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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Local Anesthetics: Common Agents and Their Applications01:23

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
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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 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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Collecting And Measuring Wound Exudate Biochemical Mediators In Surgical Wounds
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Bupivacaine local anesthetic to decrease opioid requirements after radical cystectomy: Does formulation matter?

Bogdana Schmidt1, Hriday P Bhambhvani1, Daniel R Greenberg1

  • 1Department of Urology, Stanford University School of Medicine, Stanford, CA.

Urologic Oncology
|December 11, 2020
PubMed
Summary
This summary is machine-generated.

High-dose standard bupivacaine (SB) and liposomal bupivacaine (LB) provide similar pain relief and opioid reduction after radical cystectomy (RC). This study found no significant differences in pain scores or hospital stay between the two anesthetic methods.

Keywords:
Bladder cancerLiposomal bupivacainePain managementPerioperative analgesiaRadical cystectomy

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Area of Science:

  • Urology
  • Anesthesiology
  • Pain Management

Background:

  • Opioid reduction is crucial in radical cystectomy (RC) recovery.
  • Liposomal bupivacaine (LB) is a costly, slow-absorbing analgesic with limited comparative studies.
  • Standard bupivacaine (SB) formulations offer an alternative for postoperative pain management.

Purpose of the Study:

  • To compare postoperative opioid requirements in patients receiving LB versus high-dose SB during RC.
  • To evaluate differences in pain scores and length of stay between LB and SB groups.
  • To assess the efficacy of SB as a cost-effective alternative to LB for pain control post-RC.

Main Methods:

  • A prospective cohort of 28 patients receiving intraoperative high-volume SB was compared to a historical cohort of 34 patients who received LB.
  • Primary endpoints included morphine equivalent dose (MED), Numeric Rating Scale (NRS) pain scores, and length of stay.
  • All patients were managed under enhanced recovery after surgery (ERAS) protocols.

Main Results:

  • No significant differences were observed in MED between SB and LB groups in the postanesthesia care unit (P=0.29) or during the hospital stay (P=0.81).
  • Patient-reported NRS pain scores on postoperative days 1, 2, and 3 were similar for both groups (P>0.19).
  • Length of stay was comparable between the SB and LB cohorts (P=0.93), with no differences noted in subgroup analyses of open or robotic RC.

Conclusions:

  • High-volume SB is as effective as LB in managing postoperative pain and reducing opioid consumption in RC patients under ERAS protocols.
  • SB presents a viable, potentially more cost-effective alternative to LB for intraoperative pain management in RC.
  • Further research may explore long-term outcomes and cost-effectiveness of SB versus LB in major urologic surgeries.