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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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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 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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The Epidural Treatment of Sciatica: Its Origin and Evolution.

Bastiaan C Ter Meulen1, Henry Weinstein, Raymond Ostelo

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Epidural injections with corticosteroids are a common treatment for lower back pain and sciatica. While their effectiveness is debated, these injections offer short-term relief for leg pain.

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Area of Science:

  • Pain Management
  • Neurology
  • Pharmacology

Background:

  • Epidural injections are a prevalent treatment for lower back pain and sciatica.
  • The technique originated in Paris around 1900, initially using cocaine.
  • Corticosteroids were introduced for epidural use in the early 1950s.

Observation:

  • Early pioneers like Jean Sicard and Fernand Cathelin independently administered injections.
  • The practice gradually expanded across Europe and North America.
  • Clinical trials since the 1970s have investigated epidural corticosteroid efficacy.

Findings:

  • Epidural corticosteroid injections demonstrate a statistically significant, albeit modest, short-term benefit for leg pain compared to placebo.
  • The historical evolution shows a transition from cocaine to corticosteroids for epidural therapy.
  • Despite ongoing discussions regarding safety and efficacy, the procedure remains widely utilized.

Implications:

  • Epidural corticosteroid injections continue to be a popular therapeutic option for specific pain conditions.
  • Further research may refine understanding of long-term outcomes and optimal patient selection.
  • The historical development highlights the iterative nature of medical treatment evolution.