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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 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...

General Anesthesia: Overview

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

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

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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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Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

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Published on: January 31, 2025

Spinal anesthesia: an evergreen technique.

Simone Di Cianni¹, Maria Rossi, Andrea Casati

¹Department of Anesthesia and Pain Therapy, University Hospital, Parma, Italy.

Acta Bio-Medica : Atenei Parmensis

|June 17, 2008

Summary

Spinal anesthesia offers safe and effective surgical blocks with recent drug and technique advancements. This review highlights developments in local anesthetics, side effects, and intrathecal anesthesia for evolving patient needs.

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Area of Science:

Anesthesiology
Pharmacology

Background:

Spinal anesthesia is a widely used technique for surgical procedures.
Recent changes in healthcare necessitate adaptations in anesthesia techniques.

Purpose of the Study:

To review recent developments in local anesthetic drugs for spinal anesthesia.
To discuss side effects and special techniques of intrathecal anesthesia.
To examine the evolving clinical use of spinal anesthesia.

Main Methods:

Review of recent literature on spinal anesthesia.
Analysis of local anesthetic properties and clinical applications.
Evaluation of safety and efficacy data.

Main Results:

Spinal anesthesia is generally safe with rare severe complications.
Cardiovascular effects are common but manageable.
Dose of local anesthetic is critical for effects; long-acting agents in small doses are effective for outpatients.
Levopivacaine shows lower toxicity than bupivacaine.

Conclusions:

Spinal anesthesia remains a safe and effective technique.
Newer drugs and techniques are improving its clinical utility.
Adaptations are needed for outpatient and elderly patient populations.