Talk:Local anesthetic nerve block

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Kkokinawa. Peer reviewers: Ronald.nguyen.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 00:13, 18 January 2022 (UTC)[reply]

Equine Lameness

Has anyone noticed that a couple of sections of this article are taken from a book on Equine Lameness - a veterinarian text, while the article appears to deal with humans. — Preceding unsigned comment added by 100.6.12.89 (talk) 22:06, 1 May 2015 (UTC)[reply]

Page Edit

I will to edit this page and add a few sections on specific nerve blocks to provide readers with more information. Kkokinawa (talk) 22:45, 30 July 2017 (UTC)[reply]

Could you be more specific? Please see this page for a great example to follow. Mgiulietti (talk) 17:14, 7 August 2017 (UTC)[reply]

I added information about:

Common local anesthetics
Upper extremity nerve blocks
Lower extremity nerve blocks

Paravertebral blocks Kkokinawa (talk) 18:16, 14 August 2017 (UTC)[reply]

The additional information is looking good. No grammatical fixes from this standpoint. The sources are also holding up.Ronald.nguyen (talk) 23:58, 14 August 2017 (UTC)[reply]

Advisor Edits — Preceding unsigned comment added by Mgiulietti (talk • contribs) 19:10, 15 August 2017 (UTC)[reply]

My suggested edits regard the following sections:

Mechanism of action

1. Do all local anesthetics act on the voltage-gated sodium channel? It seems that lidocaine inhibits voltage-gated sodium channels, some potassium channels, G-protein coupled receptors, NMDA receptors, and calcium channels to name some targets (see van der Wal et al., 2016 European J. Pain 20, 655-674). Part of the uncertainty relates to very different responses depending on dose. Given that doses are high micromolar or above, it seems unlikely that there is a specific target binding site.

2. Do local anesthetics target the open state of the sodium channel? On page 657 van der Wal indicates that lidocaine preferentially binds to the inactivated state of voltage gated sodium channels. Perhaps it would be better to indicate that the duration of the block is dependent on the concentration of the anesthetic near the nerve (rather than time), as blood flow, lipid solubility, and vasoconstrictors all act to alter the concentration. This seems particularly important as much of the complexity of delivering anesthetics relates to varying amounts of the anesthetic given to the patient.

3. When you state that local anesthetics bind on the inner side of the nerve membrane and prevent ion flow, do you know if the binding is to the alpha or beta subunit of the voltage-gated sodium channel? Is the stoichiometry known for the number of molecules needed to inhibit? Or is it possible that the lipid-soluble molecules act through the lipid fluidity and do not, per se, bind to specific protein sites (given that action requires high micromolar or low millimolar amounts). In this sense, what is the evidence that lidocaine or other anesthetics bind to the inner side of the membrane? Might it be better to indicate that they partition into the membrane, and not focus on the binding site if that is not really known? Referencing a paper from 1976 relating the mechanism of action does not seem very informative given the state of knowledge about anesthetic mechanisms in the 1970s.

Common local anesthetics and adjuvants

1. Might it be useful to show structures of the ester-linked and amide-linked anesthetics? In some of your references it is shown that all are weak bases, and that the ionization state determines lipid solubility and potency.

2. Might be nice to describe what an adjuvant is, and how these might increase the duration of analgesia (what is the logic of using an adjuvant). The next sentence states that “Additives may include epinephrine, clonidine, ….” Are these additives the adjuvants described in the preceeding sentence?

3. You state the epinephrine use is controversial? Why is it neurotoxic? Any how does this relate to being a valuable biomarker for intravascular injection? Confusing.

4. You state that epinephrine increases the length of analgesic and decreases blood glow by acting as an agonist at the alpha1-adrenoceptor. This sounds like two unrelated effects. Is the length of analgesic action the result of decreases in blood flow? Or another mechanism. Why point out the target as the alpha1-adrenoceptor unless you describe what this protein does to vascular tone?

Upper Extremity Nerve Blocks

1. You indicate that lidocaine is injected to numb the skin, and then a local anesthetic is injected. I am wondering if lidocaine is the most commonly used nerve block?

2. In this section you start sentence 2 with the word “It” and sentence 5 uses the word “it” in the last phrase. In technical writing it is almost never okay to use the word it, as the subject is not always clear.

TSQUIER (talk) 18:48, 15 August 2017 (UTC)[reply]

Future Direction

The lead section goes into too much detail which should be relegated to other sections, new or otherwise. Please see this page and especially the writing lead sections subheading on that page.

Additionally, there are several bolded words in this article. Are these suppose to be links? Please remove these as this is not in the manual of style. According to the manual, boldface is not to be used and italics should be used very sparingly for emphasis. Mgiulietti (talk) 23:48, 23 August 2017 (UTC)[reply]

Draft:Anaesthetic Block

Please consider incorporating material from the above draft submission into this article. Drafts are eligible for deletion after 6 months of inactivity. ~Kvng (talk) 00:13, 29 October 2020 (UTC)[reply]

Surgical Focus

This article seems to be primarily about the uses of peripheral nerve blocks in a surgical setting. Nerve blocks also have a role in multi-modal pain control following surgery, headache disorders, and chronic pain syndromes. Is it beyond the scope of this article to include these? It may be better to structure the article based on the indication for the nerve block rather than the anatomic location of the nerve itself. DogMcBarkMD (talk) 00:09, 29 September 2022 (UTC)[reply]