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Related Concept Videos

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...
429
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

352
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...
352
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

571
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...
571
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

408
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...
408
Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

210
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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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

462
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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Related Experiment Video

Updated: May 28, 2025

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia

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Multimodal analgesia with thoracic paravertebral block decrease pain and side effects in mastectomy patients.

Pei-Chin Liu1,2, Fu-Wei Su2,3, Yi-Fang Tsai4,5

  • 1Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC.

Journal of the Chinese Medical Association : JCMA
|February 12, 2025
PubMed
Summary
This summary is machine-generated.

Enhanced recovery after surgery (ERAS) using multimodal analgesia (MMA) with nonintubated general anesthesia (GA) and thoracic paravertebral block (TPVB) significantly reduces pain and analgesic needs in breast cancer patients compared to traditional GA.

Keywords:
Enhanced recovery after surgeryIntravenous anesthesiaMastectomyParavertebral blockPostoperative complication

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Area of Science:

  • Anesthesiology
  • Surgical Oncology
  • Pain Management

Background:

  • Enhanced Recovery After Surgery (ERAS) protocols are increasingly adopted for breast cancer surgery.
  • Multimodal analgesia (MMA) is a key component of ERAS, aiming to optimize pain control.
  • This study investigates a specific ERAS approach combining nonintubated general anesthesia (GA) with thoracic paravertebral block (TPVB) for MMA.

Purpose of the Study:

  • To evaluate the efficacy of an ERAS protocol using nonintubated GA with TPVB-based MMA.
  • To compare postoperative outcomes, including pain scores, analgesic consumption, and PONV, with traditional GA.
  • To assess the safety and viability of this combined anesthetic technique for breast cancer surgery.

Main Methods:

  • Retrospective review of 60 female patients undergoing unilateral mastectomy with or without SLNB.
  • Comparison between 30 patients receiving nonintubated GA with TPVB (MMA group) and 30 patients receiving conventional GA.
  • Analysis of numerical rating scale (NRS) pain scores, total analgesic consumption (converted to morphine equivalents), and postoperative nausea and vomiting (PONV) rates.

Main Results:

  • The MMA group demonstrated significantly lower NRS pain scores (p < 0.001) and reduced total analgesic consumption (p < 0.001) compared to the conventional GA group.
  • Postoperative nausea and vomiting (PONV) rates were lower in the MMA group (0% vs. 13%), though not statistically significant (p = 0.112).
  • No significant difference in pain scores or need for additional analgesics was observed between double- and triple-level TPVB.

Conclusions:

  • Nonintubated general anesthesia (GA) combined with total intravenous anesthesia (TIVA) and MMA utilizing thoracic paravertebral block (TPVB) is a safe and effective alternative for breast cancer surgery.
  • This ERAS approach leads to decreased postoperative pain and analgesic requirements compared to conventional GA.
  • PONV outcomes are comparable between the investigated ERAS protocol and standard intravenous pain management strategies.