Quote from nesher
the doc used marcane which is seemes is derived from cocaine - I spent the night awake, but very sleepy from the general - counting the hours hoping the block would finally depart.
Just some clarification (your information is incorrect), marcaine is an amide local anesthetic and cocaine is an ester local anesthetic. Marcaine is a synthetic local anesthetic, no relation. This excerpt may help a little:
"THE DEVELOPMENT OF THE LOCAL ANESTHETICS
The revolution in the history of local anesthetics broke in 1904, when Einhorn troduced novocaine (procaine), a local anesthetic with fewer side effects than cocaine. Nevertheless, the duration of its action has been short-lived, a fact which has limited its use for the most part to operations with a short duration. This problem was solved by Braun, who proposed the addition of adrenaline to the local anesthetic, for the purpose of prolonging both the duration and the validity of the local anesthetic.
In the year 1928, Eisleb composes tetracaine (pantocaine) a substance with higher anesthetic power and higher duration of action. This progress has come up against the problem of the higher degree of toxicity as compared with procaine. Both these local anesthetics belong to the group of aminoalkylesters.
In 1943 Nils Loefgren composed lidocaine, which belongs to the group of aminoalcylamids[36,37]. Loefgren' remark with regard to the common structural principle of the local anesthetics; In short, that the local anesthetics have a lipophilic and one hydrophilic end was significant. The lipophilic term usually consists one aromatic and one heterocyclic group and is connected to the hydrophile end which consists, as a rule, of a secondary or tertiary group of amines, through a chain which defines the extent to which the local anesthetics originate from the group of the esters or the group of amides. Beyond any doubt, the lidocaine has been the main substance and, at the same time, the base for all the later studies of the local anesthetics that followed. The later researches led to the discovery of new local anesthesia such as etidocaine, the prilocaine, and the bupivacaine, focused initially 12: on the relation between the chemical structure of the anesthetic and its anesthetic action, on the physical and chemical properties of the local anesthetic through variations on the points of restoration of the hydrophile or lipophile groups or the intermediate chain, on the beginning of action, the power, the duration of the action and toxicity, the place of action of the anesthetics, on features, such as the alcalic nature, the fat-solubility the water solubility of the base and the proteinic charge."
A regional block for surgery is an excellent way to alleviate the hyperalgesia that occurs post surgery by inhibiting peripheral sensitization. Central sensitization can be preempted by the use of NMDA receptor antagonists and later by COX inhibitors.