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Related Concept Videos

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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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
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Drugs Acting on Autonomic Ganglia: Blockers01:28

Drugs Acting on Autonomic Ganglia: Blockers

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Ganglionic blockers inhibit autonomic activity by blocking nicotinic receptors in the autonomic ganglia, suppressing impulse transmission. These blockers lack selectivity between sympathetic and parasympathetic ganglia and are ineffective as neuromuscular junction antagonists. They can be categorized into two groups:
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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...
726
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

912
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...
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Related Experiment Video

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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
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Peripheral Nerve Blocks: A Tool for Inpatient Pediatric Status Migrainosus.

Ajay Goenka1, Mahesh Chikkannaiah1, Laura D Fonseca2

  • 1Department of Neurology, Dayton Children's Hospital, Dayton, Ohio; Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio.

Pediatric Neurology
|November 24, 2022
PubMed
Summary

Peripheral nerve blocks (PNB) offer a safe and effective inpatient treatment for pediatric status migrainosus, reducing pain and hospital stays. PNBs achieved target pain control with fewer side effects compared to DHE.

Keywords:
DihydroergotaminePediatricPeripheral nerve blockStatus migrainosus

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Area of Science:

  • Pediatric Neurology
  • Pain Management
  • Anesthesiology

Background:

  • Status migrainosus is a debilitating neurological condition in pediatric patients.
  • Inpatient management of status migrainosus often involves intravenous therapies.
  • Refractory cases require evaluation of alternative treatment strategies.

Purpose of the Study:

  • To evaluate the efficacy and safety of peripheral nerve blocks (PNB) for inpatient pediatric status migrainosus.
  • To compare PNBs with dihydroergotamine (DHE) in achieving pain control and reducing hospital stay.
  • To assess the side effect profiles of PNB and DHE treatments.

Main Methods:

  • Retrospective cohort analysis of pediatric patients (13-18 years) with status migrainosus admitted between 2017-2022.
  • Patients refractory to first- and second-line intravenous therapy received either PNB or DHE.
  • Primary outcome: 50% reduction in pain score (Visual Analog Scale); secondary outcome: duration of hospital stay.

Main Results:

  • Peripheral nerve block (PNB) achieved target pain control in 38 of 77 patients, while DHE achieved it in 59 of 100 patients.
  • Patients responding to PNB had a significantly shorter hospital stay (3.6 days) compared to DHE (4.9 days).
  • PNB showed a lower incidence of side effects (injection site pain, 39%) compared to DHE (nausea/vomiting, 50%).

Conclusions:

  • Peripheral nerve blocks are a safe and effective inpatient treatment option for pediatric status migrainosus.
  • PNB administration in a hospital setting can lead to successful pain management.
  • PNB treatment is associated with a reduced hospital stay duration and minimal adverse events.