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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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...

Local Anesthetics: Clinical Application as Spinal Anesthesia

Local Anesthetics: Clinical Application as Spinal Anesthesia

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...

General Anesthesia: Overview

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

Local Anesthetics: Clinical Application as Epidural Anesthesia

Local Anesthetics: Clinical Application as Epidural Anesthesia

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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Reverse Total Shoulder Arthroplasty

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Shoulder Surgeries under Regional Anesthesia Approach and Outcome - A Case Series.

Vinay Jaiswal¹, Ravindra Kumar Gupta², Neha Dhake¹

¹Department of Anaesthesiology, L N C T. Medical College and Sewakunj Hospital, Indore, Madhya Pradesh, India.

Journal of Orthopaedic Case Reports

|October 9, 2024

Summary

Regional anesthesia, including interscalene brachial plexus and suprascapular nerve blocks, offers effective pain control for shoulder surgery. This approach enhances recovery and is a safer alternative for high-risk patients.

Keywords:

Shoulder arthroscopy interscalene nerve block peripheral nerve stimulation regional anesthesia shoulder surgery suprascapular nerve block

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Area of Science:

Anesthesiology
Orthopedic Surgery

Background:

Postoperative pain after shoulder surgery significantly impedes recovery and joint mobility.
Regional anesthesia provides superior pain management compared to general anesthesia, facilitating faster patient recovery.
Successful regional anesthesia necessitates a thorough understanding of shoulder neural innervation.

Purpose of the Study:

To evaluate the efficacy and safety of ultrasound-guided regional anesthesia for shoulder surgeries.
To assess patient and surgeon satisfaction with regional anesthesia in high-risk surgical candidates.

Main Methods:

A case series of 10 high-risk patients (including ASA 3) undergoing shoulder surgery.
Utilized PNS-guided interscalene brachial plexus block combined with suprascapular nerve block.
Administered mild sedation alongside regional anesthesia.

Main Results:

Regional anesthesia provided effective pain control and facilitated early joint mobilization.
High levels of patient and surgeon satisfaction were reported perioperatively.
The technique proved particularly beneficial for patients with multiple comorbidities.

Conclusions:

Interscalene nerve block combined with suprascapular nerve block is a viable alternative to general anesthesia for shoulder surgeries.
Sole regional anesthesia is a safe and effective approach, especially for ASA Grade III and IV patients.
This technique enhances perioperative outcomes and patient recovery.