Related Experiment Video
Updated: Jun 28, 2026
05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Regional anesthesia techniques for ambulatory orthopedic surgery
Brian D O'Donnell1, Gabriella Iohom
1Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland.
Current Opinion in Anaesthesiology
|November 15, 2008
Summary
Short-acting anesthetic agents and selective nerve blocks enhance recovery in ambulatory orthopedic surgery. Continuous catheters extend pain relief into the home setting, improving patient outcomes.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Regional anesthesia offers advantages for ambulatory orthopedic procedures.
- Optimizing patient recovery and analgesia is crucial in same-day surgery.
Purpose of the Study:
- To review advancements in regional anesthesia for ambulatory orthopedic surgery.
- To discuss new findings on neuraxial anesthesia and peripheral nerve blocks.
Main Methods:
- Review of current literature on regional anesthetic techniques.
- Analysis of short-acting anesthetic agents and peripheral nerve blocks.
- Evaluation of continuous perineural catheters for extended analgesia.
Main Results:
- Short-acting agents like mepivacaine, 2-chloroprocaine, and articaine facilitate rapid intrathecal anesthesia and early recovery.
- Peripheral nerve blocks show potential for enabling self-care in ambulatory limb surgery patients.
- Continuous perineural catheters safely extend perioperative analgesia into the home environment.
Conclusions:
- Shorter-acting neuraxial anesthetics tailored to surgery duration improve ambulatory recovery.
- There is a trend towards more peripheral and selective nerve blocks, such as the infrapatellar block for knee arthroscopy.
- Perineural catheters effectively extend analgesia into the postoperative period, enhancing ambulatory care.
Related Concept Videos
01:16Local 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...
One of the advantages of...
01:11Local 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...
01:30Local 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...
01:24General 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...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
01:29Local 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...
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...
01:23Local 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...
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...