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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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 Epidural Anesthesia01:29

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...

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Spinal perianal block: a prospective, randomized, double-blind comparison with spinal saddle block.

Medhat R Wassef1, Emil I Michaels, Jeffrey M Rangel

  • 1Department of Anesthesiology, Mount Sinai School of Medicine, Elmhurst Hospital, New York, USA. medhatrwassef@verizon.net

Anesthesia and Analgesia
|May 22, 2007
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Summary

A very low dose of spinal bupivacaine (1.5 mg) is sufficient for short perianal surgery, leading to faster recovery and discharge. This finding supports the use of minimal effective spinal anesthesia doses for specific procedures.

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Area of Science:

  • Anesthesiology
  • Surgical Procedures

Background:

  • Investigated the efficacy of low-dose spinal bupivacaine for short perianal surgery.
  • Evaluated safety and sufficiency of minimal anesthetic doses.

Purpose of the Study:

  • To determine if a very low dose of spinal bupivacaine is adequate for short perianal surgery.
  • To compare outcomes between a low dose (1.5 mg) and a higher dose (6.0 mg) of spinal bupivacaine.

Main Methods:

  • Prospective, randomized, double-blind study.
  • Eighty patients received either 1.5 mg or 6.0 mg of hyperbaric bupivacaine via spinal anesthesia.
  • Outcomes assessed included anesthesia quality, sensory block level, time to ambulation, and hospital discharge.

Main Results:

  • The 1.5 mg dose provided satisfactory anesthesia with a less extensive sensory block (median S4).
  • Patients receiving the lower dose experienced significantly earlier ambulation (98 vs. 147 minutes) and hospital discharge (126 vs. 249 minutes).
  • Statistical significance (P < 0.01) was observed for all compared outcomes.

Conclusions:

  • A 1.5 mg dose of spinal bupivacaine is effective and safe for short perianal surgical procedures.
  • Minimal effective spinal anesthesia doses can optimize patient recovery and resource utilization.
  • This approach offers a viable alternative to higher anesthetic doses in specific surgical contexts.