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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

367
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...
367
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

585
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...
585
General Anesthesia: Overview01:24

General Anesthesia: Overview

196
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...
196
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

414
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...
414
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

976
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...
976
Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

392
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
392

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Related Experiment Video

Updated: Jun 8, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
04:19

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

Published on: November 8, 2024

359

Local/Regional Anesthesia Versus General Anesthesia in Phalanx Fractures/Dislocations.

Matthew D Rich1, Anna Rauzi1, Thomas J Sorenson2

  • 1Division of Plastic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

Plastic Surgery (Oakville, Ont.)
|November 4, 2024
PubMed
Summary

Local or regional anesthesia for phalanx fractures offers comparable outcomes to general anesthesia, with similar complication rates. This approach provides a safe alternative when general anesthesia is not preferred.

Keywords:
WALANTlocal anesthesialocal/regional anesthesiaphalanx dislocationphalanx fractureupper extremity

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology

Background:

  • Traditional phalanx fracture repair utilized general anesthesia.
  • Wide-awake Local Anesthesia No Tourniquet (WALANT) presents an alternative for patients where general anesthesia is contraindicated or undesirable.
  • Regional/local anesthesia may mitigate comorbidities associated with general anesthesia.

Purpose of the Study:

  • To compare the outcomes and adverse events of local/regional anesthesia versus general anesthesia for phalanx fracture/dislocation repair.
  • To test the hypothesis that local/regional anesthesia yields comparable outcomes and fewer adverse events than general anesthesia.

Main Methods:

  • Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2015-2019).
  • Inclusion of patients undergoing operative fixation for phalanx fracture or dislocation, stratified by anesthesia type (local/regional vs. general).
  • Analysis of preoperative demographic data and 30-day postoperative complications.

Main Results:

  • A total of 2831 patients were analyzed; 13% received local/regional anesthesia, 87% received general anesthesia.
  • No clinically significant differences in surgical site occurrences were observed between the two anesthesia groups.
  • Low rates of 30-day postoperative complications were reported for both cohorts, including deep vein thrombosis (0.03%) and pulmonary embolism (0.02%) in the local/regional group, and pneumonia (0.12%) and stroke (0.08%) in the general anesthesia group.

Conclusions:

  • Local/regional anesthesia techniques are safe for surgical repair of phalanx fractures and dislocations.
  • These techniques provide a viable alternative to general anesthesia, especially when general anesthesia is undesirable.
  • Postoperative complication rates within 30 days are comparable between local/regional and general anesthesia approaches for phalanx surgery.