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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...
635
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...
425
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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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
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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
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

327
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: Jul 6, 2025

Subcutaneous Neurotrophin 4 Infusion Using Osmotic Pumps or Direct Muscular Injection Enhances Aging Rat Laryngeal Muscles
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Analgesia in Transcutaneous Laryngeal Botulinum Toxin Injections: A Randomized Crossover Trial.

Richard Heyes1, Charles H Adler2, Claire Yee3

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.

The Laryngoscope
|December 29, 2023
PubMed
Summary

Pain during laryngeal injections for spasmodic dysphonia (SD) was similar with local anesthetic, a vibrating wand, or no pain relief. Patients preferred the vibrating wand or no anesthesia over lidocaine, suggesting individualized pain management is key.

Keywords:
analgesialaryngeal dystoniaspasmodic dysphoniavocal tremor

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Area of Science:

  • Otolaryngology
  • Neurology
  • Pain Management

Background:

  • Laryngeal injections, particularly for spasmodic dysphonia (SD), can be painful.
  • Improving the patient experience during these in-office procedures is crucial.
  • Current literature lacks data on effective pain reduction methods for awake laryngeal injections.

Purpose of the Study:

  • To evaluate the efficacy of local anesthetic and a vibrating instrument in reducing pain during transcervical botulinum toxin injections.
  • To compare patient-reported pain levels across three different analgesic techniques.
  • To determine patient preference for pain management during laryngeal injections for SD.

Main Methods:

  • An unblinded, prospective randomized control trial with a crossover design was conducted.
  • Thirty-two patients with adductor SD received transcutaneous botulinum toxin injections.
  • Treatments included no anesthesia, local anesthetic (2% lidocaine), and a vibrating instrument, with randomized order and patient preference assessment.

Main Results:

  • No statistically significant difference in pain was found between the three analgesic techniques (p=0.38).
  • The vibrating wand was the most preferred technique (44%), followed by lidocaine (37%) and no anesthesia (19%).
  • A combined 63% of patients preferred the vibrating wand or no anesthesia over lidocaine.

Conclusions:

  • No significant difference in pain perception exists between local anesthetic, vibrating instrument, or no analgesia during laryngeal botulinum toxin injections.
  • Over half of patients preferred a technique not involving lidocaine, highlighting the need for personalized pain management.
  • Individualizing analgesia strategies is recommended for transcutaneous laryngeal injections to enhance patient experience.