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Related Concept Videos

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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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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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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General Anesthesia: Overview01:24

General Anesthesia: Overview

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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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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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Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Related Experiment Video

Updated: Dec 6, 2025

External Cephalic Version: Is it an Effective and Safe Procedure?
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Nitrous oxide analgesia for external cephalic version: A randomized controlled trial.

Lacey E Straube1, Kristen L Fardelmann1, Amy A Penwarden1

  • 1University of North Carolina School of Medicine, Department of Anesthesiology, N2198 UNC Hospitals CB#7010, Chapel Hill, NC 27599-7010, USA.

Journal of Clinical Anesthesia
|October 5, 2020
PubMed
Summary
This summary is machine-generated.

Nitrous oxide did not reduce pain or anxiety during external cephalic version compared to oxygen placebo. This study does not support the routine use of nitrous oxide for this procedure.

Keywords:
AnesthesiaExternal cephalic versionNitrous oxideObstetricOxygenRandomized control trial

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Area of Science:

  • Obstetrics and Gynecology
  • Pain Management
  • Anesthesiology

Background:

  • Pain and anxiety can limit the success of external cephalic version (ECV) for breech presentation.
  • Neuraxial anesthesia is effective but not always feasible due to resource limitations.
  • Nitrous oxide is a noninvasive analgesic option with minimal side effects and limited facility requirements.

Purpose of the Study:

  • To determine if nitrous oxide analgesia reduces pain during ECV compared to an oxygen placebo.
  • To evaluate the effects of nitrous oxide on anxiety, patient satisfaction, and procedure difficulty during ECV.

Main Methods:

  • Double-blinded, randomized, placebo-controlled trial conducted in a labor and delivery triage room.
  • Forty-eight patients (≥18 years, ≥37 weeks gestation, singleton breech presentation, ASA physical status I-III) undergoing ECV.
  • Patients received either self-administered 50% nitrous oxide/50% oxygen or 100% oxygen placebo.

Main Results:

  • No significant difference in intra-procedural pain scores (5.5 ± 2.3 vs. 5.4 ± 2.7) or anxiety scores (1.6 ± 2.0 vs. 1.2 ± 1.8) between groups.
  • Procedural difficulty was similar between the nitrous oxide and placebo groups (6.1 ± 2.2 vs. 6.1 ± 3.2).
  • Increased version attempts were noted in the nitrous oxide group (3.9 ± 1.9 vs. 2.8 ± 1.4), and patient satisfaction was significantly lower (4.3 ± 4.0 vs. 6.9 ± 3.6).

Conclusions:

  • Nitrous oxide provided no analgesic benefit over oxygen placebo for external cephalic version.
  • The routine use of nitrous oxide for ECV is not supported by these findings.
  • Further research may be needed to explore alternative pain management strategies for ECV.