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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 Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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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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Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

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Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
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Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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

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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...
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Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

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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...
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Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Localization modalities for botulinum neurotoxin injection.

Barbara Illowsky Karp1, Ann Ly2, Katharine E Alter3

  • 1National Institute of Neurological Disorders and Stroke, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD, 20892, USA.

Toxicon : Official Journal of the International Society on Toxinology
|June 18, 2025
PubMed
Summary
This summary is machine-generated.

Guidance techniques for botulinum toxin injections, including manual, electromyography (EMG), and ultrasound (US), improve accuracy. Instrumented methods are superior for precise skeletal muscle and salivary gland injections.

Keywords:
AnatomyBotulinum toxinDystoniaElectrical stimulation (e-stim)Electromyography (EMG)GuidanceHypersalivationSpasticityUltrasound

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Area of Science:

  • Medical procedures
  • Neurology
  • Pharmacology

Background:

  • Botulinum toxin is a targeted therapeutic agent administered via injection.
  • Accurate guidance is crucial for effective delivery to target sites like muscles and glands.
  • Various guidance methodologies exist for percutaneous injections in an office setting.

Purpose of the Study:

  • To review and compare different guidance techniques for botulinum toxin injections.
  • To evaluate the advantages, disadvantages, accuracy, and therapeutic impact of each method.
  • To inform optimal technique selection for skeletal muscle and salivary gland injections.

Main Methods:

  • Review of guidance methodologies: manual needle placement, electromyography (EMG), electrical stimulation (e-stim), ultrasound (US), and combined US+EMG or US+e-stim.
  • Analysis of accuracy and therapeutic outcomes for each technique.
  • Focus on percutaneous injection guidance in office settings.

Main Results:

  • Manual placement is adequate for large, superficial muscles; instrumented techniques enhance accuracy.
  • EMG provides muscle activity data; e-stim assists injections in non-voluntarily activating muscles.
  • Ultrasound visualizes internal structures, enabling safe trajectories for deep or small targets.

Conclusions:

  • Instrumented guidance techniques significantly improve the accuracy of botulinum toxin injections.
  • EMG and e-stim offer unique functional feedback for muscle injections.
  • Ultrasound is essential for precise guidance to deep or difficult-to-access anatomical targets.