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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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Drug Delivery: Parenteral Route01:29

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The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
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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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Laminotomy for Lumbar Dorsal Root Ganglion Access and Injection in Swine
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Path of Least Resistance: Multilevel Epidural Spread Following Large Volume Intertransverse Process Injection.

James C Krakowski1, Stuart A Grant1, Andres F Rojas1

  • 1Department of Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, NC.

Journal of Cardiothoracic and Vascular Anesthesia
|March 24, 2026
PubMed
Summary
This summary is machine-generated.

A 20 mL intertransverse process (ITP) block in cadavers showed greater variability and extensive epidural spread compared to 10 mL. This suggests a potential increased risk of hypotension with larger volumes during ITP procedures.

Keywords:
analgesiaanatomyanesthesia, conductionanesthetics, localcardiac surgeryepidural spacepain managementthoracic surgery

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Area of Science:

  • Anesthesiology
  • Anatomy
  • Radiology

Background:

  • The intertransverse process (ITP) block is a regional anesthesia technique.
  • Understanding injectate spread is crucial for efficacy and safety.

Purpose of the Study:

  • To compare paraspinal injectate spread following ITP blocks using 10 mL versus 20 mL in cadavers.
  • To evaluate the anatomical continuity between the ITP and epidural spaces.

Main Methods:

  • Prospective study in an academic anatomy laboratory using adult cadavers.
  • Ultrasound-guided injection of 0.1% methylene blue dye into the T3-4 or T7-8 ITP space.
  • 12 injections performed (6 per volume: 10 mL and 20 mL) using the mid-transverse process technique.

Main Results:

  • Paravertebral spread occurred in 11/12 injections.
  • Median spread was 2 levels in the paravertebral space for both volumes.
  • Epidural spread occurred in 5/6 injections per group; however, 20 mL showed multilevel epidural spread (≥3 levels) in 3/6 injections versus 0/6 for 10 mL, indicating greater variability and occasional extensive spread.

Conclusions:

  • Confirms anatomical continuity between the ITP and epidural spaces.
  • 20 mL ITP injections demonstrate increased variability and potential for extensive epidural spread compared to 10 mL.
  • This may elevate the risk of sympathectomy-related adverse effects, such as hypotension.