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Neuraxial Blockade
Neuraxial blockade is local anaesthesia placed around the nerves of the central nervous system, such as spinal anaesthesia, caudal anaesthesia, epidural anaesthesia, and combined spinal and epidural anaesthesia. The technique is used in surgery, obstetrics, and for postoperative and chronic pain Chronic pain is pain that persists or recurs for longer than 3 months.https://icd.who.int/browse/2025-01/mms/en#1581976053 It is also known as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is in cont ... relief. See also * History of neuraxial anesthesia References Anesthesia {{surgery-stub ...
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Local Anaesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. The following terms are often used interchangeably: * ''Local anesthesia'', in a strict sense, is anesthesia of a small part of the body such as a tooth or an area of skin. * ''Regional anesthesia'' is aimed at anesthetizing a larger part of the body such as a leg or arm. * ''Conduction anesthesia'' encompasses a great variety of local and regional anesthetic techniques. Medical A local anesthetic is a drug that causes reversible local anesthesia and a loss of nociception. When it is used on specific nerve pathways (nerve block), effects such as an ...
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Central Nervous System
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all parts of the bodies of bilateria, bilaterally symmetric and triploblastic animals—that is, all multicellular animals except sponges and Coelenterata, diploblasts. It is a structure composed of nervous tissue positioned along the Anatomical_terms_of_location#Rostral,_cranial,_and_caudal, rostral (nose end) to caudal (tail end) axis of the body and may have an enlarged section at the rostral end which is a brain. Only arthropods, cephalopods and vertebrates have a true brain, though precursor structures exist in onychophorans, gastropods and lancelets. The rest of this article exclusively discusses the vertebrate central nervous system, which is radically distinct from all other animals. Overview In vertebrates, the brain and spinal ...
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Spinal Anaesthesia
Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic with or without an opioid into the subarachnoid space. Usually a single-shot dose is administrered through a fine needle, alternatively continuous spinal anaesthesia through a intrathecal catheter can be performed. It is a safe and effective form of anesthesia usually performed by anesthesiologists and CRNAs that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true anaesthesia, motor, sensory and autonomic (sympathetic) blockade. Administering analgesics (opioid, alpha2-adrenoreceptor agonist) in the cerebrospinal fluid without a local anaestheti ...
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Caudal Anaesthesia
Caudal anaesthesia (or caudal anesthesia) is a form of neuraxial regional anaesthesia conducted by accessing the epidural space via the sacral hiatus. It is typically used in paediatrics to provide peri- and post-operative analgesia for surgeries below the umbilicus. In adults, it can be used in the context of anorectal surgery or for chronic low back pain management. It can be used as an alternative to general anaesthesia or as adjunct to it. Indications Caudal anaesthesia is a relatively low-risk technique commonly used, either on its own or in combination with sedation or general anaesthesia. Caudal anesthesia may be favored for sub-umbilical region surgeries in the pediatric population, such as inguinal hernia repair, circumcision, hypospadias repair, anal atresia, or to immobilise newborns with hip dysplasia. Success rate is limited when used for mid-abdominal interventions such as umbilical hernia repair. This is due to the unpredictable cephalad spread of the local an ...
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Epidural Anaesthesia
Epidural administration (from Ancient Greek ἐπί, "upon" + '' dura mater'') is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and nurse anesthetists to administer local anesthetic agents, analgesics, diagnostic medicines such as radiocontrast agents, and other medicines such as glucocorticoids. Epidural administration involves the placement of a catheter into the epidural space, which may remain in place for the duration of the treatment. The technique of intentional epidural administration of medication was first described in 1921 by the Spanish Aragonese military surgeon Fidel Pagés. Epidural anaesthesia causes a loss of sensation, including pain, by blocking the transmission of signals through nerve fibres in or near the spinal cord. For this reason, epidurals are commonly used for pain control during childbirth and surgery, for which the technique is c ...
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Combined Spinal And Epidural Anaesthesia
Combined spinal and epidural anaesthesia is a regional anaesthetic technique, which combines the benefits of both spinal anaesthesia and epidural anaesthesia and analgesia. The spinal component gives a rapid onset of a predictable block. The indwelling epidural catheter gives the ability to provide long lasting analgesia and to titrate the dose given to the desired effect. Indications This technique also allows for better post operative pain relief. The epidural catheter may be left in place for up to 72 hours if required. In labouring women, the onset of analgesia is more rapid with combined spinal and epidural anaesthesia compared with epidural analgesia.Simmons SW, Cyna AM, Dennis AT et al. Combined spinal-epidural versus epidural analgesia in labour. pdate of Cochrane Database of Systematic Reviews 2003; 4. CD003401 Cochrane Database of Systematic Reviews 2007; 4. CD003401 Combined spinal and epidural anaesthesia in labour was formerly thought to enable women to mobilise ...
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UpToDate
UpToDate, Inc. is a company in the Wolters Kluwer Health division of Wolters Kluwer, the main product of which is the eponymous UpToDate, a software system that is a Point of care medical information summary, point-of-care medical resource. The UpToDate system is an evidence-based medicine, evidence-based clinical resource. It includes a collection of medical and patient information, access to Lexicomp drug monographs and drug interaction, drug-to-drug interactions, and a number of medical calculators. UpToDate is written by over 7,100 physician authors, editors, and peer reviewers. It is available both via the Internet and offline on personal computers or mobile devices. It requires a subscription for full access. The company was launched in 1992 by Burton Rose along with Joseph Rush out of Rose's home. They started with nephrology and have since added over twenty other specialties, with more in development. Controversies UpToDate's articles are Scholarly peer review#Anonymous, a ...
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Obstetrics
Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field. Main areas Prenatal care Prenatal care is important in screening for various complications of pregnancy. This includes routine office visits with physical exams and routine lab tests along with telehealth care for women with low-risk pregnancies: Image:Ultrasound_image_of_a_fetus.jpg, 3D ultrasound of fetus (about 14 weeks gestational age) Image:Sucking his thumb and waving.jpg, Fetus at 17 weeks Image:3dultrasound 20 weeks.jpg, Fetus at 20 weeks First trimester Routine tests in the first trimester of pregnancy generally include: * Complete blood count * Blood type ** Rh-negative antenatal patients should receive RhoGAM at 28 weeks to prevent Rh disease. * Indirect Coombs test (AGT) to assess risk of hem ...
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Chronic Pain
Chronic pain is pain that persists or recurs for longer than 3 months.https://icd.who.int/browse/2025-01/mms/en#1581976053 It is also known as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is in contrast to acute pain, which is pain associated with a cause that can be relieved by treating the cause, and decreases or stops when the cause improves. Chronic pain can last for years. Persistent pain often serves no apparent useful purpose. The most common types of chronic pain are back pain, severe headache, migraine, and facial pain. Chronic pain can cause very severe psychological and physical effects that sometimes continue until the end of life. Analysis of the grey matter (damage to brain neurons), insomnia and sleep deprivation, metabolic problems, chronic stress, obesity, and heart attack are examples of physical disorders; and Depression (mood), depression, and neurocognitive disorders are examples of mental disorders. A wide ra ...
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History Of Neuraxial Anesthesia
The history of neuraxial anaesthesia dates back to the late 1800s and is closely intertwined with the development of anaesthesia in general. Neuraxial anaesthesia, in particular, is a form of regional analgesia placed in or around the Central Nervous System, used for pain management and anaesthesia for certain surgeries and procedures. 19th century In 1855, Friedrich Gaedcke (18281890) became the first to chemically isolate cocaine, the most potent alkaloid of the coca plant. Gaedcke named the compound "erythroxyline". In 1884, Austrian ophthalmologist Karl Koller (18571944) instilled a 2% solution of cocaine into his own eye and tested its effectiveness as a local anesthetic by pricking the eye with needles. His findings were presented a few weeks later at annual conference of the Heidelberg Ophthalmological Society. The following year, William Halsted (18521922) performed the first brachial plexus block. Also in 1885, James Leonard Corning (18551923) injected cocaine betwe ...
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