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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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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 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: 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.
One of the advantages of...
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General Anesthesia: Overview01:24

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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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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 Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures.

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Adding local anesthesia to general anesthesia for pediatric bone marrow aspirations and biopsies did not reduce opioid use but did lower immediate recovery pain scores. This approach did not improve quality of life in pediatric cancer patients undergoing these painful procedures.

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Area of Science:

  • Pediatric Oncology
  • Pain Management
  • Anesthesiology

Background:

  • Pediatric cancer patients endure frequent, painful procedures like bone marrow aspirations and biopsies (BMABs).
  • Effective pain management is crucial for reducing patient distress and improving quality of life during cancer treatment.

Purpose of the Study:

  • To compare the efficacy of general anesthesia (GA) alone versus GA combined with local anesthesia (LA) in managing pain during BMABs in pediatric neuroblastoma patients.
  • To assess the impact of GA + LA on postprocedural opioid requirements, pain scores, analgesic use, quality of life, and toxicity.

Main Methods:

  • A prospective, single-blind, crossover trial involving pediatric neuroblastoma patients undergoing two sequential BMABs.
  • Participants received either GA alone or GA + LA for each procedure, with random assignment to the sequence.
  • Primary endpoint was the percentage of patients needing postprocedural opioids; secondary endpoints included pain scores, analgesic consumption, and quality of life.

Main Results:

  • No significant difference was observed in the percentage of participants requiring postprocedural opioids between the GA and GA + LA groups (24% vs. 20%, P = .5).
  • Pain scores in the recovery room were significantly lower with GA + LA compared to GA alone (median [IQR]: 0 [0-2] vs. 2 [0-4], P = .002).
  • There were no statistically significant differences in other secondary outcomes, including total analgesic use, later pain scores, time to first analgesic, quality of life interference, or toxicity.

Conclusions:

  • Local anesthesia, when added to general anesthesia for BMABs, significantly reduces immediate postprocedural pain.
  • However, the addition of LA did not decrease the need for postprocedural opioids or improve overall quality of life for these pediatric patients.
  • The findings suggest that while LA offers short-term pain relief, its broader impact on recovery and opioid use in this context requires further investigation.