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Related Concept Videos

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 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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Spinal Nerves: Anatomy01:23

Spinal Nerves: Anatomy

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Spinal nerves are pivotal conduits in the nervous system, bridging the central nervous system (CNS) with the peripheral nervous system (PNS). These nerves enable a complex communication network between the brain, spinal cord, and the rest of the body, facilitating sensory input, motor output, and autonomic functions.
There are 31 bilateral pairs of spinal nerves, each emerging from the spinal cord through the intervertebral foramina—openings between adjacent vertebrae. These nerves are...
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Spinal Cord01:26

Spinal Cord

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The spinal cord, a critical component of the central nervous system, extends from the base of the brainstem to the lumbar region of the vertebral column. It is essential for maintaining physical stability and facilitating communication between the brain and peripheral parts of the body.
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Spinal Cord: Cross-sectional Anatomy01:16

Spinal Cord: Cross-sectional Anatomy

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The cross-sectional anatomy of the spinal cord offers a detailed view of its complex structure and function within the central nervous system. At the core of the spinal cord lies the gray matter, characterized by its butterfly or "H"-shaped appearance in cross-section. This central region is enveloped by white matter, with the overall structure divided into symmetrical halves by the dorsal median sulcus and the ventral median fissure.
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Related Experiment Video

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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

Published on: January 31, 2025

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Spinal sonography and central neuraxial blocks.

Ranjith Kumar Sivakumar1, Manoj Kumar Karmakar1

  • 1Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, SAR, China.

Best Practice & Research. Clinical Anaesthesiology
|June 15, 2023
PubMed
Summary

Ultrasound-guided central neuraxial blocks (CNBs) offer an improved alternative to traditional landmark techniques. This method enhances safety and efficacy, particularly in challenging patient populations requiring spinal or epidural anesthesia.

Keywords:
analgesiaanesthesiacaudalepidurallumbarneuraxialspinalspineultrasound

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Area of Science:

  • Anesthesiology
  • Medical Imaging
  • Regional Anesthesia

Background:

  • Central neuraxial blocks (CNBs), including spinal and epidural injections, are crucial for anesthesia and analgesia.
  • Traditional CNB techniques rely on anatomical landmarks, which have limitations in certain patient groups (obstetric, obese, respiratory compromise).
  • These limitations highlight the need for advanced techniques to ensure successful and safe CNB procedures.

Purpose of the Study:

  • To review ultrasound imaging of the lumbosacral spine.
  • To explore the application of ultrasound-guided (USG) techniques for central neuraxial blocks.
  • To address the shortcomings of traditional landmark-based CNB approaches.

Main Methods:

  • Review of current literature on ultrasound imaging of the lumbosacral spine.
  • Analysis of research data on the application of ultrasound in performing CNBs.
  • Comparison of ultrasound-guided techniques versus traditional anatomical landmark methods.

Main Results:

  • Ultrasound technology has advanced significantly, offering solutions to the limitations of landmark-based CNBs.
  • USG techniques provide enhanced visualization of anatomical structures, improving accuracy and safety.
  • Recent data support the efficacy of ultrasound guidance in various clinical scenarios for CNBs.

Conclusions:

  • Ultrasound-guided central neuraxial blocks represent a significant advancement over traditional methods.
  • USG is particularly beneficial in patients where landmark identification is challenging.
  • This review underscores the value of integrating ultrasound imaging into CNB procedures for improved patient outcomes.