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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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.
One of the advantages of...
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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: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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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.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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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: 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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Local Anesthetics: Chemistry and Structure-Activity Relationship01:30

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Local anesthetics (LAs) are drugs that induce a temporary loss of sensation in a limited body area, preventing pain. Cocaine was the first local anesthetic discovered in the late 19th century. Cocaine is a benzoic acid ester obtained from the leaves of coca shrubs and was often used for its psychotropic effects. Cocaine was first isolated in 1860 by Albert Niemann. Sigmund Freud studied the physiological actions of cocaine. Carl Koller later introduced it into clinical practice in 1884 as a...
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Regional anaesthesia for cleft lip surgery in a developing world setting.

V Malherbe1, A T Bosenberg2, A K Lizarraga Lomeli3

  • 1Kimberley Hospital Complex, Northern Cape, South Africa.

South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
|September 7, 2017
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Regional anesthesia for cleft lip surgery in older children in developing countries is safe and effective. This study found no major complications, showing it

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Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Global Health

Background:

  • The use of regional anesthesia for cleft lip surgery in developing nations is under-researched.
  • Limited data exists on the safety and efficacy of regional anesthesia in resource-limited settings for pediatric plastic surgery.

Purpose of the Study:

  • To evaluate the safety and effectiveness of regional anesthesia as the sole anesthetic technique for cleft lip repair in patients over 14 years old.
  • To assess the incidence of intraoperative and postoperative complications associated with regional anesthesia in this specific patient population and setting.

Main Methods:

  • Retrospective chart review of 100 patients aged >14 years undergoing cleft lip surgery.
  • Procedures were performed during Operation Smile South Africa (OSSA) programs in Madagascar (2007-2008).
  • Regional anesthesia involved bilateral infraorbital nerve block, dorsal nasal nerve block, septal block, and peri-incisional infiltration.

Main Results:

  • 74 patients initiated surgery under regional anesthesia without intraoperative complications.
  • No postoperative complications or conversions to general anesthesia were recorded.
  • Two patients required supplemental analgesia post-operatively.

Conclusions:

  • Regional anesthesia was well-tolerated in patients over 14 undergoing cleft lip surgery.
  • It demonstrated a low complication rate, proving to be a safe and effective sole anesthetic option for cheiloplasty in the developing world.