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Related Concept Videos

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 Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

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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: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

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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 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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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

1.2K
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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Feasibility and initial experience with continuous nerve blocks by emergency physicians.

Marc L Martel1, Mark R Robidoux1, Jaleesa L Morris1

  • 1Hennepin County Medical Center, Department of Emergency Medicine, EMS-825, 701 Park Avenue, Minneapolis, MN 55415, United States of America.

The American Journal of Emergency Medicine
|February 29, 2020
PubMed
Summary
This summary is machine-generated.

Emergency physicians can effectively manage continuous nerve blocks for trauma patients, significantly reducing opioid use. This approach offers a feasible pain management strategy for hip and rib fractures.

Keywords:
Continuous regional anesthesiaHip fractureNerve blockOpioidsRib fracture

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Area of Science:

  • Emergency Medicine
  • Anesthesiology
  • Trauma Surgery

Background:

  • Peripheral nerve blocks and regional anesthesia are standard for pain management in emergency departments.
  • Continuous nerve blocks offer prolonged analgesia, but their initiation and management by emergency physicians for trauma are less explored.

Purpose of the Study:

  • To assess the feasibility and initial experience of emergency physicians initiating and managing continuous nerve blocks for trauma patients.
  • To evaluate the effectiveness of continuous nerve blocks in reducing opioid consumption for rib and hip fractures.

Main Methods:

  • Retrospective observational cohort study of 41 adult patients with rib or hip fractures.
  • Data collected included demographics, injury details, anesthesia type, opioid use, and complications.
  • Descriptive statistical analyses were performed.

Main Results:

  • Continuous nerve blockade was initiated and managed by emergency physicians in 41 patients.
  • Mean duration of nerve blockade was 3.4 days, with a 58% reduction in hourly opioid use.
  • The most common complication was catheter dislodgement; no serious complications like pneumothorax or infection occurred.

Conclusions:

  • Emergency physicians can feasibly and effectively initiate and manage continuous nerve blocks for acute hip and rib fractures.
  • Continuous nerve blockade demonstrates potential for significant opioid reduction in trauma patients.