Anesthetic Solution Research Articles

Effect of Back-Pressure Anesthesia on Postoperative Pain after the Endodontic Treatment in Patients with Symptomatic Irreversible Pulpitis: Randomized Double-Blind Clinical Trial

IntroductionThe present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. MethodsOne-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. ResultsThe initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. ConclusionsPatients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.

The Impact of 4% Articaine on ECG: Insights from a Randomised Control Trial

Aim and Background of The Study: Articaine can be used as alternative drug of choice for lignocaine because it has rapid onset and longer duration of action so these qualities of articaine can be beneficial for patient travelling from long distance in which patient can be free from pain. The aim of this study is to Compare the efficacy and safety such as blood pressure and pulse rate, ECG of the both of 4% Articaine with 1:100,000 epinephrine and 2% Lignocaine with 1:100,000 epinephrine in patients operated for mandibular third molar impaction. Method: This is a randomized controlled clinical trial a total 30 subjects were participated in the study with age ranging from 22-45 years and parameters such as Drug volume(ml), Duration of surgical procedure, Intra operative pain evaluation, Onset of anesthesia, Duration of anesthesia, Duration of postoperative analgesia, ECG,blood pressure,pulse,spo2,temperature were assessed. Results: It was evident that 4% articaine has longer duration of action and great postoperative analgesia in terms of 2% lignocaine and there was no significant difference in ECG, blood pressure, pulse, spo2, temperature. Conclusion: It was established that 4% articaine is more effective than 2% lignocaine. Hence might be thought of as a lignocaine substitute in clinical settings.A local anaesthetic solution that is efficient enough to produce sufficient anaesthesia while causing minimal problems is essential for minor oral surgical procedures.

Comparison of Proparacaine, Tetracaine, and Oxybuprocaine in Corneal Sensitivity Measurement.

Purpose: This study aimed to determine the onset and duration of action of 3 commercially available topical anesthetic solutions in Brazil, using the Cochet-Bonnet esthesiometer (Luneau®, Paris, France) and to quantitatively assess patient-reported discomfort during application. Methods: A prospective, randomized, masked, and double-blind study was conducted, involving 40 eyes from 21 patients. Patients were administered each one of the topical anesthetics weekly, and corneal sensitivity was measured using the Cochet-Bonnet esthesiometer's corneal touch threshold (CTT). Patients rated the burning sensation using a visual analogue scale (VAS). Results: Among the 21 patients (42.9% male), with a mean age of 31.95 years (±standard deviation = 10.17, range = 22.0-58.0), corneal sensitivity significantly decreased 30 s after application, returning to baseline after 30 min for all groups (P < 0.0001). Significant differences in CTT were observed at 5 min, with proparacaine exhibiting a superior anesthetic effect (P = 0.0003), at 10 min, where tetracaine displayed the most substantial anesthetic effect (P = 0.0135), and at 20 min, where tetracaine demonstrated the highest anesthetic efficacy (P < 0.0001). VAS scores indicated the most intense burning sensation with tetracaine (P < 0.0001). Men reported experiencing more discomfort during instillation compared with women (P = 0.0168). Conclusions: Proparacaine exhibited the fastest onset of action among the 3 topical anesthetics and provided a more comfortable eye sensation during instillation. However, tetracaine demonstrated the longest duration of action despite causing more discomfort.

A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7-9-year-old children: A randomized split-mouth cross-over trial.

Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7-9-year-old children. A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.

Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years.

Local anesthetics are used to alleviate pain, but the prick of the injection delivering anesthesia is known to cause anxiety and pain that affect dental treatment. The most difficult aspect of pediatric dentistry is minimizing discomfort while the intraoral local anesthetic is administered. This pain has been treated using physical, psychological, pharmacological, and combinations of these approaches. Recently, the idea of vibration, which is based on the gates control theory, has gained popularity as a way to reduce discomfort while local anesthesia (LA) is being administered. The aim of this trial was to evaluate the efficacy of mucosal vibrators in children aged 6-10 years to alleviate pain associated with LA administration. A total of 60 patients aged 6-10 years requiring inferior alveolar nerve block were enrolled for this randomized, single-blind clinical trial. In group I, before and during LA administration, the customized mucosal vibrator was placed at the injection site. In group II, the topical local anesthetic gel was applied to the injection site prior to the administration of LA. Then, the local anesthetic solution was deposited using a disposable syringe needle on both groups. The pain was evaluated using the physiological scale (pulse rate and oxygen saturation), the subjective scale (Wong-Baker scale), and the objective scale [Face, Legs, Activity, Cry, Consolability (FLACC) scale] by an experienced assistant who was unaware of the procedure. A customized mucosal vibrator along with local anesthetic injections resulted in significantly less pain (p = 0.001*) when compared with the injections with topical anesthetic gel. The results show that the customized mucosal vibrator is an effective and inexpensive means to reduce pain during LA administration. Tatiya N, Singh C, Surana P, et al. Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years. Int J Clin Pediatr Dent 2024;17(4):404-409.

Comparison of Automatically Controlled Injection System with a Traditional. Syringe for Multiple Infiltrations in Children Aged 6-12 Years: A Randomized Controlled Trial.

Children's conduct is significantly impacted by pain during dental procedures. Children's pain and discomfort can be reduced using computer-controlled local anesthetic delivery, which applies a steady, gradual flow of the anesthetic solution into the tissues. Using a self-report anxiety scale, the study aimed to assess and compare children's perceptions of discomfort following a new auto-controlled injection method to a traditional local anesthetic procedure. A total of 25 children, ages 6-12 requiring the use of local anesthesia for treatment on both sides of the arch were selected. It was a split-mouth design, in which each participating child received both types of infiltrations in two separate, consecutive visits, using a metallic syringe in one session, and using the I-Ject device in the other. Before administering anesthesia, all the children's anxiety scales were recorded using the Modified Child Dental Anxiety Faces Scale simplified to assess the anxiety level of a child. In the first appointment, Conventional anesthetic technique was and in the second appointment anesthesia was delivered using a computer-controlled device. Faces pain scaleRevised, a selfreport measure of pain was recorded immediately after completion of both types of local anesthesia (LA) administration. Patients reported greater comfort with the I-Ject computer-controlled device than with conventional anesthesia. Together with the practitioner, the computer system produced a pleasant and cozy environment for the youngster.

Retrospective comparison between low-volume high-concentration and high-volume low-concentration levobupivacaine for bilateral erector spinae plane block in dogs undergoing hemilaminectomy

ObjectiveTo compare the analgesic effect of a bilateral ultrasound-guided erector spinae plane block (ESPB) in dogs undergoing hemilaminectomy using either a low-volume high-concentration (LV-HC) or a high-volume low-concentration (HV-LC) local anaesthetic solution. Study designRetrospective observational equivalence trial. AnimalsA total of 391 client-owned dogs undergoing hemilaminectomy. MethodsDogs were assigned to group LV-HC or HV-LC depending on whether 0.2–0.25% levobupivacaine (0.4–0.5 mL kg–1) or 0.125–0.15% levobupivacaine (0.8–1 mL kg–1) was used to perform the ESPB, respectively. The number of dogs in which intraoperative rescue fentanyl boluses were administered, the total dose of fentanyl administered, the overall methadone consumption during the first 24 hours postoperatively and anaesthetic complications were recorded. Univariate and multivariate statistical analyses were performed considering p < 0.05 significant. ResultsA total of 248 and 143 dogs were assigned to groups LV-HC and HV-LC, respectively. In group HV-LC, the number of dogs requiring fentanyl intraoperatively (64.3%) was higher (p = 0.0001) than that in group LV-HC (43.5%). The overall intraoperative fentanyl consumption was higher in group HV-LC between the first skin incision and the end of the lamina drilling (p = 0.028). According to the regression analysis, the group allocation was the best variable to predict the intraoperative fentanyl consumption (p < 0.001).Antimuscarinic drugs were administered more frequently in group LV-HC (p < 0.02). However, the prevalence of hypotension and other pharmacological cardiovascular interventions did not differ between groups. No differences in methadone consumption during the first 24 hours postoperatively were found between the groups. Conclusionsand clinical relevanceWhen performing a bilateral ESPB in dogs undergoing hemilaminectomy, compared with HV-LC, the use of LV-HC local anaesthetic solution reduces the intraoperative fentanyl consumption without affecting the postoperative methadone requirement.

Is it possible to extract primary maxillary molars without palatal injection?: a controlled clinical trial

ObjectivesThe absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times.Materials and methodsA single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS).ResultsIn terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05).ConclusionsWhile the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction.Clinical relevanceExtraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.

Comparative Evaluation of the Anesthetic Efficacy of Needle-Free Anesthesia and Conventional Anesthesia in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

Introduction Pain is the primary reason for which most of the patients seek endodontic treatment. Local anesthesia is considered to be the most important step in the procedure to reduce the pain. However, the majority of the patients do not cooperate due to the fear of syringe anesthesia. The aim of this clinical trial was to compare the anesthetic efficacy of needle-free anesthesia and conventional anesthesia in patients with symptomatic irreversible pulpitis undergoing root canal therapy. Materials and methods A total of 54 patients were enrolled in the study, and the treatment was administered by a single operator. The initial assessment of vitality included cold testing, heat testing, and electric pulp testing. Preoperative pain was assessed using the Visual Analog Scale (VAS) before the administration of anesthesia. Local anesthesia was administered according to the group assigned: Group 1 (conventional anesthesia) and Group 2 (needle-free anesthesia). The pain was assessed during the administration of anesthesia. Following the administration of anesthesia, the vitality of the tooth was evaluated using cold testing, heat testing, and electric pulp testing. Subsequently, the tooth was isolated with a rubber dam, and the access cavity was prepared. The pain was assessed during access cavity preparation and during the first file insertion. Working length was determined using an apex locator (Root ZX Mini, J Morita, Saitama, Japan) and was confirmed using intraoral periapical radiographs. Later on, further treatment was carried out. Results A total of 54 participants were included in this clinical trial. There was no significant difference in mean age distribution between the two groups (p=0.852). Considering the frequency distribution of gender, there was no significant difference; however, Group 1 had more female participants (59.3%) compared to Group 2 (33.3%). There was a significant reduction in the mean pain score in Group 2 compared to Group 1 during the delivery of anesthetic agents (p=0.000). Conclusion Needle-free anesthesia proves to be equally effective as the conventional syringe system in patients experiencing symptomatic irreversible pulpitis undergoing root canal treatment. However, it is noteworthy that patients exhibited greater comfort levels with needle-free anesthesia systems specifically during the administration of the anesthetic solution.

Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis

PurposeWide-Awake Local Anaesthesia No Tourniquet (WALANT), a groundbreaking anaesthetic technique resurging in practice, warrants a comprehensive safety analysis for informed adoption. Our study aimed to identify complications/side effects of WALANT upper limb procedures through a systematic review and meta-analysis.MethodsThis PROSPERO-registered study was performed with strict adherence to PRISMA guidelines. Embase, OVIDMedline, Cochrane, Web of Science, and Scopus databases were searched until February 2023. Inclusion criteria involved English articles, reporting complications/side effects in primary WALANT upper limb surgeries. Outcomes included all complications and side effects, data on the anaesthetic mixture, publication year/location, study type, and procedures performed. The meta-analysis employed the Freeman-Tukey Double Arcsine Transformation, computed I2 statistics, and utilized common or random effects models for pooled analysis.Results2002 studies were identified; 79 studies met the inclusion criteria representing 15,595 WALANT patients. A total of 301 patients had complications, and the meta-analysis using a random effects model provided a complication rate of 1.7% (95% CI: 0.93–2.7%). The most reported complications were superficial infection (41%, n = 123/300), other/specified (12%, n = 37/300), and recurrent disease (6.7%, n = 20/300). A decade-by-decade analysis revealed no statistically significant difference in complication rates spanning the last three decades (p = 0.42). Adding sodium bicarbonate to the anaesthetic solution significantly reduced postoperative complications (p = 0.025).ConclusionWALANT has a low overall complication rate of 1.7%, with no significant temporal variation and a significant reduction in complications when sodium bicarbonate is added to the anaesthetic solution. Our findings support the safety of WALANT in upper limb procedures.RegistrationPROSPERO: CRD42023404018.

Efficacy of analgesia promoted by lidocaine and articaine in third molar extraction surgery. A split-mouth, randomized, controlled trial.

The aim of this study was to compare the analgesic efficacy of 4% articaine associated with epinephrine (1:100,000), and 2% lidocaine associated with epinephrine (1:100,000) in third molar extraction surgery. Sixty patients who underwent surgeries to extract upper and lower third molars were included in this split-mouth, double-blind, randomized, controlled trial. The groups in this study were divided according to the anesthetic solution used to provide local anesthesia during extraction of upper and lower third molars: (1) 4% articaine associated with epinephrine (1:100,000); (2) 2% lidocaine associated with epinephrine (1:100,000). The time to the beginning and end of the sensation of analgesia, pain sensation according to the VAS scale, and number of anesthetic tubes necessary for supplementation were analyzed. It was found that the onset time for analgesia was shorter on the side anesthetized with articaine compared to the side anesthetized with lidocaine (122.1 ± 52.90s vs. 144.5 ± 68.85s) (p < 0.05). In addition, the number of tubes used for anesthetic supplementation was also reduced on the articaine side compared to the lidocaine side (0.26 ± 0.48 vs. 0.50 ± 0.75) (p < 0.05). There were no differences between the anesthetic solutions in the other evaluated parameters. It can be concluded that the use of 4% articaine associated with epinephrine (1:100,000) reduced the time of onset of analgesia and the necessity for anesthetic supplementation in third molar extraction surgeries compared to the use of 2% lidocaine associated with epinephrine (1:100,000).

Validating the Modified Small Double Opposing Z-Plasty for Palatal Lengthening in Primary Palatoplasty.

To appraise the degree of intraoperative palatal lengthening with the modified Furlow small double-opposing Z-plasty (sDOZ). Retrospective single-surgeon (R.D.) study. Nonsyndromic children (n = 167) with Veau types I to IV cleft palates who underwent primary sDOZ palatoplasty. Intraoperative measurements of palatal lengths and widths were collected using calipers, paper rulers, and metal rulers before the administration of local anesthetic solution and before the removal of the mouth gag (initial and final palatal dimensions, respectively). Assessment of the intraoperative percentage change (difference between final and initial values) in surface palatal length, straight palatal length, and soft palatal length. Bivariate and multivariate analyses were performed to identify independent predictors (sex, age at surgery, Veau, Kernahan/ Stark, and Randall classifications, widest cleft width, presence of lateral relaxing incision, type of coverage with buccal fat flap, and postoperative complications) of soft palatal lengthening. Surface palatal, straight palatal, and soft palatal lengths had an intraoperative increase of 8%, 14.7%, and 27.7%, respectively. The degree of intraoperative soft palatal lengthening significantly varied among Veau cleft types (I = II < III = IV). Veau type III and cleft lip/palate were independent positive predictors (P < .001) of soft palatal lengthening, while other tested variables were not correlated (P > .05) with this outcome. Overall intraoperative palatal lengthening occurs with the modified sDOZ palatoplasty, with differences within the spectrum of cleft palate deformity.

Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study.

To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management. Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure. 34 patients were included. During the median length of stay of 4days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12h post-op, decreasing to 38% by 48h post-op. The median consumption decreased in the first 48h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48h intervals, respectively. The median time to perform block procedure was 6min (IQR 4-8min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption. Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.

Pharmacokinetics of Local Anesthetics in Dentistry: The Example of Articaine-Containing and Mepivacaine- Containing Anesthetics

Aim. To analyze current data on the pharmacokinetics of drugs used for local anesthesia in dental practice, with particular emphasis on articaine-containing and mepivacaine-containing anesthetics. Materials and Methods. The study of up-to-date information from the Cyberleninka, Elibrary, Google Scholar and PubMed electronic databases was carried out during a systematic review of the literature. Selected and included articles, the content of which concerns the pharmacokinetics of local anesthetics articaine and mepivacaine. Results. 55 publications were reviewed. After analyzing the literature for inclusion criteria, the total number of publications has become 42. Conclusions. According to the analyzed data, the choice of local anaesthetic solution should be made individually for each patient and be based on the pharmacokinetics of the drug.

A literature review on various diagnostic modalities and treatment options for the treatment of the osteomyelitis of the jaw

Osteomyelitis of the jaw is found to be the most common disease affecting the maxillofacial region. Osteomyelitis is found to be true bacterial infection affecting the jaw bone. Different types of osteomyelitis which are distinguishable are acute osteomyelitis, primary chronic osteomyelitis and secondary chronic osteomyelitis of the jaw. The main characteristic features of the osteomyelitis of the jaw are, formation of the fistula, suppuration, and sequestration of the jaw bone. Different treatment modalities of the osteomyelitis of the jaw include surgery, debridement of the lesion superficially and curettage and in non surgical approach it includes usage of proper antibiotics, usage of topical agents, usage of hyperbaric oxygen, local anesthetic solution.

Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis.

This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success. A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression. Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030]. The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.

Origami-Based Haptic Syringe for Local Anesthesia Simulator.

Although medical simulators have benefited from the use of haptics and virtual reality (VR) for decades, the former has become the bottleneck in producing a low-cost, compact, and accurate training experience. This is particularly the case for the inferior alveolar nerve block (IANB) procedure in dentistry, which is one of the most difficult motor skills to acquire. As existing works are still oversimplified or overcomplicated for practical deployment, we introduce an origami-based haptic syringe interface for IANB local anesthesia training. By harnessing the versatile mechanical tunability of the Kresling origami pattern, our interface simulated the tactile experience of the plunger while injecting the anesthetic solution. We present the design, development, and characterization process, as well as a preliminary usability study. The force profile generated by the syringe interface is perceptually similar with that of the Carpule syringe. The usability study suggests that the haptic syringe significantly improves the IANB training simulation and its potential to be utilized in several other medical training/simulation applications.

Comparison of levobupivacaine with dexamethasone versus levobupivacaine for ultrasound-guided transversus abdominis plane block in lower abdominal surgeries in a tertiary care hospital in Chengalpattu district – A randomized control trial

Introduction: Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. Ultrasound guidance is now considered the gold standard in TAP blocks. It involves the injection of a local anesthetic solution into a plane between the internal oblique muscle and transversus abdominis muscle. Since the thoracolumbar nerves originating from the T6 to L1 spinal roots run into this plane and supply sensory nerves to the anterolateral abdominal wall, the local anesthetic spread in this plane can block the neural afferents and provide analgesia to the anterolateral abdominal wall. Levobupivacaine is a local anesthetic from the amino amide class of medications. Adjuvants are drugs when added along with local anesthetics have a synergistic action to improve the duration and quality of analgesia. Objectives: The objective of this study was to study the effectiveness of ultrasound-guided transversus abdominis plane block using levobupivacaine with dexamethasone in terms of hemodynamic stability and duration of postoperative analgesia and pain scores (visual analog scale [VAS]), time of requirement of rescue analgesics among patients who have undergone lower abdominal surgeries. Methods: This is a double-blinded randomized control trial. This study was conducted among 60 patients who have undergone lower abdominal surgeries in a tertiary care hospital. Postsurgery, intraoperatively prior shifting out the patient, two groups received transversus abdominis plane block, one received 28 ml of 0.25% levobupivacaine with 2 ml of normal saline and another group received 28 ml of 0.25% levobupivacaine with 2 ml (8 mg) dexamethasone. Duration of postoperative analgesia and the efficacy between the two groups were compared with hemodynamic parameters and VAS score. Results: The study groups were not significantly different in terms of demographic data or the American Society of Anesthesiologists Grading. The mean onset of breakthrough pain was significantly higher in the L group. The time of requirement of rescue analgesics was also significantly shorter in the L group compared to the LD group. The VAS pain score was significantly lower in the Group LD as compared to the L group. Conclusion: Hence, it was noticed that dexamethasone when added to levobupivacaine had better hemodynamic stability in terms of blood pressure, heart rate, saturation, respiratory rate, and mean arterial pressure. The requirement of rescue analgesics was also reduced in this group and the time of breakthrough pain was also prolonged. This group had significantly lower pain scores.

Rib fracture as a cause of hindlimb lameness in a horse

SummaryA 2‐year‐old racing Thoroughbred gelding in training was presented with moderate (6/10) right hindlimb lameness unresponsive to regional anaesthesia of the right hindlimb. Gamma scintigraphic examination revealed severe, focal, increased radio‐pharmaceutical uptake over the dorsal aspect of the right 18th rib, which had an abnormal contour. Ultrasonographic examination of this area confirmed the presence of a complete, displaced fracture of the proximal aspect of the right 18th rib. Local infiltration with anaesthetic solution around the right 18th right rib (10 mL cranial and 10 mL caudal to the fracture site) abolished the right hindlimb lameness. A diagnosis of rib fracture causing moderate ipsilateral hindlimb lameness was made. The horse returned to walking exercise after 12 weeks of rest and was reported to be sound on the same limb 12 months after presentation. Caudal rib fractures should be considered as a possible cause of hindlimb lameness. Local diagnostic anaesthesia around the fracture site can aid localisation of the origin of lameness.

Regional anaesthesia practice in public hospitals in Botswana: A cross-sectional study.

Little is known about the regional anesthesia practice in low resources settings (LRS). The aim of this study was to describe the regional anesthesia capacity, characteristics of regional anesthesia practice, and challenges and solutions of practicing safe regional anesthesia in public hospitals in Botswana. This was a cross-sectional survey of anesthesia providers working in public hospitals in Botswana. A purposive sampling method of public hospitals was used to achieve representation of different hospital levels across Botswana. Paper-based questionnaires were sent to anesthesia providers from selected hospitals. Descriptive statistics were used for analysis. Questionnaires were distributed to 47 selected anesthesia providers from selected hospitals; 38 (80.9%) were returned. Most participants were nurse anesthetists and medical officers (57.8%). All hospitals perform spinal anesthesia; however, other regional techniques were performed by a small number of participants in one referral hospital. Most hospitals had adequate regional anesthesia drugs and sedation medications, however, most hospitals (except one referral hospital) lacked ultrasound machine and the regional anesthesia kit. The common challenges reported were lack of knowledge and skills, lack of equipment and supplies, and lack of hospital engagement and support. Some solutions were proposed such as regional anesthesia training and engaging the hospital management to get resources. The results of this study suggest that spinal anesthesia is the most common regional anesthesia technique performed by anesthesia providers working in public hospitals in Botswana followed by few upper limb blocks. However, most public hospitals lack enough training capacity, equipment, and supplies for regional anesthesia. More engagement of the hospital management, investment in regional anesthesia resources, and training are needed in order to improve the regional anesthesia capacity and provide safe surgery and anesthesia in Botswana.