Changes

==Mechanism of Action==

==Mechanism of Action==

==Side Effects and Contraindications==

==Side Effects and Contraindications==

Local anaesthetics may have undesirable effects on the CNS. These include termors, convulsions and respiratory depression. The cardiovasular system may also be adversely affected, with drug administration leasing to reduced cardiac contractility, vasodilation and hypotension. [[#Bupivicaine|bupivicaine]] is particularly cardiotoxic, but stereoisomerism exists. The cardio- and neuro-toxic effects of dextrobupivicaine are greatly increased compared to that of levobupivicaine. Commercially available preparations of [[#Bupivicaine|bupivicaine]] are a 50:50 mixture of the two forms of the drug.

Local anaesthetics may have undesirable effects on the CNS. These include termors, convulsions and respiratory depression. The cardiovasular system may also be adversely affected, with drug administration leading to reduced cardiac contractility, vasodilation and hypotension. [[#Bupivicaine|bupivicaine]] is particularly cardiotoxic, but stereoisomerism exists. The cardio- and neuro-toxic effects of dextrobupivicaine are greatly increased compared to that of levobupivicaine. Commercially available preparations of [[#Bupivicaine|bupivicaine]] are a 50:50 mixture of the two forms of the drug.

Local anaesthetic drugs are known to reduce epithelial repair, and so it it wise to administer them away from the site of surgical incision so that healing is not impaired. Inadvertent intravenous administration of these drugs can result in tissue irritation and allergic reactions.

Local anaesthetic drugs are known to reduce epithelial repair, and so it it wise to administer them away from the site of surgical incision so that healing is not impaired. Inadvertent intravenous administration of these drugs can result in tissue irritation and allergic reactions.

Lidocaine is an amide-linked local anaesthetic, which aslo has anti-arrhythmic properties. The time to onset of action is 3-10mins, after which the drug's effects last 60-90mins. The duration of action may be prolonged by the addition of adrenaline to the preparation. Lidocaine is a very cheap drug, and is a component of EMLA cream.

Lidocaine is an amide-linked local anaesthetic, which aslo has anti-arrhythmic properties. The time to onset of action is 3-10mins, after which the drug's effects last 60-90mins. The duration of action may be prolonged by the addition of adrenaline to the preparation. Lidocaine is a very cheap drug, and is a component of EMLA cream.

===Bupivicaine===

===Bupivacaine===

Bupivicaine is also an amide-linked local anaesthetic, but with a duration of action of around 8 hours, it is longer acting than lidocaine. It also has a longer time to onset (20-30mins). It is very cardiotoxic, casuing asystole by decreasing the force of contraction, and therefore must NOT be given intravenously.

Bupivacaine is also an amide-linked local anaesthetic, but with a duration of action of around 8 hours, it is longer acting than lidocaine. It also has a longer time to onset (20-30mins). It is very cardiotoxic, casuing asystole by decreasing the force of contraction, and therefore must NOT be given intravenously.

===Mepivicaine===

===Mepivicaine===

"EMLA" stands for Eutectic Mix of Local Anaesthetic, and is formulated as a cream containing [[#Lidocain|lidocaine]] and prilocaine. It is used for topical anaesthesia of the skin, for example before venupuncture. It must be applied 30-60mins before the anticipated insult to allow absorption and effect to take place.

"EMLA" stands for Eutectic Mix of Local Anaesthetic, and is formulated as a cream containing [[#Lidocain|lidocaine]] and prilocaine. It is used for topical anaesthesia of the skin, for example before venupuncture. It must be applied 30-60mins before the anticipated insult to allow absorption and effect to take place.