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Related Concept Videos

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: 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 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...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...

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Related Experiment Video

Updated: May 20, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
03:14

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Published on: January 31, 2025

[The Myth of Predictable Spinal Anaesthesia: What Determines Block Spread?]

Manuel Wenk, Christina Massoth

    Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
    |May 18, 2026
    PubMed
    Summary

    Predicting spinal anaesthesia spread is challenging. While dose, baricity, and patient positioning are key controllable factors, patient-specific variables like cerebrospinal fluid volume are crucial for planning effective spinal anaesthesia.

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    Area of Science:

    • Anesthesiology
    • Neurosurgery

    Background:

    • Spinal anaesthesia is a common procedure with partially unpredictable spread.
    • Numerous factors influencing spread have limited clinical applicability.

    Purpose of the Study:

    • To identify the most relevant factors determining spinal anaesthesia spread in clinical practice.
    • To guide the planning of spinal anaesthesia based on predictable variables.

    Main Methods:

    • Review of existing evidence on factors affecting spinal anaesthesia spread.
    • Analysis of modifiable technical variables versus patient-specific factors.

    Main Results:

    • Dose, baricity, and patient positioning are the primary controllable determinants of block spread.
    • Lumbosacral cerebrospinal fluid volume is the sole reliable patient-specific predictor.
    • Demographic variables (height, weight, sex) do not reliably predict spread.

    Conclusions:

    • Spinal anaesthesia planning should prioritize modifiable technical variables.
    • Precise prediction of individual patient block spread remains unattainable.