The features desirable in a good local anesthetic for spinal use are summarized as follows: (1) depression of sensory nerve function; (2) reversible action, with no damage to nerve tissue; (3) selective action on nerve tissue; (4) low systemic toxicity in concentrations used clinically; (5) no irritation or pain at injection site; (6) rapid onset of action; (7) optimum duration of action; (8) solubility in aqueous solutions at usual pH; (9) stability during sterilization and in solution; and (10) compatibility with vasoconstrictors. The duration of the anesthetic action is a matter of greatest importance in spinal anesthesia. Means of increasing the duration are (1) use of another drug, (2) use of continuous spinal anesthesia, or (3) use of vasoconstrictors. The maximal reflex vasoconstriction in unanesthetized areas occurring as a normal part of spinal anesthesia renders patients especially susceptible to shock and hemorrhage.
Featherstone RM. PHARMACOLOGY OF COMPOUNDS USED TO PRODUCE SPINAL ANESTHESIA. JAMA. 1958;168(10):1327–1330. doi:10.1001/jama.1958.03000100029006
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