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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...
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 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...
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...
General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
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 12, 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

Epidural steroids: a comprehensive, evidence-based review.

Steven P Cohen1, Mark C Bicket, David Jamison

  • 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. scohen40@jhmi.edu

Regional Anesthesia and Pain Medicine
|April 20, 2013
PubMed
Summary

Epidural steroid injections (ESIs) offer modest pain relief for select patients, lasting under 3 months. While generally safe, efficacy varies by injection type and physician specialty, with some evidence suggesting potential surgical avoidance.

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Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
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Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome

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Last Updated: May 12, 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

Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
05:18

Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome

Published on: May 26, 2023

Area of Science:

  • Pain Management
  • Interventional Pain Medicine
  • Spinal Injections

Background:

  • Epidural steroid injections (ESIs) are a globally prevalent pain management technique.
  • Despite extensive research, controversy persists regarding ESI safety and efficacy.
  • Study outcomes are often influenced by the performing physician's specialty.

Purpose of the Study:

  • To critically evaluate the existing literature on epidural steroid injections.
  • To identify factors influencing the efficacy and outcomes of ESIs.
  • To assess the safety profile and potential surgical implications of ESIs.

Main Methods:

  • Systematic review and analysis of placebo-controlled studies and systematic reviews.
  • Subgroup analyses examining injection techniques (transforaminal, interlaminar, caudal).
  • Evaluation of factors such as control group type, injection volume, and steroid formulation.

Main Results:

  • Over half of controlled studies show modest, short-term ( < 3 months) positive effects in well-selected patients.
  • Transforaminal injections and lumbar herniated discs show higher likelihood of positive response.
  • Serious complications are rare with proper precautions; strategic ESI use may prevent surgery in some cases.

Conclusions:

  • ESI efficacy is modest and variable, influenced by technique, patient selection, and physician expertise.
  • While generally safe, careful consideration of injection parameters and patient response is crucial.
  • ESIs may offer a non-surgical option for select patients, potentially preventing the need for surgery.