Active substances: Isotretinoin
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Progressively larger fibers require a larger volume of anesthetic to block enough adjacent channels to stop conduction.
Pain fibers are the most sensitive, followed by sensory, and finally motor fibers. Local anesthetics are organic amines with an intermediary ester or amide linkage separating the lipophilic ringed head from the hy- drophilic hydrocarbon tail.
The amino ester group of anesthetics in- cludes procaine, tetracaine, and benzocaine. These anesthetics have been used for a long time and are known to have a higher allergic po- tential than the amide-linked group of anesthetics lidocaine, bupiva- caine, and ropivacaine now in common usage.
The amino ester group is thought to have their allergic potential because of their metabolite p-aminobenzoic acid PABA. The members of the amide group, which do not have this metabolite, are known to have a very low allergic po- tential and little cross-reactivity.
Preservative-free amide anesthetics are therefore rec- ommended for all injection procedures.
Bupivacaine is a second-generation amide anesthetic that has a prolonged duration of action.
It is, however, as- sociated with more cardiac and neurotoxic reactions and has a maxi- mum recommended safe dose of 150 mg. Because of the poorer car- diac profile of bupivacaine, third-generation amide anesthetics were developed.
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