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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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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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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.
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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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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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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Building an Inclusive Practice Within Regional Anesthesia and Acute Pain Medicine.

Iyabo O Muse1, James Sabra2, Uchenna O Umeh3

  • 1Department of Anesthesiology, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22903, USA.

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Summary

Disparities exist in regional anesthesia and acute pain medicine (RAAPM). Promoting diversity and inclusion in RAAPM is crucial for equitable, high-quality acute pain management and improved patient outcomes.

Keywords:
DiversityEquityInclusionLGBTQ+Pain disparitiesRegional anesthesiaSocial determinants of health

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Area of Science:

  • Healthcare Disparities
  • Acute Pain Medicine
  • Regional Anesthesia

Background:

  • Healthcare disparities are prevalent in perioperative pain management.
  • Existing literature highlights inequities within the practice of regional anesthesia and acute pain medicine (RAAPM).

Purpose of the Study:

  • To review disparities in RAAPM practice.
  • To emphasize the role of diversity and inclusion in mitigating these disparities.
  • To improve acute pain management and patient outcomes.

Main Methods:

  • Literature review focusing on RAAPM.
  • Analysis of studies documenting health care disparities in perioperative pain.
  • Identification of solutions and policies for reducing disparities.

Main Results:

  • Significant disparities identified in perioperative pain management within RAAPM.
  • Diversity and inclusion are key factors in addressing these inequities.
  • Evidence suggests improved patient outcomes with inclusive practices.

Conclusions:

  • Addressing disparities in RAAPM is essential for equitable care.
  • Implementing diversity and inclusion strategies can enhance acute pain management.
  • Collaborative efforts by clinicians, organizations, and journals are needed to reduce disparities.