Analysis of local anesthetics side effects and determination of ways for their minimization

Abstract

According to the World Health Organization (WHO), the development of side effects of drugs is one of the serious medical problems.The relevance of this problem is proven by numerous statistical data obtained in different countries of the world. The aim of the study was to determine the assortment of local anesthetics (LAs) on the pharmaceutical market of Ukraine, to analyze the evidence base of the effectiveness and safety of modern LAs, to monitor the side effects (SEs) of LAs in Kharkiv and Kharkiv region for the period 2018–2021, and to provide recommendations for their minimization. The methods of passive pharmacovigilance, method of spontaneous reports, method of system approach and system analysis were used in the study. To analyze the clinical effectiveness and conditions of rational use of LAs, well-known data bases were used: Cochrane Library, Trip Database, and PubMed. These databases contain systematized primary or secondary information on a specific clinical issue: the effectiveness and safety of various medical technologies. The results of the analysis of the assortment of LAs on the pharmaceutical market of Ukraine showed that in 2023, based on 9 international non-patented names of LAs, 65 trade names were presented. Bupivacaine and procaine drugs (16 trade names each) and articaine drugs in combinations (13 trade names) are market leaders. The results of the analysis of notification cards with cases of SEs for 4 years revealed that the majority of them in the form of dizziness, weakness, changes in blood pressure, heart rate, edema, itching, hyperemia at the site of application were recorded when using lidocaine drugs, which are the most in demand and popular among doctors. According to the data of systematic reviews, the main directions for reducing the side effects of LAs have been established, such as administration under ultrasound control, the use of the least toxic modern anesthetics ropivacaine and levobupivacaine (not available on the Ukrainian market), the addition of substances with vasoconstrictive properties to the anesthetic solution, the use of combinations of long-acting and short-acting anesthetics. The results obtained can be used by practicing doctors and health care organizers to optimize LAs.