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Some local anaesthetics, lidocaine and bupivacaine, can be used in combination with adrenaline. Adrenaline is a vasoconstrictor and its use increases the speed of onset and prolongs the duration of action of the local anaesthetic. Vasoconstrictors should never be used with local anaesthetics in digits or appendages, because of the risk of vasoconstriction leading to ischaemic necrosis. See page injectable drugs that can be administered by podiatrists. Lidocaine is the most commonly used local anaesthetic.
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Fortunately, neurons that carry the sensation of pain are of the smallest diameter unmyelinated and myelinated type and as such are affected by low doses of local anaesthetic, leaving larger motor neurons unaffected. Complications can arise because of technical errors such as broken needles or practitioner error, for example injection of the wrong solution or accidental injection into a blood vessel.
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