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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...
Aneurysm IV: Nursing Management01:22

Aneurysm IV: Nursing Management

Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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...
Pleural Effusion II: Symptoms and Management01:28

Pleural Effusion II: Symptoms and Management

Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
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.
Analgesia and Pain Management01:25

Analgesia and Pain Management

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

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Related Experiment Video

Updated: May 21, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
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Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Published on: January 31, 2025

Failed epidural: causes and management.

J Hermanides1, M W Hollmann, M F Stevens

  • 1Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands.

British Journal of Anaesthesia
|June 28, 2012
PubMed
Summary
This summary is machine-generated.

Failed epidural anesthesia is common, often due to placement issues or incorrect dosing. Optimizing catheter techniques and using adjuvants like opioids can improve success rates for better pain management.

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Area of Science:

  • Anesthesiology
  • Pain Management

Background:

  • Epidural anesthesia and analgesia failures are more common than often acknowledged.
  • Understanding factors influencing epidural block success is crucial for clinical practice.

Purpose of the Study:

  • To review factors affecting the success rate of epidural anesthesia.
  • To identify reasons for inadequate epidural blocks and strategies for improvement.

Main Methods:

  • Review of literature on epidural anesthesia success factors.
  • Analysis of causes for primary and secondary epidural catheter failure.
  • Evaluation of local anesthetic properties and adjuvant effects.

Main Results:

  • Inadequate epidural blocks result from incorrect placement, catheter migration, or suboptimal drug dosing.
  • Techniques like loss of resistance, patient positioning, and approach (midline/paramedian) impact success.
  • Continuous infusion dose is key; adjuvants (opioids, epinephrine) enhance analgesia.
  • Patient-controlled epidural analgesia with background infusion is optimal for postoperative pain.

Conclusions:

  • Optimizing epidural techniques and judicious use of adjuvants can significantly improve success rates.
  • Patient-controlled epidural analgesia offers superior postoperative pain control.