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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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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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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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Circumferential Epidural Patch for Postdural Puncture Headache: A Technical Report.

Soren Christensen1, Peter G Kranz2, Michael D Malinzak2

  • 1From the Duke University School of Medicine (S.C., D.Z.), Durham, North Carolina.

AJNR. American Journal of Neuroradiology
|October 10, 2025
PubMed
Summary
This summary is machine-generated.

Persistent postdural puncture headaches (PDPH) may require advanced treatment. A new CT fluoroscopy-guided circumferential epidural blood patch (EBP) technique offers 360° coverage, successfully treating patients with chronic PDPH.

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Area of Science:

  • Neurosurgery
  • Radiology
  • Pain Management

Background:

  • Postdural puncture headache (PDPH) can persist despite conventional treatments.
  • Standard epidural blood patches (EBPs) may not cover ventral dural surfaces, leading to treatment failure.
  • Chronic PDPH causes significant disability.

Purpose of the Study:

  • To describe the CT fluoroscopy-guided circumferential epidural blood patch (EBP) technique.
  • To evaluate the technical success and clinical outcomes of this novel EBP approach for persistent PDPH.

Main Methods:

  • A CT fluoroscopy-guided circumferential EBP technique was developed, involving combined ventral transforaminal and dorsal interlaminar injections for 360° thecal sac coverage.
  • Procedural details were documented.
  • Six patients with PDPH, including four with prior failed dorsal-only EBPs, underwent the procedure.

Main Results:

  • Intraprocedural imaging confirmed complete circumferential patch coverage in all six patients.
  • All six patients reported substantial or complete symptomatic resolution of their PDPH.
  • The technique demonstrated technical success and positive clinical outcomes.

Conclusions:

  • CT fluoroscopy-guided circumferential EBP is a feasible technique for treating persistent PDPH.
  • This approach provides comprehensive coverage of the dural puncture site.
  • It offers a potential solution for patients refractory to conventional epidural blood patching.