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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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 Anesthesia01:29

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 Anesthesia01:16

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 Surface, Infiltration, and Conduction Block Anesthesia01:30

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...
Classification of Skeletal Muscle Relaxants01:28

Classification of Skeletal Muscle Relaxants

Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...

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Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
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Paravertebral block: cervical, thoracic, lumbar, and sacral.

André P Boezaart1, Stephan D Lucas, Clint E Elliott

  • 1Department of Anesthesiology, Division of Acute Pain Medicine and Regional Anesthesia, University of Florida College of Medicine, Gainesville, Florida 32610, USA. aboezaart@anest.ufl.edu

Current Opinion in Anaesthesiology
|August 15, 2009
PubMed
Summary

This review details advancements in cervical, thoracic, lumbar, and sacral paravertebral blocks, emphasizing their shared techniques and risks due to proximity to the dura mater.

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Area of Science:

  • Anesthesiology and Pain Management
  • Regional Anesthesia Techniques

Background:

  • Paravertebral blocks (PVBs) are regional anesthesia techniques targeting nerve roots or plexuses.
  • Understanding the anatomical proximity of PVBs to the dura mater is crucial for safe practice.

Purpose of the Study:

  • To review new developments in cervical, thoracic, lumbar, and sacral paravertebral blocks.
  • To highlight commonalities, differences, and emerging concerns across these block types.

Main Methods:

  • Review of current literature on paravertebral block techniques and advancements.
  • Analysis of anatomical considerations and potential complications.

Main Results:

  • All paravertebral blocks share fundamental techniques and risks due to their location near the dura mater.
  • Despite varied nomenclature (e.g., 'posterior approach,' 'psoas compartment'), the underlying principles remain consistent.
  • Novel approaches, including ultrasound, are emerging, but their established clinical value requires further investigation.

Conclusions:

  • Paravertebral blocks, regardless of anatomical site, necessitate the same level of caution as spinal or epidural blocks due to shared risks like intrathecal injection.
  • Emerging indications and concerns, particularly regarding nerve microanatomy, warrant further research and discussion.