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Updated: May 9, 2025

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy

Published on: January 31, 2025

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Spinal Anesthesia Administered in Preoperative Holding for Total Joint Arthroplasty Is Safe and Improves Operating

Spencer S Schulte1, Joshua E Simson2, Richard L Purcell3

  • 1Madigan Army Medical Center, Tacoma, Washington.

Journal of Surgical Orthopaedic Advances
|May 6, 2025
PubMed

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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...
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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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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.
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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.
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