Local Anesthetic Metabolism -

Not all anesthetics are broken down in the same theater. This is where chemistry dictates destiny.

Amide local anesthetics (e.g., lidocaine, bupivacaine, ropivacaine, mepivacaine) contain an amide linkage and are generally more stable in solution than esters. Basic pharmacology of local anaesthetics - PMC - NIH local anesthetic metabolism

A Comprehensive Review of Local Anesthetic Metabolism: Implications for Clinical Practice Not all anesthetics are broken down in the same theater

| Class | Chemical Link | Examples | Primary Metabolic Site | | :--- | :--- | :--- | :--- | | | Amide bond (-NH-CO-) | Lidocaine, Bupivacaine, Ropivacaine, Mepivacaine, Prilocaine | Liver (CYP450, primarily CYP3A4 & CYP1A2) | | Esters | Ester bond (-CO-O-) | Cocaine, Procaine, Tetracaine, Benzocaine, Chloroprocaine | Plasma (Pseudocholinesterase / Butyrylcholinesterase) | Basic pharmacology of local anaesthetics - PMC -

Amide LAs undergo complex biotransformation almost exclusively in the . They are not hydrolyzed in plasma. The process involves: