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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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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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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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Depolarizing Blockers: Pharmocokinetics01:19

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Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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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.
One of the advantages of...
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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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 12, 2025

Intraoperative Ultrasound in Spinal Surgery
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Intraoperative Clonidine in Spine Surgery: A Randomised Controlled Trial.

Stine Birkebæk1, Niels Juul2, Mikkel Mylius Rasmussen1,3

  • 1Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

Acta Anaesthesiologica Scandinavica
|May 7, 2025
PubMed
Summary

Intraoperative intravenous clonidine did not reduce post-operative opioid use or pain intensity in spine surgery patients. Hypotension was more common in the clonidine group, indicating no significant benefit for pain management.

Keywords:
intraoperative clonidinepostoperative painspine surgery

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Neurosurgery

Background:

  • Post-operative pain is a significant concern for patients undergoing spine surgery.
  • Clonidine, an alpha-2 agonist, has demonstrated analgesic properties that may be beneficial in managing surgical pain.

Purpose of the Study:

  • To evaluate the efficacy of a single intraoperative intravenous dose of clonidine in reducing post-operative opioid consumption and pain intensity in spine surgery patients.
  • To assess the impact of clonidine on side effects such as post-operative nausea and vomiting (PONV), sedation, and hypotension.

Main Methods:

  • A randomized, double-blinded, placebo-controlled trial was conducted with 120 patients undergoing spine surgery.
  • Patients received either intraoperative intravenous clonidine (3 μg/kg) or a placebo.
  • Primary outcome was opioid consumption within 3 hours post-surgery; secondary outcomes included pain intensity, PONV, sedation, and hypotension.

Main Results:

  • No significant difference was found in opioid consumption within the first 3 hours post-surgery between the clonidine and placebo groups (5 mg vs. 10 mg morphine equivalents).
  • Pain intensity at rest upon arrival at the post-anaesthesia care unit (PACU) was similar between groups (4 vs. 3 on the pain scale).
  • Hypotension occurred more frequently in the clonidine group (24 patients) compared to the placebo group (13 patients).

Conclusions:

  • A single intraoperative intravenous dose of clonidine does not effectively reduce post-operative opioid consumption or pain intensity in patients undergoing spine surgery.
  • The increased incidence of hypotension in the clonidine group suggests a potential safety concern without clear clinical benefit for pain relief.