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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 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...

Parenteral Anesthetics: Overview

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 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...

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: Common Agents and Their Applications

Local Anesthetics: Common Agents and Their Applications

Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...

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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma

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Bupivacaine 0.5% versus ropivacaine 0.75% wound infiltration to decrease postoperative pain in total thyroidectomy, a

M Ayman¹, G Materazzi, M Bericotti

¹Department of General Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan. aymanmismar@yahoo.com

Minerva Chirurgica

|January 22, 2013

Summary

This summary is machine-generated.

Ropivacaine 0.75% wound infiltration offers a short-term reduction in postoperative pain following thyroidectomy compared to bupivacaine 0.5%. The analgesic effect is limited to the first hour after surgery.

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Area of Science:

Anesthesiology
Surgical Pain Management
Pharmacology

Background:

Effective postoperative pain control is crucial for patient recovery and surgical team satisfaction.
The optimal local analgesia for wound infiltration after thyroidectomy remains under investigation.
This study addresses the efficacy of different local anesthetics for wound infiltration.

Purpose of the Study:

To compare the efficacy of ropivacaine 0.75% and bupivacaine 0.5% for local wound infiltration in managing postoperative pain after total thyroidectomy.
To evaluate the duration of analgesic effect provided by wound infiltration.

Main Methods:

A prospective, randomized, double-blind study involving 60 patients undergoing total thyroidectomy.
Patients were divided into three groups: control (no infiltration), bupivacaine 0.5% infiltration, and ropivacaine 0.75% infiltration.
Postoperative pain was assessed using the Visual Analogue Scale (VAS) at 1, 4, 8, and 16 hours post-surgery.

Main Results:

Ropivacaine 0.75% demonstrated a statistically significant reduction in pain at 1 hour postoperatively (P=0.028).
Bupivacaine 0.5% showed a non-significant decrease in pain at 1 hour.
No significant difference in pain perception was observed between the groups at 4 hours and beyond.

Conclusions:

Local wound infiltration with local analgesia provides a limited, short-term benefit in reducing postoperative pain.
Ropivacaine 0.75% is recommended over bupivacaine 0.5% for the initial postoperative hour.
The analgesic effect of these agents is transient, highlighting the need for multimodal pain management strategies.