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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: 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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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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Local Anesthetics: Common Agents and Their Applications01:23

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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.
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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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Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
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Selective Nerve Block Combined With Tumescent Anesthesia.

Candemir Ceran1, Berrak Aksam2, Ersin Aksam3

  • 1Plastic, Reconstructive and Aesthetic Surgery Clinic, Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey.

The Journal of Hand Surgery
|November 4, 2015
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Selective nerve blocks before tumescent anesthesia significantly reduced injection pain in hand surgery patients. This approach enhanced patient satisfaction without affecting overall intraoperative or postoperative pain and anxiety levels.

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Area of Science:

  • Anesthesiology
  • Plastic Surgery
  • Pain Management

Background:

  • Tumescent anesthesia is commonly used for superficial surgical procedures.
  • Patient comfort during anesthesia administration is crucial for overall satisfaction.
  • Preemptive pain management strategies can improve surgical outcomes.

Purpose of the Study:

  • To assess the impact of selective nerve blocks preceding tumescent anesthesia on patient pain and anxiety.
  • To compare pain and anxiety levels in patients receiving tumescent anesthesia alone versus those receiving nerve blocks followed by tumescent anesthesia.

Main Methods:

  • Prospective study involving 80 patients undergoing hand surgery.
  • Group 1: Tumescent anesthesia only (n=40).
  • Group 2: Selective nerve blocks followed by tumescent anesthesia (n=40).
  • Pain and anxiety assessed preoperatively, intraoperatively, and postoperatively via questionnaires.
  • Data analyzed using independent samples t-test.

Main Results:

  • No significant differences in age, sex, or diagnosis between groups.
  • No complications were reported for tumescent anesthesia or nerve blocks.
  • The group receiving nerve blocks reported significantly lower pain during anesthesia injections.
  • No significant differences in intraoperative or postoperative pain and anxiety levels were observed between groups.

Conclusions:

  • Combining selective nerve blocks with tumescent anesthesia in hand surgery effectively reduces injection-related pain.
  • This combined approach leads to increased patient satisfaction.
  • The technique offers a valuable strategy for improving patient experience during tumescent anesthesia.