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Related Concept Videos

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

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

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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...
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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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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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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

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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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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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Related Experiment Video

Updated: Jul 26, 2025

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve
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Local anaesthetic adjuncts for peripheral nerve blockade.

Neel Desai1,2, Eric Albrecht3

  • 1Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust.

Current Opinion in Anaesthesiology
|June 14, 2023
PubMed
Summary

Intravenous dexamethasone is the preferred local anesthetic adjunct for extending nerve blockade duration and pain relief. This method offers significant improvements in sensory and motor blockade, as well as analgesia, for surgical patients.

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Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Moderate-to-severe pain is a significant clinical challenge.
  • Peripheral nerve blockade offers improved pain relief and fewer side effects than opioids alone.
  • Single-shot nerve blockade's short duration necessitates effective local anesthetic adjuncts.

Approach:

  • This review summarizes evidence on local anesthetic adjuncts for peripheral nerve blockade.
  • Comparative analysis of dexamethasone and dexmedetomidine as adjuncts.
  • Evaluation of intravenous versus perineural administration routes.

Key Points:

  • Dexamethasone and dexmedetomidine show promise as ideal local anesthetic adjuncts.
  • Dexamethasone demonstrated superior efficacy over dexmedetomidine in upper limb blocks for sensory, motor, and analgesic duration.
  • No significant differences were observed between intravenous and perineural dexamethasone administration.

Conclusions:

  • Intravenous dexamethasone is the recommended adjunct, significantly prolonging sensory blockade, motor blockade, and analgesia.
  • A dose of 0.1-0.2 mg/kg intravenous dexamethasone is suggested for all surgical patients.
  • Further research into the synergistic effects of intravenous dexamethasone and perineural dexmedetomidine is warranted.