Strategies to Optimize the Efficacy of Regional Anesthesia

2016 ◽  
Author(s):  
Jeremy Pearl ◽  
Pedram Aleshi
Keyword(s):  
Peripheral Nerve ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Mode Of Delivery ◽  
Intermittent Bolus ◽  
Risks And Benefits ◽  
Anesthetic Concentration ◽  
Few Data ◽  
Labor Epidural ◽  
Analgesic Potency

The mode of delivery of epidural solutions has progressed from clinician-delivered boluses, to automated continuous epidural infusions and the addition of patient-controlled epidural analgesia (PCEA), and now to programmed intermittent epidural boluses (PIEBs) in addition to PCEA. Currently, there is promising evidence for the use of combination PIEB and PCEA to minimize additional bolus requirements and reduce the amount of local anesthetic consumed, as well as improved patient satisfaction. There are few data regarding this mode of delivery in peripheral nerve catheters. The existing data in the peripheral nerve catheters do not show a clear advantage for the use of the programmed intermittent bolus (PIB) method. More studies are needed in various peripheral nerve/fascia plane blocks to answer this question. Studies looking at the median effective dose in 50% of patients of local anesthetics for labor epidurals (minimum local anesthetic concentration [MLAC]) have allowed the comparison of the relative potency of different local anesthetics. Even though the absolute numbers are not useful, we know that ropivacaine is only 60% as potent as bupivacaine for its analgesic potency and development of motor block, so it provides no advantage over bupivacaine for the labor epidural setting. MLAC studies have also allowed the study of adjuvants and their effect on labor analgesia. Fentanyl, epinephrine, and clonidine have been studied, showing significant local anesthetic–sparing effects. The risks and benefits of each adjuvant should be weighed for each patient, but fentanyl and epinephrine have an excellent benefit-to-risk ratio.

Local Anesthetics – Substances with Multiple Application in Medicine

2016 ◽  
Vol 4 (1) ◽  
pp. 17
Author(s):  
Rodica Sîrbu ◽  
Emin Cadar ◽  
Cezar Laurențiu Tomescu ◽  
Cristina Luiza Erimia ◽  
Stelian Paris ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Medical Care ◽  
Local Anesthesia ◽  
Short Duration ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Nerve Roots ◽  
Nervous Control ◽  
Painful Sensation ◽  
Action Groups

Local anesthetics are substances which, by local action groups on the runners, cause loss of reversible a painful sensation, delimited corresponding to the application. They allow small surgery, short in duration and the endoscopic maneuvers. May be useful in soothe teething pain of short duration and in the locking of the nervous disorders in medical care. Local anesthesia is a process useful for the carrying out of surgery and of endoscopic maneuvers, to soothe teething pain in certain conditions, for depriving the temporary structures peripheral nervous control. Reversible locking of the transmission nociceptive, the set of the vegetative and with a local anesthetic at the level of the innervations peripheral nerve, roots and runners, a trunk nervous, around the components of a ganglion or coolant is cefalorahidian practice anesthesia loco-regional. Local anesthetics summary and semi-summary have multiple applications in dentistry, consulting, surgery and obstetrics, constituting "weapons" very useful in the fight against the pain.

Local Anesthetics – Substances with Multiple Application in Medicine

2016 ◽  
Vol 2 (1) ◽  
pp. 17
Author(s):  
Rodica Sîrbu ◽  
Emin Cadar ◽  
Cezar Laurențiu Tomescu ◽  
Cristina Luiza Erimia ◽  
Stelian Paris ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Medical Care ◽  
Local Anesthesia ◽  
Short Duration ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Nerve Roots ◽  
Nervous Control ◽  
Painful Sensation ◽  
Action Groups

Local anesthetics are substances which, by local action groups on the runners, cause loss of reversible a painful sensation, delimited corresponding to the application. They allow small surgery, short in duration and the endoscopic maneuvers. May be useful in soothe teething pain of short duration and in the locking of the nervous disorders in medical care. Local anesthesia is a process useful for the carrying out of surgery and of endoscopic maneuvers, to soothe teething pain in certain conditions, for depriving the temporary structures peripheral nervous control. Reversible locking of the transmission nociceptive, the set of the vegetative and with a local anesthetic at the level of the innervations peripheral nerve, roots and runners, a trunk nervous, around the components of a ganglion or coolant is cefalorahidian practice anesthesia loco-regional. Local anesthetics summary and semi-summary have multiple applications in dentistry, consulting, surgery and obstetrics, constituting "weapons" very useful in the fight against the pain.

scholarly journals Intralipid Therapy for Inadvertent Peripheral Nervous System Blockade Resulting from Local Anesthetic Overdose

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ihab Kamel ◽  
Gaurav Trehan ◽  
Rodger Barnette
Keyword(s):  
Nervous System ◽  
Lower Extremity ◽  
Peripheral Nerve ◽  
Local Anesthetic ◽  
Safety Profile ◽  
Local Anesthetics ◽  
Peripheral Nerves ◽  
Significant Morbidity ◽  
Intravascular Injection ◽  
Local Anesthetic Systemic Toxicity

Although local anesthetics have an acceptable safety profile, significant morbidity and mortality have been associated with their use. Inadvertent intravascular injection of local anesthetics and/or the use of excessive doses have been the most frequent causes of local anesthetic systemic toxicity (LAST). Furthermore, excessive doses of local anesthetics injected locally into the tissues may lead to inadvertent peripheral nerve infiltration and blockade. Successful treatment of LAST with intralipid has been reported. We describe a case of local anesthetic overdose that resulted in LAST and in unintentional blockade of peripheral nerves of the lower extremity; both effects completely resolved with administration of intralipid.

scholarly journals Wide Awake Open Carpal Tunnel Release: The Effect of Local Anesthetics in the Postoperative Outcome

2020 ◽  
Author(s):  
Nikolaos Karamanis ◽  
Georgia Stamatiou ◽  
Dionysia Vasdeki ◽  
Nikolaos Sakellaridis ◽  
Konstantinos C. Xarchas ◽  
...  
Keyword(s):  
Grip Strength ◽  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Carpal Tunnel Release ◽  
Postoperative Outcome ◽  
Anesthetic Concentration ◽  
Open Carpal Tunnel Release ◽  
Wide Awake

Abstract Introduction Wide awake open carpal tunnel decompression is a procedure performed under local anesthesia. This study aimed to present the effect of various local anesthetics in peri and postoperative analgesia in patients undergoing this procedure. Materials and Methods A total of 140 patients, with 150 hands involved, underwent carpal tunnel release under local anesthesia. Patients were divided in five groups according to local anesthetic administered: lidocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, and chirocaine 0.25%. Total 400 mg of gabapentin were administered to a subgroup of 10 cases from each group (50 cases totally), 12 hours before surgery. Patients were evaluated immediately, 2 weeks and 2 months after surgery according to VAS pain score, grip strength, and two-point discrimination. Results In all patients, pain and paresthesia improved significantly postoperatively, while the use of gabapentin did not affect outcomes. Grip strength recovered and exceeded the preoperative value 2 months after surgery, without any difference between the groups. No case of infection, hematoma, or revision surgery was reported. Conclusion Recovery after open carpal tunnel release appears to be irrelevant of the type of local anesthetic used during the procedure. Solutions of low local anesthetic concentration (lidocaine 2%, ropivacaine 0.375%, and chirocaine 0.25%) provide adequate intraoperative analgesia without affecting the postoperative course.

scholarly journals Continuous Peripheral Nerve Blocks

2010 ◽  
Vol 112 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Brian M. Ilfeld ◽  
Lisa K. Moeller ◽  
Edward R. Mariano ◽  
Vanessa J. Loland ◽  
Jennifer E. Stevens-Lapsley ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Femoral Nerve ◽  
Lumbar Plexus ◽  
Nerve Blocks ◽  
Maximum Voluntary Isometric Contraction ◽  
Ambulatory Ability ◽  
Anesthetic Concentration ◽  
Secondary Endpoints

Background The main determinant of continuous peripheral nerve block effects--local anesthetic concentration and volume or simply total drug dose--remains unknown. Methods We compared two different concentrations and basal rates of ropivacaine--but at equivalent total doses--for continuous posterior lumbar plexus blocks after hip arthroplasty. Preoperatively, a psoas compartment perineural catheter was inserted. Postoperatively, patients were randomly assigned to receive perineural ropivacaine of either 0.1% (basal 12 ml/h, bolus 4 ml) or 0.4% (basal 3 ml/h, bolus 1 ml) for at least 48 h. Therefore, both groups received 12 mg of ropivacaine each hour with a possible addition of 4 mg every 30 min via a patient-controlled bolus dose. The primary endpoint was the difference in maximum voluntary isometric contraction (MVIC) of the ipsilateral quadriceps the morning after surgery, compared with the preoperative MVIC, expressed as a percentage of the preoperative MVIC. Secondary endpoints included hip adductor and hip flexor MVIC, sensory levels in the femoral nerve distribution, hip range-of-motion, ambulatory ability, pain scores, and ropivacaine consumption. Results Quadriceps MVIC for patients receiving 0.1% ropivacaine (n = 26) declined by a mean (SE) of 64.1% (6.4) versus 68.0% (5.4) for patients receiving 0.4% ropivacaine (n = 24) between the preoperative period and the day after surgery (95% CI for group difference: -8.0-14.4%; P = 0.70). Similarly, the groups were found to be equivalent with respect to secondary endpoints. Conclusions For continuous posterior lumbar plexus blocks, local anesthetic concentration and volume do not influence nerve block characteristics, suggesting that local anesthetic dose (mass) is the primary determinant of perineural infusion effects.

scholarly journals New Application of Low-Molecular Weight Dextran as Local Anesthetic Adjuvant for Ultrasound-Guided Nerve Block

2021 ◽  
Author(s):  
Masahiko Tsuchiya
Keyword(s):  
Molecular Weight ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Systemic Absorption ◽  
Low Molecular Weight ◽  
Opioid Overdose ◽  
Increased Risk ◽  
Ultrasound Technology

Advances in ultrasound technology and the increased risk of opioid overdose following surgery have expanded applications of nerve block for surgical cases, resulting in reevaluation of adjuvants used to potentiate local anesthetics. We have found that a mixture of local anesthetic with low-molecular weight dextran, one such local anesthetic adjuvant, greatly enhances analgesic duration and potency in patients receiving an interfascial compartment nerve block under ultrasound-guidance as well as those receiving a single peripheral nerve block. Notably, a compartment nerve block in the abdominal trunk with an extra-large amount of low-molecular weight dextran mixture, which results in a longer duration of the injected drugs at the injection site, provides good analgesia that is comparable to epidural anesthesia. Such a dextran mixture also suppresses systemic absorption of local anesthetics, thus reducing their systemic toxicity, which enhances regional anesthesia safety. Furthermore, it controls unintended spread of injected local anesthetics, thus increasing nerve block accuracy. In this chapter, recent findings regarding use of low-molecular weight dextran as a local anesthetic adjuvant obtained in our laboratory are presented.

scholarly journals Lidocaine: A Local Anesthetic, Its Adverse Effects and Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 782
Author(s):  
Entaz Bahar ◽  
Hyonok Yoon
Keyword(s):  
Adverse Effects ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Adverse Reactions ◽  
Rapid Diagnosis ◽  
Diagnosis And Treatment ◽  
Allergic Reactions ◽  
Life Threatening

The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.

scholarly journals Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1013
Author(s):  
Daniel Spitzer ◽  
Katharina J. Wenger ◽  
Vanessa Neef ◽  
Iris Divé ◽  
Martin A. Schaller-Paule ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brachial Plexus ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Central Nervous System Toxicity ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block ◽  
System Toxicity

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

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