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Related Concept Videos

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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Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

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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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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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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.
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Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

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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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Optimal Anesthesia for Polyacrylamide Hydrogel Injection: A Randomized Trial.

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Summary
This summary is machine-generated.

A combined anesthetic protocol, including a periurethral block, significantly reduced pain during in-office polyacrylamide hydrogel (PAHG) injections for stress urinary incontinence (SUI). This approach also improved post-procedure voiding, supporting its use for SUI/ISD treatment.

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Area of Science:

  • Urology
  • Anesthesiology
  • Gynecology

Background:

  • Stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) are common conditions in women.
  • Urethral bulking with polyacrylamide hydrogel (PAHG) is a popular in-office treatment for SUI/ISD.
  • Optimal anesthetic protocols for PAHG injections have not been established.

Purpose of the Study:

  • To compare pain scores between a combined anesthetic protocol and a topical-only anesthetic protocol during in-office PAHG injections.
  • To evaluate secondary outcomes including patient-reported incontinence and improvement scores.
  • To assess the safety and efficacy of different anesthetic approaches for PAHG procedures.

Main Methods:

  • A single-blinded randomized trial compared two anesthetic protocols: combined (EMLA cream, intraurethral lidocaine, periurethral block) versus topical-only (EMLA cream, intraurethral lidocaine).
  • The primary outcome was pain assessed using a 10-point visual analog scale (VAS).
  • Secondary outcomes included ICIQ-UI and PGI-I scores, with a safety endpoint for unplanned block requirements.

Main Results:

  • Recruitment was halted early due to the safety endpoint being met in the topical-only arm.
  • The combined anesthetic group reported significantly lower mean VAS pain scores (4.5) compared to the topical-only group (7.4) (P<0.01).
  • Subjects receiving the combined anesthetic were less likely to require post-procedure catheterization (0% vs. 33%, P=0.04).

Conclusions:

  • The use of a periurethral block in conjunction with topical anesthetics effectively reduces pain during in-office PAHG injections.
  • A combined anesthetic protocol improves post-procedure voiding and patient comfort.
  • These findings support the implementation of a combined anesthetic approach for PAHG procedures in women with SUI/ISD.