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Related Concept Videos

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.
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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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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: 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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Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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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 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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Updated: Jan 14, 2026

Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
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High-Utility Ultrasound-Guided Nerve Blocks for Emergency Department Use.

Joseph Brown1, Michael Prats2, Hilary Stroud2

  • 1University of Colorado, Anschutz Medical Campus, Aurora, Colorado.

The Journal of Emergency Medicine
|October 23, 2025
PubMed
Summary
This summary is machine-generated.

Ultrasound-guided nerve blocks (UGNBs) are vital for pain management in emergency departments, offering an opioid-sparing approach. This review covers key UGNBs for treating acute injuries and facilitating procedures.

Keywords:
POCUSnerve blockopioidsregional analgesiaregional anesthesiaultrasound-guided nerve blocksultrasound-guided procedures

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Area of Science:

  • Emergency medicine
  • Anesthesiology
  • Pain management

Background:

  • Ultrasound-guided nerve blocks (UGNBs) are increasingly used for multimodal analgesia in emergency settings.
  • UGNBs offer safe and effective pain relief for various conditions and procedural sedation.

Purpose of the Study:

  • To review the evidence for high-utility nerve blocks performed by emergency physicians.
  • To highlight the expanding role of UGNBs in emergency departments (EDs).

Main Methods:

  • Review of existing literature on commonly performed UGNBs in the ED.
  • Focus on blocks with demonstrated utility in acute injury and procedural contexts.

Main Results:

  • Specific blocks reviewed include superficial cervical plexus, interscalene brachial plexus, serratus anterior plane, erector spinae plane, pericapsular nerve, and transgluteal sciatic nerve blocks.
  • UGNBs are effective for pain management and as part of opioid reduction strategies.

Conclusions:

  • UGNBs are becoming a critical tool in ED patient care.
  • These blocks represent a valuable option for multimodal analgesia in acutely injured patients.