Medication Summary
The goal of pharmacotherapy is to achieve pain control perioperatively or postoperatively.
Local anesthetics
Class Summary
Local anesthetics block the initiation and conduction of nerve impulses. Ephinephrine may be coadministered to prolong the duration of anesthetic effects.
Mepivacaine (Carbocaine, Polocaine, Polocaine-MPF)
Mepivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.
Ropivacaine (Naropin)
Ropivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. It is a longer-acting agent.
Bupivacaine (Marcaine, Sensorcaine, Sensorcaine MPF)
Bupivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.It is a longer acting-agent. It is more cardiotoxic than ropivacaine.
Tetracaine
Tetracaine decreases permeability to soduim ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This is an option for longer analgesia.
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Sciatic nerve anatomy.
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Supine position
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Bent leg-supine approach.
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Leg on stand-supine approach.
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Above, PN and TN together. Below, TN and PN separate. PA=Popliteal artery, PN=Common Peroneal nerve, TN=Tibial nerve. Reproduced with permission.