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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 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 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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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Skeletal Muscle Relaxants: Adverse Effects01:21

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Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
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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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Paravertebral block: anatomy and relevant safety issues.

Alberto E Ardon1, Justin Lee2, Carlo D Franco3

  • 1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA.

Korean Journal of Anesthesiology
|March 17, 2020
PubMed
Summary

Thoracic paravertebral block offers effective surgical analgesia but carries risks. Careful anatomical knowledge and needle manipulation, like limiting medial/lateral orientation and using caudal redirection, can minimize complications.

Keywords:
AnatomyParavertebralPostoperative painSafetyTruncal nerve blockregional anesthesia

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Surgical Procedures

Background:

  • Paravertebral block, particularly thoracic paravertebral block, is a valuable regional anesthetic technique.
  • It provides significant analgesia for various surgeries, including breast, pulmonary, and herniorrhaphy.
  • Despite its effectiveness, the technique has potential adverse effects.

Purpose of the Study:

  • To discuss the anatomy and technical aspects of paravertebral blocks.
  • To emphasize the importance of proper needle manipulation for minimizing complications.
  • To propose safety measures for performing paravertebral blocks.

Main Methods:

  • Review of anatomical and technical aspects of paravertebral blocks.
  • Discussion of needle manipulation strategies for risk reduction.
  • Consideration of landmark-based and ultrasound-guided approaches.

Main Results:

  • Proper anatomical knowledge and technique are crucial for decreasing adverse effects.
  • Limiting medial and lateral needle orientation and using caudal redirection enhance safety in landmark-based approaches.
  • Identifying targets distant from the neurovascular bundle is beneficial in ultrasound-guided procedures.

Conclusions:

  • Paravertebral blocks are effective but require meticulous technique to avoid complications.
  • Specific needle manipulation strategies can significantly improve the safety margin.
  • Enhanced understanding and application of technique are key to successful paravertebral blockade.