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Related Concept Videos

Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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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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Analgesia and Pain Management01:25

Analgesia and Pain Management

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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Opioid Analgesics: Morphine and Other Natural Cogeners01:20

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Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
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Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

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Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
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Parenteral Anesthetics: Overview01:24

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Buprenorphine: An anesthesia-centric review.

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Buprenorphine offers an effective alternative to full agonist opioids for managing acute and chronic pain. Continuing buprenorphine during surgery is now preferred, though optimal dosing requires further study.

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Area of Science:

  • Pharmacology and Pain Management
  • Addiction Medicine and Anesthesiology

Background:

  • Buprenorphine, developed for analgesia, is also a key treatment for Opioid Use Disorder (OUD).
  • Full agonist opioids (FAOs) are common for perioperative pain despite risks, contrasting with multimodal analgesia trends.
  • Traditional practice often involved stopping buprenorphine before surgery, but this is evolving.

Purpose of the Study:

  • To review evidence supporting buprenorphine as an analgesic alternative to FAOs for acute and chronic pain.
  • To examine the shift towards continuing buprenorphine perioperatively for patients with Opioid Use Disorder.
  • To identify remaining questions regarding perioperative buprenorphine dosing.

Main Methods:

  • Literature review of studies on buprenorphine's efficacy in pain management.
  • Analysis of current clinical practices and guidelines regarding perioperative buprenorphine use.
  • Examination of research addressing buprenorphine's role in Opioid Use Disorder management.

Main Results:

  • Buprenorphine demonstrates effectiveness as an analgesic, comparable to FAOs in various pain settings.
  • Continuing buprenorphine throughout the perioperative period is increasingly recommended for OUD patients.
  • Evidence suggests buprenorphine's partial agonism and long duration are beneficial for pain and OUD treatment.

Conclusions:

  • Buprenorphine is a viable alternative to FAOs for acute and chronic pain management.
  • Continuing buprenorphine perioperatively is a beneficial paradigm shift for OUD patients.
  • Further research is needed to optimize perioperative buprenorphine dosing strategies.