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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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Spinal Nerves: Plexus I01:22

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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
The Cervical Plexus
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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

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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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Bioequivalence Experimental Study Designs: Completely Randomized and Randomized Block Designs01:20

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Body:Bioequivalence experimental study designs are crucial methodologies used in evaluating and comparing the bioavailability of different drug products. These designs are categorized into various types: completely randomized, randomized block, repeated measures, cross and carry-over, and Latin square designs.Completely randomized designs involve randomly allocating treatments to all subjects participating in the experiment. This allocation is achieved by assigning unique random numbers to...
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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: 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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Retroclavicular vs Infraclavicular block for brachial plexus anesthesia: a multi-centric randomized trial.

Andrés Felipe Gil Blanco1, Pascal Laferrière-Langlois1, David Jessop2

  • 1Department of Anesthesiology, Medicine and Health Sciences Faculty, Centre Hospitalier Universitaire de Sherbrooke (CHUS), 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.

BMC Anesthesiology
|October 29, 2019
PubMed
Summary

The retroclavicular (RCB) approach for brachial plexus anesthesia is comparable in performance time to the coracoid (ICB) approach. RCB significantly improves needle visualization during ultrasound-guided regional anesthesia.

Keywords:
AmbulatoryAnatomyBrachial plexusRegional anesthesiaUpper extremity

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Ultrasound-Guided Procedures

Background:

  • The coracoid approach (ICB) for brachial plexus regional anesthesia offers simplicity but presents challenges in needle visualization.
  • The retroclavicular approach (RCB) was investigated as a potential alternative to improve needle visibility.

Purpose of the Study:

  • To compare the performance time of the retroclavicular (RCB) approach versus the coracoid (ICB) approach for ultrasound-guided brachial plexus anesthesia.
  • To evaluate if the RCB approach offers improved needle visualization compared to the ICB approach.

Main Methods:

  • A randomized, controlled, non-inferiority trial was conducted in two hospitals.
  • Patients undergoing distal upper limb surgery were randomized to either ICB or RCB brachial plexus block.
  • Performance time (visualization and needling) was the primary outcome, with secondary outcomes including blockade depth, success rate, and complications.

Main Results:

  • Mean performance time for RCB was 4.8 minutes, compared to 5.2 minutes for ICB (p=0.06), demonstrating non-inferiority.
  • The RCB approach significantly improved needle visibility and achieved an ultrasound-needle angle closer to 0°.
  • No significant differences were observed in secondary outcomes between the two groups.

Conclusions:

  • The retroclavicular (RCB) approach is a viable alternative to the coracoid (ICB) approach for brachial plexus anesthesia, with similar performance times.
  • RCB offers superior needle visibility, a critical factor for successful ultrasound-guided regional anesthesia.
  • The findings support RCB as an effective technique for brachial plexus blocks.