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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.
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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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Analgesia and Pain Management01:25

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

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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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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
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[Pain therapy during labour].

Stefan Jochberger1, Clemens Ortner2, Klaus Ulrich Klein2

  • 1Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich. stefan.jochberger@i-med.ac.at.

Wiener Medizinische Wochenschrift (1946)
|June 4, 2017
PubMed
Summary
This summary is machine-generated.

Programmed intermittent epidural bolus (PIEB) offers superior labor pain relief and patient satisfaction compared to continuous epidural infusions. Emerging alternatives like remifentanil and nitrous oxide require careful monitoring and interdisciplinary collaboration for optimal pain management.

Keywords:
Epidural analgesiaLabour painNitrous oxidePIEBRemifentanil

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Pain Management

Background:

  • Epidural analgesia is the standard for labor pain management.
  • Programmed intermittent epidural bolus (PIEB) shows advantages over continuous infusions.
  • Alternative analgesia methods like remifentanil and nitrous oxide are emerging.

Purpose of the Study:

  • To compare the effectiveness and side effects of different labor pain management techniques.
  • To highlight the benefits of PIEB over continuous epidural infusion.
  • To discuss the potential and risks of alternative analgesics.

Main Methods:

  • Review of current literature on labor analgesia.
  • Comparison of PIEB, continuous epidural infusion, remifentanil, and nitrous oxide.
  • Emphasis on patient outcomes, safety, and satisfaction.

Main Results:

  • PIEB provides better pain reduction, less motor block, and higher parturient satisfaction than continuous epidural infusion.
  • Remifentanil necessitates close hemodynamic monitoring due to potential cardiac and respiratory impairment.
  • Nitrous oxide, while a greenhouse gas with potential B12 interactions, is becoming more attractive with new extraction systems.

Conclusions:

  • PIEB is a highly effective method for labor pain management.
  • Alternative analgesics require careful consideration of risks and benefits.
  • An interdisciplinary approach involving obstetricians, midwives, and anesthesiologists is crucial for tailoring pain management strategies.