From the Guidelines
Local anesthesia is preferred over epidural anesthesia for certain procedures due to its faster onset, shorter recovery time, and lower risk of complications, as evidenced by a recent study published in 2023 1.
Key Benefits of Local Anesthesia
- Faster onset of action, typically within 5-10 minutes
- Shorter recovery time, allowing patients to go home sooner after procedures
- Lower risks of complications such as hypotension, urinary retention, or headaches
- Technically simpler to administer, requiring less specialized training and equipment
Comparison with Epidural Anesthesia
- Local anesthesia is particularly advantageous for outpatient procedures, minor surgeries, dental work, and situations where patients have contraindications to epidurals like coagulation disorders or infection at the injection site
- However, local anesthesia is limited to smaller surgical areas and may not provide sufficient pain control for more extensive or deeper procedures where epidurals excel
- A meta-analysis published in 2021 found that multi-drug local anesthesia had lower postoperative pain scores, lower opioid consumption, and in one meta-analysis a shorter length of hospital stay 1
Recent Evidence
- A 2023 study published in the World Journal of Emergency Surgery found that local anesthetic wound infiltration during abdominal surgery was associated with a decrease in morphine consumption at 24 h 1
- Another study published in 2021 found that single-injection local anesthesia had analgesic effects with no side effects, and that multi-drug local anesthesia resulted in significant benefits during the first 24 h in terms of less pain at rest and during movement, and a reduction in opioid consumption 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Local Anesthesia Benefits
The benefits of local anesthesia compared to epidural anesthesia include:
- Faster onset and rapid recovery with certain local anesthetics, such as 2-chloroprocaine 2
- Reduced risk of transient neurologic symptoms, which can be a significant risk with intrathecal lidocaine in the lithotomy position 2
- Effective alternatives to bupivacaine in day-case spinal anesthesia, although more safety and outcome data are required 2
- Improved safety with smaller doses of local anesthetics in ultrasound-guided regional anesthesia, although this may be weighed against possible reductions in speed of onset and analgesic duration 2
Comparison to Epidural Anesthesia
In comparison to epidural anesthesia, local anesthesia has several benefits, including:
- Reduced plasma concentrations of local anesthetics, which can reduce the risk of systemic toxicity 3
- Faster onset of block with alkalinized local anesthetic mixtures, such as a mixture of lignocaine and bupivacaine with sodium bicarbonate 4
- Similar onset and complete spread of sensory blockade with lidocaine-bupivacaine mixtures, although the duration of action may be intermediate between the two single drugs 5
- A review of pharmacological considerations for local anesthetics highlights their efficacy and safety in medical and dental practice, although providers should be aware of their pharmacotherapeutic principles 6