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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 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 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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Related Experiment Video

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The Sacral Erector Spinae Plane Block: A Narrative Review.

Burhan Dost1, Madan Narayanan2, Francesco Marrone3

  • 1Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey. burhandost@hotmail.com.

Pain and Therapy
|December 23, 2025
PubMed
Summary

The sacral erector spinae plane (S-ESP) block shows promise for postoperative pain relief in various surgeries. While safe and effective in the short term, more research is needed to standardize techniques and confirm its benefits.

Keywords:
Caudal blockNerve blockPostoperative analgesiaRegional anesthesiaSacral erector spinae plane blockUltrasound

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Area of Science:

  • Regional Anesthesia
  • Pain Management
  • Surgical Analgesia

Background:

  • The sacral erector spinae plane (S-ESP) block is a novel regional anesthesia technique targeting sacral dermatomes.
  • It has emerged as a potential option for perioperative analgesia in sacral, perineal, and pelvic surgeries since its first report in 2019.

Purpose of the Study:

  • To critically appraise the current anatomical, technical, and clinical evidence on the S-ESP block.
  • To outline its mechanisms, approaches, efficacy, safety, and identify research gaps.

Main Methods:

  • A narrative review integrating anatomical descriptions, sonographic techniques, and RCTs.
  • Comprehensive literature search in major databases (PubMed, Embase, Scopus, Web of Science, Ovid) up to July 21, 2025.
  • Inclusion of full-text RCTs on ultrasound-guided S-ESP blocks for perioperative analgesia.

Main Results:

  • Fourteen RCTs (2023-2025) included pediatric and adult populations for various surgeries.
  • Pediatric S-ESP blocks generally showed longer time to first analgesia and reduced consumption compared to caudal/penile blocks.
  • Adult S-ESP blocks consistently reduced pain scores and opioid requirements.

Conclusions:

  • Midline and paramedian S-ESP techniques appear feasible, safe short-term, and provide relevant analgesia for selected pediatric, anorectal, and orthopedic surgeries.
  • Heterogeneity in techniques, small sample sizes, and limited indications restrict generalizability.
  • Large, multicenter RCTs with standardized protocols are necessary to optimize S-ESP block use and compare it with established techniques.