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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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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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Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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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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Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

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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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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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Regional anesthesia does not decrease opioid demand in pelvis and acetabulum fracture surgery.

Daniel J Cunningham1, J Patton Robinette2, Ariana R Paniagua3

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

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie
|September 14, 2021
PubMed
Summary
This summary is machine-generated.

Regional anesthesia (RA) for pelvic and acetabular fractures increased inpatient and outpatient opioid demand. This suggests RA may not benefit these patients regarding opioid consumption.

Keywords:
OpioidPelvis and acetabulum fracture surgeryRegional anesthesia

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology
  • Pain Management

Background:

  • Pelvic and acetabular fractures cause significant perioperative pain.
  • Regional anesthesia (RA) techniques like nerve blocks and spinal analgesia are used for pain management.
  • The impact of RA on opioid consumption in these patients is not well understood.

Purpose of the Study:

  • To evaluate the effect of perioperative RA on inpatient opioid consumption.
  • To assess the impact of perioperative RA on outpatient opioid demand.

Main Methods:

  • Retrospective observational study of 205 adult patients undergoing surgery for pelvic and acetabular fractures.
  • Analysis of inpatient opioid consumption and outpatient opioid demand.
  • Adjusted analyses controlled for patient demographics, comorbidities, and injury characteristics.

Main Results:

  • Adjusted models showed increased inpatient opioid consumption between 48-72 hours post-op with RA (p < 0.05).
  • Cumulative outpatient opioid demand was significantly higher with RA from discharge to 90 days post-op (p < 0.05).
  • No significant differences in opioid consumption were observed at other inpatient time points or for outpatient demand up to two weeks post-op.

Conclusions:

  • Regional anesthesia in patients with pelvic and acetabular fractures is associated with increased inpatient and outpatient opioid demand.
  • RA may not provide benefits in reducing opioid consumption for these specific fracture types.
  • Further research is needed to understand the implications of these findings on long-term opioid use.