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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: 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 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...
629
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: 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: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Variation in Hospital Neuraxial Labor Analgesia Rates in California.

Pooja Parameshwar1, Nan Guo2, Jason Bentley3

  • 1Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.

Anesthesiology
|February 27, 2024
PubMed
Summary

Neuraxial analgesia use during labor varies significantly across California hospitals, with a substantial number of hospitals having low prevalence. Further research is needed to understand and address these disparities.

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Area of Science:

  • Obstetrics and Gynecology
  • Anesthesiology
  • Health Services Research

Background:

  • Neuraxial analgesia is a common method for labor pain management.
  • Significant variation in its prevalence across U.S. hospitals is suspected but not well-documented.

Purpose of the Study:

  • To assess and quantify hospital-level variation in neuraxial analgesia prevalence among birthing patients in California.

Main Methods:

  • Retrospective cross-sectional study of over 1.5 million laboring patients across 200 California hospitals (2016-2020).
  • Analysis of hospital neuraxial analgesia prevalence and between-hospital variability, adjusted for patient and hospital factors.
  • Quantification of variability using median odds ratio and intraclass correlation coefficients.

Main Results:

  • Nearly 69% of 1,510,750 patients received neuraxial analgesia.
  • Hospital prevalence showed a skewed distribution with a long left tail, indicating many hospitals with low rates.
  • Adjusted median odds ratio of 2.3 indicated significantly higher odds of receiving analgesia in higher-prevalence hospitals.
  • Hospital-level factors explained a moderate portion (19.1%) of the overall variability.

Conclusions:

  • Wide variation in neuraxial analgesia prevalence exists across California hospitals, unexplained by patient or hospital characteristics.
  • Hospitals in the lowest prevalence group require targeted interventions.
  • Exploring patient preferences, staffing, and provider attitudes is crucial to address prevalence disparities.