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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...

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 Spinal Anesthesia

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 Surface, Infiltration, and Conduction Block Anesthesia

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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...

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Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Published on: January 31, 2025

[Ultrasound-guided epidural block].

Kunihisa Hotta¹

¹[Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, School of Medicine, Shimotsuke 329-0498]

Masui. the Japanese Journal of Anesthesiology

|June 4, 2008

Summary

Ultrasound imaging enhances epidural block procedures by providing crucial anatomical details. This improves the accuracy and safety of epidural needle placement, aiding clinicians in identifying the epidural space.

Area of Science:

Anesthesiology
Medical Imaging
Anatomy

Background:

Epidural blocks traditionally rely on surface landmarks and the loss of resistance technique.
Limited visualization of anatomical structures can pose challenges during epidural procedures.
Ultrasound offers potential for enhanced anatomical information.

Purpose of the Study:

To evaluate the utility of ultrasound in guiding epidural block placement.
To determine if ultrasound provides critical anatomical information for improved safety and ease of procedure.
To assess the correlation between ultrasound-measured epidural space depth and needle insertion depth.

Main Methods:

Ultrasound probe positioned at interspinous processes in transverse and longitudinal planes.

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Identification of the spinal canal and dura mater (echogenic structure).

Prepuncture ultrasound examination to determine puncture site, depth, and angle.

Main Results:

Ultrasound provides additional anatomical information for epidural blocks.
Strong correlation observed between ultrasound-measured epidural space depth and actual needle depth.
Ultrasound aids in identifying the puncture point, depth, and angle to the epidural space.

Conclusions:

Prepuncture ultrasound examination is valuable for epidural block procedures.
Ultrasound can make epidural blocks easier and safer by providing key anatomical insights.
This imaging modality assists in precise needle guidance for epidural anesthesia.