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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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.
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Local Anesthetics: Clinical Application as Spinal Anesthesia

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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...

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Local Anesthetics: Clinical Application as Epidural Anesthesia

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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.
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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...

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Related Experiment Video

Updated: May 31, 2026

Non-Intubated Video-Assisted Thoracoscopic Surgery

Non-Intubated Video-Assisted Thoracoscopic Surgery

Published on: May 26, 2023

Update on thoracic paravertebral blocks.

Vesna Novak-Jankovic¹

¹Ljubljana University Medical Center, Clinical Department of Anaesthesiology and Intensive Therapy, Ljubljana, Slovenia. vnovakjankovic@gmail.com

Collegium Antropologicum

|July 16, 2011

Summary

Thoracic paravertebral block, a regional anesthesia technique, involves injecting local anesthetic into the thoracic paravertebral space. This method offers effective pain relief for thoracic and abdominal surgeries with fewer side effects than other regional blocks.

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Area of Science:

Anesthesiology
Pain Management
Thoracic Surgery

Background:

Thoracic paravertebral block was a common practice in the early 20th century.
This regional anesthesia technique has experienced a resurgence in popularity over the last decade.
It involves injecting local anesthetic into the thoracic paravertebral space for afferent blockade.

Purpose of the Study:

To review the indications and benefits of thoracic paravertebral analgesia.
To compare thoracic paravertebral blocks with alternative regional anesthesia techniques.
To highlight the potential of thoracic paravertebral blocks for surgical pain management.

Main Methods:

Review of historical and recent literature on thoracic paravertebral blocks.
Comparison of analgesic efficacy and side effect profiles with epidural, intercostal, and interpleural blocks.
Analysis of indications for thoracic paravertebral analgesia in thoracic and abdominal surgeries.

Main Results:

Thoracic paravertebral analgesia is primarily indicated for unilateral thoracic and abdominal surgical procedures.
Paravertebral blocks provide analgesia comparable or superior to other regional techniques.
This method demonstrates a favorable side effect profile compared to epidural, intercostal, and interpleural blocks.

Conclusions:

Thoracic paravertebral blocks offer effective analgesia with a good safety profile for specific surgical procedures.
The technique warrants further investigation and consideration in modern pain management strategies.
It presents a viable alternative to other regional anesthesia methods for thoracic and abdominal surgery.