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Original Question

lidocaine is the most widely used agent, but all local anesthetics have comparable efficacy. They differ in potency and several pharmacokinetic parameters that account for differences in the onset and duration of anesthesia. Selection of a particular agent must take into account the duration of the procedure planned and issues regarding vasopressor concentrations. For lengthy procedures, bupivacaine is the logical choice, but it has been implicated as one of the more painful agents during injection according to studies that have compared various anesthetics.8-10 One strategy is to provide the initial 60-90 minutes of anesthesia with a less irritating agent (lidocaine or prilocaine) and then reinject the anesthetized tissue with bupivacaine to provide analgesia well into the postoperative period. Such a strategy is most effective after nerve blocks; shorter duration should be anticipated after soft tissue infiltration. See Table 2 for durations and maximum doses. rewrite

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