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Related Concept Videos

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 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...
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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...
Drug Delivery: Parenteral Route01:29

Drug Delivery: Parenteral Route

The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
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...

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Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
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Epidural injections: past, present and future.

Marcos Masini1

  • 1School of Medicine, University of Planalto Central and South Lake Hospital, Brasilia, DF, Brazil. marcos.masini@uol.com.br

Acta Neurochirurgica. Supplement
|November 26, 2010
PubMed
Summary
This summary is machine-generated.

Historically, spinal surgery focused on structural defects causing pain. Now, advanced treatments like epidural injections and epiduroscopy offer effective pain management and functional restoration for persistent low-back pain.

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Area of Science:

  • Neurosurgery
  • Pain Management
  • Spinal Diagnostics

Background:

  • Past spinal pain treatment centered on surgical intervention for identified structural defects like those seen on myelogram or CT scans.
  • Neural compression was the primary suspected cause of all spinal pain, leading to spinal arthrodesis.
  • Early surgical approaches often failed to provide relief for many patients.

Observation:

  • The limitations of solely structural-based interventions became apparent as many patients did not improve post-surgery.
  • Epidural injections evolved from non-localized to precisely targeted procedures.
  • Inflammation mediation and neuromodulation emerged as key strategies for pain control.

Findings:

  • Persistent low-back pain management has evolved significantly beyond early surgical paradigms.
  • Targeted epidural injections represent an advancement in non-surgical pain relief.
  • Epiduroscopy is identified as the most recent, comprehensive, and effective treatment for chronic low-back pain.

Implications:

  • The understanding of spinal pain etiology has broadened to include inflammatory and neurological pathways.
  • Minimally invasive techniques like epiduroscopy offer new hope for patients with refractory low-back pain.
  • A multimodal approach integrating diagnostics, inflammation control, and neuromodulation is crucial for functional restoration.