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Related Concept Videos

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: 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: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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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.
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...
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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: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

898
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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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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Earlier liposomal bupivacaine blocks improve analgesia and decrease opioid requirements for bariatric surgery

Alexis L Cralley1, Juliana Hopman1, Kiara Leasia1

  • 1Department of Surgery, Denver Health Medical Center, Denver, CO, USA.

American Journal of Surgery
|February 27, 2022
PubMed
Summary
This summary is machine-generated.

Administering liposomal bupivacaine (LB) transversus abdominis plane (TAP) blocks before bariatric surgery reduces narcotic needs. This timing strategy for LB TAP blocks offers improved pain management post-operation.

Keywords:
Bariatric surgeryGastric bypassLiposomal bupivacainePost-operative painTransversus abdominis plane blocks

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Area of Science:

  • Anesthesiology
  • Surgical Pain Management
  • Pharmacology

Background:

  • Bariatric surgery necessitates effective postoperative pain control.
  • The optimal timing for liposomal bupivacaine (LB) transversus abdominis plane (TAP) blocks in bariatric procedures remains undetermined.
  • Early pain management strategies can significantly impact patient recovery and opioid consumption.

Purpose of the Study:

  • To investigate the impact of administering LB TAP blocks before versus after bariatric surgery on postoperative narcotic requirements.
  • To determine if pre-incisional LB TAP blocks lead to reduced opioid use compared to post-completion blocks.
  • To evaluate the effect of block timing on pain management and discharge medication needs.

Main Methods:

  • A retrospective review was conducted on 86 bariatric surgery patients who received LB TAP blocks between February 2019 and August 2020.
  • Patients were divided into two groups: those receiving LB TAP blocks at the beginning of surgery (Beg-LB group, n=44) and those receiving them at the end (End-LB group, n=42).
  • Morphine equivalent daily doses (MEDD) and discharge oxycodone prescriptions were compared between the two groups.

Main Results:

  • Patients in the Beg-LB group required significantly lower MEDD on postoperative day 0 (4.8 vs 6.8, p=0.01) and postoperative day 2 (16 vs 32, p=0.04) compared to the End-LB group.
  • The Beg-LB group also had fewer discharge oxycodone prescriptions (15 vs 20, p=0.008).
  • These findings indicate a substantial reduction in opioid consumption when LB TAP blocks are administered preoperatively.

Conclusions:

  • Administering liposomal bupivacaine TAP blocks prior to bariatric surgery significantly reduces postoperative narcotic requirements.
  • Preincisional LB TAP blocks are more effective in managing pain and decreasing opioid dependence compared to blocks given at the end of surgery.
  • This study supports the use of preemptive LB TAP blocks as an optimal strategy for pain management in bariatric surgery patients.