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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...
673
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...
1.1K
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

908
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...
908
Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

626
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.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
626
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

539
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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Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve
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New peripheral nerve blocks and local anesthetics.

Sinem Sari1,2, Jennifer Kumar3, Alparslan Turan1,3

  • 1Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.

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New regional anesthesia blocks and local anesthetics show promise, but further research is needed to confirm their efficacy and safety compared to standard methods. More studies are required to guide clinical practice.

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Area of Science:

  • Anesthesiology
  • Regional Anesthesia
  • Pain Management

Background:

  • Ultrasound guidance has spurred the development of novel regional anesthesia blocks.
  • Existing studies on new blocks often lack comparison with gold standards and have small sample sizes.
  • Recent advancements include new local anesthetics and adjuvants, with ongoing evaluation of their long-term effects.

Purpose of the Study:

  • To review current regional blocks, their applications, and clinical utility.
  • To discuss newly introduced local anesthetics and those in development.
  • To highlight the need for comparative studies on novel techniques and agents.

Main Methods:

  • Literature review of recent advancements in regional anesthesia.
  • Analysis of studies on new regional blocks and local anesthetics.
  • Synthesis of current evidence regarding efficacy, safety, and clinical application.

Main Results:

  • Several new regional blocks (e.g., erector spinae plane, pectoral nerve blocks) have emerged with ultrasound guidance.
  • Evidence for many new blocks is limited by small study sizes and lack of comparison to established techniques.
  • The efficacy and safety of newer local anesthetics, including liposomal bupivacaine, require further investigation and comparison with conventional agents.

Conclusions:

  • Novel regional anesthesia techniques and local anesthetics offer potential benefits but require rigorous validation.
  • Future research should prioritize large-scale, comparative studies to establish the efficacy and safety of new agents and techniques.
  • The focus should be on optimizing prolonged analgesia through minimally invasive regional methods and comparing new local anesthetics against current standards.