From the Research
Inflammation can significantly reduce the effectiveness of local anesthesia, and clinicians should consider using alternative approaches or adjusting their anesthetic techniques to achieve adequate pain control in inflamed tissues. When tissues are inflamed, the acidic environment created by inflammation interferes with the action of local anesthetics like lidocaine, bupivacaine, and mepivacaine, as they need to be in their uncharged form to penetrate nerve membranes effectively 1. In inflamed tissues with lower pH, more of the anesthetic molecules become ionized (charged), making them less able to cross nerve membranes and reach their site of action.
Some key points to consider when dealing with inflammation and local anesthesia include:
- The role of inflammation in pain regulation, including the activation of glial cells and the production of proinflammatory cytokines and chemokines 1
- The potential for neurogenic inflammation and neuroinflammation to contribute to pain conditions, including postoperative pain and opioid-induced hyperalgesia 1
- The importance of adjusting anesthetic techniques, such as using larger volumes of anesthetic or adding vasoconstrictors like epinephrine, to overcome the challenges posed by inflammation 2, 3
- The potential benefits of using alternative approaches, such as nerve blocks at a distance from the inflamed site or systemic analgesics, to achieve adequate pain control in inflamed tissues 4, 5
Overall, the most recent and highest quality study on this topic is from 2021 5, which highlights the importance of considering the effects of inflammation on local anesthesia and adjusting anesthetic techniques accordingly to achieve optimal pain control. Therefore, clinicians should prioritize using the most effective anesthetic techniques and adjusting their approaches as needed to ensure adequate pain control in inflamed tissues.