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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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Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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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.
One of the advantages of...
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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy01:26

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy

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Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
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Related Experiment Video

Updated: Apr 16, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Intraoperative Local Anesthesia and Opioid Use in Enhanced Recovery After Surgery-based Breast Reduction.

Joanna Sajdlowska1, Amaury Martinez Garcia1,2, Felippe Sartorato1

  • 1From the Department of General/Plastic Surgery, St. Joseph's University Medical Center (SJUMC), Paterson, NJ.

Plastic and Reconstructive Surgery. Global Open
|April 15, 2026
PubMed
Summary
This summary is machine-generated.

Intraoperative local anesthetics, particularly immediate-release bupivacaine, significantly reduce postoperative opioid use in breast reduction surgery. This opioid-sparing strategy enhances recovery pathways and patient outcomes.

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Area of Science:

  • Anesthesiology
  • Pain Management
  • Plastic Surgery

Background:

  • Traditional opioid use for postoperative pain presents risks like side effects and dependence.
  • There is a growing need for effective opioid-sparing strategies in surgical pain management.
  • Bilateral breast reduction surgery provides a model to study these strategies.

Purpose of the Study:

  • To evaluate the impact of intraoperative local anesthetic techniques on postoperative opioid consumption.
  • To assess the effect of these techniques on postanesthesia care unit (PACU) time.
  • To identify optimal analgesic adjuncts for breast reduction patients.

Main Methods:

  • Retrospective review of 199 bilateral breast reduction patients (July 2017-December 2022).
  • Patients categorized by intraoperative analgesic adjunct: pectoralis nerve block, liposomal bupivacaine, immediate-release bupivacaine, or no local anesthetic.
  • Primary outcomes measured: opioid use (MMEs) and PACU discharge time (minutes).

Main Results:

  • Anesthetic adjuncts significantly reduced PACU opioid consumption compared to controls (P < 0.05).
  • Immediate-release bupivacaine group showed the lowest mean opioid use (1.96 mg MME).
  • No significant association found between anesthetic adjuncts and PACU time.

Conclusions:

  • Intraoperative local anesthetics are effective in multimodal analgesia for breast reduction.
  • Immediate-release bupivacaine is linked to significantly lower postoperative opioid requirements.
  • This technique can be integrated into enhanced recovery pathways for breast reduction surgery.