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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

524
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...
524
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

731
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...
731
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

484
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...
484
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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

1.2K
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...
1.2K
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

914
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...
914

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Related Experiment Video

Updated: Aug 22, 2025

The Superficial Inferior Epigastric Artery Fascia Flap for Nerve Reconstruction in Rabbits
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Published on: June 13, 2025

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Continuous Ropivacaine Peroneal Nerve Infiltration for Fibula Free Flap in Cervicofacial Cancer Surgery: A Randomized

Cyrus Motamed1, Frederic Plantevin1, Jean Xavier Mazoit2

  • 1Service d'Anesthésie, Gustave Roussy Cancer Center, 94800 Villejuif, France.

Journal of Clinical Medicine
|November 11, 2022
PubMed
Summary

Common peroneal nerve block with ropivacaine did not significantly reduce pain after free flap surgery. While effective for harvest site pain on day 1, it did not lower opioid use and showed potential toxicity.

Keywords:
fibula free flaplocal anesthetic toxicitypostoperative painropivacaine infiltration

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Area of Science:

  • Anesthesiology
  • Oncology
  • Surgical Reconstruction

Background:

  • Post-cervicofacial cancer surgery pain is often undertreated.
  • Regional anesthesia at flap harvest sites is rational but understudied.
  • Fibular free flap reconstruction is used for oropharyngeal cancer mandibular reconstruction.

Purpose of the Study:

  • To assess the effect of common peroneal nerve infiltration on pain and opioid consumption.
  • To evaluate long-term pain after fibular free flap mandibular reconstruction.

Main Methods:

  • Fifty-six patients undergoing oropharyngeal cancer surgery with fibular free flap mandibular reconstruction were randomized.
  • One group received continuous ropivacaine infiltration via perineural catheter (ROPI), the other received systemic analgesia (CONTROL).
  • Pain scores, morphine consumption, and ropivacaine levels were monitored for 48 hours; long-term pain was assessed retrospectively.

Main Results:

  • Ropivacaine infiltration significantly reduced harvest site pain only on day 1.
  • Overall postoperative opioid consumption was not influenced by the nerve block.
  • Potentially toxic ropivacaine concentrations were observed in 50% of patients by day 2.
  • Chronic pain was rare, with only one patient in the ROPI group reporting harvest site pain.

Conclusions:

  • Continuous common peroneal nerve infiltration with ropivacaine did not significantly reduce overall postoperative pain or opioid consumption.
  • The technique resulted in blood concentrations near the toxic threshold.
  • Further research is needed to optimize efficacy and safety for regional anesthesia in this setting.