Which anesthetic agents are used in a posterior tibial nerve block?

Updated: Jun 14, 2018
  • Author: Heather Tassone, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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The 2 main classes of local anesthetics currently in use are amino esters and amino amides. Both inhibit ionic fluxes required for the initiation and conduction of nerve impulses. [13]

Lidocaine, the most commonly used anesthetic, has a fast onset of action and a duration of action of 30-120 minutes, which is increased to 60-400 minutes with the addition of epinephrine. [12, 13] The total cumulative dose of lidocaine to be infiltrated is 5 mg/kg (not to exceed 300 mg) if lidocaine without epinephrine is used, and 7 mg/kg (not to exceed 500 mg) if lidocaine with epinephrine is used.

Anesthetic preparations that contain epinephrine are commonly used in the emergency department. Epinephrine induces vasoconstriction, decreasing the amount of local bleeding at the site of injection. In addition, it increases the duration of action of the anesthetic with which it is combined. Despite these advantages, the vasoconstrictive properties of epinephrine may contribute to tissue hypoxia, and its use should be avoided in areas of poor perfusion (ie, fingers, toes, penis, ears, nose).

In children or noncompliant adults, consider using topical anesthetic mixtures, such as lidocaine, epinephrine, and tetracaine or a eutectic mixture of lidocaine and prilocaine.

Pediatric or elderly patients may require additional sedation for compliance.

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