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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.
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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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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Nondepolarizing neuromuscular blockers induce paralysis by competitively blocking nicotinic acetylcholine receptors at the muscle end plate. Examples include pancuronium, mivacurium, vecuronium, and rocuronium. These quaternary ammonium derivatives are administered intravenously, are poorly absorbed, and are excreted via the kidneys.
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Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
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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.
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Update on paravertebral blocks.

Richa Wardhan1

  • 1Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA.

Current Opinion in Anaesthesiology
|August 27, 2015
PubMed
Summary
This summary is machine-generated.

Paravertebral blocks (PVBs) show significant advancements in managing acute surgical and chronic nonsurgical pain. Research highlights their expanding role in various surgical fields and potential impact on cancer pain management.

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Surgical Innovation

Background:

  • Paravertebral blocks (PVBs) are increasingly recognized for their efficacy.
  • Recent years have seen substantial research into their applications beyond traditional acute pain management.

Purpose of the Study:

  • To provide an update on recent developments in paravertebral blocks.
  • To foster discussion on advancements in PVB techniques and applications.

Main Methods:

  • Review of recent literature on paravertebral blocks.
  • Analysis of PVB applications in various surgical and nonsurgical pain contexts.

Main Results:

  • Significant progress in utilizing PVBs for acute pain in breast, thoracic, and cardiac surgery.
  • Growing evidence for PVB effectiveness in pediatric surgery and nonsurgical pain.
  • Emerging techniques and procedures for performing PVBs have been developed.

Conclusions:

  • Paravertebral analgesia shows promise for managing cancer pain and potentially preventing metastasis.
  • The expanding data on PVBs has led to their resurgence in acute pain management across diverse fields.