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Related Concept Videos

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: 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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Imaging Studies V: Intravenous Urography and Retrograde Pyelography01:22

Imaging Studies V: Intravenous Urography and Retrograde Pyelography

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IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
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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...
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Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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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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Related Experiment Video

Updated: Aug 3, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Paravertebral block vs. epidural block for percutaneous nephrolithotomy: A prospective, randomized study.

Pengcheng Zhu1, Qianqian Meng1, YuanYuan Miao1

  • 1Department of Anesthesiology, The Second Hospital of Dalian Medical University, Dalian, China.

Frontiers in Surgery
|April 10, 2023
PubMed
Summary

Paravertebral nerve block (PNB) provides effective surgical analgesia for percutaneous nephrolithotripsy (PCNL) with minimal impact on quadriceps femoris muscle strength. This anesthesia method supports faster patient ambulation post-procedure.

Keywords:
ERASepidural anesthesianephrolithiasisparavertebral nerve blockpercutaneous nephrostolithotomy

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Area of Science:

  • Anesthesiology
  • Urology
  • Nephrology

Background:

  • Percutaneous nephrolithotripsy (PCNL) is a primary treatment for urinary calculi.
  • A need exists for anesthesia methods that minimally affect circulation and postoperative patient activity.

Purpose of the Study:

  • To compare the effects of paravertebral nerve block (PNB) and epidural block (EPB) on quadriceps femoris muscle (QFM) strength in patients undergoing PCNL.

Main Methods:

  • 163 patients were randomized into PNB (82) or EPB (81) groups.
  • Primary outcomes included QFM strength and knee range of motion (RoM) at various time points post-anesthesia induction (AI).
  • Secondary outcomes assessed ambulation time, sensory recovery, analgesic use, side effects, hospital stay, and hemodynamic parameters.

Main Results:

  • No significant difference in QFM strength or knee RoM was observed between groups at 24 hours post-AI.
  • PNB group showed shorter time to first ambulation but longer sensory recovery time compared to EPB.
  • PNB group required more intraoperative analgesics and reported higher VAS scores earlier post-AI, with higher MAP at 1 hour post-AI.

Conclusions:

  • Paravertebral nerve block (PNB) is a viable anesthesia option for PCNL, meeting surgical analgesia needs.
  • PNB demonstrates minimal impact on quadriceps femoris muscle strength, facilitating patient recovery.