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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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...
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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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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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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: Differential Sensitivity of Nerve Fibers01:24

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
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A randomised controlled comparison between stimulating and standard catheters for lumbar plexus block.

G Cappelleri1, D Ghisi2, E Ceravola3

  • 1Department of Anaesthesia, Istituto Ortopedico G. Pini, Milan, Italy.

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Summary

Stimulating catheters significantly reduce the required anesthetic volume for lumbar plexus blocks. This method, using mepivacaine, halves the effective anesthetic dose and improves block success rates compared to standard catheters.

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia

Background:

  • Continuous lumbar plexus blocks are crucial for managing lower limb pain.
  • Optimizing anesthetic volume and ensuring block success are key clinical challenges.

Purpose of the Study:

  • To compare the efficacy of stimulating catheters versus standard catheters in reducing the minimum effective anesthetic volume (MEAV50) for lumbar plexus blocks.
  • To evaluate the impact of stimulating catheters on the success rate of lumbar plexus blocks.

Main Methods:

  • A randomized, prospective, blinded study involving 58 patients (ASA physical status 1-3).
  • Patients received lumbar plexus blocks using either a stimulating or standard catheter with mepivacaine 1.5%.
  • The up-and-down staircase method was used to determine MEAV50.

Main Results:

  • The MEAV50 was significantly lower with stimulating catheters (12.2 ml) compared to standard catheters (24.8 ml) (p < 0.0001).
  • Complete lumbar plexus block was achieved in 100% of patients with stimulating catheters versus 69% with standard catheters (p = 0.002).

Conclusions:

  • Stimulating catheters effectively reduce the minimum effective anesthetic volume for lumbar plexus blocks by approximately 50%.
  • The use of stimulating catheters enhances the success rate of continuous lumbar plexus blocks.