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Local Anesthetics: Clinical Application as Epidural Anesthesia

Local Anesthetics: Clinical Application as Epidural Anesthesia

Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...

Drug Delivery: Enteral Route

Drug Delivery: Enteral Route

The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
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Analgesia and Pain Management

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...

Parenteral Anesthetics: Overview

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.

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Updated: Jul 18, 2026

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

Analgesia delivery in the ED.

¹Department of Medicine, Royal Sussex County Hospital, Brighton, BN2 5BE, UK. drpaul.grant@orange.net

The American Journal of Emergency Medicine

|November 14, 2006

Summary

Patients with acute pain in the emergency department experience significant delays in receiving analgesia, with 68% not meeting British Association of Accident and Emergency Medicine (BAEM) guidelines. This study highlights poor performance and identifies areas for improved patient care.

Area of Science:

Emergency Medicine
Pain Management
Healthcare Quality Improvement

Background:

Effective pain management is crucial in emergency departments.
Adherence to established guidelines, such as those from the British Association of Accident and Emergency Medicine (BAEM), is essential for optimal patient care.
Previous assessments of analgesia delivery timeliness in acute pain settings are limited.

Purpose of the Study:

To evaluate the effectiveness and timeliness of analgesia delivery for acute pain patients in an emergency department setting.
To assess compliance with British Association of Accident and Emergency Medicine (BAEM) guidelines for pain management.
To identify specific delays in the patient journey from arrival to analgesia administration.

Main Methods:

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An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)

An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)

Published on: January 27, 2010

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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)

An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)

Published on: January 27, 2010

Retrospective analysis of emergency department patient records.

Measurement of time intervals: patient arrival, assessment, and analgesia delivery.

Comparison of clinical outcomes and process times against national target guidelines (BAEM).

Main Results:

Mean analgesia delivery time for moderate pain: 3 hours 46 minutes.
Mean analgesia delivery time for severe pain: 1 hour 12 minutes.
A significant majority (68%) of patients did not receive analgesia within BAEM best practice guidelines.

Conclusions:

There are substantial delays in providing analgesia to emergency department patients with acute pain.
Current performance significantly falls short of BAEM guidelines, indicating a need for improvement.
Practical changes in service provision and patient care are necessary to enhance analgesia delivery timeliness.