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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...

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 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: 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: Jun 22, 2026

A Protocol for Roux-en-Y Gastric Bypass in Rats using Linear Staplers

A Protocol for Roux-en-Y Gastric Bypass in Rats using Linear Staplers

Published on: August 21, 2021

Regional anesthesia and obesity.

Jerry Ingrande¹, Jay B Brodsky, Hendrikus Jm Lemmens

¹Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.

Current Opinion in Anaesthesiology

|June 25, 2009

Summary

Regional anesthesia offers benefits for obese patients, but requires experienced anesthesiologists. Careful consideration of unique patient physiology is key for successful peripheral and neuraxial blockade in obesity.

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An Acupoint Catgut-embedding Therapy for Treating Obesity

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Published on: April 4, 2025

Area of Science:

Anesthesiology
Obesity Medicine

Background:

Global increase in overweight and obese populations presents daily challenges for anesthesiologists.
Regional anesthesia is a growing option for anesthetic management in obese patients.
Obesity introduces unique physiological and pharmacological considerations for anesthetic procedures.

Purpose of the Study:

To review the application of regional anesthesia in obese patients.
To highlight the specific challenges anesthesiologists face with obese patients.
To discuss the successful use of regional anesthesia in this population.

Main Methods:

Review of recent studies on regional anesthesia in obese patients.
Analysis of success rates and challenges in peripheral and neuraxial blockade.
Consideration of ambulatory surgery settings.

Main Results:

Obese patients may experience increased difficulty in achieving peripheral and neuraxial blockade.
Higher incidence of failed blocks reported in obese versus normal-weight patients.
Regional anesthesia can be successfully employed in obese patients, including ambulatory settings.

Conclusions:

Successful regional anesthesia in obese patients necessitates anesthesiologist expertise in regional techniques.
A thorough understanding of obesity-specific physiological and pharmacological differences is crucial.
Experienced practitioners can achieve successful peripheral and neuraxial blockade in obese individuals.