Administration Of Local Anesthetic Agents Research Articles

Knowledge and Attitude towards Anaphylaxis Reaction by Local Anesthesia among Dental Practitioners

Background: Anaphylaxis or Type I hypersensitivity response is an acute, severe, and potentially life-threatening response to an allergen. It occurs as an immune mediated reaction due to the release of mediators by mast cells. The anaphylactic response involves skin, cardiovascular, respiratory or gastrointestinal systems. In dental settings, anaphylaxis can be faced in reaction to multiple medications including the administration of local anesthetic agents. The reaction involves difficulty in breathing, light headedness, wheezing or clammy skin. The knowledge and attitude of the treating dentist related to the anaphylaxis reaction is of prime importance as it may result in morbidity or mortality if not managed properly. Aim and objective: The aim of the study was to assess the knowledge and attitude of dental practitioners in Islamabad-Rawalpindi related to anaphylaxis reactions in patients who have been administered local anesthesia. Method: This cross-sectional study was conducted in Islamabad-Rawalpindi between Jan to June 2021. Total 377 dentist were enrolled in this study after taking consent the closed-ended questionnaire-filled. The questionnaire had two sections regarding the knowledge and practice attitude towards anaphylaxis reaction in response to local anesthesia. The data was analyzed by chi-Square test using SPSS version 24. Results: There were 377 dentists in the sample, with the age between 5-30 years old, with less than 5 years of experience. Only 4% of dentists said they routinely offer a test dosage, despite the fact that 96% of dentists had the practice of asking about previous medication allergies before beginning treatment. Just 28.9% of dentists were doing aspiration before the administration of local anesthesia with 63.1% were checked expiry date. Interestingly, most dentists kept epinephrine, antihistamine, corticosteroids, glucagon, and albutamol as emergency medicine but 79.7% agreed on epinephrine as a drug of choice and injected intramuscularly. Conclusion: Although anaphylaxis during dental operations is uncommon, it may have serious repercussions if it does occur. Results from the current research highlight dentists' knowledge gaps when it comes to dealing with adverse responses. Keywords: Anaphylaxis, Epinephrine, Hypersensitivity, Local anesthetic agent

Sacrococcygeal epidural administration of 0.5% bupivacaine in seven cats undergoing pelvic or hind limb orthopaedic procedures

BackgroundEpidural administration of local anaesthetic agents provides good intraoperative antinociception for orthopaedic procedures of the pelvis and the pelvic limb. However, in cats the spinal cord extends approximately to the level of the first sacrococcygeal vertebra, and therefore the sacrococcygeal epidural could be a safer alternative to the lumbosacral epidural in cats. This case series describes perioperative analgesia and the haemodynamic status of seven client-owned cats that received sacrococcygeal epidural injection of 0.5% bupivacaine and underwent orthopaedic hind leg or pelvic surgeries under general anaesthesia.Case presentationEach cat received either 0.2 or 0.3 mL/kg of 0.5% bupivacaine with or without 0.2 mg/kg of morphine in the sacrococcygeal epidural space. Intraoperative antinociceptive response to surgical stimulus and haemodynamic changes were monitored and reported.ConclusionIn these seven anaesthetised cats, 0.2 or 0.3 mL/kg of 0.5% bupivacaine, administered alone or in combination with morphine into the sacrococcygeal epidural space, enhanced antinociception so that intraoperative rescue analgesia was unnecessary in all but one cat. It also reduced the anticipated requirement for postoperative opioid use. However, a high incidence of hypotension was observed in the cats in this report, and hence intraoperative blood pressure monitoring should be considered mandatory in anaesthetised cats following epidural injection of local anaesthetic agents, regardless of injection site.

Comparative evaluation of sedative and anti-nociceptive effects of epidural romifidine, romifidine-lidocaine, and lidocaine in donkeys (Equus asinus).

Local and regional anesthetic procedures are valuable tools in veterinary practice. Caudal epidural administration of local anesthetic agents is widely reported for surgical interventions of the tail, anus, rectum, vulva, vagina, urethra, and bladder in the standing horse. Epidural analgesia is also obtained using various drugs such as alpha-2 adrenoceptor agonists, dissociative anesthetics, and opioids. The present study evaluates the anti-nociceptive and sedative effects of epidural administration of romifidine, a romifidine-lidocaine combination, and lidocaine alone in donkeys. In a randomized prospective study, twenty-four healthy adult donkeys were assigned to four groups (three experimental and one control; n = 6) received either 50 μg/kg of romifidine, 0.30 mg/kg of lidocaine, combined romifidine (50 μg/kg) and lidocaine (0.30 mg/kg) diluted in 0.9% sterile normal saline solution to a total injection volume of 12 ml, or an equivalent volume of sterile saline epidurally. After epidural injection of each treatment, the onset, degree, and duration of sedation and anatomical extension of anti-nociception were documented. Observations began immediately (time 0) pre-administration and at 5, 15, 30, 45, 60, and 30-min intervals subsequently until 210 min after drug injection. Time to onset of perineal analgesia was documented every minute after the epidural injection by evaluating the animal's response to pinpricks. Only romifidine and romifidine-lidocaine induced mild to moderate sedation. Romifidine, romifidine-lidocaine, and lidocaine induced complete bilateral caudal epidural analgesia with loss of sensation in the perineum, tail, inguinal region, caudal aspect of the upper hind limb, chest areas, and extended distally to the dorsal metatarsal area. Sedation lasted longer (p < 0.05) with romifidine (160 ± 15.4 min) than with romifidine-lidocaine (141.6 ± 13.2 min). Longer-lasting analgesia (p < 0.05) was obtained with romifidine (158.3 ± 9.8 min) and romifidine-lidocaine (165 ± 9.4 min) than with lidocaine (75.8 ± 8 min). Epidural administration of a single dose of romifidine or a combination of romifidine-lidocaine produced mild to moderate sedation and complete anti-nociception in the perineal and inguinal regions of donkeys. The clinical usefulness of epidural romifidine or romifidine-lidocaine combinations to perform obstetric procedures in donkeys needs to be assessed.

Knowledge, attitude and practice on usage and toxicity of local anaesthetic agents (LA) amongst health care professionals in obstetrics and gynaecology

A sound knowledge of LA and their dosage is essential for effective anaesthesia and patient safety as LA toxicity could be potentially life-threatening and clinicians undertaking LA procedures must be competent in early recognition of toxicity and instigating remedial measures timely. This is a prospective national-level survey using self-administered questionnaires among health care professionals in Obstetrics and Gynaecology primarily based in Worcestershire Acute Hospital NHS Trust and further extended to other regions of the United Kingdom. The survey was focussed on evaluating the knowledge, attitude and practice (KAP) of the common local anaesthetic agents, their dosage, early recognition and management of LA systemic toxicity(LAST). We understood that all groups of health care professionals did not demonstrate adequate knowledge of safe and effective use of LA agents. We thereby propose an accredited knowledge-based learning module, laminated safety information cards for LA use and ensuring availability of Lipid-emulsion therapy in clinical areas. IMPACT STATEMENT What is already known on this subject? Health care professionals using LA should have sufficient knowledge of LA including the required and maximum dose allowance, pharmacokinetic properties, possible complications and management of systemic toxicity. The lack this can trigger potentially fatal and life-threatening complications if misused. Therefore, the key objectives of the use of LA in clinical settings are to optimise pain management while ensuring safe practice. What do the results of this study add? We understood that all groups of health care professionals did not demonstrate adequate knowledge of the safe and effective use of LA agents and appropriate management of its toxicity. This highlights the urgent need for extending awareness among the professionals on the safe administration of LA, early identification and prompt management of LAST. This will improve not only the safety but also the overall patient experience and quality of care. What are the implications of these findings for clinical practice and/or further research? We thereby propose that an accredited knowledge-based module on safe administration and safety concerns of LA must be made compulsory for all those administering LA. Laminated safety information cards on LA with explicit algorithms/guidelines should be made available in all clinical areas to avoid any delays in the management of toxicity. Moreover, all health-care institutions must ensure the availability of Lipid Emulsion Therapy.

Is systemic administration of local anesthetic agents effective for relieving neuropathic pain? A Cochrane Review summary with commentary.

The role of systemic use of local anesthetics in the treatment of neuropathic pain (NP) is still unclear. To assess the efficacy and safety of systemic local anesthetics for NP. To summarize and to discuss the rehabilitation perspective on the published Cochrane Systematic Review "Systemic administration of local anesthetic agents to relieve neuropathic pain" by Challapalli V et al.RESULTS:The review included 30 RCTs including patients with NP treated with iv lidocaine, oral mexiletine, lidocaine and mexiletine, or oral tocainide. Low-to-moderate quality of the evidence suggest that intravenous lidocaine or oral mexiletine may slightly reduce NP vs placebo, but the efficacy of these drugs is comparable to anticonvulsants or morphine. Systemic administration of local anesthetics is not supported by scientific evidence for pain relief as well as for functional improvement.

Skin disinfection practice before skin anaesthesia, prior to neuraxial blockade: a survey of government hospital practices in South Africa

Background: Infectious complications following neuraxial block, although being of low incidence, may lead to morbidity and mortality. Two common methods utilised for skin disinfection before skin anaesthesia prior to a neuraxial block are the isopropanol only method (isopropanol method) and the full aseptic technique (classic method). The objective of this study was to survey government-employed South African anaesthesiologists’ preference regarding the disinfection practices before the administration of local anaesthetic agents to the skin prior to the performance of a neuraxial block. Methods: Ethics approval was obtained prior to commencing the study. An electronic, web-based questionnaire in the form of a survey was distributed to various anaesthetic departments in various government teaching hospitals in South Africa. Descriptive statistics were used on the raw data using the Fisher exact test to measure associations between the different categorical variables. Results: A significant response rate of 60.3% was achieved. Regarding subarachnoid blocks, more than half of the participants (52.0%) that participated in the survey utilise the isopropanol method whereas less than half of the participants utilise the isopropanol method when performing an epidural block. Close to 75% of participants with zero to five years anaesthetic experience prefer the isopropanol method whilst only 20.9% of anaesthetists with more than ten years’ experience prefer the isopropanol method when performing a subarachnoid block (p &lt; 0.01). Conclusion: Both methods described in this study (classic and isopropanol methods) are practised commonly by the participants in the survey and neither the classic nor the isopropanol method dominates. Local guidelines need to address the technique used to disinfect the skin before the administration of the local anaesthetic agent to the skin prior to performing a neuraxial block.

A 1-year comparative evaluation of clinical performance of nanohybrid composite with Activa™ bioactive composite in Class II carious lesion: A randomized control study.

Aim:The aim of this study was to compare and evaluate the clinical performance of nanohybrid composite with Activa™ bioactive composites in Class II carious lesion.Methodology:After ethical approval, patients were selected according to the inclusion-exclusion criteria with minimum of two carious lesions in a single patient. Lesions were randomly divided into two groups: Group A – nanohybrid composite and Group B – Activa™ bioactive composite. After administration of local anesthetic agent, Class II cavity preparation was done followed by rubber dam application. For deep lesion, pulp protection was done with light-cured calcium hydroxide. Then, the cavities were restored. Finishing and polishing were done. Evaluation of the restorations was done at 1 week, 6 months, and 1 year time interval by second-blinded examiner according to the modified USPHS criteria. The results of the study were tabulated, and statistical analysis was done.Results:The results showed no statistically significant difference in the clinical performance of nanohybrid composite and Activa™ bioactive composites in Class II carious lesions at the end of 1 week, 6 months, and 1 year.Conclusion:It can be concluded that both materials showed equal and acceptable clinical performance at the end of 1 year. Both materials can be successfully be used to restore Class II carious lesions.

A cadaveric study of the anatomical variations of the lumbar plexus with clinical implications

IntroductionThe main objective was to study the normal and abnormal lumbar plexus. Material and methodsWe analyzed 131 lumbar plexuses from 68 embalmed cadavers at the Cadaveric Surgical Training Center, Faculty of Medicine, Chiang Mai University in the period between April 2012 and June 2013. Morphometric measurements were taken. ResultsThe lumbar plexus was located within psoas major muscle (100.0%). The iliohypogastric nerve originated from the ventral rami of L1 (96.5%) followed by the ilioinguinal nerve (90.1%). The genitofemoral nerves originated from the ventral rami of L1 and L2 (98.5%). The lateral femoral cutaneous nerves (LFCN) originated from the ventral rami of L2 and L3 (84.0%). The femoral and obturator nerves originated from ventral rami of L2–L3–L4 (100.0%). The distance between the origin of LFCN to L3 transverse process was at an average 1.96±0.67cm. The distance from nerve to L4 transverse process was above L3 and between L3 and L4 transverse process at an average 2.8±1.63cm. The distance between femoral nerve to L3 and L4 transverse process was inferior to L4 transverse process at an average of 5.13±2.18cm and 2.53±2.26cm, respectively. The distance between obturator nerve to L3 and L4 transverse process was found inferior to L4 transverse process at an average 5.42±1.73cm and 2.75±1.75cm, respectively. DiscussionThe knowledge of anatomical variations of LP may be important for administration of local anaesthetic agents and avoid any inadvertent injuries.

In vivo study of an extended release bupivacaine formulation following site-directed nerve injection

Site-directed administration of local anesthetic agents incorporated into a slow controlled-release injectable implant prolongs the analgesic effect. However, there are potential neuro- and myotoxic consequences. We evaluated a local anesthetic agent (bupivacaine) loaded into a slow-release biodegradable polymer based on castor oil and poly(lactic acid). The formulation was applied directly to the sciatic nerve area in female imprinting control region mice along with appropriate controls. Local nerve and muscle and systemic toxicity were evaluated over a 3-month period following injection of 0.05, 0.1, and 0.125 mL of the 15% bupivacaine–polymer formulation. Histological samples were prepared and examined; no signs of severe inflammation were observed. Histological inflammation signs were more prominent in both nerves and muscles following application of the largest volumes of the polymer formulation (0.1 and 0.125 mL). Following application of 0.1 mL, 15% bupivacaine–polymer formulation, maximal changes were seen in nerve samples two days and two weeks after injection, with complete resolution one month following injection. Neither blank polymer nor plain bupivacaine 0.5% caused any histological changes. Local nerve and muscle toxicity were affected by duration the of exposure and dose of the local anesthetic agent. However, there were clear indications of time-related healing process 3 months after injection.

Administration of Local Anesthetic Agents to Decrease Pain Associated With Peripheral Vascular Access

The purpose of this study was to compare a variety of local anesthetic agents before starting an intravenous (i.v.) device to determine which method is the most comfortable for patients. Using a randomized, double-blind, placebo-controlled, pretest-posttest experimental design, the study compared 5 treatment groups (anesthetic spray, placebo spray, anesthetic intradermal injection, placebo intradermal injection, and a control group with no local anesthetic agent) in 84 emergency department patients. Pain was measured with a visual analog scale before and after the application of the local anesthetic agents and after i.v. insertion. Pain was significantly higher in the anesthetic intradermal injection group 1 minute after anesthetic application compared with the other treatment groups. Pain ratings 3 minutes after i.v. insertion were found to be similar for the 5 treatment groups. These study results do not support the use of intradermal anesthetic agents before i.v. catheter insertion.

Parkinson Disease: Systemic and Orofacial Manifestations, Medical and Dental Management

More than 1.5 million Americans have Parkinson disease (PD), and this figure is expected to rise as the population ages. However, the dental literature offers little information about the illness. The authors conducted a MEDLINE search using the key terms "Parkinson's disease," "medical management" and "dentistry." They selected contemporaneous articles published in peer-reviewed journals and gave preference to articles reporting randomized controlled trials. PD is a progressive neurodegenerative disorder caused by loss of dopaminergic and nondopaminergic neurons in the brain. These deficits result in tremor, slowness of movement, rigidity, postural instability and autonomic and behavioral dysfunction. Treatment consists of administering medications that replace dopamine, stimulate dopamine receptors and modulate other neurotransmitter systems. Oral health may decline because of tremors, muscle rigidity and cognitive deficits. The dentist should consult with the patient's physician to establish the patient's competence to provide informed consent and to determine the presence of comorbid illnesses. Scheduling short morning appointments that begin 90 minutes after administration of PD medication enhances the patient's ability to cooperate with care. Inclination of the dental chair at 45 degrees, placement of a bite prop, use of a rubber dam and high-volume oral evacuation enhance airway protection. To avoid adverse drug interactions with levodopa and entacapone, the dentist should limit administration of local anesthetic agents to three cartridges of 2 percent lidocaine with 1:100,000 epinephrine per half hour, and patients receiving selegiline should not be given agents containing epinephrine or levonordefrin. The dentist should instruct the patient and the caregiver in good oral hygiene techniques.

Vietinių anestetikų šalutinis poveikis - alergija ar kitas nepageidaujamas poveikis

Straipsnyje aptartas galimas vietinių anestetikų nepageidaujamas poveikis, kurį sunku atskirti nuo tikrosiosalergijos. Vietinio anestetiko sukeltus simptomus reikėtų laikyti vaisto nepageidaujamu toksiniu poveikiu. Kartu reikiaįvertinti kitas galimas priežastis: paciento susijaudinimą, hiperventiliaciją, klajoklio nervo ir kraujagyslines reakcijas beiadrenalino, esančio kai kurių vietinių anestetikų tirpaluose, poveikį. Taip pat svarbu įsitikinti, ar pacientas nėra įsijautrinęslateksui. Tikrąsias alergines reakcijas anestetikai sukelia labai retai – jos tesudaro 1 proc. visų nepageidaujamų šiųvaistų reakcijų. Gydytojams svarbu atskirti tikrosios alergijos ir kito nepageidaujamo poveikio simptomus ir skirti tinkamągydymą. Pacientą, kuriam įtariama buvusi alerginė reakcija vietiniam anestetikui, reikėtų siųsti pas alergologą. Alergijaipatvirtinti paprastai atliekami odos ir didėjančių dozių provokaciniai mėginiai. Straipsnyje pateiktos alerginių reakcijų įvietinius anestetikus gydymo rekomendacijos.

Systemic administration of local anesthetic agents to relieve neuropathic pain.

Lidocaine, mexiletine, tocainide, and flecainide are local anesthetics which give an analgesic effect when administered orally or parenterally. Early reports described the use of intravenous lidocaine or procaine to relieve cancer and postoperative pain (Keats 1951; Gilbert 1951; De Clive-Lowe 1958; Bartlett 1961). Interest reappeared decades later when patient series and clinical trials reported that parenteral lidocaine and its oral analogs tocainide, mexiletine, and flecainide relieved neuropathic pain in some patients (Boas 1982; Lindblom 1984; Petersen 1986; Dunlop 1988; Bach 1990; Awerbuch 1990). With the recent publication of clinical trials with high quality standards, we have reviewed the use of systemic lidocaine and its oral analogs in neuropathic pain to update our knowledge, to measure their benefit and harm, and to better define their role in therapy. To evaluate pain relief and adverse effect rates between systemic local anesthetic-type drugs and other control interventions. We searched MEDLINE (1966 through 15 May 2004), EMBASE (January 1980 to December 2002), Cancer Lit (through 15 December 2002), Cochrane Central Register of Controlled Trials (2nd Quarter, 2004), System for Information on Grey Literature in Europe (SIGLE), and LILACS, from January 1966 through March 2001. We also hand searched conference proceedings, textbooks, original articles and reviews. We included trials with random allocation, that were double blinded, with a parallel or crossover design. The control intervention was a placebo or an analgesic drug for neuropathic pain from any cause. We collected efficacy and safety data from all published and unpublished trials. We calculated combined effect sizes using continuous and binary data for pain relief and adverse effects as primary and secondary outcome measurements, respectively. Thirty-two controlled clinical trials met the selection criteria; two were duplicate articles. The treatment drugs were intravenous lidocaine (16 trials), mexiletine (12 trials), lidocaine plus mexiletine sequentially (one trial), and tocainide (one trial). Twenty-one trials were crossover studies, and nine were parallel. Lidocaine and mexiletine were superior to placebo [weighted mean difference (WMD) = -11; 95% CI: -15 to -7; P <0.00001], and limited data showed no difference in efficacy (WMD = -0.6; 95% CI: -7 to 6), or adverse effects versus carbamazepine, amantadine, gabapentin or morphine. In these trials, systemic local anesthetics were safe, with no deaths or life-threatening toxicities. Sensitivity analysis identified data distribution in three trials as a probable source of heterogeneity. There was no publication bias. Lidocaine and oral analogs were safe drugs in controlled clinical trials for neuropathic pain, were better than placebo, and were as effective as other analgesics. Future trials should enroll specific diseases and test novel lidocaine analogs with better toxicity profiles. More emphasis is necessary on outcomes measuring patient satisfaction to assess if statistically significant pain relief is clinically meaningful.

Effects of Histamine on Nerve Block with Lidocaine

Background: The failure to achieve satisfactory anesthesia following the administration of local anesthetic agents in acute inflammatory tissues is a recognized clinical phenomenon. Many inflammatory mediators can reduce the threshold of nociception during inflammation, and histamine, one of the most important inflammatory mediator, may attenuated local anesthetic effect during inflammation. The purpose of this study was to investigate if histamine can antagonize a lidocaine induced nerve block in vitro. Methods: Recordings of the compound acton potentials (CAP) of A-fiber components were obtained from the isolated sciatic nerves of male Sprague-Dawley rats. The nerve sheath of the sciatic nerve was removed and desheathed nerve was mounted in a recording chamber. Single pulse stimuli (0.5 msec, supramaximal stimuli) were repeatedly applied (2 Hz) to me end of the nerve and CAP recordings were made at the other. The effect of histamine on the suppression of CAP by lidocaine and the effect of histamine on the recovery time to the nerve block by lidocaine were measured. Results: Compared with the baseline amplitude, the amplitudes of CAP were 11.7 4.1 % for the lidocaine group, 18.3 4.6% for the lidocaine + histamine 0.05% group, and 26.1 5.6% for the lidocaine + histamine 0.5% group. Nerve block recovery times were: 38.6 3.5 min for the modified Krebs group, 29.8 4.2 min for histamine 0.05% in the modified Krebs group, and 192 1.1 min for histamine 0.5% in the modified Krebs group. Conclusions: Histamine shortened the recovery time induced by lidocaine. We suggest that histamine may significantly attenuate the effects of local anesthetics in inflammed tissue.

Central Effects Index — a semiquantitative method for the assessment of CNS toxicity of local anaesthetic agents in sheep

Local anaesthetic agents can cause central nervous system (CNS) and cardiovascular system toxicity. Whereas most previous work has described their behavioural CNS effects qualitatively (i.e., absence or presence of convulsions), we wished to describe their CNS effects more quantitatively. We hypothesised that early CNS excitatory or disinhibitory effects leading to convulsions represent a prodrome to the onset of chaotic dynamics in the form of a bifurcation in the chaotic map. We therefore used a chaotic map with a continuous scale to model their CNS effects. A Central Effects Index (CEI) was developed from our observation of behaviours before and after intravenous (iv) administration of local anaesthetic agents in graded doses to conscious sheep. These behaviours were ranked in severity, and modelled according to a logistic population growth equation using the onset of convulsive behaviour and death as point attractors. The behaviours, scaled to the maximum and area under the curve (AUC) CEI units, were then compared for intravenous doses of (±)- RS-bupivacaine and (−)-( S)-bupivacaine (or levobupivacaine), which is being evaluated as a substitute for (±)- RS-bupivacaine. (−)-( S)-bupivacaine produced smaller maximum and AUC CEI values at 75 and 100 mg doses, but equivalent values at 150 and 200 mg when the doses exceeded the convulsant threshold. It was concluded that the CEI provides a useful quantitative tool for evaluating these agents in subconvulsant doses, and that the CNS stimulatory potency of (−)-( S)-bupivacaine is less than that of (±)- RS-bupivacaine.

THE ACUTE PAIN SERVICE

The often inadequate treatment of acute pain is more often due to improper application of available therapies than to the unavailability of effective drugs and techniques. In our institution, the establishment of an acute pain service has improved the safety and efficacy of postoperative pain control. This has been achieved not simply through the immediate availability of a group of specialist physicians and nurses, but also through staff education. The latter has addressed many of the misconceptions preventing proper and safe use of potent analgesic agents. Although provision of intravenously administered patient-controlled analgesia appears not to influence patient outcome, it can result in improved analgesia and patient satisfaction when used properly. Epidurally administered patient-controlled analgesia, on the other hand, appears to provide superior relief of activity pain and earlier resolution of postoperative ileus. The administration of local anesthetic agents, in particular, may reduce reflex diaphragmatic dysfunction following thoracoabdominal surgery and decrease the incidence of graft occlusion following lower extremity vascular procedures. Epidural catheter placement, however, is not without risk, especially in subjects with an established or potential coagulopathy.

Patients'experiences of postoperative respirator treatment ‐ influence of anaesthetic and pain treatment regimens

The influences of premedication, anaesthetic agents, and postoperative sedation and pain treatment regimens on the experiences of postoperative respirator treatment of surgical patients (n = 107) have been assessed. Of the patients, 55% recalled the respirator treatment. Administration of anticholinergic drugs and halogenated anaesthetic agents was found to impair the memory process and reduce the number of recallers, and sedation in the ICU with benzodiazepines was found to decrease the number of discomforts experienced by the recalling patients. Most of the patients who received treatment postoperatively for pain, mainly by epidural administration of local anaesthetic agents and/or morphine, recalled the respirator treatment period (85%), as compared to only 50% of the patients receiving intravenous opioids. The number and type of complaints experienced by patients receiving epidural pain treatment did not, however, differ from those reported by intravenously treated patients, and no significant adverse psychological reactions seemed to occur. It is concluded that the use of mainly regional techniques, when appropriate, for pain treatment of surgical patients needing postoperative ventilatory support seems advantageous. The primary aim of relieving pain from the wound area is achieved, allowing such light intravenous sedation and pain treatment that the possibility of communication and giving comforting reassurance is maintained. Such nursing care may be more efficient in helping the patient to cope with the stressful respirator treatment situation then heavy intravenous sedation and pain treatment regimens.

The pharmacological management of postoperative pain : C.P. Venter, S. Afr. med. J., 52 (1977) 21–27

The physiology and pharmacological management of postoperative pain are briefly discussed. Although narcotic analgesics are still the mainstay in the management of postoperative pain the judicious use of non-narcotic analgesics, anticholinergics, tranquillizers and soporifics as well as the administration of local anaesthetic agents could contribute greatly to the alleviation of postoperative pain and discomfort. Certain regimens for intravenous medication are outlined and strong emphasis is placed on the fact that postoperative pain relief is the duty of the doctor and not that of unskilled nursing staff.