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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 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 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...

Local Anesthetics: Common Agents and Their Applications

Local Anesthetics: Common Agents and Their Applications

Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...

Local Anesthetics: Pharmacokinetics

Local Anesthetics: Pharmacokinetics

The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...

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Related Experiment Video

Updated: Jul 3, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Published on: January 31, 2025

Regional anesthesia at home.

Gloria S Cheng¹, Lynna P Choy, Brian M Ilfeld

¹Department of Anesthesiology, University of California San Diego, San Diego, California, USA.

Current Opinion in Anaesthesiology

|July 29, 2008

Summary

Regional anesthesia and analgesia at home are increasingly studied, with continuous peripheral nerve blocks showing potential benefits for recovery. Perineural catheters offer improved pain relief and are used in both adult and pediatric populations for home-based care.

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Area of Science:

Anesthesiology
Pain Management
Ambulatory Care

Background:

Regional anesthesia and analgesia are evolving beyond hospital settings.
Home-based pain management strategies are gaining traction.
Patient recovery profiles and hospitalization durations are key considerations.

Purpose of the Study:

To review recent peer-reviewed literature on regional anesthesia and analgesia for patients at home.
To assess the benefits and risks of home-based regional anesthesia.
To explore the use of continuous peripheral nerve blocks in outpatient settings.

Main Methods:

Literature review of recently published peer-reviewed studies.
Analysis of data on regional anesthesia techniques used in home settings.
Focus on continuous peripheral nerve blocks and perineural catheters.

Main Results:

Growing data available on the benefits and risks of home-based regional anesthesia.
Continuous peripheral nerve blocks at home may influence hospitalization duration and recovery.
Interscalene block effective for shoulder surgery analgesia with few complications.
Intraarticular injections' impact and risks at home require further clarification.

Conclusions:

Regional techniques offer site-specific anesthesia and reduced postoperative opioid consumption.
Perineural catheters are a valuable option for improved pain relief at home.
Home use of perineural catheters is expanding in both adult and pediatric patients.