Subcutaneous infiltration of local anesthetics
- Deborah C Hsu, MD, MEd
Deborah C Hsu, MD, MEd
- Associate Professor of Pediatrics, Section of Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Ron M Walls, MD, FRCPC, FAAEM
Ron M Walls, MD, FRCPC, FAAEM
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Adult Resuscitation
- Neskey Family Professor of Emergency Medicine
- Harvard Medical School
- Brigham and Women's Hospital
- Stanley J Miller, MD
Stanley J Miller, MD
- Section Editor — Dermatologic Surgery
- Associate Professor of Dermatology and Otolaryngology/Head and Neck Surgery, Part-Time
- Johns Hopkins Hospital
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The subcutaneous infiltration of local anesthetics for minor skin procedures (eg, wound repair, lumbar puncture, or insertion of vascular catheters) will be reviewed here.
Topical anesthetics in children, peripheral nerve blocks, and regional anesthesia are discussed separately:
ANATOMY AND PHYSIOLOGY
The skin is made up of the epidermis and dermis. The subcutaneous layer lies beneath the dermis (figure 1). Direct infiltration of local anesthetic into the subcutaneous layer effectively blocks pain transmission from the free nerve endings located in the epidermal and dermal layers . Intradermal injection is also effective but more painful than subcutaneous injection.
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- ANATOMY AND PHYSIOLOGY
- CLASSIFICATION OF LOCAL ANESTHETICS
- CHOICE OF ANESTHETIC
- History of adverse reaction
- Methods to decrease injection pain
- - Direct infiltration
- - Field block
- FOLLOW-UP CARE
- Systemic toxicity
- - Treatment
- Catecholamine sensitivity
- Vasovagal syncope
- Allergic reaction
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS