Ultrasound Blocks for the Anterior Abdominal Wall

84 | Ultrasound Blocks for the Anterior Abdominal Wall
12. Local Anesthetics, Pharmacokinetics
and Adjuvants
Amedeo Costantini
The action of local anesthetics is elicited through a specific
block of the sodium channels in the peripheral and central
nervous system. They block both nerve impulse generation and
propagation. Local anesthetics have a particularly high level of
activity in the central nervous system and the cardiovascular
system.
When using local anesthetics for regional anesthesia blocks,
patient safety procedures such as a safe vein access, oxygen
availability, intensive care equipment, adequate monitoring,
immediate availability of general anesthesia, and a sterile
procedure should be assured according to national and
international guidelines (Bertini 2006). Guidelines for an
adequate postoperative pain treatment strategy and
management of local anesthetic systemic toxicity must be also
taken into account (Savoia 2010, Neal 2010).
Dose, Concentration and Volume Correlations
The concentration is defined as the mass of a constituent (the
local anesthetic) divided by the volume of the mixture (volume
of solution) (Table 12.1).