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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...

Depolarizing Blockers: Pharmocokinetics

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

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 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: 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...

Depolarizing Blockers: Mechanism of Action

Depolarizing Blockers: Mechanism of Action

Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
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The art of peripheral regional anesthesia.

Revista brasileira de anestesiologia·2009

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Related Experiment Video

Updated: Jun 16, 2026

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

Published on: June 18, 2021

Failure of subarachnoid blocks.

Hugo Praxedes¹, Antonio Leite Oliva Filho

¹Gerente Médico de Farmacovigilância do Laboratório Cristália.

Revista Brasileira De Anestesiologia

|February 20, 2010

Summary

Subarachnoid block failures, though infrequent, often stem from technical issues. Addressing anatomy, drug choice, dosage, and patient positioning is key to successful outcomes and minimizing patient discomfort.

Area of Science:

Anesthesiology
Neurosurgery
Surgical Procedures

Background:

Subarachnoid blocks are crucial for surgical anesthesia but can occasionally fail, causing patient discomfort.
The definition and causes of subarachnoid block failure have historically varied.
Identifying failure causes is essential for improving patient outcomes.

Purpose of the Study:

To systematically review publications and identify the primary causes of subarachnoid block failure.
To analyze factors contributing to block failure, including technical and pharmacological aspects.
To provide insights for minimizing subarachnoid block complications.

Main Methods:

Systematic review of medical literature focusing on studies with a significant patient cohort.

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Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage

Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage

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Analysis categorized into three main topics: anatomy, anesthetic agents, and dosage.

Evaluation of drug selection, solutions, additions, concentration, volume, and baricity.

Main Results:

Subarachnoid block failures are frequently linked to technical factors.
Inadequate anatomic assessment and incorrect needle/puncture site selection are common issues.
Improper drug storage, incorrect dosage, and inadequate baricity contribute to failure.

Conclusions:

Technical factors are the most common cause of subarachnoid block failure.
Judicious selection of needle, puncture site, and drug is critical.
Proper patient positioning and adequate dosing are essential for successful subarachnoid blocks.