesthesia">intravenous regional anesthesia</a>, epidural anesthesia </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Chronic_pain">Chronic pain</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=5" title="Edit section: Chronic pain"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Chronic_pain" title="Chronic pain">Chronic pain</a> is a complex and often serious condition that requires diagnosis and treatment by an expert in pain medicine. LAs can be applied repeatedly or continuously for prolonged periods to relieve chronic pain, usually in combination with medication such as <a href="/wiki/Opioid" title="Opioid">opioids</a>, <a href="/wiki/NSAID" class="mw-redirect" title="NSAID">NSAIDs</a>, and <a href="/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsants</a>. Though it can be easily performed, repeated local anesthetic blocks in chronic pain conditions are not recommended as there is no evidence of long-term benefits.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=6" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Virtually every part of the body can be anesthetized using conduction anesthesia. However, only a limited number of techniques are in common clinical use. Sometimes, conduction anesthesia is combined with <a href="/wiki/General_anesthesia" class="mw-redirect" title="General anesthesia">general anesthesia</a> or <a href="/wiki/Sedation" title="Sedation">sedation</a> for the patient's comfort and ease of surgery. However, many anesthetists, surgeons, patients and nurses believe that it is safer to perform major surgeries under local anesthesia than general anesthesia.<sup id="cite_ref-pmid19918020_7-0" class="reference"><a href="#cite_note-pmid19918020-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Typical operations performed under conduction anesthesia include: </p> <table class="wikitable"> <tbody><tr> <th>Type of surgery </th> <th>Purposes or procedures </th></tr> <tr> <td><a href="/wiki/Dentistry" title="Dentistry">Dentistry</a> </td> <td><a href="/wiki/Topical_anesthesia" class="mw-redirect" title="Topical anesthesia">topical anesthesia</a> (surface anesthesia), <a href="/w/index.php?title=Infiltration_anesthesia&action=edit&redlink=1" class="new" title="Infiltration anesthesia (page does not exist)">infiltration anesthesia</a> and <a href="/w/index.php?title=Intraligamentary_anesthesia&action=edit&redlink=1" class="new" title="Intraligamentary anesthesia (page does not exist)">intraligamentary anesthesia</a> during restorative operations such as fillings, crowns, and root canals,<sup id="cite_ref-Torpy2011_8-0" class="reference"><a href="#cite_note-Torpy2011-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> or extractions, and regional nerve blocks during extractions and surgeries </td></tr> <tr> <td><a href="/wiki/Podiatry" title="Podiatry">Podiatry</a><br />(surgery of feet, ankles, and legs) </td> <td><a href="/w/index.php?title=Cutaneous_anesthesia&action=edit&redlink=1" class="new" title="Cutaneous anesthesia (page does not exist)">cutaneous anesthesia</a>, <a href="/w/index.php?title=Nail_avulsion&action=edit&redlink=1" class="new" title="Nail avulsion (page does not exist)">nail avulsions</a>, <a href="/wiki/Matricectomy" class="mw-redirect" title="Matricectomy">matricectomy</a>, <a href="/wiki/Bunionectomy" class="mw-redirect" title="Bunionectomy">bunionectomy</a>, <a href="/w/index.php?title=Hammertoe_repair&action=edit&redlink=1" class="new" title="Hammertoe repair (page does not exist)">hammertoe repair</a><sup id="cite_ref-Torpy2011_8-1" class="reference"><a href="#cite_note-Torpy2011-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> and various other podiatric procedures </td></tr> <tr> <td><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a> </td> <td>surface anesthesia with <a href="/wiki/Topical_anesthetic" title="Topical anesthetic">topical anesthetics</a> or <a href="/wiki/Retrobulbar_block" title="Retrobulbar block">retrobulbar block</a> during cataract removal or other ophthalmic procedures<sup id="cite_ref-Torpy2011_8-2" class="reference"><a href="#cite_note-Torpy2011-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><a href="/wiki/Head_and_neck_surgery" class="mw-redirect" title="Head and neck surgery">Head and neck surgery</a><br />(ENT operations) </td> <td>infiltration anesthesia, field blocks, or peripheral nerve blocks, <a href="/w/index.php?title=Plexus_anesthesia&action=edit&redlink=1" class="new" title="Plexus anesthesia (page does not exist)">plexus anesthesia</a> </td></tr> <tr> <td><a href="/wiki/Shoulder_surgery" title="Shoulder surgery">Shoulder surgery</a><br /><a href="/w/index.php?title=Arm_surgery&action=edit&redlink=1" class="new" title="Arm surgery (page does not exist)">Arm surgery</a> </td> <td>plexus anesthesia or intravenous regional anesthesia<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a> (heart surgery)<br /><a href="/w/index.php?title=Pulmonary_surgery&action=edit&redlink=1" class="new" title="Pulmonary surgery (page does not exist)">Pulmonary surgery</a> (lung surgery) </td> <td>epidural anesthesia combined with general anesthesia </td></tr> <tr> <td><a href="/wiki/Abdominal_surgery" title="Abdominal surgery">Abdominal surgery</a> </td> <td>epidural anesthesia or <a href="/wiki/Spinal_anesthesia" class="mw-redirect" title="Spinal anesthesia">spinal anesthesia</a>, often combined with general anesthesia during inguinal hernia repair or other abdominal surgery<sup id="cite_ref-Torpy2011_8-3" class="reference"><a href="#cite_note-Torpy2011-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><a href="/wiki/Gynecological_surgery" title="Gynecological surgery">Gynecological surgery</a><br /><a href="/wiki/Obstetric_surgery" class="mw-redirect" title="Obstetric surgery">Obstetric surgery</a><br /><a href="/wiki/Urological_surgery" class="mw-redirect" title="Urological surgery">Urological surgery</a> </td> <td>spinal anesthesia or epidural anesthesia </td></tr> <tr> <td><a href="/wiki/Bone_surgery" class="mw-redirect" title="Bone surgery">Bone surgery</a> and <a href="/w/index.php?title=Joint_surgery&action=edit&redlink=1" class="new" title="Joint surgery (page does not exist)">joint surgery</a> of the <a href="/wiki/Pelvis" title="Pelvis">pelvis</a>, <a href="/wiki/Hip" title="Hip">hip</a>, and <a href="/wiki/Leg" title="Leg">leg</a> </td> <td>spinal anaesthesia or epidural anesthesia, peripheral nerve blocks, or intravenous regional anesthesia </td></tr> <tr> <td><a href="/wiki/Skin_surgery" class="mw-redirect" title="Skin surgery">Skin surgery</a> and <a href="/w/index.php?title=Peripheral_vascular_surgery&action=edit&redlink=1" class="new" title="Peripheral vascular surgery (page does not exist)">peripheral vascular surgery</a> </td> <td><a href="/wiki/Topical_anesthesia" class="mw-redirect" title="Topical anesthesia">topical anesthesia</a>, <a href="/w/index.php?title=Field_block&action=edit&redlink=1" class="new" title="Field block (page does not exist)">field blocks</a>, peripheral nerve blocks, spinal anesthesia or epidural anesthesia<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Diagnostic_tests">Diagnostic tests</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=7" title="Edit section: Diagnostic tests"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diagnostic tests such as bone marrow aspiration, lumbar puncture (spinal tap) and aspiration of cysts or other structures are made to be less painful upon administration of local anesthetic before insertion of larger needles.<sup id="cite_ref-Torpy2011_8-4" class="reference"><a href="#cite_note-Torpy2011-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Other_uses">Other uses</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=8" title="Edit section: Other uses"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Local anesthesia is also used during insertion of IV devices, such as pacemakers and implantable defibrillators, ports used for giving chemotherapy medications and hemodialysis access catheters.<sup id="cite_ref-Torpy2011_8-5" class="reference"><a href="#cite_note-Torpy2011-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p><p>Topical anesthesia, in the form of <a href="/wiki/Lidocaine/prilocaine" title="Lidocaine/prilocaine">lidocaine/prilocaine</a> (EMLA) is most commonly used to enable relatively painless <a href="/wiki/Venipuncture" title="Venipuncture">venipuncture</a> (<a href="/wiki/Blood" title="Blood">blood</a> collection) and placement of <a href="/wiki/Peripheral_venous_catheter" title="Peripheral venous catheter">intravenous cannulae</a>. It may also be suitable for other kinds of punctures such as <a href="/wiki/Ascites" title="Ascites">ascites</a> drainage and <a href="/wiki/Amniocentesis" title="Amniocentesis">amniocentesis</a>. </p><p>Surface anesthesia also facilitates some <a href="/wiki/Endoscopy" title="Endoscopy">endoscopic</a> procedures such as <a href="/wiki/Bronchoscopy" title="Bronchoscopy">bronchoscopy</a> (visualization of the lower airways) or <a href="/wiki/Cystoscopy" title="Cystoscopy">cystoscopy</a> (visualization of the inner surface of the bladder) </p> <div class="mw-heading mw-heading2"><h2 id="Side_effects">Side effects</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=9" title="Edit section: Side effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Localized_side_effects">Localized side effects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=10" title="Edit section: Localized side effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Edema of tongue, pharynx and larynx may develop as a side effect of local anesthesia. This could be caused by a variety of reasons including trauma during injection, infection, an allergic reaction, haematoma or injection of irritating solutions such as cold-sterilization solutions. Usually there is tissue swelling at the point of injection. This is due to puncturing of the vein which allows the blood to flow into loose tissues in the surrounding area. Blanching of the tissues in the area where the local anesthetic is deposited is also common. This gives the area a white appearance as the blood flow is prevented due to vasoconstriction of arteries in the area. The vasoconstriction stimulus gradually wears off and subsequently the tissue returns to normal in less than two hours.<sup id="cite_ref-P._2016_11-0" class="reference"><a href="#cite_note-P._2016-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p><p>The side effects of inferior alveolar nerve block include feeling tense, clenching of the fists and moaning.<sup id="cite_ref-worldcat.org_12-0" class="reference"><a href="#cite_note-worldcat.org-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p><p>The duration of soft tissue anesthesia is longer than pulpal anesthesia and is often associated with difficulty eating, drinking and speaking.<sup id="cite_ref-worldcat.org_12-1" class="reference"><a href="#cite_note-worldcat.org-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Risks">Risks</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=11" title="Edit section: Risks"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The risk of temporary or permanent nerve damage varies between different locations and types of <a href="/wiki/Nerve_block" title="Nerve block">nerve blocks</a>.<sup id="cite_ref-RoyalCol_13-0" class="reference"><a href="#cite_note-RoyalCol-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>There is risk of accidental damage to local blood vessels during injection of the local anesthetic solution. This is referred to as <a href="/wiki/Hematoma" title="Hematoma">haematoma</a> and could result in pain, <a href="/wiki/Trismus" title="Trismus">trismus</a>, swelling and/or discolouration of the region. The density of tissues surrounding the injured vessels is an important factor for haematoma. There is greatest chance of this occurring in a posterior superior alveolar nerve block or in a pterygomandibular block.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2022)">citation needed</span></a></i>]</sup> </p><p>Giving local anesthesia to patients with liver disease can have significant consequences. Thorough evaluation of the disease should be carried out to assess potential risk to the patient as in significant liver dysfunction, the half-life of amide local anesthetic agents may be drastically increased thus increasing the risk of overdose. </p><p>Local anesthetics and vasoconstrictors may be administered to pregnant patients however it is very important to be extra cautious when giving a pregnant patient any type of drug. Lidocaine can be safely used but bupivacaine and mepivacaine should be avoided.  Consultation with the obstetrician is vital before administering any type of local anesthetic to a pregnant patient.<sup id="cite_ref-P._2016_11-1" class="reference"><a href="#cite_note-P._2016-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Recovery">Recovery</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=12" title="Edit section: Recovery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Permanent nerve damage after a peripheral nerve block is rare. Symptoms are 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. An estimated one in 5,000 to 30,000 nerve blocks results in some degree of permanent persistent nerve damage.<sup id="cite_ref-RoyalCol_13-1" class="reference"><a href="#cite_note-RoyalCol-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>Symptoms may continue to improve for up to 18 months following injury. </p> <div class="mw-heading mw-heading3"><h3 id="Potential_side_effects">Potential side effects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=13" title="Edit section: Potential side effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>General systemic adverse effects are due to the pharmacological effects of the anesthetic agents used. The conduction of electric impulses follows a similar mechanism in <a href="/wiki/Peripheral_nervous_system" title="Peripheral nervous system">peripheral nerves</a>, the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a>, and the <a href="/wiki/Heart" title="Heart">heart</a>. 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. High plasma levels might arise, for example, when doses intended for <a href="/wiki/Epidural_administration" title="Epidural administration">epidural</a> or intrasupport tissue administration are accidentally delivered as <a href="/wiki/Intravascular" class="mw-redirect" title="Intravascular">intravascular</a> injection.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (October 2018)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading4"><h4 id="Emotional_reactions">Emotional reactions</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=14" title="Edit section: Emotional reactions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>When patients are emotionally affected in the form of nervousness or fear, it can lead to vasovagal collapse. This is the anticipation of pain during administration that activates the <a href="/wiki/Parasympathetic_nervous_system" title="Parasympathetic nervous system">parasympathetic nervous system</a> while inhibiting the orthosympathetic nervous system.<sup id="cite_ref-:1_14-0" class="reference"><a href="#cite_note-:1-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> What results is a dilation of arteries in muscles which can lead to a reduction in circulating blood volume inducing a temporary shortness of blood flow to the brain. Notable symptoms include restlessness, visibly looking pale, perspiration and possible loss of consciousness. In severe cases, clonic cramps resembling an epileptic insult may occur.<sup id="cite_ref-:1_14-1" class="reference"><a href="#cite_note-:1-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p>On the other hand, fear of administration can also result in accelerated, shallow breathing, or <a href="/wiki/Hyperventilation" title="Hyperventilation">hyperventilation</a>. The patient may feel a tingling sensation in hands and feet or a sense of light-headedness and increased chest pressure.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (February 2022)">citation needed</span></a></i>]</sup> </p><p>Hence, it is crucial for the medical professional administrating the local anesthesia, especially in the form of an injection, to ensure that the patient is in a comfortable setting and has any potential fears alleviated in order to avoid these possible complications. </p> <div class="mw-heading mw-heading4"><h4 id="Central_nervous_system">Central nervous system</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=15" title="Edit section: Central nervous system"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Depending on local tissue concentrations of local anesthetics, excitatory or depressant effects on the central nervous system may occur. </p><p>Initial symptoms of systemic toxicity include ringing in the ears (<a href="/wiki/Tinnitus" title="Tinnitus">tinnitus</a>), a metallic taste in the mouth, tingling or numbness of the mouth, dizziness and/or disorientation. </p><p>At higher concentrations, a relatively selective depression of inhibitory neurons results in cerebral excitation, which may lead to more advanced symptoms include motor twitching in the periphery followed by <a href="/wiki/Grand_Mal_seizures" class="mw-redirect" title="Grand Mal seizures">grand mal seizures</a>. It is reported that seizures are more likely to occur when bupivacaine is used, particularly in combination with chloroprocaine.<sup id="cite_ref-:2_15-0" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>A profound depression of brain functions may occur at even higher concentrations which may lead to <a href="/wiki/Coma" title="Coma">coma</a>, <a href="/wiki/Respiratory_arrest" title="Respiratory arrest">respiratory arrest</a>, and death.<sup id="cite_ref-Mulroy,_M._2002_16-0" class="reference"><a href="#cite_note-Mulroy,_M._2002-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Such tissue concentrations may be due to very high plasma levels after intravenous injection of a large dose. </p><p>Another possibility is direct exposure of the central nervous system through the <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal fluid</a>, i.e., overdose in spinal anesthesia or accidental injection into the subarachnoid space in epidural anesthesia. </p> <div class="mw-heading mw-heading4"><h4 id="Cardiovascular_system">Cardiovascular system</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=16" title="Edit section: Cardiovascular system"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Cardiac toxicity can result from improper injection of agent into a vessel. Even with proper administration, it is inevitable for some diffusion of agent into the body from the site of application due to unforeseeable anatomical idiosyncrasies of the patient.<sup id="cite_ref-:2_15-1" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> This may affect the nervous system or cause the agent to enter into general circulation. However, infections are very seldom transmitted. </p><p>Cardiac toxicity associated with overdose of intravascular injection of local anesthetic is characterized by <a href="/wiki/Hypotension" title="Hypotension">hypotension</a>, <a href="/wiki/Atrioventricular_node" title="Atrioventricular node">atrioventricular</a> conduction delay, <a href="/wiki/Idioventricular_rhythm" title="Idioventricular rhythm">idioventricular</a> rhythms, and eventual cardiovascular collapse. Although all local anesthetics potentially shorten the myocardial refractory period, <a href="/wiki/Bupivacaine" title="Bupivacaine">bupivacaine</a> blocks the cardiac sodium channels, thereby making it most likely to precipitate malignant <a href="/wiki/Heart_arrhythmia" class="mw-redirect" title="Heart arrhythmia">arrhythmias</a>. Even <a href="/wiki/Levobupivacaine" title="Levobupivacaine">levobupivacaine</a> and <a href="/wiki/Ropivacaine" title="Ropivacaine">ropivacaine</a> (single-enantiomer derivatives), developed to ameliorate cardiovascular side effects, still harbor the potential to disrupt cardiac function.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Toxicity from anesthetic combinations is additive.<sup id="cite_ref-:2_15-2" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Endocrine">Endocrine</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=17" title="Edit section: Endocrine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Endocrine and metabolic systems only have slightly adverse effects with most cases being without clinical repercussions.<sup id="cite_ref-:2_15-3" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Immunologic_allergy">Immunologic allergy</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=18" title="Edit section: Immunologic allergy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Adverse reactions to local anesthetics (especially the esters) are not uncommon, but legitimate <a href="/wiki/Allergy" title="Allergy">allergies</a> are very rare. Allergic reactions to the esters is usually due to a sensitivity to their metabolite, <a href="/wiki/Para-aminobenzoic_acid" class="mw-redirect" title="Para-aminobenzoic acid">para-aminobenzoic acid</a>, and does not result in cross-allergy to amides.<sup id="cite_ref-Dolan,_R._2004_18-0" class="reference"><a href="#cite_note-Dolan,_R._2004-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ReferenceA_19-0" class="reference"><a href="#cite_note-ReferenceA-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Therefore, amides can be used as alternatives in those patients. Nonallergic reactions may resemble allergy in their manifestations. In some cases, skin tests and provocative challenge may be necessary to establish a diagnosis of allergy. Also cases of allergy to <a href="/wiki/Paraben" title="Paraben">paraben</a> derivatives occur, which are often added as preservatives to local anesthetic solutions. </p> <div class="mw-heading mw-heading4"><h4 id="Methemoglobinemia">Methemoglobinemia</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=19" title="Edit section: Methemoglobinemia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Methemoglobinemia" title="Methemoglobinemia">Methemoglobinemia</a> is a process where iron in hemoglobin is altered, reducing its oxygen-carrying capability, which produces <a href="/wiki/Cyanosis" title="Cyanosis">cyanosis</a> and symptoms of <a href="/wiki/Hypoxia_(medical)" class="mw-redirect" title="Hypoxia (medical)">hypoxia</a>. Exposure to aniline group chemicals such as <a href="/wiki/Benzocaine" title="Benzocaine">benzocaine</a>, <a href="/wiki/Lidocaine" title="Lidocaine">lidocaine</a>, and <a href="/wiki/Prilocaine" title="Prilocaine">prilocaine</a> can produce this effect, especially benzocaine.<sup id="cite_ref-Dolan,_R._2004_18-1" class="reference"><a href="#cite_note-Dolan,_R._2004-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ReferenceA_19-1" class="reference"><a href="#cite_note-ReferenceA-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> The systemic toxicity of prilocaine is comparatively low, but its metabolite, o-toluidine, is known to cause <a href="/wiki/Methemoglobinemia" title="Methemoglobinemia">methemoglobinemia</a>. </p> <div class="mw-heading mw-heading4"><h4 id="Second-generation_effects">Second-generation effects</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=20" title="Edit section: Second-generation effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Application of local anesthetics during oocyte removal during in vitro fertilization has been up to debate. Pharmacological concentrations of anesthetic agents have been found in follicular fluid.<sup id="cite_ref-:2_15-4" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Clinical trials have not concluded any effects on pregnant women. However, there is some concern with the behavioral effects of lidocaine on offspring in rats.<sup id="cite_ref-:2_15-5" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>During pregnancy, it is not common for local anesthetics to have any adverse effect on the fetus. Despite this, risks of toxicity may be higher in pregnancy due to an increase in unbound fraction of local anesthetic and physiological changes increase the transfer of local anesthetic into the central nervous system.<sup id="cite_ref-:2_15-6" class="reference"><a href="#cite_note-:2-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Hence, it is recommended that pregnant women use a lower dose of local anesthetic to reduce any potential complications. </p> <div class="mw-heading mw-heading4"><h4 id="Treatment_of_overdose:_"Lipid_rescue""><span id="Treatment_of_overdose:_.22Lipid_rescue.22"></span>Treatment of overdose: "Lipid rescue"</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=21" title="Edit section: Treatment of overdose: "Lipid rescue""><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><b>Lipid emulsion therapy</b> or <b>lipid rescue</b> is a method of toxicity treatment was invented by Dr. Guy Weinberg in 1998, and was not widely used until after the first published successful rescue in 2006. Evidence indicates <a href="/wiki/Intralipid" class="mw-redirect" title="Intralipid">Intralipid</a>, a commonly available intravenous lipid emulsion, can be effective in treating severe cardiotoxicity secondary to local anesthetic overdose, including human case reports.<sup id="cite_ref-Weinberg_1998_20-0" class="reference"><a href="#cite_note-Weinberg_1998-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Weinberg_2003_21-0" class="reference"><a href="#cite_note-Weinberg_2003-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Picard2006_22-0" class="reference"><a href="#cite_note-Picard2006-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Rosenblatt2006_23-0" class="reference"><a href="#cite_note-Rosenblatt2006-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Litz2006_24-0" class="reference"><a href="#cite_note-Litz2006-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> However, the evidence at this point is still limited.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p><p>Though most case reports to date have recorded most common use of Intralipid, other emulsions, such as <a href="/w/index.php?title=Liposyn&action=edit&redlink=1" class="new" title="Liposyn (page does not exist)">Liposyn</a> and <a href="/w/index.php?title=Medialipid&action=edit&redlink=1" class="new" title="Medialipid (page does not exist)">Medialipid</a>, have also been shown effective.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (April 2023)">citation needed</span></a></i>]</sup> </p><p>Ample supporting animal evidence<sup id="cite_ref-Weinberg_1998_20-1" class="reference"><a href="#cite_note-Weinberg_1998-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Weinberg_2003_21-1" class="reference"><a href="#cite_note-Weinberg_2003-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> and human case reports show successful use of lipid rescue in this way.<sup id="cite_ref-Rosenblatt2006_23-1" class="reference"><a href="#cite_note-Rosenblatt2006-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Litz2006_24-1" class="reference"><a href="#cite_note-Litz2006-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> In the UK, efforts have been made to publicize lipid rescue more widely.<sup id="cite_ref-Picard2006_22-1" class="reference"><a href="#cite_note-Picard2006-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> In 2010, lipid rescue had been officially promoted as a treatment of local anesthetic toxicity by the <a href="/wiki/Association_of_Anaesthetists_of_Great_Britain_and_Ireland" title="Association of Anaesthetists of Great Britain and Ireland">Association of Anaesthetists of Great Britain and Ireland</a>.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> One published case has been reported of successful treatment of refractory <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a> in <a href="/wiki/Bupropion" title="Bupropion">bupropion</a> and <a href="/wiki/Lamotrigine" title="Lamotrigine">lamotrigine</a> overdose using lipid emulsion.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>The design of a 'homemade' lipid rescue kit has been described.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>Although lipid rescue mechanism of action is not completely understood, the added lipid in the blood stream may act as a sink, allowing for the removal of lipophilic toxins from affected tissues. This theory is compatible with two studies on lipid rescue for clomipramine toxicity in rabbits<sup id="cite_ref-Harvey_2007_29-0" class="reference"><a href="#cite_note-Harvey_2007-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Harvey_2009_30-0" class="reference"><a href="#cite_note-Harvey_2009-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> and with a clinical report on the use of lipid rescue in veterinary medicine to treat a puppy with <a href="/wiki/Moxidectin" title="Moxidectin">moxidectin</a> toxicosis.<sup id="cite_ref-Crandell_2009_31-0" class="reference"><a href="#cite_note-Crandell_2009-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism_of_action">Mechanism of action</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=22" title="Edit section: Mechanism of action"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>All LAs are <a href="/wiki/Plasma_membrane" class="mw-redirect" title="Plasma membrane">membrane</a>-stabilizing drugs; they reversibly decrease the rate of depolarization and repolarization of excitable membranes (like <a href="/wiki/Nociceptors" class="mw-redirect" title="Nociceptors">nociceptors</a>). Though many other drugs also have membrane-stabilizing properties, not all are used as LAs (<a href="/wiki/Propranolol" title="Propranolol">propranolol</a>, for example, though it has LA properties). LA drugs act mainly by inhibiting <a href="/wiki/Sodium" title="Sodium">sodium</a> influx through sodium-specific <a href="/wiki/Ion_channel" title="Ion channel">ion channels</a> in the <a href="/wiki/Neuron" title="Neuron">neuronal</a> <a href="/wiki/Cell_membrane" title="Cell membrane">cell membrane</a>, in particular the so-called voltage-gated sodium channels. When the influx of sodium is interrupted, an <a href="/wiki/Action_potential" title="Action potential">action potential</a> 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 sodium channels in an activated state, thus onset of neuronal blockade is faster in rapidly firing neurons. This is referred to as state-dependent blockade. </p><p>LAs are weak <a href="/wiki/Base_(chemistry)" title="Base (chemistry)">bases</a> and are usually formulated as the hydrochloride salt to render them water-soluble. At a pH equal to the protonated base's pKa, the protonated (ionized) and unprotonated (unionized) forms of the molecule exist in equimolar amounts, but only the unprotonated base diffuses readily across cell membranes. Once inside the cell, the local anesthetic will be in equilibrium, with the formation of the protonated (ionized) 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 LA binding site on the inside of the ion channel near the cytoplasmic end. Most LAs work on the internal surface of the membrane - the drug has to penetrate the cell membrane, which is achieved best in the nonionised form. This is exemplified by the permanently ionised LA <a href="/wiki/RAC_421-II" title="RAC 421-II">RAC 421-II</a> which cannot <a href="/wiki/Diffusion" title="Diffusion">diffuse</a> across the cell membrane but, if injected into the cytosol of a nerve fibre, can induce NaKATPase blockage and anesthetic effects. </p><p>Acidosis such as caused by inflammation at a wound partly reduces the action of LAs. This is partly because most of the anesthetic is ionized and therefore unable to cross the cell membrane to reach its cytoplasmic-facing site of action on the sodium channel. </p> <div class="mw-heading mw-heading3"><h3 id="Sensitivity_of_nerve_fibers_to_local_anesthetics">Sensitivity of nerve fibers to local anesthetics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=23" title="Edit section: Sensitivity of nerve fibers to local anesthetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>For most patients, administration of local anesthetics causes the sensation of pain to be lost first, followed by temperature, touch, deep pressure, and finally motor function.<sup id="cite_ref-Catterall2023_32-0" class="reference"><a href="#cite_note-Catterall2023-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> The sensitivity of nerve fibers to blockade depends on a combination of diameter and myelination. Their different sensitivities to LA blockade is termed differential blockade. Myelinated fibers are more sensitive to blockade as they are interrupted by <a href="/wiki/Nodes_of_Ranvier" class="mw-redirect" title="Nodes of Ranvier">nodes of Ranvier</a>, thus interruption of only consecutive nodes of Ranvier will prevent action potential propagation. In turn, in unmyelinated nerves, an entire length needs to be blocked.<sup id="cite_ref-Piehl2015_33-0" class="reference"><a href="#cite_note-Piehl2015-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Regarding diameter, the generally accepted principle is that susceptibility to local anesthesia depends inversely on fiber diameter.<sup id="cite_ref-Gretchen2001_34-0" class="reference"><a href="#cite_note-Gretchen2001-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>In general, autonomic fibers <a href="/wiki/Group_B_nerve_fiber" title="Group B nerve fiber">Type B fibers</a>, small unmyelinated <a href="/wiki/Group_C_nerve_fiber" title="Group C nerve fiber">type C</a> (pain sensation), and small myelinated <a href="/wiki/Group_A_nerve_fiber" title="Group A nerve fiber">Aδ fibers</a>(pain and temperature sensations) are blocked before the larger myelinated Aγ, Aβ, and Aα fibers (mediating postural, touch, pressure, and motor information).<sup id="cite_ref-Catterall2023_32-1" class="reference"><a href="#cite_note-Catterall2023-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Techniques">Techniques</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=24" title="Edit section: Techniques"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Local anesthetics can block almost every nerve between the peripheral nerve endings and the central nervous system. The most peripheral technique is topical anesthesia to the skin or other body surface. Small and large peripheral nerves can be anesthetized individually (peripheral nerve block) or in anatomic nerve bundles (plexus anesthesia). Spinal anesthesia and epidural anesthesia merge into the central nervous system. </p><p>Injection of LAs is often painful. A number of methods can be used to decrease this pain, including buffering of the solution with bicarbonate and warming.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p><p>Clinical techniques include: </p> <ul><li>Surface anesthesia is the application of an LA spray, solution, or cream to the skin or a mucous membrane; the effect is short lasting and is limited to the area of contact.</li> <li>Infiltration anesthesia is <a href="/wiki/Injection_(medicine)#Infiltration" title="Injection (medicine)">infiltration</a> of LA into the tissue to be anesthetized; surface and infiltration anesthesia are collectively topical anesthesia</li> <li>Field block is subcutaneous injection of an LA in an area bordering on the field to be anesthetized.</li> <li><a href="/wiki/Peripheral_nerve_block" class="mw-redirect" title="Peripheral nerve block">Peripheral nerve block</a> is injection of LA in the vicinity of a peripheral nerve to anesthetize that nerve's area of innervation.</li> <li>Plexus anesthesia is injection of LA in the vicinity of a <a href="/wiki/Nerve_plexus" title="Nerve plexus">nerve plexus</a>, often inside a tissue compartment that limits the diffusion of the drug away from the intended site of action. The anesthetic effect extends to the innervation areas of several or all nerves stemming from the plexus.</li> <li>Epidural anesthesia is an LA injected into the <a href="/wiki/Epidural_space" title="Epidural space">epidural space</a>, where it acts primarily on the <a href="/wiki/Spinal_nerve" title="Spinal nerve">spinal nerve</a> roots; depending on the site of injection and the volume injected, the anesthetized area varies from limited areas of the abdomen or chest to large regions of the body.</li> <li>Spinal anesthesia is an LA injected into the <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal fluid</a>, usually at the lumbar spine (in the lower back), where it acts on <a href="/wiki/Spinal_nerve" title="Spinal nerve">spinal nerve</a> roots and part of the <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a>; the resulting anesthesia usually extends from the legs to the abdomen or chest.</li> <li><a href="/wiki/Intravenous_regional_anesthesia" title="Intravenous regional anesthesia">Intravenous regional anesthesia</a> (Bier's block) is when blood circulation of a limb is interrupted using a tourniquet (a device similar to a blood-pressure cuff), then a large volume of LA is injected into a peripheral vein. The drug fills the limb's venous system and diffuses into tissues, where peripheral nerves and nerve endings are anesthetized. The anesthetic effect is limited to the area that is excluded from blood circulation and resolves quickly once circulation is restored.</li> <li>Local anesthesia of body cavities includes intrapleural anesthesia and intra-articular anesthesia.</li></ul> <p><span class="anchor" id="catheter_anesthesia"></span> </p> <ul><li>Transincision (or transwound) catheter anesthesia uses a multilumen catheter inserted through an incision or wound and aligned across it on the inside as the incision or wound is closed, providing continuous administration of local anesthetic along the incision or wounds<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup></li></ul> <p>Dental-specific techniques include: </p> <div class="mw-heading mw-heading3"><h3 id="Vazirani–Akinosi_technique"><span id="Vazirani.E2.80.93Akinosi_technique"></span>Vazirani–Akinosi technique</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=25" title="Edit section: Vazirani–Akinosi technique"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Vazirani–Akinosi technique is also known as the closed-mouth mandibular nerve block. It is mostly used in patients who have limited opening of the mandible or in those that have trismus; spasm of the muscles of mastication. The nerves which are anesthetised in this technique are the inferior alveolar, incisive, mental, lingual and mylohyoid nerves. </p><p>Dental needles are available in two lengths, short and long. As Vazirani–Akinosi is a local anesthetic technique which requires penetration of a significant thickness of soft tissues, a long needle is used. The needle is inserted into the soft tissue which covers the medial border of the mandibular ramus, in region of the inferior alveolar, lingual and mylohyoid nerves. The positioning of the bevel of the needle is very important as it must be positioned away from the bone of the mandibular ramus and instead towards the midline.<sup id="cite_ref-Malamed_2013_37-0" class="reference"><a href="#cite_note-Malamed_2013-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Intraligamentary_Infiltration">Intraligamentary Infiltration</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=26" title="Edit section: Intraligamentary Infiltration"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Intraligamentary infiltration, also known as periodontal ligament injection or intraligamentary injection (ILI), is known as "the most universal of the supplemental injections". ILIs are usually administered when inferior alveolar nerve block techniques are inadequate or ineffective.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> ILIs are purposed for: </p> <ol><li>Single-tooth anesthesia</li> <li>Low anesthetic dose</li> <li>Contraindication for systemic anesthesia</li> <li>Presence of systemic health problems<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup></li></ol> <p>ILI utilization is expected to increase because dental patients prefer fewer soft tissue anesthesia and dentists aim to reduce administration of traditional inferior alveolar nerve block (INAB) for routine restorative procedures.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>Injection methodology: The periodontal ligament space provides an accessible route to the cancellous alveolar bone, and the anesthetic reaches the pulpal nerve via natural perforation of intraoral bone tissue.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p><p>Advantages of ILI over INAB: rapid onset (within 30 seconds), small dosage required (0.2–1.0 mL), limited area of numbness,<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> lower intrinsic risks such as neuropathy, hematoma, trismus/jaw sprain<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-shabazfar_46-0" class="reference"><a href="#cite_note-shabazfar-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> and self-inflicted periodontal tissue injury,<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid6439659_48-0" class="reference"><a href="#cite_note-pmid6439659-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> as well as decreased cardiovascular disturbances.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> Its usage as a secondary or supplementary anesthesia on the mandible has reported a high success rate of above 90%.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>Disadvantages: Risk of temporary periodontal tissue damage, likelihood of bacteriemia and endocarditis for at-risk populations,<sup id="cite_ref-:4_52-0" class="reference"><a href="#cite_note-:4-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> appropriate pressure and correct needle placement are imperative for anesthetic success, short duration of pulpal anesthesia limits the use of ILIs for several restorative procedures that require longer duration,<sup id="cite_ref-:4_52-1" class="reference"><a href="#cite_note-:4-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> postoperative discomfort, and injury on unerupted teeth such as enamel hypoplasia and defects. </p><p>Technique description: </p> <ul><li>All plaque and calculus to be eradicated, optimally before the operative visit to assist gingival tissue healing.</li> <li>Before injection, disinfect gingival sulcus with 0.2% chlorhexidine solution.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup></li> <li>Administration of soft tissue anesthesia is recommended prior to ILI administration. This helps to enhance patient comfort.</li> <li>Needle gauges of sizes 27-gauge short or 30-gauge ultra-short needle are usually utilized.<sup id="cite_ref-Malamed_1982_54-0" class="reference"><a href="#cite_note-Malamed_1982-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup></li> <li>The needle is inserted along the long axis, at a 30 degree angle, of the mesial or distal root for single rooted teeth and on the mesial and distal roots of multi-rooted teeth. Bevel orientation toward the root provides easier advancement of the needle apically.<sup id="cite_ref-:5_55-0" class="reference"><a href="#cite_note-:5-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup></li> <li>When the needle reaches between the root and crestal bone, significant resistance is experience.</li> <li>Anesthetic deposition is recommended at 0.2 mL, per root or site, over minimally 20 seconds.</li> <li>For its success, the anesthetic must be administered under pressure. It must not leak out of the sulcus into the mouth.</li> <li>Withdraw needle for minimally 10–15 seconds to permit complete deposition of solution. This can be slower than other injections as there is pressure build-up from the anesthetic administration.</li> <li>Blanching of the tissue is observed and may be more evident when vasoconstrictors are used. It is caused by a temporary obstruction of blood flow to the tissue.<sup id="cite_ref-:5_55-1" class="reference"><a href="#cite_note-:5-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup></li></ul> <p>Syringes: </p> <ul><li>Standard syringes can be used.</li> <li>The intraligamentary syringe offers mechanical advantage by using a trigger-grasp or click apparatus to employ a gear or lever that improves control and results in increased force to push the anesthetic cartridge's rubber stopper forward for medication deposition with greater ease.</li> <li>C-CLADs (computer controlled local anesthetic delivery devices) can be used. Its usage of computer microprocessors allows for control of fluid dynamics and anesthetic deposition. This minimizes subjective flow rates and variability in pressure. This thereby results in enhanced hydrodynamic diffusion of solution into bone or the target area of deposition,<sup id="cite_ref-56" class="reference"><a href="#cite_note-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> thus permitting larger amounts of anesthetic solution to be delivered during ILIs without increased tissue damage.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup></li></ul> <p>Things to note: </p> <ul><li>ILIs are not recommended for patients with active periodontal inflammation.</li> <li>ILIs should not be administered at tooth sites with 5 mm or more of periodontal attachment loss.</li></ul> <div class="mw-heading mw-heading3"><h3 id="Gow-Gates_Technique">Gow-Gates Technique</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=27" title="Edit section: Gow-Gates Technique"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Gow-Gates technique is used to provide anesthetics to the mandible of the patient's mouth. With the aid of extra and intraoral landmarks, the needle is injected into the intraoral latero-anterior surface of the condyle, steering clear below the insertion of the lateral pterygoid muscle.<sup id="cite_ref-Gow-Gates_1998_61-0" class="reference"><a href="#cite_note-Gow-Gates_1998-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> The extraoral landmarks used for this technique are the lower border of the ear tragus, corners of the mouth and the angulation of the tragus on the side of the face.<sup id="cite_ref-Gow-Gates_1998_61-1" class="reference"><a href="#cite_note-Gow-Gates_1998-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p><p>Biophysical forces (pulsation of the maxillary artery, muscular function of jaw movement) and gravity will aid with the diffusion of anesthetic to fill the whole pterygomandibular space. All three oral sensory parts of the mandibular branch of the trigeminal nerve and other sensory nerves in the region will come in contact with the anesthetic and this reduces the need to anesthetise supplementary innervation.<sup id="cite_ref-Gow-Gates_1998_61-2" class="reference"><a href="#cite_note-Gow-Gates_1998-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p><p>In comparison to other regional block methods of anestheising the lower jaw, the Gow-Gates technique has a higher success rate in fully anesthetising the lower jaw. One study found that out of 1,200 patients receiving injections through the Gow-Gates technique, only 2 of them did not obtain complete anesthesia.<sup id="cite_ref-Gow-Gates_1998_61-3" class="reference"><a href="#cite_note-Gow-Gates_1998-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Types">Types</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=28" title="Edit section: Types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:LA_syringe.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/LA_syringe.JPG/220px-LA_syringe.JPG" decoding="async" width="220" height="112" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/LA_syringe.JPG/330px-LA_syringe.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/53/LA_syringe.JPG/440px-LA_syringe.JPG 2x" data-file-width="2047" data-file-height="1043" /></a><figcaption>This LA system is designed to prevent <a href="/wiki/Needlestick_injury" title="Needlestick injury">needlestick injury</a>. A cartridge of LA fits into the disposable needle, which can be locked when not in use and can be separated from the handle.</figcaption></figure> <p>Local anesthetic solutions for injection typically consist of:<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p> <ul><li>The local anesthetic agent itself</li> <li>A vehicle, which is usually water-based or just sterile water</li> <li><a href="/wiki/Vasoconstrictor" class="mw-redirect" title="Vasoconstrictor">Vasoconstrictor</a> possibly (see below)</li> <li><a href="/wiki/Reducing_agent" title="Reducing agent">Reducing agent</a> (antioxidant), e.g. if epinephrine is used, then <a href="/wiki/Sodium_metabisulfite" title="Sodium metabisulfite">sodium metabisulfite</a> is used as a reducing agent</li> <li><a href="/wiki/Preservative" title="Preservative">Preservative</a>, e.g. <a href="/wiki/Methylparaben" title="Methylparaben">methylparaben</a></li> <li><a href="/wiki/Buffer_solution" title="Buffer solution">Buffer</a></li></ul> <p><a href="/wiki/Amino_esters" title="Amino esters">Esters</a> are prone to producing allergic reactions, which may necessitate the use of an <a href="/wiki/Amide" title="Amide">amide</a>. The names of each locally clinical anesthetic have the suffix "-caine". Most ester LAs are metabolized by <a href="/wiki/Butyrylcholinesterase" title="Butyrylcholinesterase">pseudocholinesterase</a>, while amide LAs are metabolized in the liver. This can be a factor in choosing an agent in patients with liver failure,<sup id="cite_ref-isbn0-07-136704-7_63-0" class="reference"><a href="#cite_note-isbn0-07-136704-7-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> although since cholinesterases are produced in the liver, physiologically (e.g. very young or very old individual) or pathologically (e.g. <a href="/wiki/Cirrhosis" title="Cirrhosis">cirrhosis</a>) impaired hepatic metabolism is also a consideration when using esters. </p><p>Sometimes, LAs are combined, e.g.: </p> <ul><li><a href="/wiki/Lidocaine/prilocaine" title="Lidocaine/prilocaine">Lidocaine/prilocaine</a> (EMLA, eutectic mixture of local anesthetic)</li> <li>Lidocaine/tetracaine (Rapydan)</li> <li><a href="/wiki/Topical_tac" title="Topical tac">TAC</a></li></ul> <p>LA solutions for injection are sometimes mixed with vasoconstrictors (<a href="/wiki/Combination_drug" title="Combination drug">combination drug</a>) to increase the duration of local anesthesia by constricting the blood vessels, thereby safely concentrating the anesthetic agent for an extended duration, as well as reducing <a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">hemorrhage</a>.<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> Because the vasoconstrictor temporarily reduces the rate at which the systemic circulation removes the local anesthetic from the area of the injection, the maximum doses of LAs when combined with a vasoconstrictor is higher compared to the same LA without any vasoconstrictor. Occasionally, cocaine is administered for this purpose. Examples include: </p> <ul><li><a href="/wiki/Prilocaine" title="Prilocaine">Prilocaine</a> hydrochloride and <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> (<a href="/wiki/Trade_name" title="Trade name">trade name</a> Citanest Forte)</li> <li><a href="/wiki/Lidocaine" title="Lidocaine">Lidocaine</a>, <a href="/wiki/Bupivacaine" title="Bupivacaine">bupivacaine</a>, and <a href="/wiki/Epinephrine" class="mw-redirect" title="Epinephrine">epinephrine</a> (recommended final concentrations of 0.5, 0.25, and 0.5%, respectively)</li> <li><a href="/wiki/Iontocaine" title="Iontocaine">Iontocaine</a>, consisting of lidocaine and epinephrine</li> <li>Septocaine (trade name Septodont), a combination of <a href="/wiki/Articaine" title="Articaine">articaine</a> and epinephrine</li></ul> <p>One combination product of this type is used topically for surface anaesthesia, TAC (5–12% <a href="/wiki/Tetracaine" title="Tetracaine">tetracaine</a>,<sup>1</sup>/<sub>2000</sub> (0.05%, 500 <a href="/wiki/Parts-per_notation#ppm" title="Parts-per notation">ppm</a>, <style data-mw-deduplicate="TemplateStyles:r1154941027">.mw-parser-output .frac{white-space:nowrap}.mw-parser-output .frac .num,.mw-parser-output .frac .den{font-size:80%;line-height:0;vertical-align:super}.mw-parser-output .frac .den{vertical-align:sub}.mw-parser-output .sr-only{border:0;clip:rect(0,0,0,0);clip-path:polygon(0px 0px,0px 0px,0px 0px);height:1px;margin:-1px;overflow:hidden;padding:0;position:absolute;width:1px}</style><span class="frac"><span class="num">1</span>⁄<span class="den">2</span></span> per mille) adrenaline, 4 or 10% cocaine). </p><p>Using LA with vasoconstrictor is safe in regions supplied by <a href="/wiki/End_artery" title="End artery">end arteries</a>. The commonly held belief that LA with vasoconstrictor can cause <a href="/wiki/Necrosis" title="Necrosis">necrosis</a> in extremities such as the nose, ears, fingers, and toes (due to constriction of end arteries), is invalidated, since no case of necrosis has been reported since the introduction of commercial lidocaine with epinephrine in 1948.<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Ester_group">Ester group</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=29" title="Edit section: Ester group"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Procaine.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4a/Procaine.svg/220px-Procaine.svg.png" decoding="async" width="220" height="95" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4a/Procaine.svg/330px-Procaine.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4a/Procaine.svg/440px-Procaine.svg.png 2x" data-file-width="512" data-file-height="222" /></a><figcaption><a href="/wiki/Procaine" title="Procaine">Procaine</a></figcaption></figure> <ul><li><a href="/wiki/Benzocaine" title="Benzocaine">Benzocaine</a></li> <li><a href="/wiki/Chloroprocaine" title="Chloroprocaine">Chloroprocaine</a></li> <li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></li> <li><a href="/wiki/Cyclomethycaine" title="Cyclomethycaine">Cyclomethycaine</a></li> <li><a href="/wiki/Dimethocaine" title="Dimethocaine">Dimethocaine</a> (Larocaine)</li> <li><a href="/wiki/Piperocaine" title="Piperocaine">Piperocaine</a></li> <li><a href="/wiki/Propoxycaine" title="Propoxycaine">Propoxycaine</a></li> <li><a href="/wiki/Procaine" title="Procaine">Procaine</a> (Novocaine)</li> <li><a href="/wiki/Proparacaine" class="mw-redirect" title="Proparacaine">Proparacaine</a></li> <li><a href="/wiki/Tetracaine" title="Tetracaine">Tetracaine</a> (Amethocaine)</li></ul> <div class="mw-heading mw-heading3"><h3 id="Amide_group">Amide group</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=30" title="Edit section: Amide group"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Lidocaine.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/46/Lidocaine.svg/220px-Lidocaine.svg.png" decoding="async" width="220" height="98" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/46/Lidocaine.svg/330px-Lidocaine.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/46/Lidocaine.svg/440px-Lidocaine.svg.png 2x" data-file-width="385" data-file-height="171" /></a><figcaption><a href="/wiki/Lidocaine" title="Lidocaine">Lidocaine</a></figcaption></figure> <ul><li><a href="/wiki/Articaine" title="Articaine">Articaine</a></li> <li><a href="/wiki/Bupivacaine" title="Bupivacaine">Bupivacaine</a></li> <li><a href="/wiki/Cinchocaine" title="Cinchocaine">Cinchocaine</a> (Dibucaine)</li> <li><a href="/wiki/Etidocaine" title="Etidocaine">Etidocaine</a></li> <li><a href="/wiki/Levobupivacaine" title="Levobupivacaine">Levobupivacaine</a></li> <li><a href="/wiki/Lidocaine" title="Lidocaine">Lidocaine</a> (Lignocaine)</li> <li><a href="/wiki/Mepivacaine" title="Mepivacaine">Mepivacaine</a></li> <li><a href="/wiki/Prilocaine" title="Prilocaine">Prilocaine</a></li> <li><a href="/wiki/Ropivacaine" title="Ropivacaine">Ropivacaine</a></li> <li><a href="/wiki/Trimecaine" title="Trimecaine">Trimecaine</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Naturally_derived">Naturally derived</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=31" title="Edit section: Naturally derived"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Tetrodotoxin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Tetrodotoxin.svg/220px-Tetrodotoxin.svg.png" decoding="async" width="220" height="122" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Tetrodotoxin.svg/330px-Tetrodotoxin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Tetrodotoxin.svg/440px-Tetrodotoxin.svg.png 2x" data-file-width="620" data-file-height="345" /></a><figcaption><a href="/wiki/Tetrodotoxin" title="Tetrodotoxin">Tetrodotoxin</a></figcaption></figure> <ul><li><a href="/wiki/Saxitoxin" title="Saxitoxin">Saxitoxin</a></li> <li><a href="/wiki/Neosaxitoxin" title="Neosaxitoxin">Neosaxitoxin</a></li> <li><a href="/wiki/Tetrodotoxin" title="Tetrodotoxin">Tetrodotoxin</a></li> <li><a href="/wiki/Menthol" title="Menthol">Menthol</a></li> <li><a href="/wiki/Eugenol" title="Eugenol">Eugenol</a></li> <li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></li> <li><a href="/wiki/Spilanthol" title="Spilanthol">Spilanthol</a></li></ul> <p>Most naturally occurring local anesthetics with the exceptions of menthol, eugenol and cocaine are <a href="/wiki/Neurotoxin" title="Neurotoxin">neurotoxins</a>, and have the suffix -toxin in their names. Cocaine binds the <a href="/wiki/Intracellular" class="mw-redirect" title="Intracellular">intracellular</a> side of the channels while saxitoxin, neosaxitoxin and tetrodotoxin bind to the <a href="/wiki/Extracellular" class="mw-redirect" title="Extracellular">extracellular</a> side of sodium channels. </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=32" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-More_citations_needed_section plainlinks metadata ambox ambox-content ambox-Refimprove" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Local_anesthetic" title="Special:EditPage/Local anesthetic">improve this article</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a> in this section. Unsourced material may be challenged and removed.</span> <span class="date-container"><i>(<span class="date">February 2014</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>In <a href="/wiki/Peru" title="Peru">Peru</a>, the ancient <a href="/wiki/Inca_mythology#Deities" title="Inca mythology">Incas</a> are believed to have used the leaves of the <a href="/wiki/Coca" title="Coca">coca plant</a> as a local anesthetic in addition to its stimulant properties.<sup id="cite_ref-Boca_Raton_66-0" class="reference"><a href="#cite_note-Boca_Raton-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> It was also used for slave payment and is thought to play a role in the subsequent destruction of <a href="/wiki/Inca_Empire#Coca" title="Inca Empire">Incas culture</a> when Spaniards realized the effects of chewing the coca leaves and took advantage of it.<sup id="cite_ref-Boca_Raton_66-1" class="reference"><a href="#cite_note-Boca_Raton-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Cocaine" title="Cocaine">Cocaine</a> was first used as a local anesthetic in 1884. The search for a less toxic and less addictive substitute led to the development of the aminoester local anesthetics <a href="/wiki/Stovaine" class="mw-redirect" title="Stovaine">stovaine</a> in 1903 and <a href="/wiki/Procaine" title="Procaine">procaine</a> in 1904. Since then, several synthetic local anesthetic drugs have been developed and put into clinical use, notably lidocaine in 1943, bupivacaine in 1957, and prilocaine in 1959. </p><p>The invention of clinical use of local anaesthesia is credited to the Vienna School which included Sigmund Freud (1856-1939), Carl Koller (1857-1944) and Leopold Konigstein (1850–1942). They introduced local anaesthesia, using cocaine, through 'self-experimation' on their oral mucosa before introducing it to animal or human experimentation. The Vienna school first started using cocaine as local anaesthesia in ophthalmology and it was later incorporated into ophthalmologic practice. Dr. Halsted and Dr. Hall, in the United States in 1885 described an intraoral anesthetic technique of blocking the inferior alveolar nerve and the antero-superior dental nerve using 4% cocaine.{<sup id="cite_ref-López-Valverde_2014_67-0" class="reference"><a href="#cite_note-López-Valverde_2014-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p><p>Shortly after the first use of cocaine for topical anesthesia, blocks on peripheral nerves were described. Brachial plexus anesthesia by percutaneous injection through axillary and supraclavicular approaches was developed in the early 20th century. The search for the most effective and least traumatic approach for plexus anesthesia and peripheral nerve blocks continues to this day. In recent decades, continuous regional anesthesia using catheters and automatic pumps has evolved as a method of pain therapy. </p><p>Intravenous regional anesthesia was first described by <a href="/wiki/August_Bier" title="August Bier">August Bier</a> in 1908. This technique is still in use and is remarkably safe when drugs of low systemic toxicity such as prilocaine are used. </p><p>Spinal anesthesia was first used in 1885, but not introduced into clinical practice until 1899, when August Bier subjected himself to a clinical experiment in which he observed the anesthetic effect, but also the typical side effect of postpunctural headache. Within a few years, spinal anesthesia became widely used for surgical anesthesia and was accepted as a safe and effective technique. Although atraumatic (noncutting-tip) cannulae and modern drugs are used today, the technique has otherwise changed very little over many decades. </p><p>Epidural anesthesia by a caudal approach had been known in the early 20th century, but a well-defined technique using lumbar injection was not developed until 1921, when <a href="/wiki/Fidel_Pag%C3%A9s" title="Fidel Pagés">Fidel Pagés</a> published his article "Anestesia Metamérica". This technique was popularized in the 1930s and 1940s by Achile Mario Dogliotti. With the advent of thin, flexible catheters, continuous infusion and repeated injections have become possible, making epidural anesthesia still a highly successful technique. Besides its many uses for surgery, epidural anesthesia is particularly popular in obstetrics for the treatment of labor pain. </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=33" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Amylocaine" title="Amylocaine">Amylocaine</a></li> <li><a href="/wiki/Anesthetic" title="Anesthetic">Anesthetic</a></li> <li><a href="/wiki/General_anesthetic" class="mw-redirect" title="General anesthetic">General anesthetic</a></li> <li><a href="/wiki/List_of_cocaine_analogues" title="List of cocaine analogues">List of cocaine analogues</a></li> <li><a href="/wiki/List_of_local_anesthetics" title="List of local anesthetics">List of local anesthetics</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=34" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-nhs.uk-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-nhs.uk_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-nhs.uk_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.nhs.uk/conditions/anaesthesia/">"Types of Anaesthesia"</a>. <i>nhs.uk</i>. 17 October 2017<span class="reference-accessdate">. Retrieved <span class="nowrap">10 April</span> 2023</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nhs.uk&rft.atitle=Types+of+Anaesthesia&rft.date=2017-10-17&rft_id=https%3A%2F%2Fwww.nhs.uk%2Fconditions%2Fanaesthesia%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.nhs.uk/conditions/local-anaesthesia/#:~:text=Local%20anaesthesia%20involves%20numbing%20an,or%20relieve%20pain%20after%20surgery.">"Local anaesthesia"</a>. <i>nhs.uk</i>. 19 October 2017<span class="reference-accessdate">. Retrieved <span class="nowrap">10 April</span> 2023</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=nhs.uk&rft.atitle=Local+anaesthesia&rft.date=2017-10-19&rft_id=https%3A%2F%2Fwww.nhs.uk%2Fconditions%2Flocal-anaesthesia%2F%23%3A~%3Atext%3DLocal%2520anaesthesia%2520involves%2520numbing%2520an%2Cor%2520relieve%2520pain%2520after%2520surgery.&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGreenbaumKayeMason1987" class="citation journal cs1">Greenbaum, R. A.; Kaye, G.; Mason, P. D. (July 1987). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1290901">"Experience with nalbuphine, a new opioid analgesic, in acute myocardial infarction"</a>. <i>Journal of the Royal Society of Medicine</i>. <b>80</b> (7): 418–421. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F014107688708000708">10.1177/014107688708000708</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/0141-0768">0141-0768</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1290901">1290901</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/3309298">3309298</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+Royal+Society+of+Medicine&rft.atitle=Experience+with+nalbuphine%2C+a+new+opioid+analgesic%2C+in+acute+myocardial+infarction&rft.volume=80&rft.issue=7&rft.pages=418-421&rft.date=1987-07&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1290901%23id-name%3DPMC&rft.issn=0141-0768&rft_id=info%3Apmid%2F3309298&rft_id=info%3Adoi%2F10.1177%2F014107688708000708&rft.aulast=Greenbaum&rft.aufirst=R.+A.&rft.au=Kaye%2C+G.&rft.au=Mason%2C+P.+D.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1290901&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Heavner2017-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-Heavner2017_4-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHeavner2017" class="citation book cs1">Heavner, James E. (2017). Longnecker, David E.; Mackey, Sean C.; Newman, Mark F.; Sandberg, Warren S. (eds.). <a rel="nofollow" class="external text" href="http://accessanesthesiology.mhmedical.com/content.aspx?aid=1144119460"><i>Local Anesthetics</i></a> (3 ed.). New York, NY: McGraw-Hill Education<span class="reference-accessdate">. Retrieved <span class="nowrap">10 April</span> 2023</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Local+Anesthetics&rft.place=New+York%2C+NY&rft.edition=3&rft.pub=McGraw-Hill+Education&rft.date=2017&rft.aulast=Heavner&rft.aufirst=James+E.&rft_id=http%3A%2F%2Faccessanesthesiology.mhmedical.com%2Fcontent.aspx%3Faid%3D1144119460&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span> <span class="cs1-visible-error citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: </span><span class="cs1-visible-error citation-comment"><code class="cs1-code">|work=</code> ignored (<a href="/wiki/Help:CS1_errors#periodical_ignored" title="Help:CS1 errors">help</a>)</span></span> </li> <li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRyanHodgeHolyoakVlok2019" class="citation journal cs1">Ryan T, Hodge A, Holyoak R, Vlok R, Melhuish T, Binks M, et al. (July 2019). "Tramadol as an adjunct to intra-articular local anesthetic infiltration in knee arthroscopy: a systematic review and meta-analysis". <i>ANZ Journal of Surgery</i>. <b>89</b> (7–8): 827–832. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fans.14920">10.1111/ans.14920</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30684306">30684306</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:59275648">59275648</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ANZ+Journal+of+Surgery&rft.atitle=Tramadol+as+an+adjunct+to+intra-articular+local+anesthetic+infiltration+in+knee+arthroscopy%3A+a+systematic+review+and+meta-analysis&rft.volume=89&rft.issue=7%E2%80%938&rft.pages=827-832&rft.date=2019-07&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A59275648%23id-name%3DS2CID&rft_id=info%3Apmid%2F30684306&rft_id=info%3Adoi%2F10.1111%2Fans.14920&rft.aulast=Ryan&rft.aufirst=T&rft.au=Hodge%2C+A&rft.au=Holyoak%2C+R&rft.au=Vlok%2C+R&rft.au=Melhuish%2C+T&rft.au=Binks%2C+M&rft.au=Hurtado%2C+G&rft.au=White%2C+L&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-6"><span class="mw-cite-backlink"><b><a href="#cite_ref-6">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1">"Current world literature. Drugs in anaesthesia". <i>Current Opinion in Anesthesiology</i>. <b>16</b> (4): 429–436. August 2003. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00001503-200308000-00010">10.1097/00001503-200308000-00010</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17021493">17021493</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Opinion+in+Anesthesiology&rft.atitle=Current+world+literature.+Drugs+in+anaesthesia&rft.volume=16&rft.issue=4&rft.pages=429-436&rft.date=2003-08&rft_id=info%3Adoi%2F10.1097%2F00001503-200308000-00010&rft_id=info%3Apmid%2F17021493&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-pmid19918020-7"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid19918020_7-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBodenhamHowell2009" class="citation journal cs1">Bodenham AR, Howell SJ (December 2009). <a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fbja%2Faep310">"General anaesthesia vs local anaesthesia: an ongoing story"</a>. <i>British Journal of Anaesthesia</i>. <b>103</b> (6): 785–789. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Fbja%2Faep310">10.1093/bja/aep310</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19918020">19918020</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Anaesthesia&rft.atitle=General+anaesthesia+vs+local+anaesthesia%3A+an+ongoing+story&rft.volume=103&rft.issue=6&rft.pages=785-789&rft.date=2009-12&rft_id=info%3Adoi%2F10.1093%2Fbja%2Faep310&rft_id=info%3Apmid%2F19918020&rft.aulast=Bodenham&rft.aufirst=AR&rft.au=Howell%2C+SJ&rft_id=https%3A%2F%2Fdoi.org%2F10.1093%252Fbja%252Faep310&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Torpy2011-8"><span class="mw-cite-backlink">^ <a href="#cite_ref-Torpy2011_8-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Torpy2011_8-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Torpy2011_8-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Torpy2011_8-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-Torpy2011_8-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-Torpy2011_8-5"><sup><i><b>f</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTorpyLynmGolub2011" class="citation journal cs1">Torpy JM, Lynm C, Golub RM (September 2011). <a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Fjama.306.12.1395">"JAMA patient page. Local anesthesia"</a>. <i>JAMA</i>. <b>306</b> (12): 1395. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Fjama.306.12.1395">10.1001/jama.306.12.1395</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21954483">21954483</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=JAMA+patient+page.+Local+anesthesia&rft.volume=306&rft.issue=12&rft.pages=1395&rft.date=2011-09&rft_id=info%3Adoi%2F10.1001%2Fjama.306.12.1395&rft_id=info%3Apmid%2F21954483&rft.aulast=Torpy&rft.aufirst=JM&rft.au=Lynm%2C+C&rft.au=Golub%2C+RM&rft_id=https%3A%2F%2Fdoi.org%2F10.1001%252Fjama.306.12.1395&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-9"><span class="mw-cite-backlink"><b><a href="#cite_ref-9">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBrownWeissGreenbergFlatow1993" class="citation journal cs1">Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU (1993). "Interscalene block for shoulder arthroscopy: comparison with general anesthesia". <i>Arthroscopy</i>. <b>9</b> (3): 295–300. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0749-8063%2805%2980425-6">10.1016/S0749-8063(05)80425-6</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8323615">8323615</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Arthroscopy&rft.atitle=Interscalene+block+for+shoulder+arthroscopy%3A+comparison+with+general+anesthesia&rft.volume=9&rft.issue=3&rft.pages=295-300&rft.date=1993&rft_id=info%3Adoi%2F10.1016%2FS0749-8063%2805%2980425-6&rft_id=info%3Apmid%2F8323615&rft.aulast=Brown&rft.aufirst=AR&rft.au=Weiss%2C+R&rft.au=Greenberg%2C+C&rft.au=Flatow%2C+EL&rft.au=Bigliani%2C+LU&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-10"><span class="mw-cite-backlink"><b><a href="#cite_ref-10">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFlahertyHornDerby2014" class="citation journal cs1">Flaherty, James; Horn, Jean-Louis; Derby, Ryan (September 2014). <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25113725/">"Regional anesthesia for vascular surgery"</a>. <i>Anesthesiology Clinics</i>. <b>32</b> (3): 639–659. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.anclin.2014.05.002">10.1016/j.anclin.2014.05.002</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1932-2275">1932-2275</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25113725">25113725</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology+Clinics&rft.atitle=Regional+anesthesia+for+vascular+surgery&rft.volume=32&rft.issue=3&rft.pages=639-659&rft.date=2014-09&rft.issn=1932-2275&rft_id=info%3Apmid%2F25113725&rft_id=info%3Adoi%2F10.1016%2Fj.anclin.2014.05.002&rft.aulast=Flaherty&rft.aufirst=James&rft.au=Horn%2C+Jean-Louis&rft.au=Derby%2C+Ryan&rft_id=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F25113725%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-P._2016-11"><span class="mw-cite-backlink">^ <a href="#cite_ref-P._2016_11-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-P._2016_11-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFChitre2016" class="citation book cs1">Chitre AP (2016). <i>Manual of local anaesthesia in dentistry</i>. [Place of publication not identified]: Jaypee Brothers Medical P. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-9352501984" title="Special:BookSources/978-9352501984"><bdi>978-9352501984</bdi></a>. <a href="/wiki/OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/930829770">930829770</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Manual+of+local+anaesthesia+in+dentistry.&rft.place=%5BPlace+of+publication+not+identified%5D&rft.pub=Jaypee+Brothers+Medical+P&rft.date=2016&rft_id=info%3Aoclcnum%2F930829770&rft.isbn=978-9352501984&rft.aulast=Chitre&rft.aufirst=AP&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-worldcat.org-12"><span class="mw-cite-backlink">^ <a href="#cite_ref-worldcat.org_12-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-worldcat.org_12-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFReaderNussteinDrum2014" class="citation book cs1">Reader A, Nusstein J, Drum M (12 September 2014). <i>Successful local anesthesia for restorative dentistry and endodontics</i>. Chicago. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780867156157" title="Special:BookSources/9780867156157"><bdi>9780867156157</bdi></a>. <a href="/wiki/OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/892911544">892911544</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Successful+local+anesthesia+for+restorative+dentistry+and+endodontics&rft.place=Chicago&rft.date=2014-09-12&rft_id=info%3Aoclcnum%2F892911544&rft.isbn=9780867156157&rft.aulast=Reader&rft.aufirst=A&rft.au=Nusstein%2C+J&rft.au=Drum%2C+M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span><span class="cs1-maint citation-comment"><code class="cs1-code">{{<a href="/wiki/Template:Cite_book" title="Template:Cite book">cite book</a>}}</code>: CS1 maint: location missing publisher (<a href="/wiki/Category:CS1_maint:_location_missing_publisher" title="Category:CS1 maint: location missing publisher">link</a>)</span></span> </li> <li id="cite_note-RoyalCol-13"><span class="mw-cite-backlink">^ <a href="#cite_ref-RoyalCol_13-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-RoyalCol_13-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation journal cs1 cs1-prop-long-vol"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20071009110706/http://www.rcoa.ac.uk/docs/nerve-peripheral.pdf">"Nerve damage associated with peripheral nerve block"</a> <span class="cs1-format">(PDF)</span>. <i>Risks Associated with Your Anesthetic</i>. Section 12. January 2006. Archived from <a rel="nofollow" class="external text" href="http://www.rcoa.ac.uk/docs/nerve-peripheral.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 9 October 2007<span class="reference-accessdate">. Retrieved <span class="nowrap">10 October</span> 2007</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Risks+Associated+with+Your+Anesthetic&rft.atitle=Nerve+damage+associated+with+peripheral+nerve+block&rft.volume=Section+12&rft.date=2006-01&rft_id=http%3A%2F%2Fwww.rcoa.ac.uk%2Fdocs%2Fnerve-peripheral.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-:1-14"><span class="mw-cite-backlink">^ <a href="#cite_ref-:1_14-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:1_14-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBaartBrand2017" class="citation book cs1">Baart JA, Brand HS (7 June 2017). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=xRgnDwAAQBAJ&q=side+effects"><i>Local Anaesthesia in Dentistry</i></a>. Springer. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9783319437057" title="Special:BookSources/9783319437057"><bdi>9783319437057</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Local+Anaesthesia+in+Dentistry&rft.pub=Springer&rft.date=2017-06-07&rft.isbn=9783319437057&rft.aulast=Baart&rft.aufirst=JA&rft.au=Brand%2C+HS&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DxRgnDwAAQBAJ%26q%3Dside%2Beffects&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-:2-15"><span class="mw-cite-backlink">^ <a href="#cite_ref-:2_15-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:2_15-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:2_15-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-:2_15-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-:2_15-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-:2_15-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-:2_15-6"><sup><i><b>g</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAronson2008" class="citation book cs1">Aronson JK (7 October 2008). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=NYiQYoPjJl4C&q=local+anesthesia+general+side+effects"><i>Meyler's Side Effects of Drugs Used in Anesthesia</i></a>. Elsevier. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780444532701" title="Special:BookSources/9780444532701"><bdi>9780444532701</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Meyler%27s+Side+Effects+of+Drugs+Used+in+Anesthesia&rft.pub=Elsevier&rft.date=2008-10-07&rft.isbn=9780444532701&rft.aulast=Aronson&rft.aufirst=JK&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DNYiQYoPjJl4C%26q%3Dlocal%2Banesthesia%2Bgeneral%2Bside%2Beffects&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Mulroy,_M._2002-16"><span class="mw-cite-backlink"><b><a href="#cite_ref-Mulroy,_M._2002_16-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMulroy2002" class="citation journal cs1">Mulroy MF (2002). "Systemic toxicity and cardiotoxicity from local anesthetics: incidence and preventive measures". <i>Regional Anesthesia and Pain Medicine</i>. <b>27</b> (6): 556–561. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1053%2Frapm.2002.37127">10.1053/rapm.2002.37127</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12430104">12430104</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:36915462">36915462</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Regional+Anesthesia+and+Pain+Medicine&rft.atitle=Systemic+toxicity+and+cardiotoxicity+from+local+anesthetics%3A+incidence+and+preventive+measures&rft.volume=27&rft.issue=6&rft.pages=556-561&rft.date=2002&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A36915462%23id-name%3DS2CID&rft_id=info%3Apmid%2F12430104&rft_id=info%3Adoi%2F10.1053%2Frapm.2002.37127&rft.aulast=Mulroy&rft.aufirst=MF&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-17"><span class="mw-cite-backlink"><b><a href="#cite_ref-17">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFStilesPrielipp2009" class="citation journal cs1">Stiles P, Prielipp RC (Spring 2009). <a rel="nofollow" class="external text" href="http://www.apsf.org/newsletters/html/2009/spring/12_Intralipid.htm">"Intralipid Treatment Of Bupicavaine Toxicity"</a>. <i>Anesthesia Patient Safety Foundation</i>. <b>24</b> (1)<span class="reference-accessdate">. Retrieved <span class="nowrap">12 June</span> 2013</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+Patient+Safety+Foundation&rft.atitle=Intralipid+Treatment+Of+Bupicavaine+Toxicity&rft.ssn=spring&rft.volume=24&rft.issue=1&rft.date=2009&rft.aulast=Stiles&rft.aufirst=P&rft.au=Prielipp%2C+RC&rft_id=http%3A%2F%2Fwww.apsf.org%2Fnewsletters%2Fhtml%2F2009%2Fspring%2F12_Intralipid.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Dolan,_R._2004-18"><span class="mw-cite-backlink">^ <a href="#cite_ref-Dolan,_R._2004_18-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Dolan,_R._2004_18-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDolan2003" class="citation book cs1">Dolan R (17 October 2003). <i>Facial plastic, reconstructive, and trauma surgery</i>. Marcel Dekker. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8247-4595-0" title="Special:BookSources/978-0-8247-4595-0"><bdi>978-0-8247-4595-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Facial+plastic%2C+reconstructive%2C+and+trauma+surgery&rft.pub=Marcel+Dekker&rft.date=2003-10-17&rft.isbn=978-0-8247-4595-0&rft.aulast=Dolan&rft.aufirst=R&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-ReferenceA-19"><span class="mw-cite-backlink">^ <a href="#cite_ref-ReferenceA_19-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-ReferenceA_19-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text">Univ. of Wisconsin, Local Anesthesia and Regional Anesthetics</span> </li> <li id="cite_note-Weinberg_1998-20"><span class="mw-cite-backlink">^ <a href="#cite_ref-Weinberg_1998_20-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Weinberg_1998_20-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWeinbergVadeBoncouerRamarajuGarcia-Amaro1998" class="citation journal cs1">Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ (April 1998). <a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000542-199804000-00028">"Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats"</a>. <i>Anesthesiology</i>. <b>88</b> (4): 1071–1075. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000542-199804000-00028">10.1097/00000542-199804000-00028</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9579517">9579517</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:1661916">1661916</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology&rft.atitle=Pretreatment+or+resuscitation+with+a+lipid+infusion+shifts+the+dose-response+to+bupivacaine-induced+asystole+in+rats&rft.volume=88&rft.issue=4&rft.pages=1071-1075&rft.date=1998-04&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A1661916%23id-name%3DS2CID&rft_id=info%3Apmid%2F9579517&rft_id=info%3Adoi%2F10.1097%2F00000542-199804000-00028&rft.aulast=Weinberg&rft.aufirst=GL&rft.au=VadeBoncouer%2C+T&rft.au=Ramaraju%2C+GA&rft.au=Garcia-Amaro%2C+MF&rft.au=Cwik%2C+MJ&rft_id=https%3A%2F%2Fdoi.org%2F10.1097%252F00000542-199804000-00028&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Weinberg_2003-21"><span class="mw-cite-backlink">^ <a href="#cite_ref-Weinberg_2003_21-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Weinberg_2003_21-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWeinbergRipperFeinsteinHoffman2003" class="citation journal cs1">Weinberg G, Ripper R, Feinstein DL, Hoffman W (2003). "Lipid emulsion infusion rescues dogs from bupivacaine-induced cardiac toxicity". <i>Regional Anesthesia and Pain Medicine</i>. <b>28</b> (3): 198–202. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1053%2Frapm.2003.50041">10.1053/rapm.2003.50041</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12772136">12772136</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:6247454">6247454</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Regional+Anesthesia+and+Pain+Medicine&rft.atitle=Lipid+emulsion+infusion+rescues+dogs+from+bupivacaine-induced+cardiac+toxicity&rft.volume=28&rft.issue=3&rft.pages=198-202&rft.date=2003&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A6247454%23id-name%3DS2CID&rft_id=info%3Apmid%2F12772136&rft_id=info%3Adoi%2F10.1053%2Frapm.2003.50041&rft.aulast=Weinberg&rft.aufirst=G&rft.au=Ripper%2C+R&rft.au=Feinstein%2C+DL&rft.au=Hoffman%2C+W&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Picard2006-22"><span class="mw-cite-backlink">^ <a href="#cite_ref-Picard2006_22-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Picard2006_22-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPicardMeek2006" class="citation journal cs1">Picard J, Meek T (February 2006). "Lipid emulsion to treat overdose of local anesthetic: the gift of the glob". <i>Anaesthesia</i>. <b>61</b> (2): 107–109. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1365-2044.2005.04494.x">10.1111/j.1365-2044.2005.04494.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16430560">16430560</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:29843241">29843241</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anaesthesia&rft.atitle=Lipid+emulsion+to+treat+overdose+of+local+anesthetic%3A+the+gift+of+the+glob&rft.volume=61&rft.issue=2&rft.pages=107-109&rft.date=2006-02&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A29843241%23id-name%3DS2CID&rft_id=info%3Apmid%2F16430560&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2044.2005.04494.x&rft.aulast=Picard&rft.aufirst=J&rft.au=Meek%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Rosenblatt2006-23"><span class="mw-cite-backlink">^ <a href="#cite_ref-Rosenblatt2006_23-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Rosenblatt2006_23-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRosenblattAbelFischerItzkovich2006" class="citation journal cs1">Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JB (July 2006). <a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000542-200607000-00033">"Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest"</a>. <i>Anesthesiology</i>. <b>105</b> (1): 217–218. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000542-200607000-00033">10.1097/00000542-200607000-00033</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16810015">16810015</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:40214528">40214528</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesiology&rft.atitle=Successful+use+of+a+20%25+lipid+emulsion+to+resuscitate+a+patient+after+a+presumed+bupivacaine-related+cardiac+arrest&rft.volume=105&rft.issue=1&rft.pages=217-218&rft.date=2006-07&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A40214528%23id-name%3DS2CID&rft_id=info%3Apmid%2F16810015&rft_id=info%3Adoi%2F10.1097%2F00000542-200607000-00033&rft.aulast=Rosenblatt&rft.aufirst=MA&rft.au=Abel%2C+M&rft.au=Fischer%2C+GW&rft.au=Itzkovich%2C+CJ&rft.au=Eisenkraft%2C+JB&rft_id=https%3A%2F%2Fdoi.org%2F10.1097%252F00000542-200607000-00033&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Litz2006-24"><span class="mw-cite-backlink">^ <a href="#cite_ref-Litz2006_24-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Litz2006_24-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLitzPoppStehrKoch2006" class="citation journal cs1">Litz RJ, Popp M, Stehr SN, Koch T (August 2006). "Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion". <i>Anaesthesia</i>. <b>61</b> (8): 800–801. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1365-2044.2006.04740.x">10.1111/j.1365-2044.2006.04740.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16867094">16867094</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:43125067">43125067</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anaesthesia&rft.atitle=Successful+resuscitation+of+a+patient+with+ropivacaine-induced+asystole+after+axillary+plexus+block+using+lipid+infusion&rft.volume=61&rft.issue=8&rft.pages=800-801&rft.date=2006-08&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A43125067%23id-name%3DS2CID&rft_id=info%3Apmid%2F16867094&rft_id=info%3Adoi%2F10.1111%2Fj.1365-2044.2006.04740.x&rft.aulast=Litz&rft.aufirst=RJ&rft.au=Popp%2C+M&rft.au=Stehr%2C+SN&rft.au=Koch%2C+T&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-25"><span class="mw-cite-backlink"><b><a href="#cite_ref-25">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCaveHarvey2009" class="citation journal cs1">Cave G, Harvey M (September 2009). <a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1553-2712.2009.00499.x">"Intravenous lipid emulsion as antidote beyond local anesthetic toxicity: a systematic review"</a>. <i>Academic Emergency Medicine</i>. <b>16</b> (9): 815–824. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1553-2712.2009.00499.x">10.1111/j.1553-2712.2009.00499.x</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19845549">19845549</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Academic+Emergency+Medicine&rft.atitle=Intravenous+lipid+emulsion+as+antidote+beyond+local+anesthetic+toxicity%3A+a+systematic+review&rft.volume=16&rft.issue=9&rft.pages=815-824&rft.date=2009-09&rft_id=info%3Adoi%2F10.1111%2Fj.1553-2712.2009.00499.x&rft_id=info%3Apmid%2F19845549&rft.aulast=Cave&rft.aufirst=G&rft.au=Harvey%2C+M&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252Fj.1553-2712.2009.00499.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-26"><span class="mw-cite-backlink"><b><a href="#cite_ref-26">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://anaesthetists.org/Search-Results?search=Local%20anaesthetic%20toxicity">"Management of severe local anaesthetic toxicity"</a>. <i>anaesthetists.org. <a href="/wiki/Association_of_Anaesthetists_of_Great_Britain_and_Ireland" title="Association of Anaesthetists of Great Britain and Ireland">Association of Anaesthetists of Great Britain and Ireland</a> (AAGBI)</i>. December 2010<span class="reference-accessdate">. Retrieved <span class="nowrap">10 April</span> 2023</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=anaesthetists.org.+Association+of+Anaesthetists+of+Great+Britain+and+Ireland+%28AAGBI%29.&rft.atitle=Management+of+severe+local+anaesthetic+toxicity&rft.date=2010-12&rft_id=https%3A%2F%2Fanaesthetists.org%2FSearch-Results%3Fsearch%3DLocal%2520anaesthetic%2520toxicity&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-27"><span class="mw-cite-backlink"><b><a href="#cite_ref-27">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSirianniOsterhoudtCalelloMuller2008" class="citation journal cs1">Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, et al. (April 2008). "Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine". <i>Annals of Emergency Medicine</i>. <b>51</b> (4): 412–5, 415.e1. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.annemergmed.2007.06.004">10.1016/j.annemergmed.2007.06.004</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17766009">17766009</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Emergency+Medicine&rft.atitle=Use+of+lipid+emulsion+in+the+resuscitation+of+a+patient+with+prolonged+cardiovascular+collapse+after+overdose+of+bupropion+and+lamotrigine&rft.volume=51&rft.issue=4&rft.pages=412-5%2C+415.e1&rft.date=2008-04&rft_id=info%3Adoi%2F10.1016%2Fj.annemergmed.2007.06.004&rft_id=info%3Apmid%2F17766009&rft.aulast=Sirianni&rft.aufirst=AJ&rft.au=Osterhoudt%2C+KC&rft.au=Calello%2C+DP&rft.au=Muller%2C+AA&rft.au=Waterhouse%2C+MR&rft.au=Goodkin%2C+MB&rft.au=Weinberg%2C+GL&rft.au=Henretig%2C+FM&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-28"><span class="mw-cite-backlink"><b><a href="#cite_ref-28">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://lipidrescue.squarespace.com/sample-lipidrescue-kit">"lipidrescue - Sample LipidRescue Kit"</a>. <i>lipidrescue.squarespace.com</i>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220725082408/http://lipidrescue.squarespace.com/sample-lipidrescue-kit">Archived</a> from the original on 25 July 2022.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=lipidrescue.squarespace.com&rft.atitle=lipidrescue+-+Sample+LipidRescue+Kit&rft_id=http%3A%2F%2Flipidrescue.squarespace.com%2Fsample-lipidrescue-kit&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Harvey_2007-29"><span class="mw-cite-backlink"><b><a href="#cite_ref-Harvey_2007_29-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHarveyCave2007" class="citation journal cs1">Harvey M, Cave G (February 2007). "Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity". <i>Annals of Emergency Medicine</i>. <b>49</b> (2): 178–85, 185.e1–4. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.annemergmed.2006.07.016">10.1016/j.annemergmed.2006.07.016</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17098328">17098328</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Annals+of+Emergency+Medicine&rft.atitle=Intralipid+outperforms+sodium+bicarbonate+in+a+rabbit+model+of+clomipramine+toxicity&rft.volume=49&rft.issue=2&rft.pages=178-85%2C+185.e1-4&rft.date=2007-02&rft_id=info%3Adoi%2F10.1016%2Fj.annemergmed.2006.07.016&rft_id=info%3Apmid%2F17098328&rft.aulast=Harvey&rft.aufirst=M&rft.au=Cave%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Harvey_2009-30"><span class="mw-cite-backlink"><b><a href="#cite_ref-Harvey_2009_30-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHarveyCaveHoggett2009" class="citation journal cs1">Harvey M, Cave G, Hoggett K (February 2009). <a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1553-2712.2008.00313.x">"Correlation of plasma and peritoneal diasylate clomipramine concentration with hemodynamic recovery after intralipid infusion in rabbits"</a>. <i>Academic Emergency Medicine</i>. <b>16</b> (2): 151–156. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1553-2712.2008.00313.x">10.1111/j.1553-2712.2008.00313.x</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19133855">19133855</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Academic+Emergency+Medicine&rft.atitle=Correlation+of+plasma+and+peritoneal+diasylate+clomipramine+concentration+with+hemodynamic+recovery+after+intralipid+infusion+in+rabbits&rft.volume=16&rft.issue=2&rft.pages=151-156&rft.date=2009-02&rft_id=info%3Adoi%2F10.1111%2Fj.1553-2712.2008.00313.x&rft_id=info%3Apmid%2F19133855&rft.aulast=Harvey&rft.aufirst=M&rft.au=Cave%2C+G&rft.au=Hoggett%2C+K&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252Fj.1553-2712.2008.00313.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Crandell_2009-31"><span class="mw-cite-backlink"><b><a href="#cite_ref-Crandell_2009_31-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCrandellWeinberg2009" class="citation journal cs1">Crandell DE, Weinberg GL (April 2009). <a rel="nofollow" class="external text" href="https://zenodo.org/record/898154">"Moxidectin toxicosis in a puppy successfully treated with intravenous lipids"</a>. <i>Journal of Veterinary Emergency and Critical Care</i>. <b>19</b> (2): 181–186. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1476-4431.2009.00402.x">10.1111/j.1476-4431.2009.00402.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19691569">19691569</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Veterinary+Emergency+and+Critical+Care&rft.atitle=Moxidectin+toxicosis+in+a+puppy+successfully+treated+with+intravenous+lipids&rft.volume=19&rft.issue=2&rft.pages=181-186&rft.date=2009-04&rft_id=info%3Adoi%2F10.1111%2Fj.1476-4431.2009.00402.x&rft_id=info%3Apmid%2F19691569&rft.aulast=Crandell&rft.aufirst=DE&rft.au=Weinberg%2C+GL&rft_id=https%3A%2F%2Fzenodo.org%2Frecord%2F898154&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Catterall2023-32"><span class="mw-cite-backlink">^ <a href="#cite_ref-Catterall2023_32-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Catterall2023_32-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCatterallMackie2023" class="citation book cs1">Catterall WA, Mackie K (2023). <a rel="nofollow" class="external text" href="https://accessanesthesiology.mhmedical.com/content.aspx?bookid=3191&sectionid=268045025">"Local Anesthetics"</a>. In Brunton LL, Knollmann BC (eds.). <i>Goodman & Gilman's: The Pharmacological Basis of Therapeutics</i> (14th ed.). McGraw Hill. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-264-25807-9" title="Special:BookSources/978-1-264-25807-9"><bdi>978-1-264-25807-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Local+Anesthetics&rft.btitle=Goodman+%26+Gilman%27s%3A+The+Pharmacological+Basis+of+Therapeutics&rft.edition=14th&rft.pub=McGraw+Hill&rft.date=2023&rft.isbn=978-1-264-25807-9&rft.aulast=Catterall&rft.aufirst=WA&rft.au=Mackie%2C+K&rft_id=https%3A%2F%2Faccessanesthesiology.mhmedical.com%2Fcontent.aspx%3Fbookid%3D3191%26sectionid%3D268045025&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Piehl2015-33"><span class="mw-cite-backlink"><b><a href="#cite_ref-Piehl2015_33-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPiehlBucklin2015" class="citation book cs1">Piehl E, Bucklin BA (2015). <a rel="nofollow" class="external text" href="https://accessanesthesiology.mhmedical.com/content.aspx?bookid=1364&sectionid=82007590">"Drugs commonly used in obstetric anesthesia."</a>. In Santos AC, Epstein JN, Chaudhuri K (eds.). <i>Obstetric Anesthesia</i>. McGraw Hill. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-178613-3" title="Special:BookSources/978-0-07-178613-3"><bdi>978-0-07-178613-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Drugs+commonly+used+in+obstetric+anesthesia.&rft.btitle=Obstetric+Anesthesia&rft.pub=McGraw+Hill&rft.date=2015&rft.isbn=978-0-07-178613-3&rft.aulast=Piehl&rft.aufirst=E&rft.au=Bucklin%2C+BA&rft_id=https%3A%2F%2Faccessanesthesiology.mhmedical.com%2Fcontent.aspx%3Fbookid%3D1364%26sectionid%3D82007590&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Gretchen2001-34"><span class="mw-cite-backlink"><b><a href="#cite_ref-Gretchen2001_34-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHenkel2001" class="citation journal cs1">Henkel G (December 2001). "Susceptibility of Nerve Fibers to Local Anesthesia:"Size Principle" Challenged". <i>The Journal of the American Society of Anesthesiologists</i>. <b>95</b> (6): 5A–6A. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000542-200112000-00003">10.1097/00000542-200112000-00003</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+the+American+Society+of+Anesthesiologists&rft.atitle=Susceptibility+of+Nerve+Fibers+to+Local+Anesthesia%3A%22Size+Principle%22+Challenged.&rft.volume=95&rft.issue=6&rft.pages=5A-6A&rft.date=2001-12&rft_id=info%3Adoi%2F10.1097%2F00000542-200112000-00003&rft.aulast=Henkel&rft.aufirst=G&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-35"><span class="mw-cite-backlink"><b><a href="#cite_ref-35">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://bestbets.org/bets/bet.php?id=1480">"BestBets: The Effect of Warming Local anesthetics on Pain of Infiltration"</a>. <i>bestbets.org</i>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=bestbets.org&rft.atitle=BestBets%3A+The+Effect+of+Warming+Local+anesthetics+on+Pain+of+Infiltration&rft_id=https%3A%2F%2Fbestbets.org%2Fbets%2Fbet.php%3Fid%3D1480&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-36"><span class="mw-cite-backlink"><b><a href="#cite_ref-36">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKampeWarmKasperDiefenbach2003" class="citation journal cs1">Kampe S, Warm M, Kasper SM, Diefenbach C (July 2003). "Concept for postoperative analgesia after pedicled TRAM flaps: continuous wound instillation with 0.2% ropivacaine via multilumen catheters. A report of two cases". <i>British Journal of Plastic Surgery</i>. <b>56</b> (5): 478–483. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0007-1226%2803%2900180-2">10.1016/S0007-1226(03)00180-2</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12890461">12890461</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Journal+of+Plastic+Surgery&rft.atitle=Concept+for+postoperative+analgesia+after+pedicled+TRAM+flaps%3A+continuous+wound+instillation+with+0.2%25+ropivacaine+via+multilumen+catheters.+A+report+of+two+cases&rft.volume=56&rft.issue=5&rft.pages=478-483&rft.date=2003-07&rft_id=info%3Adoi%2F10.1016%2FS0007-1226%2803%2900180-2&rft_id=info%3Apmid%2F12890461&rft.aulast=Kampe&rft.aufirst=S&rft.au=Warm%2C+M&rft.au=Kasper%2C+SM&rft.au=Diefenbach%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Malamed_2013-37"><span class="mw-cite-backlink"><b><a href="#cite_ref-Malamed_2013_37-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMalamed2013" class="citation book cs1">Malamed SF (2013). <i>Handbook of local anesthesia</i> (6th ed.). St. Louis, Missouri: Elsevier. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/9780323074131" title="Special:BookSources/9780323074131"><bdi>9780323074131</bdi></a>. <a href="/wiki/OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/769141511">769141511</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Handbook+of+local+anesthesia&rft.place=St.+Louis%2C+Missouri&rft.edition=6th&rft.pub=Elsevier&rft.date=2013&rft_id=info%3Aoclcnum%2F769141511&rft.isbn=9780323074131&rft.aulast=Malamed&rft.aufirst=SF&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-38"><span class="mw-cite-backlink"><b><a href="#cite_ref-38">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMeechan1992" class="citation journal cs1">Meechan JG (December 1992). "Intraligamentary anaesthesia". <i>Journal of Dentistry</i>. <b>20</b> (6): 325–332. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2F0300-5712%2892%2990018-8">10.1016/0300-5712(92)90018-8</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/1452871">1452871</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Dentistry&rft.atitle=Intraligamentary+anaesthesia&rft.volume=20&rft.issue=6&rft.pages=325-332&rft.date=1992-12&rft_id=info%3Adoi%2F10.1016%2F0300-5712%2892%2990018-8&rft_id=info%3Apmid%2F1452871&rft.aulast=Meechan&rft.aufirst=JG&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-39"><span class="mw-cite-backlink"><b><a href="#cite_ref-39">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBlantonJeske2003" class="citation journal cs1">Blanton PL, Jeske AH (June 2003). "The key to profound local anesthesia: neuroanatomy". <i>Journal of the American Dental Association</i>. <b>134</b> (6): 753–760. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.14219%2Fjada.archive.2003.0262">10.14219/jada.archive.2003.0262</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12839412">12839412</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Dental+Association&rft.atitle=The+key+to+profound+local+anesthesia%3A+neuroanatomy&rft.volume=134&rft.issue=6&rft.pages=753-760&rft.date=2003-06&rft_id=info%3Adoi%2F10.14219%2Fjada.archive.2003.0262&rft_id=info%3Apmid%2F12839412&rft.aulast=Blanton&rft.aufirst=PL&rft.au=Jeske%2C+AH&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-40"><span class="mw-cite-backlink"><b><a href="#cite_ref-40">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBoynes2018" class="citation web cs1">Boynes SG (1 June 2018). <a rel="nofollow" class="external text" href="https://www.dentalacademyofce.com/courses/3580%2FPDF%2F1807cei_Boynes_web.pdf">"Intraligamentary Injections in Dentistry"</a> <span class="cs1-format">(PDF)</span>. Dental Academy of Continuing Education.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Intraligamentary+Injections+in+Dentistry&rft.pub=Dental+Academy+of+Continuing+Education&rft.date=2018-06-01&rft.aulast=Boynes&rft.aufirst=SG&rft_id=https%3A%2F%2Fwww.dentalacademyofce.com%2Fcourses%2F3580%252FPDF%252F1807cei_Boynes_web.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-41"><span class="mw-cite-backlink"><b><a href="#cite_ref-41">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMeechan2002" class="citation journal cs1">Meechan JG (November 2002). "Supplementary routes to local anaesthesia". <i>International Endodontic Journal</i>. <b>35</b> (11): 885–896. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1365-2591.2002.00592.x">10.1046/j.1365-2591.2002.00592.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12453016">12453016</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Endodontic+Journal&rft.atitle=Supplementary+routes+to+local+anaesthesia&rft.volume=35&rft.issue=11&rft.pages=885-896&rft.date=2002-11&rft_id=info%3Adoi%2F10.1046%2Fj.1365-2591.2002.00592.x&rft_id=info%3Apmid%2F12453016&rft.aulast=Meechan&rft.aufirst=JG&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-42"><span class="mw-cite-backlink"><b><a href="#cite_ref-42">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFD'SouzaWaltonPeterson1987" class="citation journal cs1">D'Souza JE, Walton RE, Peterson LC (March 1987). "Periodontal ligament injection: an evaluation of the extent of anesthesia and postinjection discomfort". <i>Journal of the American Dental Association</i>. <b>114</b> (3): 341–344. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.14219%2Fjada.archive.1987.0080">10.14219/jada.archive.1987.0080</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/3470356">3470356</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Dental+Association&rft.atitle=Periodontal+ligament+injection%3A+an+evaluation+of+the+extent+of+anesthesia+and+postinjection+discomfort&rft.volume=114&rft.issue=3&rft.pages=341-344&rft.date=1987-03&rft_id=info%3Adoi%2F10.14219%2Fjada.archive.1987.0080&rft_id=info%3Apmid%2F3470356&rft.aulast=D%27Souza&rft.aufirst=JE&rft.au=Walton%2C+RE&rft.au=Peterson%2C+LC&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-43"><span class="mw-cite-backlink"><b><a href="#cite_ref-43">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFShastryKaulBaroudiUmar2014" class="citation journal cs1">Shastry SP, Kaul R, Baroudi K, Umar D (December 2014). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304051">"Hemophilia A: Dental considerations and management"</a>. <i>Journal of International Society of Preventive & Community Dentistry</i>. <b>4</b> (Suppl 3): S147–S152. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.4103%2F2231-0762.149022">10.4103/2231-0762.149022</a></span>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304051">4304051</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25625071">25625071</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+International+Society+of+Preventive+%26+Community+Dentistry&rft.atitle=Hemophilia+A%3A+Dental+considerations+and+management&rft.volume=4&rft.issue=Suppl+3&rft.pages=S147-S152&rft.date=2014-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4304051%23id-name%3DPMC&rft_id=info%3Apmid%2F25625071&rft_id=info%3Adoi%2F10.4103%2F2231-0762.149022&rft.aulast=Shastry&rft.aufirst=SP&rft.au=Kaul%2C+R&rft.au=Baroudi%2C+K&rft.au=Umar%2C+D&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4304051&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-44"><span class="mw-cite-backlink"><b><a href="#cite_ref-44">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNazif1970" class="citation journal cs1">Nazif M (January 1970). "Local anesthesia for patients with hemophilia". <i>ASDC Journal of Dentistry for Children</i>. <b>37</b> (1): 79–84. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/4904493">4904493</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=ASDC+Journal+of+Dentistry+for+Children&rft.atitle=Local+anesthesia+for+patients+with+hemophilia&rft.volume=37&rft.issue=1&rft.pages=79-84&rft.date=1970-01&rft_id=info%3Apmid%2F4904493&rft.aulast=Nazif&rft.aufirst=M&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-45"><span class="mw-cite-backlink"><b><a href="#cite_ref-45">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMooreHaas2010" class="citation journal cs1">Moore PA, Haas DA (October 2010). "Paresthesias in dentistry". <i>Dental Clinics of North America</i>. <b>54</b> (4): 715–730. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.cden.2010.06.016">10.1016/j.cden.2010.06.016</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20831934">20831934</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Dental+Clinics+of+North+America&rft.atitle=Paresthesias+in+dentistry&rft.volume=54&rft.issue=4&rft.pages=715-730&rft.date=2010-10&rft_id=info%3Adoi%2F10.1016%2Fj.cden.2010.06.016&rft_id=info%3Apmid%2F20831934&rft.aulast=Moore&rft.aufirst=PA&rft.au=Haas%2C+DA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-shabazfar-46"><span class="mw-cite-backlink"><b><a href="#cite_ref-shabazfar_46-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFShabazfarDaubländerAl-NawasKämmerer2014" class="citation journal cs1">Shabazfar N, Daubländer M, Al-Nawas B, Kämmerer PW (2014). "Periodontal intraligament injection as alternative to inferior alveolar nerve block--meta-analysis of the literature from 1979 to 2012". <i>Clinical Oral Investigations</i>. <b>18</b> (2): 351–358. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs00784-013-1113-1">10.1007/s00784-013-1113-1</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24077785">24077785</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:9525498">9525498</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Oral+Investigations&rft.atitle=Periodontal+intraligament+injection+as+alternative+to+inferior+alveolar+nerve+block--meta-analysis+of+the+literature+from+1979+to+2012&rft.volume=18&rft.issue=2&rft.pages=351-358&rft.date=2014&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A9525498%23id-name%3DS2CID&rft_id=info%3Apmid%2F24077785&rft_id=info%3Adoi%2F10.1007%2Fs00784-013-1113-1&rft.aulast=Shabazfar&rft.aufirst=N&rft.au=Daubl%C3%A4nder%2C+M&rft.au=Al-Nawas%2C+B&rft.au=K%C3%A4mmerer%2C+PW&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-47"><span class="mw-cite-backlink"><b><a href="#cite_ref-47">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNelson1981" class="citation journal cs1">Nelson PW (November 1981). "Injection system". <i>The Journal of the American Dental Association</i>. <b>103</b> (5): 692. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.14219%2Fjada.archive.1981.0380">10.14219/jada.archive.1981.0380</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+the+American+Dental+Association&rft.atitle=Injection+system&rft.volume=103&rft.issue=5&rft.pages=692&rft.date=1981-11&rft_id=info%3Adoi%2F10.14219%2Fjada.archive.1981.0380&rft.aulast=Nelson&rft.aufirst=PW&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-pmid6439659-48"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid6439659_48-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGaliliKaufmanGarfunkelMichaeli1984" class="citation journal cs1">Galili D, Kaufman E, Garfunkel AA, Michaeli Y (December 1984). "Intraligamentary anesthesia--a histological study". <i>International Journal of Oral Surgery</i>. <b>13</b> (6): 511–6. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fs0300-9785%2884%2980022-8">10.1016/s0300-9785(84)80022-8</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6439659">6439659</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Oral+Surgery&rft.atitle=Intraligamentary+anesthesia--a+histological+study&rft.volume=13&rft.issue=6&rft.pages=511-6&rft.date=1984-12&rft_id=info%3Adoi%2F10.1016%2Fs0300-9785%2884%2980022-8&rft_id=info%3Apmid%2F6439659&rft.aulast=Galili&rft.aufirst=D&rft.au=Kaufman%2C+E&rft.au=Garfunkel%2C+AA&rft.au=Michaeli%2C+Y&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-49"><span class="mw-cite-backlink"><b><a href="#cite_ref-49">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPashley1986" class="citation journal cs1">Pashley D (October 1986). "Systemic effects of intraligamental injections". <i>Journal of Endodontics</i>. <b>12</b> (10): 501–504. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fs0099-2399%2886%2980206-0">10.1016/s0099-2399(86)80206-0</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/3465856">3465856</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Endodontics&rft.atitle=Systemic+effects+of+intraligamental+injections&rft.volume=12&rft.issue=10&rft.pages=501-504&rft.date=1986-10&rft_id=info%3Adoi%2F10.1016%2Fs0099-2399%2886%2980206-0&rft_id=info%3Apmid%2F3465856&rft.aulast=Pashley&rft.aufirst=D&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-50"><span class="mw-cite-backlink"><b><a href="#cite_ref-50">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWaltonAbbott1981" class="citation journal cs1">Walton RE, Abbott BJ (October 1981). "Periodontal ligament injection: a clinical evaluation". <i>Journal of the American Dental Association</i>. <b>103</b> (4): 571–575. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.14219%2Fjada.archive.1981.0307">10.14219/jada.archive.1981.0307</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6945341">6945341</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Dental+Association&rft.atitle=Periodontal+ligament+injection%3A+a+clinical+evaluation&rft.volume=103&rft.issue=4&rft.pages=571-575&rft.date=1981-10&rft_id=info%3Adoi%2F10.14219%2Fjada.archive.1981.0307&rft_id=info%3Apmid%2F6945341&rft.aulast=Walton&rft.aufirst=RE&rft.au=Abbott%2C+BJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-51"><span class="mw-cite-backlink"><b><a href="#cite_ref-51">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSmithWaltonAbbott1983" class="citation journal cs1">Smith GN, Walton RE, Abbott BJ (December 1983). "Clinical evaluation of periodontal ligament anesthesia using a pressure syringe". <i>Journal of the American Dental Association</i>. <b>107</b> (6): 953–956. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.14219%2Fjada.archive.1983.0357">10.14219/jada.archive.1983.0357</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6581222">6581222</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+the+American+Dental+Association&rft.atitle=Clinical+evaluation+of+periodontal+ligament+anesthesia+using+a+pressure+syringe&rft.volume=107&rft.issue=6&rft.pages=953-956&rft.date=1983-12&rft_id=info%3Adoi%2F10.14219%2Fjada.archive.1983.0357&rft_id=info%3Apmid%2F6581222&rft.aulast=Smith&rft.aufirst=GN&rft.au=Walton%2C+RE&rft.au=Abbott%2C+BJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-:4-52"><span class="mw-cite-backlink">^ <a href="#cite_ref-:4_52-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:4_52-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRobertsHolzelSurySimmons1997" class="citation journal cs1">Roberts GJ, Holzel HS, Sury MR, Simmons NA, Gardner P, Longhurst P (January 1997). "Dental bacteremia in children". <i>Pediatric Cardiology</i>. <b>18</b> (1): 24–27. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs002469900103">10.1007/s002469900103</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8960488">8960488</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:7178684">7178684</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Pediatric+Cardiology&rft.atitle=Dental+bacteremia+in+children&rft.volume=18&rft.issue=1&rft.pages=24-27&rft.date=1997-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A7178684%23id-name%3DS2CID&rft_id=info%3Apmid%2F8960488&rft_id=info%3Adoi%2F10.1007%2Fs002469900103&rft.aulast=Roberts&rft.aufirst=GJ&rft.au=Holzel%2C+HS&rft.au=Sury%2C+MR&rft.au=Simmons%2C+NA&rft.au=Gardner%2C+P&rft.au=Longhurst%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-53"><span class="mw-cite-backlink"><b><a href="#cite_ref-53">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKaufmanGaliliGarfunkel1983" class="citation journal cs1">Kaufman E, Galili D, Garfunkel AA (March 1983). "Intraligamentary anesthesia: a clinical study". <i>The Journal of Prosthetic Dentistry</i>. <b>49</b> (3): 337–339. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2F0022-3913%2883%2990273-1">10.1016/0022-3913(83)90273-1</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6573480">6573480</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Prosthetic+Dentistry&rft.atitle=Intraligamentary+anesthesia%3A+a+clinical+study&rft.volume=49&rft.issue=3&rft.pages=337-339&rft.date=1983-03&rft_id=info%3Adoi%2F10.1016%2F0022-3913%2883%2990273-1&rft_id=info%3Apmid%2F6573480&rft.aulast=Kaufman&rft.aufirst=E&rft.au=Galili%2C+D&rft.au=Garfunkel%2C+AA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Malamed_1982-54"><span class="mw-cite-backlink"><b><a href="#cite_ref-Malamed_1982_54-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMalamed1982" class="citation journal cs1">Malamed SF (February 1982). "The periodontal ligament (PDL) injection: an alternative to inferior alveolar nerve block". <i>Oral Surgery, Oral Medicine, and Oral Pathology</i>. <b>53</b> (2): 117–121. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2F0030-4220%2882%2990273-0">10.1016/0030-4220(82)90273-0</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6949113">6949113</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Oral+Surgery%2C+Oral+Medicine%2C+and+Oral+Pathology&rft.atitle=The+periodontal+ligament+%28PDL%29+injection%3A+an+alternative+to+inferior+alveolar+nerve+block&rft.volume=53&rft.issue=2&rft.pages=117-121&rft.date=1982-02&rft_id=info%3Adoi%2F10.1016%2F0030-4220%2882%2990273-0&rft_id=info%3Apmid%2F6949113&rft.aulast=Malamed&rft.aufirst=SF&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-:5-55"><span class="mw-cite-backlink">^ <a href="#cite_ref-:5_55-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:5_55-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMeechan1999" class="citation journal cs1">Meechan JG (January 1999). "How to overcome failed local anaesthesia". <i>British Dental Journal</i>. <b>186</b> (1): 15–20. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.bdj.4800006">10.1038/sj.bdj.4800006</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10028738">10028738</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:6618968">6618968</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Dental+Journal&rft.atitle=How+to+overcome+failed+local+anaesthesia&rft.volume=186&rft.issue=1&rft.pages=15-20&rft.date=1999-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A6618968%23id-name%3DS2CID&rft_id=info%3Apmid%2F10028738&rft_id=info%3Adoi%2F10.1038%2Fsj.bdj.4800006&rft.aulast=Meechan&rft.aufirst=JG&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-56"><span class="mw-cite-backlink"><b><a href="#cite_ref-56">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWaltonGarnick1982" class="citation journal cs1">Walton RE, Garnick JJ (January 1982). "The periodontal ligament injection: histologic effects on the periodontium in monkeys". <i>Journal of Endodontics</i>. <b>8</b> (1): 22–26. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0099-2399%2882%2980312-9">10.1016/S0099-2399(82)80312-9</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/6948904">6948904</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Endodontics&rft.atitle=The+periodontal+ligament+injection%3A+histologic+effects+on+the+periodontium+in+monkeys&rft.volume=8&rft.issue=1&rft.pages=22-26&rft.date=1982-01&rft_id=info%3Adoi%2F10.1016%2FS0099-2399%2882%2980312-9&rft_id=info%3Apmid%2F6948904&rft.aulast=Walton&rft.aufirst=RE&rft.au=Garnick%2C+JJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-57"><span class="mw-cite-backlink"><b><a href="#cite_ref-57">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHochmanFriedmanWilliamsHochman2006" class="citation journal cs1">Hochman MN, Friedman MJ, Williams W, Hochman CB (June 2006). "Interstitial tissue pressure associated with dental injections: a clinical study". <i>Quintessence International</i>. <b>37</b> (6): 469–476. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16752703">16752703</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Quintessence+International&rft.atitle=Interstitial+tissue+pressure+associated+with+dental+injections%3A+a+clinical+study&rft.volume=37&rft.issue=6&rft.pages=469-476&rft.date=2006-06&rft_id=info%3Apmid%2F16752703&rft.aulast=Hochman&rft.aufirst=MN&rft.au=Friedman%2C+MJ&rft.au=Williams%2C+W&rft.au=Hochman%2C+CB&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-58"><span class="mw-cite-backlink"><b><a href="#cite_ref-58">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAggarwalSinglaMiglaniKohli2018" class="citation journal cs1">Aggarwal V, Singla M, Miglani S, Kohli S, Sharma V, Bhasin SS (January 2018). "Does the volume of supplemental intraligamentary injections affect the anesthetic success rate after a failed primary inferior alveolar nerve block? A randomized-double blind clinical trial". <i>International Endodontic Journal</i>. <b>51</b> (1): 5–11. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fiej.12773">10.1111/iej.12773</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28370327">28370327</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Endodontic+Journal&rft.atitle=Does+the+volume+of+supplemental+intraligamentary+injections+affect+the+anesthetic+success+rate+after+a+failed+primary+inferior+alveolar+nerve+block%3F+A+randomized-double+blind+clinical+trial&rft.volume=51&rft.issue=1&rft.pages=5-11&rft.date=2018-01&rft_id=info%3Adoi%2F10.1111%2Fiej.12773&rft_id=info%3Apmid%2F28370327&rft.aulast=Aggarwal&rft.aufirst=V&rft.au=Singla%2C+M&rft.au=Miglani%2C+S&rft.au=Kohli%2C+S&rft.au=Sharma%2C+V&rft.au=Bhasin%2C+SS&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-59"><span class="mw-cite-backlink"><b><a href="#cite_ref-59">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBerlinNussteinReaderBeck2005" class="citation journal cs1">Berlin J, Nusstein J, Reader A, Beck M, Weaver J (March 2005). "Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system". <i>Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics</i>. <b>99</b> (3): 361–366. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.tripleo.2004.11.009">10.1016/j.tripleo.2004.11.009</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15716846">15716846</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Oral+Surgery%2C+Oral+Medicine%2C+Oral+Pathology%2C+Oral+Radiology%2C+and+Endodontics&rft.atitle=Efficacy+of+articaine+and+lidocaine+in+a+primary+intraligamentary+injection+administered+with+a+computer-controlled+local+anesthetic+delivery+system&rft.volume=99&rft.issue=3&rft.pages=361-366&rft.date=2005-03&rft_id=info%3Adoi%2F10.1016%2Fj.tripleo.2004.11.009&rft_id=info%3Apmid%2F15716846&rft.aulast=Berlin&rft.aufirst=J&rft.au=Nusstein%2C+J&rft.au=Reader%2C+A&rft.au=Beck%2C+M&rft.au=Weaver%2C+J&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-60"><span class="mw-cite-backlink"><b><a href="#cite_ref-60">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFroumTarnowCaiazzoHochman2000" class="citation journal cs1">Froum SJ, Tarnow D, Caiazzo A, Hochman MN (September 2000). "Histologic response to intraligament injections using a computerized local anesthetic delivery system. A pilot study in mini-swine". <i>Journal of Periodontology</i>. <b>71</b> (9): 1453–1459. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1902%2Fjop.2000.71.9.1453">10.1902/jop.2000.71.9.1453</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11022775">11022775</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Periodontology&rft.atitle=Histologic+response+to+intraligament+injections+using+a+computerized+local+anesthetic+delivery+system.+A+pilot+study+in+mini-swine&rft.volume=71&rft.issue=9&rft.pages=1453-1459&rft.date=2000-09&rft_id=info%3Adoi%2F10.1902%2Fjop.2000.71.9.1453&rft_id=info%3Apmid%2F11022775&rft.aulast=Froum&rft.aufirst=SJ&rft.au=Tarnow%2C+D&rft.au=Caiazzo%2C+A&rft.au=Hochman%2C+MN&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Gow-Gates_1998-61"><span class="mw-cite-backlink">^ <a href="#cite_ref-Gow-Gates_1998_61-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Gow-Gates_1998_61-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Gow-Gates_1998_61-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Gow-Gates_1998_61-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGow-Gates1998" class="citation journal cs1">Gow-Gates GA (April 1998). "The Gow-Gates mandibular block: regional anatomy and analgesia". <i>Australian Endodontic Journal</i>. <b>24</b> (1): 18–19. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1747-4477.1998.tb00251.x">10.1111/j.1747-4477.1998.tb00251.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11431805">11431805</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Australian+Endodontic+Journal&rft.atitle=The+Gow-Gates+mandibular+block%3A+regional+anatomy+and+analgesia&rft.volume=24&rft.issue=1&rft.pages=18-19&rft.date=1998-04&rft_id=info%3Adoi%2F10.1111%2Fj.1747-4477.1998.tb00251.x&rft_id=info%3Apmid%2F11431805&rft.aulast=Gow-Gates&rft.aufirst=GA&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-62"><span class="mw-cite-backlink"><b><a href="#cite_ref-62">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.clevelandclinicmeded.com/medicalpubs/pharmacy/JanFeb2001/allergicreaction.htm">"Allergic Reactions"</a>. Cleveland Clinic<span class="reference-accessdate">. Retrieved <span class="nowrap">11 April</span> 2014</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Allergic+Reactions&rft.pub=Cleveland+Clinic&rft_id=https%3A%2F%2Fwww.clevelandclinicmeded.com%2Fmedicalpubs%2Fpharmacy%2FJanFeb2001%2Fallergicreaction.htm&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-isbn0-07-136704-7-63"><span class="mw-cite-backlink"><b><a href="#cite_ref-isbn0-07-136704-7_63-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFStern2002" class="citation book cs1">Stern A (2002). <span class="id-lock-registration" title="Free registration required"><a rel="nofollow" class="external text" href="https://archive.org/details/pharmacology00arno"><i>Pharmacology: PreTest self-assessment and review</i></a></span>. New York: McGraw-Hill, Medical Pub. Division. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-136704-2" title="Special:BookSources/978-0-07-136704-2"><bdi>978-0-07-136704-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pharmacology%3A+PreTest+self-assessment+and+review&rft.place=New+York&rft.pub=McGraw-Hill%2C+Medical+Pub.+Division&rft.date=2002&rft.isbn=978-0-07-136704-2&rft.aulast=Stern&rft.aufirst=A&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fpharmacology00arno&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-64"><span class="mw-cite-backlink"><b><a href="#cite_ref-64">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFYagiela1995" class="citation journal cs1">Yagiela JA (1995). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148913">"Vasoconstrictor agents for local anesthesia"</a>. <i>Anesthesia Progress</i>. <b>42</b> (3–4): 116–120. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148913">2148913</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8934977">8934977</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Anesthesia+Progress&rft.atitle=Vasoconstrictor+agents+for+local+anesthesia&rft.volume=42&rft.issue=3%E2%80%934&rft.pages=116-120&rft.date=1995&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2148913%23id-name%3DPMC&rft_id=info%3Apmid%2F8934977&rft.aulast=Yagiela&rft.aufirst=JA&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2148913&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-65"><span class="mw-cite-backlink"><b><a href="#cite_ref-65">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNielsenLumholtHölmich2014" class="citation journal cs1">Nielsen LJ, Lumholt P, Hölmich LR (October 2014). "[Local anaesthesia with vasoconstrictor is safe to use in areas with end-arteries in fingers, toes, noses and ears]". <i>Ugeskrift for Laeger</i>. <b>176</b> (44): 44. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25354008">25354008</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Ugeskrift+for+Laeger&rft.atitle=%5BLocal+anaesthesia+with+vasoconstrictor+is+safe+to+use+in+areas+with+end-arteries+in+fingers%2C+toes%2C+noses+and+ears%5D&rft.volume=176&rft.issue=44&rft.pages=44&rft.date=2014-10&rft_id=info%3Apmid%2F25354008&rft.aulast=Nielsen&rft.aufirst=LJ&rft.au=Lumholt%2C+P&rft.au=H%C3%B6lmich%2C+LR&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-Boca_Raton-66"><span class="mw-cite-backlink">^ <a href="#cite_ref-Boca_Raton_66-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Boca_Raton_66-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGazourian1985" class="citation news cs1">Gazourian A (4 April 1985). <a rel="nofollow" class="external text" href="https://news.google.com/newspapers?nid=1291&dat=19850404&id=0B1UAAAAIBAJ&pg=6387,881236">"Cocaine's use: From the Incas to the U.S."</a> <i>Boca Raton News</i><span class="reference-accessdate">. Retrieved <span class="nowrap">2 February</span> 2014</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Boca+Raton+News&rft.atitle=Cocaine%27s+use%3A+From+the+Incas+to+the+U.S.&rft.date=1985-04-04&rft.aulast=Gazourian&rft.aufirst=A&rft_id=https%3A%2F%2Fnews.google.com%2Fnewspapers%3Fnid%3D1291%26dat%3D19850404%26id%3D0B1UAAAAIBAJ%26pg%3D6387%2C881236&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> <li id="cite_note-López-Valverde_2014-67"><span class="mw-cite-backlink"><b><a href="#cite_ref-López-Valverde_2014_67-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLópez-Valverdede_VicenteMartínez-Domínguezde_Diego2014" class="citation journal cs1">López-Valverde A, de Vicente J, Martínez-Domínguez L, de Diego RG (July 2014). <a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.bdj.2014.546">"Local anaesthesia through the action of cocaine, the oral mucosa and the Vienna group"</a>. <i>British Dental Journal</i>. <b>217</b> (1): 41–43. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1038%2Fsj.bdj.2014.546">10.1038/sj.bdj.2014.546</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25012333">25012333</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=British+Dental+Journal&rft.atitle=Local+anaesthesia+through+the+action+of+cocaine%2C+the+oral+mucosa+and+the+Vienna+group&rft.volume=217&rft.issue=1&rft.pages=41-43&rft.date=2014-07&rft_id=info%3Adoi%2F10.1038%2Fsj.bdj.2014.546&rft_id=info%3Apmid%2F25012333&rft.aulast=L%C3%B3pez-Valverde&rft.aufirst=A&rft.au=de+Vicente%2C+J&rft.au=Mart%C3%ADnez-Dom%C3%ADnguez%2C+L&rft.au=de+Diego%2C+RG&rft_id=https%3A%2F%2Fdoi.org%2F10.1038%252Fsj.bdj.2014.546&rfr_id=info%3Asid%2Fen.wikipedia.org%3ALocal+anesthetic" class="Z3988"></span></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Local_anesthetic&action=edit&section=35" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="https://www.asra.com/">The American Society of Regional Anesthesia</a></li> <li><a rel="nofollow" class="external text" href="https://www.asra.com/news-publications/regional-anesthesia-pain-medicine-journal"><i>Regional Anesthesia & Pain Medicine</i></a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output .hlist ul dl,.mw-parser-output .hlist ul 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<ul><li><i>stomach acid</i> <ul><li><a href="/wiki/Antacid" title="Antacid">Antacids</a></li> <li><a href="/wiki/H2_antagonist" class="mw-redirect" title="H2 antagonist">H<sub>2</sub> antagonists</a></li> <li><a href="/wiki/Proton-pump_inhibitor" title="Proton-pump inhibitor">Proton-pump inhibitors</a></li></ul></li> <li><a href="/wiki/Antiemetic" title="Antiemetic">Antiemetics</a></li> <li><a href="/wiki/Laxative" title="Laxative">Laxatives</a></li> <li><a href="/wiki/Antidiarrhoeal" class="mw-redirect" title="Antidiarrhoeal">Antidiarrhoeals</a> / <a href="/wiki/Antipropulsive" title="Antipropulsive">Antipropulsives</a></li> <li><a href="/wiki/Anti-obesity_medication" title="Anti-obesity medication">Anti-obesity drugs</a></li> <li><a href="/wiki/Diabetes_medication" title="Diabetes medication">Diabetes medication</a></li> <li><a href="/wiki/Vitamin" title="Vitamin">Vitamins</a></li> <li><a href="/wiki/Dietary_mineral" class="mw-redirect" title="Dietary mineral">Dietary minerals</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blood" title="Blood">blood</a> and blood<br />forming organs (<a href="/wiki/ATC_code_B" title="ATC code B">B</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antithrombotic" title="Antithrombotic">Antithrombotics</a> <ul><li><a href="/wiki/Antiplatelet_drug" title="Antiplatelet drug">Antiplatelets</a></li> <li><a href="/wiki/Anticoagulant" title="Anticoagulant">Anticoagulants</a></li> <li><a href="/wiki/Thrombolytic_drug" class="mw-redirect" title="Thrombolytic drug">Thrombolytics / fibrinolytics</a></li></ul></li> <li><a href="/wiki/Antihemorrhagic" title="Antihemorrhagic">Antihemorrhagics</a> <ul><li><a href="/wiki/Platelet" title="Platelet">Platelets</a></li> <li><a href="/wiki/Coagulation" title="Coagulation">Coagulants</a></li> <li><a href="/wiki/Antifibrinolytic" title="Antifibrinolytic">Antifibrinolytics</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Circulatory_system" title="Circulatory system">cardiovascular<br />system</a> (<a href="/wiki/ATC_code_C" title="ATC code C">C</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i>cardiac therapy / <a href="/wiki/Antianginal" title="Antianginal">antianginals</a></i> <ul><li><a href="/wiki/Cardiac_glycoside" title="Cardiac glycoside">Cardiac glycosides</a></li> <li><a href="/wiki/Antiarrhythmic_agent" title="Antiarrhythmic agent">Antiarrhythmics</a></li> <li><a href="/wiki/Cardiac_stimulant" title="Cardiac stimulant">Cardiac stimulants</a></li></ul></li> <li><a href="/wiki/Antihypertensive_drug" class="mw-redirect" title="Antihypertensive drug">Antihypertensives</a></li> <li><a href="/wiki/Diuretic" title="Diuretic">Diuretics</a></li> <li><a href="/wiki/Vasodilation" title="Vasodilation">Vasodilators</a></li> <li><a href="/wiki/Beta_blocker" title="Beta blocker">Beta blockers</a></li> <li><a href="/wiki/Calcium_channel_blocker" title="Calcium channel blocker">Calcium channel blockers</a></li> <li><i><a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin system</a></i> <ul><li><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitors</a></li> <li><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">Angiotensin II receptor antagonists</a></li> <li><a href="/wiki/Renin_inhibitor" title="Renin inhibitor">Renin inhibitors</a></li></ul></li> <li><a href="/wiki/Hypolipidemic_agent" class="mw-redirect" title="Hypolipidemic agent">Antihyperlipidemics</a> <ul><li><a href="/wiki/Statin" title="Statin">Statins</a></li> <li><a href="/wiki/Fibrate" title="Fibrate">Fibrates</a></li> <li><a href="/wiki/Bile_acid_sequestrant" title="Bile acid sequestrant">Bile acid sequestrants</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_skin" title="Human skin">skin</a> (<a href="/wiki/ATC_code_D" title="ATC code D">D</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Emollient" class="mw-redirect" title="Emollient">Emollients</a></li> <li><a href="/wiki/Cicatrizant" class="mw-redirect" title="Cicatrizant">Cicatrizants</a></li> <li><a href="/wiki/Antipruritic" title="Antipruritic">Antipruritics</a></li> <li><a href="/wiki/Antipsoriatic" class="mw-redirect" title="Antipsoriatic">Antipsoriatics</a></li> <li><a href="/wiki/ATC_code_D09" title="ATC code D09">Medicated dressings</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Genitourinary_system" title="Genitourinary system">genitourinary<br />system</a> (<a href="/wiki/ATC_code_G" title="ATC code G">G</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hormonal_contraception" title="Hormonal contraception">Hormonal contraception</a></li> <li><a href="/wiki/Fertility_medication" title="Fertility medication">Fertility agents</a></li> <li><a href="/wiki/Selective_estrogen_receptor_modulator" title="Selective estrogen receptor modulator">Selective estrogen receptor modulators</a></li> <li><a href="/wiki/Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endocrine_system" title="Endocrine system">endocrine<br />system</a> (<a href="/wiki/ATC_code_H" title="ATC code H">H</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypothalamic%E2%80%93pituitary_hormone" title="Hypothalamic–pituitary hormone">Hypothalamic–pituitary hormones</a></li> <li><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a> <ul><li><a href="/wiki/Glucocorticoid" title="Glucocorticoid">Glucocorticoids</a></li> <li><a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">Mineralocorticoids</a></li></ul></li> <li><a href="/wiki/Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li> <li><a href="/wiki/Thyroid_hormone" class="mw-redirect" title="Thyroid hormone">Thyroid hormones</a> / <a href="/wiki/Antithyroid_agent" title="Antithyroid agent">Antithyroid agents</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Infection" title="Infection">infections</a> and<br /><a href="https://en.wiktionary.org/wiki/infestation" class="extiw" title="wikt:infestation">infestations</a> (<a href="/wiki/ATC_code_J" title="ATC code J">J</a>, <a href="/wiki/ATC_code_P" title="ATC code P">P</a>, <a href="/wiki/ATCvet_code_QI" title="ATCvet code QI">QI</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antimicrobial" title="Antimicrobial">Antimicrobials</a>: <a href="/wiki/Antibacterial" class="mw-redirect" title="Antibacterial">Antibacterials</a> (<a href="/wiki/Antimycobacterial" title="Antimycobacterial">Antimycobacterials</a>)</li> <li><a href="/wiki/Antifungal_drug" class="mw-redirect" title="Antifungal drug">Antifungals</a></li> <li><a href="/wiki/Antiviral_drug" title="Antiviral drug">Antivirals</a></li> <li><a href="/wiki/Antiparasitic" title="Antiparasitic">Antiparasitics</a> <ul><li><a href="/wiki/Antiprotozoal_agent" class="mw-redirect" title="Antiprotozoal agent">Antiprotozoals</a></li> <li><a href="/wiki/Anthelmintic" title="Anthelmintic">Anthelmintics</a></li> <li><a href="/wiki/Ectoparasiticide" title="Ectoparasiticide">Ectoparasiticides</a></li></ul></li> <li><a href="/wiki/Intravenous_immunoglobulin" class="mw-redirect" title="Intravenous immunoglobulin">Intravenous immunoglobulin</a></li> <li><a href="/wiki/Vaccine" title="Vaccine">Vaccines</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Malignant" class="mw-redirect" title="Malignant">malignant</a> disease<br />(<a href="/wiki/ATC_code_L" title="ATC code L">L01–L02</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chemotherapy" title="Chemotherapy">Anticancer agents</a> <ul><li><a href="/wiki/Antimetabolite" title="Antimetabolite">Antimetabolites</a></li> <li><a href="/wiki/Alkylating_antineoplastic_agent" title="Alkylating antineoplastic agent">Alkylating</a></li> <li><a href="/wiki/Spindle_poison" title="Spindle poison">Spindle poisons</a></li> <li><a href="/wiki/Antineoplastic" class="mw-redirect" title="Antineoplastic">Antineoplastic</a></li> <li><a href="/wiki/Topoisomerase_inhibitor" title="Topoisomerase inhibitor">Topoisomerase inhibitors</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Immune_system" title="Immune system">immune</a> disease<br />(<a href="/wiki/ATC_code_L" title="ATC code L">L03–L04</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Immunomodulator" class="mw-redirect" title="Immunomodulator">Immunomodulators</a> <ul><li><a href="/wiki/Immunostimulant" title="Immunostimulant">Immunostimulants</a></li> <li><a href="/wiki/Immunosuppressive_drug" title="Immunosuppressive drug">Immunosuppressants</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Muscle" title="Muscle">muscles</a>, <a href="/wiki/Bone" title="Bone">bones</a>,<br />and <a href="/wiki/Joint" title="Joint">joints</a> (<a href="/wiki/ATC_code_M" title="ATC code M">M</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anabolic_steroid" title="Anabolic steroid">Anabolic steroids</a></li> <li><a href="/wiki/Anti-inflammatory" title="Anti-inflammatory">Anti-inflammatories</a> <ul><li><a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">Non-steroidal anti-inflammatory drugs</a></li></ul></li> <li><a href="/wiki/Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">Antirheumatics</a></li> <li><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a></li> <li><a href="/wiki/Muscle_relaxant" title="Muscle relaxant">Muscle relaxants</a></li> <li><a href="/wiki/Bisphosphonate" title="Bisphosphonate">Bisphosphonates</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">brain</a> and<br /><a href="/wiki/Nervous_system" title="Nervous system">nervous system</a> (<a href="/wiki/ATC_code_N" title="ATC code N">N</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesic" title="Analgesic">Analgesics</a></li> <li><a href="/wiki/Anesthetic" title="Anesthetic">Anesthetics</a> <ul><li><a href="/wiki/General_anaesthetic" title="General anaesthetic">General</a></li> <li><a class="mw-selflink selflink">Local</a></li></ul></li> <li><a href="/wiki/Anorectic" title="Anorectic">Anorectics</a></li> <li><a href="/wiki/Antihyperkinetic" class="mw-redirect" title="Antihyperkinetic">Anti-ADHD agents</a></li> <li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Antiaddictives</a></li> <li><a href="/wiki/Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a></li> <li><a href="/wiki/Antidementia_drug" class="mw-redirect" title="Antidementia drug">Antidementia agents</a></li> <li><a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a></li> <li><a href="/wiki/Antimigraine_drug" title="Antimigraine drug">Antimigraine agents</a></li> <li><a href="/wiki/Management_of_Parkinson%27s_disease#Medication" title="Management of Parkinson's disease">Antiparkinson agents</a></li> <li><a href="/wiki/Antipsychotic" title="Antipsychotic">Antipsychotics</a></li> <li><a href="/wiki/Anxiolytic" title="Anxiolytic">Anxiolytics</a></li> <li><a href="/wiki/Aphrodisiac" title="Aphrodisiac">Aphrodisiacs</a></li> <li><a href="/wiki/Depressant" title="Depressant">Depressants</a></li> <li><a href="/wiki/Entactogen" class="mw-redirect" title="Entactogen">Entactogens</a></li> <li><a href="/wiki/Entheogen" title="Entheogen">Entheogens</a></li> <li><a href="/wiki/Euphoria" title="Euphoria">Euphoriants</a></li> <li><a href="/wiki/Psychedelics,_dissociatives_and_deliriants" class="mw-redirect" title="Psychedelics, dissociatives and deliriants">Hallucinogens</a> <ul><li><a href="/wiki/Psychedelic_drug" title="Psychedelic drug">Psychedelics</a></li> <li><a href="/wiki/Dissociative" title="Dissociative">Dissociatives</a></li> <li><a href="/wiki/Deliriant" title="Deliriant">Deliriants</a></li></ul></li> <li><a href="/wiki/Hypnotic" title="Hypnotic">Hypnotics</a> / <a href="/wiki/Sedative" title="Sedative">Sedatives</a></li> <li><a href="/wiki/Mood_stabilizer" title="Mood stabilizer">Mood stabilizers</a></li> <li><a href="/wiki/Motivation-enhancing_drug" title="Motivation-enhancing drug">Motivation-enhancing drug</a></li> <li><a href="/wiki/Neuroprotective" class="mw-redirect" title="Neuroprotective">Neuroprotectives</a></li> <li><a href="/wiki/Nootropic" title="Nootropic">Nootropics</a></li> <li><a href="/wiki/Neurotoxin" title="Neurotoxin">Neurotoxins</a></li> <li><a href="/wiki/Orexigenic" class="mw-redirect" title="Orexigenic">Orexigenics</a></li> <li><a href="/wiki/Serenic" title="Serenic">Serenics</a></li> <li><a href="/wiki/Stimulant" title="Stimulant">Stimulants</a></li> <li><a href="/wiki/Wakefulness-promoting_agent" title="Wakefulness-promoting agent">Wakefulness-promoting agents</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_system" title="Respiratory system">respiratory<br />system</a> (<a href="/wiki/ATC_code_R" title="ATC code R">R</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Decongestant" title="Decongestant">Decongestants</a></li> <li><a href="/wiki/Bronchodilator" title="Bronchodilator">Bronchodilators</a></li> <li><a href="/wiki/Cough_medicine" class="mw-redirect" title="Cough medicine">Cough medicines</a></li> <li><a href="/wiki/H1_antagonist" title="H1 antagonist">H<sub>1</sub> antagonists</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sense" title="Sense">sensory organs</a> (<a href="/wiki/ATC_code_S" title="ATC code S">S</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmologicals</a></li> <li><a href="/wiki/Otology" title="Otology">Otologicals</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">other <a href="/wiki/Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC</a> (<a href="/wiki/ATC_code_V" title="ATC code V">V</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antidote" title="Antidote">Antidotes</a></li> <li><a href="/wiki/Contrast_medium" class="mw-redirect" title="Contrast medium">Contrast media</a></li> <li><a href="/wiki/Radiopharmacology" title="Radiopharmacology">Radiopharmaceuticals</a></li> <li><a href="/wiki/Dressing_(medicine)" title="Dressing (medicine)">Dressings</a></li> <li><a href="/wiki/Senotherapeutics" class="mw-redirect" title="Senotherapeutics">Senotherapeutics</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <a href="/wiki/Category:Drugs" title="Category:Drugs">Drugs</a></li> <li><a href="/wiki/Category:Pharmacological_classification_systems" title="Category:Pharmacological classification systems">Pharmacological classification systems</a></li> <li><a href="/wiki/Category:ATC_codes" title="Category:ATC codes">ATC codes</a></li> <li><span class="noviewer" typeof="mw:File"><a href="/wiki/File:Symbol_portal_class.svg" class="mw-file-description" title="Portal"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/16px-Symbol_portal_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/23px-Symbol_portal_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/31px-Symbol_portal_class.svg.png 2x" data-file-width="180" data-file-height="185" /></a></span> <a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine portal</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="Local_anesthetics_(primarily_sodium_channel_blockers)_(N01B)" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Local_anesthetics" title="Template:Local anesthetics"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Local_anesthetics" title="Template talk:Local anesthetics"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Local_anesthetics" title="Special:EditPage/Template:Local anesthetics"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Local_anesthetics_(primarily_sodium_channel_blockers)_(N01B)" style="font-size:114%;margin:0 4em"><a class="mw-selflink selflink">Local anesthetics</a> <span style="font-size:85%;">(primarily <a href="/wiki/Sodium_channel_blocker" title="Sodium channel blocker">sodium channel blockers</a>)</span> (<a href="/wiki/ATC_code_N01#N01B" title="ATC code N01">N01B</a>)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ester" title="Ester">Esters</a> by acid</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/4-Aminobenzoic_acid" title="4-Aminobenzoic acid">Aminobenzoic</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Benzocaine" title="Benzocaine">Benzocaine</a></li> <li><a href="/wiki/Benzonatate" title="Benzonatate">Benzonatate</a></li> <li><a href="/wiki/Butacaine" title="Butacaine">Butacaine</a></li> <li><a href="/wiki/Butamben" title="Butamben">Butamben</a></li> <li><a href="/wiki/Chloroprocaine" title="Chloroprocaine">Chloroprocaine</a></li> <li><a href="/wiki/Dimethocaine" title="Dimethocaine">Dimethocaine</a></li> <li><a href="/wiki/Lucaine" class="mw-redirect" title="Lucaine">Lucaine</a></li> <li><a href="/wiki/Meprylcaine" title="Meprylcaine">Meprylcaine</a></li> <li><a href="/wiki/Metabutethamine" title="Metabutethamine">Metabutethamine</a></li> <li><a href="/wiki/Metabutoxycaine" title="Metabutoxycaine">Metabutoxycaine</a></li> <li><a href="/wiki/Nitracaine" title="Nitracaine">Nitracaine</a></li> <li><a href="/wiki/Orthocaine" title="Orthocaine">Orthocaine</a></li> <li><a href="/wiki/Propoxycaine" title="Propoxycaine">Propoxycaine</a></li> <li><a href="/wiki/Procaine" title="Procaine">Procaine (Novocaine)</a></li> <li><a href="/wiki/Proxymetacaine" title="Proxymetacaine">Proxymetacaine</a></li> <li><a href="/wiki/Risocaine" title="Risocaine">Risocaine</a></li> <li><a href="/wiki/Tetracaine" title="Tetracaine">Tetracaine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Benzoic_acid" title="Benzoic acid">Benzoic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amylocaine" title="Amylocaine">Amylocaine</a></li> <li><a href="/wiki/Cocaine" title="Cocaine">Cocaine</a></li> <li><a href="/wiki/Cyclomethycaine" title="Cyclomethycaine">Cyclomethycaine</a></li> <li><a href="/wiki/Alpha-Eucaine" class="mw-redirect" title="Alpha-Eucaine">α-Eucaine</a></li> <li><a href="/wiki/Eucaine" title="Eucaine">β-Eucaine</a></li> <li><a href="/wiki/Hexylcaine" title="Hexylcaine">Hexylcaine</a></li> <li><a href="/wiki/Isobucaine" title="Isobucaine">Isobucaine</a></li> <li><a href="/wiki/Piperocaine" title="Piperocaine">Piperocaine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">ArCO2- (not para-amino or Ph)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/w/index.php?title=Amoproxan&action=edit&redlink=1" class="new" title="Amoproxan (page does not exist)">Amoproxan</a> (3,4,5-Trimethoxybenzoyl)</li> <li><a href="/wiki/3-(p-Fluorobenzoyloxy)tropane" title="3-(p-Fluorobenzoyloxy)tropane">3-(p-Fluorobenzoyloxy)tropane</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Amide" title="Amide">Amides</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Articaine" title="Articaine">Articaine</a></li> <li><a href="/wiki/Bupivacaine" title="Bupivacaine">Bupivacaine</a><sup>#</sup>/<a href="/wiki/Levobupivacaine" title="Levobupivacaine">Levobupivacaine</a>/<a href="/wiki/Ropivacaine" title="Ropivacaine">Ropivacaine</a></li> <li><a href="/wiki/Butanilicaine" title="Butanilicaine">Butanilicaine</a></li> <li><a href="/wiki/Articaine" title="Articaine">Carticaine</a></li> <li><a href="/wiki/Cinchocaine" title="Cinchocaine"> Cinchocaine (Dibucaine)</a></li> <li><a href="/wiki/Etidocaine" title="Etidocaine">Etidocaine</a></li> <li><a href="/wiki/Lidocaine" title="Lidocaine">Lidocaine</a><sup>#</sup></li> <li><a href="/wiki/Mepivacaine" title="Mepivacaine">Mepivacaine</a></li> <li><a href="/wiki/Prilocaine" title="Prilocaine">Prilocaine</a></li> <li><a href="/wiki/Trimecaine" title="Trimecaine">Trimecaine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Combinations</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Local_anesthetic_with_vasoconstrictor" class="mw-redirect" title="Local anesthetic with vasoconstrictor">Anesthetic/vasoconstrictor</a></li> <li><a href="/wiki/Bupivacaine/meloxicam" title="Bupivacaine/meloxicam">Bupivacaine/meloxicam</a></li> <li><a href="/wiki/Lidocaine/prilocaine" title="Lidocaine/prilocaine">Lidocaine/prilocaine</a></li> <li><a href="/wiki/Topical_tac" title="Topical tac">TAC</a></li> <li><a href="/wiki/Iontocaine" title="Iontocaine">Iontocaine</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2" style="background:transparent;padding:0;"><div><div class="hlist"> <ul><li><sup>#</sup><a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li><sup>‡</sup><a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li><sup>†</sup><a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li><sup>§</sup>Never to phase III</li></ul></li></ul> </div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Neuropathic_pain_and_fibromyalgia_pharmacotherapies" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Neuropathic_pain_and_fibromyalgia_pharmacotherapies" title="Template:Neuropathic pain and fibromyalgia pharmacotherapies"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Neuropathic_pain_and_fibromyalgia_pharmacotherapies" title="Template talk:Neuropathic pain and fibromyalgia pharmacotherapies"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Neuropathic_pain_and_fibromyalgia_pharmacotherapies" title="Special:EditPage/Template:Neuropathic pain and fibromyalgia pharmacotherapies"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Neuropathic_pain_and_fibromyalgia_pharmacotherapies" style="font-size:114%;margin:0 4em"><a href="/wiki/Neuropathic_pain" title="Neuropathic pain">Neuropathic pain</a> and <a href="/wiki/Fibromyalgia" title="Fibromyalgia">fibromyalgia</a> <a href="/wiki/Pharmaceutical_drug" class="mw-redirect" title="Pharmaceutical drug">pharmacotherapies</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Monoaminergic" title="Monoaminergic">Monoaminergics</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Serotonin%E2%80%93norepinephrine_reuptake_inhibitor" title="Serotonin–norepinephrine reuptake inhibitor"><abbr title="Serotonin–norepinephrine reuptake inhibitor">SNRIs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Serotonin–norepinephrine reuptake inhibitor</span> (e.g., <a href="/wiki/Duloxetine" title="Duloxetine">duloxetine</a>, <a href="/wiki/Milnacipran" title="Milnacipran">milnacipran</a>)</li> <li><a href="/wiki/Tricyclic_antidepressants" class="mw-redirect" title="Tricyclic antidepressants"><abbr title="Tricyclic antidepressants">TCAs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Tricyclic antidepressants</span> (e.g., <a href="/wiki/Amitriptyline" title="Amitriptyline">amitriptyline</a>, <a href="/wiki/Nortriptyline" title="Nortriptyline">nortriptyline</a>, <a href="/wiki/Dosulepin" title="Dosulepin">dosulepin</a>)</li> <li><a href="/wiki/Opioid" title="Opioid">Opioid</a> <a href="/wiki/Monoamine_reuptake_inhibitors" class="mw-redirect" title="Monoamine reuptake inhibitors"><abbr title="monoamine reuptake inhibitors">MRIs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip monoamine reuptake inhibitors</span> (e.g., <a href="/wiki/Tapentadol" title="Tapentadol">tapentadol</a>, <a href="/wiki/Tramadol" title="Tramadol">tramadol</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ion_channel_blocker" class="mw-redirect" title="Ion channel blocker">Ion channel blockers</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a> (e.g., <a href="/wiki/Gabapentin" title="Gabapentin">gabapentin</a>, <a href="/wiki/Pregabalin" title="Pregabalin">pregabalin</a>, <a href="/wiki/Mirogabalin" title="Mirogabalin">mirogabalin</a>, <a href="/wiki/Carbamazepine" title="Carbamazepine">carbamazepine</a>, <a href="/wiki/Oxcarbazepine" title="Oxcarbazepine">oxcarbazepine</a>, <a href="/wiki/Lacosamide" title="Lacosamide">lacosamide</a>, <a href="/wiki/Lamotrigine" title="Lamotrigine">lamotrigine</a>)</li> <li><a class="mw-selflink selflink">Local anesthetics</a> (e.g., <a href="/wiki/Lidocaine" title="Lidocaine">lidocaine</a>)</li> <li><a href="/wiki/Mexiletine" title="Mexiletine">Mexiletine</a></li> <li><a href="/wiki/Tricyclic_antidepressants" class="mw-redirect" title="Tricyclic antidepressants"><abbr title="Tricyclic antidepressants">TCAs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Tricyclic antidepressants</span> (e.g., <a href="/wiki/Amitriptyline" title="Amitriptyline">amitriptyline</a>, <a href="/wiki/Nortriptyline" title="Nortriptyline">nortriptyline</a>, <a href="/wiki/Desipramine" title="Desipramine">desipramine</a>)</li> <li><a href="/wiki/Ziconotide" title="Ziconotide">Ziconotide</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Others</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alpha_lipoic_acid" class="mw-redirect" title="Alpha lipoic acid">Alpha lipoic acid</a></li> <li><a href="/wiki/Benfotiamine" title="Benfotiamine">Benfotiamine</a></li> <li><a href="/wiki/Botulinum_toxin_A" class="mw-redirect" title="Botulinum toxin A">Botulinum toxin A</a></li> <li><a href="/wiki/Bupropion" title="Bupropion">Bupropion</a></li> <li><a href="/wiki/Cannabinoid" title="Cannabinoid">Cannabinoids</a> (e.g., <a href="/wiki/Cannabis_(drug)" title="Cannabis (drug)">cannabis</a>, <a href="/wiki/Dronabinol" title="Dronabinol">dronabinol</a>, <a href="/wiki/Nabilone" title="Nabilone">nabilone</a>)</li> <li><a href="/wiki/NMDA_receptor_antagonist" title="NMDA receptor antagonist">NMDA receptor antagonists</a> (e.g., <a href="/wiki/Ketamine" title="Ketamine">ketamine</a>, <a href="/wiki/Dextromethorphan" title="Dextromethorphan">dextromethorphan</a>, <a href="/wiki/Methadone" title="Methadone">methadone</a>)</li> <li><a href="/wiki/Opioid" title="Opioid">Opioids</a> (e.g., <a href="/wiki/Hydrocodone" title="Hydrocodone">hydrocodone</a>, <a href="/wiki/Morphine" title="Morphine">morphine</a>, <a href="/wiki/Oxycodone" title="Oxycodone">oxycodone</a>, <a href="/wiki/Methadone" title="Methadone">methadone</a>, <a href="/wiki/Buprenorphine" title="Buprenorphine">buprenorphine</a>, <a href="/wiki/Tramadol" title="Tramadol">tramadol</a>, <a href="/wiki/Tapentadol" title="Tapentadol">tapentadol</a>)</li> <li><a href="/wiki/Sodium_oxybate" title="Sodium oxybate">Sodium oxybate (<abbr title="γ-hydroxybutyric acid">GHB</abbr>)</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Anesthesia_and_anesthesiology" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Anesthesia" title="Template:Anesthesia"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Anesthesia" title="Template talk:Anesthesia"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Anesthesia" title="Special:EditPage/Template:Anesthesia"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Anesthesia_and_anesthesiology" style="font-size:114%;margin:0 4em"><a href="/wiki/Anesthesia" title="Anesthesia">Anesthesia</a> and <a href="/wiki/Anesthesiology" title="Anesthesiology">anesthesiology</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Types</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/General_anaesthesia" title="General anaesthesia">General</a> <ul><li><a href="/wiki/Sedation" title="Sedation">Sedation</a> <ul><li><a href="/wiki/Procedural_sedation_and_analgesia" title="Procedural sedation and analgesia">Procedural sedation and analgesia</a></li></ul></li> <li><a href="/wiki/Twilight_anesthesia" title="Twilight anesthesia">Twilight anesthesia</a></li></ul></li> <li><a href="/wiki/Local_anesthesia" title="Local anesthesia">Local</a> <ul><li><a href="/wiki/Continuous_wound_infiltration" title="Continuous wound infiltration">Continuous wound infiltration</a></li> <li><a href="/wiki/Topical_anesthetic" title="Topical anesthetic">Topical</a></li></ul></li> <li><a href="/wiki/Neuraxial_blockade" title="Neuraxial blockade">Neuraxial blockade</a> <ul><li><a href="/wiki/Combined_spinal_and_epidural_anaesthesia" title="Combined spinal and epidural anaesthesia">Combined spinal and epidural anaesthesia</a></li> <li><a href="/wiki/Epidural_administration" title="Epidural administration">Epidural anesthesia</a></li> <li><a href="/wiki/Spinal_anaesthesia" title="Spinal anaesthesia">Spinal anaesthesia</a></li></ul></li> <li><a href="/wiki/Nerve_block" title="Nerve block">Nerve block</a> <ul><li><a href="/wiki/Brachial_plexus_block" title="Brachial plexus block">Brachial plexus block</a></li> <li><a href="/wiki/Fascia_iliaca_block" title="Fascia iliaca block">Fascia iliaca block</a></li> <li><a href="/wiki/Femoral_nerve_block" title="Femoral nerve block">Femoral nerve block</a></li> <li><a href="/wiki/Inferior_alveolar_nerve_anaesthesia" title="Inferior alveolar nerve anaesthesia">Inferior alveolar nerve block</a></li> <li><a href="/wiki/Intercostal_nerve_block" title="Intercostal nerve block">Intercostal nerve block</a></li> <li><a href="/wiki/Interpleural_block" title="Interpleural block">Interpleural block</a></li> <li><a href="/wiki/Intravenous_regional_anesthesia" title="Intravenous regional anesthesia">Intravenous regional anesthesia</a></li> <li><a href="/wiki/Occipital_nerve_block" title="Occipital nerve block">Occipital nerve block</a></li> <li><a href="/wiki/Paracervical_block" title="Paracervical block">Paracervical block</a></li> <li><a href="/wiki/Pudendal_anesthesia" title="Pudendal anesthesia">Pudendal nerve block</a></li> <li><a href="/wiki/Retrobulbar_block" title="Retrobulbar block">Retrobulbar block</a></li> <li><a href="/wiki/Sciatic_nerve_block" title="Sciatic nerve block">Sciatic nerve block</a></li> <li><a href="/wiki/Transverse_abdominis_plane_block" title="Transverse abdominis plane block">Transverse abdominis plane block</a></li></ul></li> <li><a href="/wiki/Total_intravenous_anaesthesia" title="Total intravenous anaesthesia">Total intravenous anaesthesia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Pharmacologic agents</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anticholinergic" title="Anticholinergic">Anticholinergics</a></li> <li><a href="/wiki/Antiemetic" title="Antiemetic">Antiemetics</a></li> <li><a href="/wiki/Butyrophenone" title="Butyrophenone">Butyrophenones</a></li> <li><a href="/wiki/List_of_benzodiazepines" title="List of benzodiazepines">Benzodiazepines</a></li> <li><a href="/wiki/Category:General_anesthetics" title="Category:General anesthetics">General anesthetics</a></li> <li><a href="/wiki/Inhalational_anesthetic" title="Inhalational anesthetic">Inhalational anesthetics</a></li> <li><a href="/wiki/List_of_local_anesthetics" title="List of local anesthetics">Local anesthetics</a></li> <li><a href="/wiki/Neuromuscular-blocking_drug" title="Neuromuscular-blocking drug">Neuromuscular-blocking drugs</a></li> <li><a href="/wiki/List_of_opioids" title="List of opioids">Opioids</a></li> <li><a href="/wiki/Category:Sedatives" title="Category:Sedatives">Sedatives</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Techniques</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Airway_management" title="Airway management">Airway management</a></li> <li><a href="/wiki/Anesthesia_provision_in_the_United_States" title="Anesthesia provision in the United States">Anesthesia provision in the US</a></li> <li><a href="/wiki/Bronchoscopy" title="Bronchoscopy">Bronchoscopy</a></li> <li><a href="/wiki/Dogliotti%27s_principle" title="Dogliotti's principle">Dogliotti's principle</a></li> <li><a href="/wiki/Intravenous_therapy" title="Intravenous therapy">Intravenous therapy</a></li> <li><a href="/wiki/Laryngoscopy" title="Laryngoscopy">Laryngoscopy</a></li> <li><a href="/wiki/Tracheal_intubation" title="Tracheal intubation">Tracheal intubation</a> <ul><li><a href="/wiki/Rapid_sequence_induction" title="Rapid sequence induction">Rapid sequence induction</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Scientific principles</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Blood%E2%80%93gas_partition_coefficient" title="Blood–gas partition coefficient">Blood–gas partition coefficient</a></li> <li><a href="/wiki/Concentration_effect" title="Concentration effect">Concentration effect</a></li> <li><a href="/wiki/Fink_effect" title="Fink effect">Fink effect</a></li> <li><a href="/wiki/Minimum_alveolar_concentration" title="Minimum alveolar concentration">Minimum alveolar concentration</a></li> <li><a href="/wiki/Second_gas_effect" title="Second gas effect">Second gas effect</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Measurements</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/ASA_physical_status_classification_system" title="ASA physical status classification system">ASA physical status classification system</a></li> <li><a href="/wiki/Baricity" title="Baricity">Baricity</a></li> <li><a href="/wiki/Bispectral_index" title="Bispectral index">Bispectral index</a></li> <li><a href="/wiki/Body_mass_index" title="Body mass index">Body mass index</a></li> <li><a href="/wiki/Capnography" title="Capnography">Capnography</a></li> <li><a href="/wiki/Entropy_monitoring" title="Entropy monitoring">Entropy monitoring</a></li> <li><a href="/wiki/Fick_principle" title="Fick principle">Fick principle</a></li> <li><a href="/wiki/Goldman_index" class="mw-redirect" title="Goldman index">Goldman index</a></li> <li><a href="/wiki/Guedel%27s_classification" title="Guedel's classification">Guedel's classification</a></li> <li><a href="/wiki/Intraoperative_neurophysiological_monitoring" title="Intraoperative neurophysiological monitoring">Intraoperative neurophysiological monitoring</a></li> <li><a href="/wiki/Mallampati_score" title="Mallampati score">Mallampati score</a></li> <li><a href="/wiki/Neuromuscular_monitoring" title="Neuromuscular monitoring">Neuromuscular monitoring</a></li> <li><a href="/wiki/Pain_scale" title="Pain scale">Pain scale</a></li> <li><a href="/wiki/Thyromental_distance" title="Thyromental distance">Thyromental distance</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Instruments_used_in_anesthesiology" title="Instruments used in anesthesiology">Instruments</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anaesthetic_machine" title="Anaesthetic machine">Anaesthetic machine</a></li> <li><a href="/wiki/Anesthetic_vaporizer" class="mw-redirect" title="Anesthetic vaporizer">Anesthetic vaporizer</a></li> <li><a href="/wiki/Arterial_catheter" class="mw-redirect" title="Arterial catheter">Arterial catheter</a></li> <li><a href="/wiki/Bronchial_blocker" title="Bronchial blocker">Bronchial blocker</a></li> <li><a href="/wiki/Double-lumen_endobronchial_tube" title="Double-lumen endobronchial tube">Double-lumen endobronchial tube</a></li> <li><a href="/wiki/Gas_cylinder" title="Gas cylinder">Gas cylinder</a></li> <li><a href="/wiki/Laryngeal_mask_airway" title="Laryngeal mask airway">Laryngeal mask airway</a></li> <li><a href="/wiki/Laryngeal_tube" title="Laryngeal tube">Laryngeal tube</a></li> <li><a href="/wiki/Magill_forceps" title="Magill forceps">Magill forceps</a></li> <li><a href="/wiki/Relative_analgesia_machine" title="Relative analgesia machine">Relative analgesia machine</a></li> <li><a href="/wiki/Tracheal_tube" title="Tracheal tube">Tracheal tube</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Complications</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergic_reactions_to_anesthesia" title="Allergic reactions to anesthesia">Allergic reactions</a></li> <li><a href="/wiki/Anesthesia_awareness" title="Anesthesia awareness">Anesthesia awareness</a></li> <li><a href="/wiki/Drug-induced_amnesia" title="Drug-induced amnesia">Drug-induced amnesia</a></li> <li><a href="/wiki/Effects_of_early-life_exposures_to_anesthesia_on_the_brain" title="Effects of early-life exposures to anesthesia on the brain">Effects of early-life exposures to anesthesia on the brain</a></li> <li><a href="/wiki/Emergence_delirium" title="Emergence delirium">Emergence delirium</a></li> <li><a href="/wiki/Local_anesthetic_toxicity" class="mw-redirect" title="Local anesthetic toxicity">Local anesthetic toxicity</a></li> <li><a href="/wiki/Malignant_hyperthermia" title="Malignant hyperthermia">Malignant hyperthermia</a></li> <li><a href="/wiki/Perioperative_mortality" title="Perioperative mortality">Perioperative mortality</a></li> <li><a href="/wiki/Postanesthetic_shivering" title="Postanesthetic shivering">Postanesthetic shivering</a></li> <li><a href="/wiki/Postoperative_nausea_and_vomiting" title="Postoperative nausea and vomiting">Postoperative nausea and vomiting</a></li> <li><a href="/wiki/Postoperative_residual_curarization" title="Postoperative residual curarization">Postoperative residual curarization</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Subspecialties</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiothoracic_anesthesiology" title="Cardiothoracic anesthesiology">Cardiothoracic</a></li> <li><a href="/wiki/Critical_emergency_medicine" title="Critical emergency medicine">Critical emergency medicine</a></li> <li><a href="/wiki/Geriatric_anesthesia" title="Geriatric anesthesia">Geriatric</a></li> <li><a href="/wiki/Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></li> <li><a href="/wiki/Obstetric_anesthesiology" title="Obstetric anesthesiology">Obstetric</a></li> <li><a href="/wiki/Oral_sedation_dentistry" title="Oral sedation dentistry">Oral sedation dentistry</a></li> <li><a href="/wiki/Pain_medicine" class="mw-redirect" title="Pain medicine">Pain medicine</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Professions</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anesthesiologist" class="mw-redirect" title="Anesthesiologist">Anesthesiologist</a></li> <li><a href="/wiki/Anesthesiologist_assistant" class="mw-redirect" title="Anesthesiologist assistant">Anesthesiologist assistant</a></li> <li><a href="/wiki/Nurse_anesthetist" title="Nurse anesthetist">Nurse anesthetist</a></li> <li><a href="/wiki/Operating_department_practitioners" class="mw-redirect" title="Operating department practitioners">Operating department practitioners</a></li> <li><a href="/wiki/Certified_anesthesia_technician" class="mw-redirect" title="Certified anesthesia technician">Certified anesthesia technician</a></li> <li><a href="/wiki/Certified_anesthesia_technologist" class="mw-redirect" title="Certified anesthesia technologist">Certified anesthesia technologist</a></li> <li><a href="/wiki/Anaesthetic_technician" class="mw-redirect" title="Anaesthetic technician">Anaesthetic technician</a></li> <li><a href="/wiki/Physicians%27_assistant_(anaesthesia)" class="mw-redirect" title="Physicians' assistant (anaesthesia)">Physicians' assistant (anaesthesia)</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">History</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/ACE_mixture" title="ACE mixture">ACE mixture</a></li> <li><a href="/w/index.php?title=Helsinki_Declaration_for_Patient_Safety_in_Anaesthesiology&action=edit&redlink=1" class="new" title="Helsinki Declaration for Patient Safety in Anaesthesiology (page does not exist)">Helsinki Declaration for Patient Safety in Anaesthesiology</a></li> <li><a href="/wiki/History_of_general_anesthesia" title="History of general anesthesia">History of general anesthesia</a></li> <li><a href="/wiki/History_of_neuraxial_anesthesia" title="History of neuraxial anesthesia">History of neuraxial anesthesia</a></li> <li><a href="/wiki/History_of_tracheal_intubation" title="History of tracheal intubation">History of tracheal intubation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Organizations</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/American_Association_of_Nurse_Anesthetists" class="mw-redirect" title="American Association of Nurse Anesthetists">American Association of Nurse Anesthetists</a></li> <li><a href="/wiki/American_Society_of_Anesthesia_Technologists_%26_Technicians" title="American Society of Anesthesia Technologists & Technicians">American Society of Anesthesia Technologists & Technicians</a></li> <li><a href="/wiki/American_Society_of_Anesthesiologists" title="American Society of Anesthesiologists">American Society of Anesthesiologists</a></li> <li><a href="/w/index.php?title=Anaesthesia_Trauma_and_Critical_Care&action=edit&redlink=1" class="new" title="Anaesthesia Trauma and Critical Care (page does not exist)">Anaesthesia Trauma and Critical Care</a></li> <li><a href="/wiki/Association_of_Anaesthetists_of_Great_Britain_and_Ireland" title="Association of Anaesthetists of Great Britain and Ireland">Association of Anaesthetists of Great Britain and Ireland</a></li> <li><a href="/wiki/Royal_College_of_Anaesthetists" title="Royal College of Anaesthetists">Royal College of Anaesthetists</a></li> <li><a href="/wiki/Association_of_Veterinary_Anaesthetists" title="Association of Veterinary Anaesthetists">Association of Veterinary Anaesthetists</a></li> <li><a href="/wiki/Australian_and_New_Zealand_College_of_Anaesthetists" title="Australian and New Zealand College of Anaesthetists">Australian and New Zealand College of Anaesthetists</a></li> <li><a href="/wiki/Australian_Society_of_Anaesthetists" title="Australian Society of Anaesthetists">Australian Society of Anaesthetists</a></li> <li><a href="/wiki/International_Anesthesia_Research_Society" title="International Anesthesia Research Society">International Anesthesia Research Society</a></li> <li><a href="/wiki/European_Society_of_Anaesthesiology_and_Intensive_Care" title="European Society of Anaesthesiology and Intensive Care">European Society of Anaesthesiology and Intensive Care</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow hlist" colspan="2"><div> <ul><li><span class="noviewer" typeof="mw:File"><span title="Category"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /></span></span> <a href="/wiki/Category:Anesthesiology" title="Category:Anesthesiology">Category</a></li> <li><span class="noviewer" typeof="mw:File"><span title="Outline"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/10px-Global_thinking.svg.png" decoding="async" width="10" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/15px-Global_thinking.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/41/Global_thinking.svg/21px-Global_thinking.svg.png 2x" data-file-width="130" data-file-height="200" /></span></span> <a href="/wiki/Outline_of_anesthesia" title="Outline of anesthesia">Outline</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319"><link rel="mw-deduplicated-inline-style" 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