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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

430
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: 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...
1.1K
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

636
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...
636
Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

838
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...
838
Classification of Skeletal Muscle Relaxants01:28

Classification of Skeletal Muscle Relaxants

2.5K
Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

429
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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Author Spotlight: Ultrasound-Guided Needle Release Combined with Corticosteroid Injection for the Treatment of Supinator Syndrome
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Periarticular Injection and Peripheral Nerve Blocks 
With Standard Agents.

Paul F Lachiewicz

    Instructional Course Lectures
    |December 13, 2023
    PubMed
    Summary

    Nerve blocks are key for total knee arthroplasty pain management. High-dose bupivacaine for saphenous nerve blocks shows effectiveness and safety, but adductor canal block efficacy requires further study.

    Area of Science:

    • Anesthesiology
    • Orthopedic Surgery
    • Pain Management

    Background:

    • Sensory nerve blocks are crucial in multimodal pain management following total knee arthroplasty (TKA).
    • Clinical practice guidelines from major orthopedic and anesthesia societies offer recommendations on nerve blocks and periarticular injections.
    • Evidence supports combining periarticular injections with intra-articular saphenous nerve blocks.

    Purpose of the Study:

    • To evaluate the efficacy and safety of nerve blocks, specifically saphenous nerve blocks and adductor canal blocks, as part of pain management after total knee arthroplasty.
    • To review current clinical practice guidelines and experimental evidence regarding regional anesthesia techniques in TKA.

    Main Methods:

    • Review of 2022 clinical practice guidelines from the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, and American Academy of Orthopaedic Surgeons.

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  • Analysis of experimental and clinical evidence supporting combined periarticular injection and intra-articular saphenous nerve block.
  • Assessment of high-dose bupivacaine injection efficacy and safety.

    • Main Results:

    • High-dose bupivacaine injection for saphenous nerve blocks has demonstrated effectiveness and safety.
    • The utility of the adductor canal block in this context remains uncertain.
    • Current guidelines provide varying strengths of recommendations for different nerve block techniques.

    Conclusions:

    • Saphenous nerve blocks, particularly with high-dose bupivacaine, are a valuable component of post-TKA pain management.
    • Further research is necessary to clarify the role of the adductor canal block.
    • Future studies should focus on developing longer-acting local anesthetic agents and innovative techniques for TKA pain control.