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Related Concept Videos

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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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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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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Paravertebral regional blocks decrease length of stay following surgery for pectus excavatum in children.

Patrick D Loftus1, Craig T Elder1, Katie W Russell1

  • 1Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA.

Journal of Pediatric Surgery
|November 19, 2015
PubMed
Summary

Paravertebral regional blocks effectively reduced length of stay for pectus excavatum repair patients compared to epidural analgesia. While not decreasing overall cost, this method offers an effective alternative for pain management.

Keywords:
EpiduralIntercostalLength of stayPain managementParavertebralPectus excavatum

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Area of Science:

  • Thoracic surgery
  • Pain management
  • Anesthesiology

Background:

  • Postoperative pain management for pectus excavatum repair traditionally involves epidural analgesia, narcotics, and benzodiazepines.
  • Minimizing inpatient length of stay (LOS) is a key goal in surgical recovery.

Purpose of the Study:

  • To investigate if intercostal or paravertebral regional blocks could decrease LOS after pectus excavatum repair.
  • To compare the efficacy of regional blocks versus traditional epidural analgesia for pain control and patient outcomes.

Main Methods:

  • Retrospective cohort study of 137 patients undergoing pectus excavatum repair (Nuss and Ravitch procedures).
  • Pain management strategies included epidural, intercostal, or paravertebral analgesia.
  • Outcomes measured: LOS, pain scores, medication requirements, emesis, and costs.

Main Results:

  • Paravertebral and intercostal blocks significantly reduced LOS in Nuss patients compared to epidural analgesia.
  • Narcotic use increased with paravertebral blocks, but emesis rates remained similar.
  • Initial pain scores were higher with regional blocks, but equivalent by day three for paravertebral blocks.

Conclusions:

  • Continuous infusion paravertebral pain catheters are an effective alternative to epidural analgesia for pectus excavatum repair.
  • This method leads to shorter LOS but does not reduce overall hospital costs.