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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

512
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...
512
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

840
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...
840
Drug Delivery: Parenteral Route01:29

Drug Delivery: Parenteral Route

929
The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
929
Drug Delivery: Miscellaneous Routes01:22

Drug Delivery: Miscellaneous Routes

491
Drug delivery methods like oral inhalation, nasal sprays, transdermal patches, eye drops, intravitreal injection,  and rectal administration provide localized effects with reduced toxicity.
Oral inhalation and nasal sprays swiftly transfer drugs across the respiratory epithelium's mucosal layer. Inhaled glucocorticoids and bronchodilators directly target lung conditions such as asthma, while fluticasone nasal spray mitigates allergic rhinitis.
Transdermal patches transport drugs...
491
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

215
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
215
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

612
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...
612

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Related Experiment Video

Updated: Sep 24, 2025

Author Spotlight: Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
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Epidural Steroid Injections.

Joseph William1, Christian Roehmer1, LeiLani Mansy2

  • 1Department and Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Vanderbilt Stallworth Rehabilitation Hospital, 1221 Children's Way, Suite 1318, Nashville, Tennessee, USA.

Physical Medicine and Rehabilitation Clinics of North America
|May 8, 2022
PubMed
Summary

Epidural steroid injections (ESI) offer effective radicular pain relief and functional improvement. The transforaminal (TF) approach shows the most robust efficacy, but technique selection depends on individual patient factors and risks.

Keywords:
Epidural steroid injectionsIntervertebral disc displacementRadicular painRadiculopathySpinal stenosis

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Area of Science:

  • Pain Medicine
  • Interventional Radiology
  • Neurosurgery

Background:

  • Radicular pain significantly impacts patient function and quality of life.
  • Epidural steroid injections (ESI) are a common interventional treatment for radicular pain.
  • Three primary ESI approaches exist: interlaminar (IL), transforaminal (TF), and caudal.

Purpose of the Study:

  • To review the efficacy and risks of different epidural steroid injection approaches.
  • To highlight the transforaminal (TF) route's strong efficacy data.
  • To emphasize personalized approach selection based on clinical factors.

Main Methods:

  • Review of existing literature on epidural steroid injection techniques.
  • Comparative analysis of efficacy and risk data for interlaminar, transforaminal, and caudal routes.
  • Consideration of patient-specific factors in treatment selection.

Main Results:

  • The transforaminal (TF) approach demonstrates the most substantial evidence for efficacy.
  • Efficacy and risk profiles differ significantly among interlaminar (IL), transforaminal (TF), and caudal injections.
  • Patient's clinical presentation, underlying pathology, and anatomy are crucial for optimal technique selection.

Conclusions:

  • Epidural steroid injections are a valuable tool for managing radicular pain.
  • The choice of injection approach (interlaminar, transforaminal, caudal) requires careful consideration of individual patient variables.
  • Personalized treatment strategies incorporating technique-specific risks and benefits are essential for maximizing outcomes.