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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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.
One of the advantages of...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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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.
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...
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Regional Terms01:12

Regional Terms

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Regional terms describe anatomy by dividing the body parts into different regions that contain structures involved in contributing similar functions. Using these terms helps increase the accurate description and identification of the particular region of interest or region affected by the disease.
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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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...
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Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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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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General Anesthesia: Overview01:24

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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.
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Regional anesthesia practice in Greece: A census report.

Erifili Argyra1, Eleni Moka2, Chryssoula Staikou1

  • 1Department of Anesthesiology, Pain Relief and Palliative Care Unit, Aretaieio Hospital, Medical School, University of Athens, Athens 11528, Greece.

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Regional anesthesia (RA) was utilized in 45.5% of Greek surgeries in 2011, with spinal anesthesia being most common. Lack of equipment and training limited RA use, particularly for peripheral nerve blocks (PNBs).

Keywords:
Central neuraxial blocksepidural techniqueperipheral nerve blocksregional anesthesiaspinal technique

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Area of Science:

  • Anesthesiology
  • Surgical Procedures
  • Regional Anesthesia

Background:

  • Regional anesthesia (RA) techniques, including central neuraxial blocks (CNBs) and peripheral nerve blocks (PNBs), are established anesthesia/analgesia methods.
  • Nationwide data on RA utilization in Greece was previously limited.

Purpose of the Study:

  • To assess the utilization and patterns of RA techniques in Greece during 2011.
  • To identify factors influencing the application of RA.

Main Methods:

  • A nationwide, cross-sectional descriptive survey was conducted in March-June 2012.
  • A structured questionnaire was distributed to 128 Greek Anesthesia Departments.
  • Data from 66 responding departments (51.56% response rate) representing 187,703 operations were analyzed.

Main Results:

  • RA was employed in 45.5% of surgical procedures.
  • Spinal anesthesia was the most frequent RA technique (51.9%), predominantly in orthopedics.
  • Epidural anesthesia/analgesia (23.2%) was common in obstetrics/gynecology; PNBs constituted 13.64%.
  • Neurostimulator use was high for PNBs (78.5%), while ultrasound guidance was limited (5%).
  • Familiarity with CNBs was high (94.49%), but lower for PNBs (46.4%).
  • Key limitations included lack of equipment (58.23%) and inadequate training (49.29%).

Conclusions:

  • Regional anesthesia modalities were routinely used in Greece in 2011.
  • Neuraxial blocks, particularly spinal anesthesia, were favored over PNBs.
  • Underutilization of RA techniques was linked to equipment shortages and insufficient training.