Supraclavicular Nerve Block Medication

Updated: Sep 06, 2018
  • Author: Alma N Juels, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to achieve pain control perioperatively or postoperatively.

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Local Anesthetics

Class Summary

Local anesthetics block the initiation and conduction of nerve impulses. Epinephrine may be coadministered to prolong the duration of anesthetic effects.

Mepivacaine (Polocaine, Prolocaine-MPF, Carbocaine)

For surgical anesthesia in adults, a single shot of 30 mL of 1.5% mepivacaine plain provides close to immediate (5 min) to 2-3 hrs of surgical analgesia. For longer surgical anesthesia up to 3-4 hrs, 1:400,000 epinephrine is added to the solution. The block completely resolves about 2 hrs later. If a longer block is needed, adding tetracaine at 2mg/mL (0.2%) prolongs the block to 4-6 hrs.

For longer postoperative analgesia, 0.25% ropivacaine or bupivacaine is used and should provide more than 12 hrs of pain relief. The onset is delayed from 5 min to about 20 min. This can be used for both perioperative and postoperative pain control. A combination of both can be used.

Mepivacaine with or without epinephrine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. Epinephrine prolongs the duration of the anesthetic effects from bupivacaine by causing vasoconstriction of the blood vessels surrounding the nerve axons.

Tetracaine

Tetracaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This agent is an option for longer analgesia if a longer block is needed.

Ropivacaine (Naropin)

Ropivacaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This agent is an option for longer postoperative analgesia.

Bupivacaine (Marcaine, Sensorcaine, Sensorcaine-MPF)

Bupivicaine decreases the permeability of soduim ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. This agent is an option for longer analgesia. It is more cardiotoxic than ropivicaine.

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