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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

510
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...
510
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

823
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...
823
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

608
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...
608
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

954
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...
954
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

1.3K
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...
1.3K
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

212
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.
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Related Experiment Video

Updated: Sep 21, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy

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Neuraxial labor analgesia: Initiation techniques.

Anthony Chau1, Lawrence Tsen2

  • 1BC Women's Hospital, Department of Anesthesia, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.

Best Practice & Research. Clinical Anaesthesiology
|June 6, 2022
PubMed
Summary

Neuraxial analgesia techniques, including epidural and combined spinal epidural, offer effective labor pain relief with minimal side effects. Techniques involving dural puncture provide faster onset and improved outcomes for maternal-fetal well-being.

Keywords:
combined spinal epidural techniquecontinuous spinal techniquedural puncture epidural techniqueepidural techniqueintrathecal catheterneuraxial labor analgesianeuraxial techniques

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Area of Science:

  • Anesthesiology
  • Obstetrics
  • Pain Management

Background:

  • The ideal labor analgesia technique requires rapid onset, predictable quality, adjustable depth/duration, ease of use, and minimal maternal/fetal side effects.
  • Catheter-based neuraxial approaches, such as epidural, combined spinal epidural (CSE), dural puncture epidural (DPE), and intrathecal catheter techniques, aim to meet these criteria.

Purpose of the Study:

  • To review the technical considerations, analgesic characteristics, and side effect profiles of various catheter-based neuraxial techniques for labor analgesia.
  • To compare techniques based on their impact on the maternal-fetal dyad and guide selection based on patient and clinical factors.

Main Methods:

  • Review of existing literature on neuraxial labor analgesia techniques.
  • Analysis of technical aspects, efficacy, and safety profiles of epidural, CSE, DPE, and intrathecal catheter methods.

Main Results:

  • Labor analgesic techniques initiating with dural puncture demonstrate faster onset, enhanced bilateral and sacral spread, and reduced epidural catheter failure rates.
  • Each neuraxial technique possesses unique characteristics influencing maternal and fetal outcomes.

Conclusions:

  • Selection of neuraxial analgesia should be individualized, considering patient/team goals, clinical context, and institutional practices.
  • Further research into the mechanisms, benefits, and risks of different neuraxial initiation techniques is warranted to optimize labor pain management.