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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

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...
955
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...
566
Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

958
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Peripheral Artery Disease V: Postoperative Nursing Management01:23

Peripheral Artery Disease V: Postoperative Nursing Management

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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

613
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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Related Experiment Video

Updated: Nov 7, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Published on: November 8, 2024

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Regional anesthesia does not decrease inpatient or outpatient opioid demand in distal femur fracture surgery.

Daniel J Cunningham1, Ariana R Paniaugua2, Micaela A LaRose2

  • 1Department of Orthopaedic Surgery, Duke University Medical Center, 200 Trent Drive, Durham, NC, 27710, USA. daniel.cunningham@duke.edu.

Archives of Orthopaedic and Trauma Surgery
|May 3, 2021
PubMed
Summary

Regional anesthesia (RA) for distal femur fractures increased inpatient and outpatient opioid demand. This study questions the routine use of RA in these cases.

Keywords:
Distal femur fractureFracture fixation.OpioidRegional anesthesia

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology
  • Pain Management

Background:

  • Regional anesthesia (RA) is utilized to mitigate pain and opioid use in distal femur fractures.
  • The real-world effects of RA on inpatient opioid consumption and subsequent outpatient opioid demand remain unclear.
  • This study hypothesized that RA would decrease both inpatient and outpatient opioid requirements.

Purpose of the Study:

  • To investigate the impact of regional anesthesia (RA) on inpatient opioid consumption.
  • To assess the effect of RA on outpatient opioid demand following operative treatment of distal femur fractures.

Main Methods:

  • A retrospective cohort study analyzed 230 patients undergoing operative treatment for distal femur fractures between 2013 and 2018.
  • Inpatient opioid consumption (0-72 hours post-op) and outpatient opioid demand (discharge to 90 days) were evaluated.
  • Multivariable models were employed to adjust for patient and operative characteristics.

Main Results:

  • Adjusted models showed a significant increase in inpatient opioid consumption between 24-48 hours post-operation in patients receiving RA (6.2 OE's) compared to those without (4.7 OE's).
  • Outpatient opioid demand was significantly higher in the RA group at 6 weeks (95.1 OE's vs. 74.9 OE's) and 90 days (113.1 OE's vs. 85 OE's).
  • No significant differences in opioid consumption were observed at other inpatient timepoints.

Conclusions:

  • Regional anesthesia in distal femur fracture surgery is associated with increased inpatient and outpatient opioid demand.
  • These findings challenge the routine application of RA for distal femur fractures.
  • Further research is warranted to explore alternative pain management strategies.