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Related Concept Videos

Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

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...
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

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...
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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...
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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...
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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...
Analgesia and Pain Management01:25

Analgesia and Pain Management

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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Updated: May 17, 2026

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
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Single-Shot Regional Anesthesia for Early Rib Fracture-Associated Pain Management: Systematic Review and Network

Christopher Partyka1,2,3, Scott Farenden3,4,5, David Tian6,7

  • 1Department of Emergency Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|March 31, 2026
PubMed
Summary
This summary is machine-generated.

Single-shot regional anesthesia (SSRA) effectively reduces pain and opioid use in patients with rib fractures compared to standard care. However, current evidence does not show superiority among different SSRA techniques for managing traumatic rib fractures.

Keywords:
erector spinae plane blockpain managementregional anesthesiarib fracturesserratus anterior plane blockthoracic trauma

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Area of Science:

  • Emergency Medicine
  • Anesthesiology
  • Trauma Care

Background:

  • Regional anesthesia techniques are increasingly used for rib fracture pain management.
  • The comparative effectiveness of various single-shot regional anesthesia (SSRA) techniques is not well-established.

Purpose of the Study:

  • To systematically review and perform a network meta-analysis of randomized clinical trials.
  • To identify the most effective SSRA techniques for early pain reduction in adult patients with rib fractures.

Main Methods:

  • Searched multiple databases (PubMed, MEDLINE, EMBASE, CINAHL, CENTRAL) for relevant randomized clinical trials.
  • Conducted random-effects meta-analysis for pairwise comparisons and Bayesian network meta-analysis.
  • Primary outcome: pain score at 4-8 hours; secondary outcomes: pain to 24 hours, respiratory function, opioid use, complications, length of stay, mortality.

Main Results:

  • Included 9 randomized clinical trials with 738 patients.
  • SSRA significantly reduced pain scores at 4-8 hours (MD -1.81) and opioid requirements at 24 hours (MD -9.35) compared to standard care.
  • Network meta-analysis did not identify a superior SSRA technique; confidence in results was moderate to low.

Conclusions:

  • Single-shot regional anesthesia techniques likely improve early pain management for rib fractures.
  • Further high-quality studies with standardized controls are needed to compare the efficacy of different SSRA techniques.