Anesthetic Solution Research Articles

Pain management and discomfort alleviation during administration of local anaesthetic solution – methods useful in paediatric dentistry

W stomatologii dziecięcej kontrola bólu śródzabiegowego uzyskiwana jest dzięki znieczuleniu miejscowemu, jednak, paradoksalnie, samo podanie roztworu leku związane jest z lękiem, niepokojem, dyskomfortem, a nawet bólem pacjenta. Już sam widok igły może przyczyniać się do wystąpienia silnego lęku u najmłodszych, który może wzmagać odczuwanie doznawanego bólu i dyskomfortu. Ból podczas podania znieczulenia miejscowego jest związany z perforacją tkanek przez igłę oraz ich rozpieraniem przez roztwór znieczulający. Lekarze dentyści dysponują szeregiem metod, pozwalających na zmniejszenie bólu i dyskomfortu związanego z iniekcją znieczulenia miejscowego. Znaczną pomoc dla stomatologów dziecięcych stanowią zarówno alternatywne wobec tradycyjnej strzykawki systemy znieczulające, modyfikacje sposobu podawania, jak i samego roztworu. Często w praktyce iniekcyjne znieczulenie miejscowe poprzedzane jest zastosowaniem działającego powierzchniowo na śluzówkę żelu, sprayu lub kremu znieczulającego, którego skuteczność można podnieść przez zastosowanie jontoforezy, która zwiększa głębokość penetracji środka do tkanek. W artykule omówiono także metody pozafarmakologiczne, takie jak zastosowanie laseroterapii, przeciwstymulację oraz strategie behawioralne, których zastosowanie pozwoli na bezbolesne i komfortowe przeprowadzenie najdelikatniejszego z zabiegów stomatologii dziecięcej, jakim jest znieczulenie miejscowe. Zapobieżenie wystąpienia bólu wpływa na reakcje dziecka podczas kolejnych wizyt, kształtuje jego zaufanie do lekarza, przyczyniając się do utrzymania zdrowia jamy ustnej.

Novel dental anaesthetic and associated devices: a scoping review protocol

<p><strong>Background: </strong>In oral health, local anaesthesia is crucial for managing pain and discomfort. Typically, anaesthesia is administered by injecting an anaesthetic solution using a needle and syringe. However, new technologies have been created to aid oral health therapists in reducing pain and discomfort during local anaesthesia administration. The purpose of this study is to analyse and investigate alternate local anaesthetic delivery systems, such as current equipment, technologies, and associated devices that help reduce injection discomfort. In addition, information gaps and limitations of existing studies will be highlighted to guide future studies. The protocol for scoping available evidence, mapping key concepts, and identifying gaps for future research is detailed in this manuscript.<strong></strong></p><p><strong>Methods:</strong> The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) Manual for Evidence Synthesis guidelines were used to create this protocol. Six electronic databases such as MEDLINE, CINAHL, AMED, Dentistry and Oral Science Source, and Scopus, and two other search engines, Google and Google Scholar, will be searched for all relevant primary and secondary studies, grey literature, and other sources relating to new technologies have been developed to assist dentists in providing reduced pain and discomfort when administering local anaesthesia. Two reviewers will independently evaluate the sources retrieved using the eligibility criteria defined by the Population Concept, and Context (PCC) framework. To track the number of identified, included, and excluded sources, a PRISMA-ScR flowchart will be used. A data extraction table will display the extracted data and variables. The synthesised results will be accompanied by narrative explanations.</p><p><strong>Conclusions: </strong>The findings of this review will be summarised to aid in identifying limitations in existing research and provide guidance and recommendations for future research for health professionals.</p>

Comparison of buffered and non‑buffered lidocaine: pH and pain perception

Commonly used local anaesthetic (LA) solutions in the field of dentistry are acidic, and have been known to cause pain and a burning sensation. The present study aimed to determine the pH levels of commercially available LA solutions with and without adrenaline and 8.4% sodium bicarbonate‑buffered LA solution, and to evaluate the pain during the administration of buffered and non‑buffered LA solutions. For this purpose, 20 patients with deep dentinal carious lesions with pulpal involvement affecting the bilateral posterior teeth and requiring the administration of a local nerve block were randomly selected to receive buffered and non‑buffered LA agents on either side, respectively. The patients were instructed to score the pain perceived during LA administration with the aid of a visual analogue scale (VAS) score of 1‑10. All the data obtained were subjected to statistical analysis. The results revealed that the LA solution of 2% lignocaine with 1:80,000 adrenaline buffered with sodium bicarbonate had a mean (± SD) pH level of 6.92±0.34 and non‑buffered LA solution had a mean pH level of 3.49±0.26. As per the VAS, a greater level of pain was reported during the non‑buffered LA administration (3.15±1.27) compared to the buffered LA administration (1.40±0.68). Buffered local anaesthetics were more likely than non‑buffered solutions to achieve successful anaesthesia [95% confidence interval (CI), 1.09‑2.41; P<0.001]. On the whole, the present study demonstrates that a significant reduction in the pain perceived in patients during the administration of LA agents buffered with sodium bicarbonate when used during pulpal involvement.

A pilot investigation of the efficacy and safety of magnesium chloride and ethanol as anesthetics in Loligo vulgaris embryos.

The inclusion of cephalopods in the legislation related to the use of animals for experimental purposes has been based on the precautionary principle that these animals have the capacity to experience pain, suffering, distress, and lasting harm. Recent studies have expanded this view and supported it. Handling cephalopod mollusks in research is challenging and whenever more invasive procedures are required, sedation and/or anesthesia becomes necessary. Therefore, finding adequate, safe, and effective anesthetics appears mandatory. Several substances have been considered in sedating cephalopods, in some instances applying those utilized for fish. However, species-specific variability requires more detailed studies. Despite long-lasting experience being linked to classic studies on squid giant axons, evidence of action on putative anesthetic substances is scarce for Loligo vulgaris and particularly for their embryos. The aim of the current study was to evaluate effects elicited by immersion of squid embryos in anesthetic solutions and examine whether these forms display a similar reaction to anesthetics as adults do. Different concentrations of ethanol (EtOH; 2, 2.5, and 3%) and magnesium chloride (MgCl2; 1, 1.5, and 1.8%) were tested by adopting a set of indicators aimed at exploring the physiological responses of squid embryos. Forty-two embryos of the common squid Loligo vulgaris (stages 27-28) were assigned to three conditions (EtOH, MgCl2, and controls) and video recorded for 15min (5min before, 5min during, and 5min after immersion in the anesthetic solutions). In each group, the heart rate, respiratory rate, buoyancy, chromatophore activity, and tentacles/arms responses were assessed to evaluate the embryos' vitality and responsiveness to stimulation. Both substances provoked a decrease in heart and respiratory rates and inhibited buoyancy, chromatophores, and tentacles/arms responses; no adverse effects were observed. EtOH had a faster onset of action and faster recovery than MgCl2, being potentially more adequate as an anesthetic for shorter procedures. Even though MgCl2 caused a longer muscle relaxation, the reversibility was not confirmed for the 1.8% concentration; however, lower concentrations triggered similar results as the ones obtained with the highest EtOH concentrations. We have shown that the late developmental stages of Loligo vulgaris embryos could represent a good model to evaluate anesthetics for cephalopods since they can display similar reactions to anesthetics as adults animals do.

Simple Sugar Solution Injection to Cure Knee Osteoarthritis (OA)

Abstract: Knee osteoarthritis (oa) is a degenerative arthritis which commonly affects knee joint , mostly bilateral1. Till date offered treatment is analgesics, physiotherapy, support in form of braces and lastly surgery. Steroid injection tried but with only short lasting effect2. We recommend use of dextrose 15% & local anaesthetic solution, each month for 3 months to stimulate regeneration and pain reliev

Evaluación in vitro de la interacción entre el clorhidrato de lidocaína y las soluciones de irrigación en la dentina del conducto radicular: Un estudio con microscopio electrónico de barrido

Aim: To investigate the precipitate formed from the interaction between 2% lidocaine hydrochloride with adrenaline (LA) with 2.5% sodium hypochlorite (NaOCl) and 0.2% chitosan nanoparticles on root canal dentin, using scanning electron microscopy (SEM). Material and Methods: Sixty mandibular premolars were decoronated, and the root length standardised. The specimens were randomly distributed into the following groups: Group 1 (control): 2% LA mixed with sterile water without root canal instrumentation, Group 2: 2% LA with 2.5% NaOCl in water without root canal instrumentation, and Group 3: 2% LA with 0.2% chitosan nanoparticles in water without root canal instrumentation. Teeth specimens were split and subjected to SEM analysis at cervical, middle, and apical root thirds. On observing precipitate formation in Group 2, 10 premolars were decoronated and treated with 2% LA and 2.5% NaOCl and subjected to root canal instrumentation. Results: Group 1 and Group 3 showed patent dentinal tubules and no precipitate formation. Group 2 showed precipitate blocking dentinal tubules in all the three sections, and the precipitate could not be removed completely after cleaning and shaping. Conclusion: NaOCl forms an insoluble precipitate on interaction with local anaesthetic solution that cannot be removed after chemo-mechanical preparation. Chitosan nanoparticles do not form any such precipitate and show patent dentinal tubules. Hence, chitosan can be used as a flushing irrigant.

SCLEROTHERAPY OF VASCULAR LESIONS IN ORAL AND MAXILLOFACIAL REGION—CASE SERIES

Sclerosing therapy of vascular lesions is widely used in the maxillofacial region, resulting in good esthetic and functional outcomes. Ethamolin, a sclerosing agent, can be applied pure or diluted in distilled water. When this therapeutic method is performed, signs and symptoms such as edema, erythema, and pain in the postoperative period can be observed. Five cases treated with monoethanolamine oleate diluted in anesthetic solution of lidocaine (1:1) will be described, including 4 male patients and 1 female patient (2 in the lower lip, 1 in the upper lip mucosa, 1 in the buccal mucosa, and 1 in the tongue). One of the patients used oral anticoagulants and had an extensive lesion on the tongue (approximately 3.5 cm). All patients reported minimal discomfort during intralesional injection. The sclerotherapy technique described above is a conservative therapeutic approach that reduced patient morbidity and postsurgical complications (scarring, hemorrhages, and paresthesia). Furthermore, it seems to reduce painful symptoms.

Iatrogenic central retinal artery occlusion following retrobulbar anesthesia with adrenaline for vitreoretinal surgery: a case report

BackgroundWe describe a patient presenting with central retinal artery occlusion (CRAO) of the right eye after retrobulbar anesthesia with adrenaline for macular pucker surgery.Case presentationThe patient, a 67-year-old Caucasian man, developed a CRAO postoperatively by the next-day control likely due to the retrobulbar injection of a combination of Xylocaine and Bupivacaine with adrenaline as anesthetic.ConclusionsThe addition of adrenaline to the standard anesthetic solution could be a risk factor for serious complications, such as CRAO.

A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis.

Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.

Evaluation of influence of bone quality on onset of action and the volume of anesthetic solution required

Aim: To evaluate the drug volume and onset of action of local anesthetic agent in different bone densities. Methodology: Present study was conducted on 40 subjects (20 male and 20 female) between 25 to 50 years attending to Sibar Institute of Dental Sciences, A 1.8ml 2% lignocaine with adrenalin was injected in the buccal mucosa(1ml) and palatal mucosa (0.8ml) in desired site of evaluation in maxilla. The duration of onset of action in minutes and drug volume used in milliliters was evaluated, where mainly comparison was done between two different densities of bone (D2,D3) according to Misch classification. Results: Areas of maxillary which had a denser cortical bone (D2) needed more volume (1.8-3.6 ml) of local anaesthetic solution (mean ± sd= 2.98 ± 1.02) for achieving its mode of action and subsequently lead to numbness when compared to D3 bone which was more of a porous variety which needed less volume of anaesthetic solution (mean ± sd= 1.63± 0.78) to achieve results. The comparative result was statistically significant (P=0.037). Conclusion: The denser the bone, more time it would take to achieve adequate level of anesthesia.

Modern Cardiac Surgical Outcomes in Nonagenarians: A Multicentre Retrospective Observational Study.

BackgroundThere have been multiple recent advancements in the selection, optimisation and management of patients undergoing cardiac surgery. However, there is limited data regarding the outcomes in nonagenarians, despite this cohort being increasingly referred for these interventions. The objective of this study was to describe the patient characteristics, management and outcomes of a cohort of nonagenarians undergoing cardiac surgery receiving contemporary peri-operative care.MethodsAfter receiving ethics approval, we conducted a retrospective observational study of nonagenarians who had undergone cardiac surgery requiring a classic median sternotomy. All operative indications were included. We excluded patients who underwent transcatheter aortic valve implantation (TAVI), and surgery on the thoracic aorta via an endovascular approach (TEVAR). Patients undergoing TEVAR often have the procedure done under sedation and regional blocks with local anesthetic solution. There is no open incision and these patients do not require cardiopulmonary bypass. We also excluded patients undergoing minimally invasive mitral valve surgery via a videoscope assisted approach. These patients do not have a median sternotomy, have the procedure done via erector spinae block, and often are extubated on table. Data were collected from four hospitals in Victoria, Australia, over an 8-year period (January 2012–December 2019). The primary objective was to assess 6-month mortality in nonagenarian patients undergoing cardiac surgery and to provide a detailed overview of postoperative complications. We hypothesized that cardiac surgery in nonagenarian patients would be associated with a 6-month postoperative mortality <10%. As a secondary outcome, we hypothesized that significant postoperative complications (i.e., Clavien Dindo Grade IIIb or greater) would occur in > 30% of patients.ResultsA total of 12,358 adult cardiac surgery patients underwent surgery during the study period, of whom 18 nonagenarians (0.15%) fulfilled inclusion criteria. The median (IQR) [min-max] age was 91.0 years (90.0:91.8) [90–94] and the median body mass index was 25.0 (kg/m2) (22.3:27.0). Comorbidities, polypharmacy, and frailty were common. The median predicted mortality as per EuroSCORE-II was 6.1% (4.1:14.5). There were no cases of intra-operative, in-hospital, or 6-month mortality. One (5.6%) patient experienced two Grade IIIa complications. Three (16.7%) patients experienced Grade IIIb complications. Three (16.7%) patients had an unplanned hospital readmission within 30 days of discharge. The median value for postoperative length of stay was 11.6 days (9.8:17.6). One patient was discharged home and all others were discharged to an inpatient rehabilitation facility.ConclusionIn this selected, contemporary cohort of nonagenarian patients undergoing cardiac surgery, postoperative 6-month mortality was zero. These findings support carefully selected nonagenarian patients being offered cardiac surgery (Trials Registry: https://www.anzctr.org.au/ACTRN12622000058774.aspx).

Déambulation, ballons et postures pendant le travail obstétrical: où en est-on ?

Obstetrical mechanics is a continuous adaptation between the fœtal head and the maternal pelvis. The pelvis is going enlarged at the level of sacroiliac joins and the fœtal head is rotated and orientated in its best diameter, guided by perineal muscles. Moving during delivery facilitates this adaptation. Deambulation, sitting on a balloon, and suspension by shoulders, are possible and beneficial for the progress of labour and for pain relief. When labour has progressed, standing impairs sacral movements and foetal accommodation. Postures are prescribed by midwifes. They support the progression of labour allowing the opening of the pelvis. On demand epidural analgesia using low concentrated anaesthetic solutions does not impair pregnant movements during delivery provided there is no motor blockade. Changes in posture do not interfere with the diffusion of epidural analgesia. Management of ambulatory analgesia requires technical devices (portable pumps, telemetry) and monitoring protocols to guarantee the safety of physiological delivery.

Comparative evaluation of pain perception during conventional greater palatine injections versus the use of a novel barovibrotactile device - In vivo study

BackgroundPain control by means of local anesthesia is an intrinsic part of clinical practice in dentistry. It is an irony that the modality used for pain free procedure itself is a source of fear & anxiety to the patient. Several modifications have been made to the injecting devices, local anesthetic solutions and techniques to render their administration comfortably. The objective of this study was thus designed to evaluate and compare anxiety and pain perception during conventional greater palatine injections versus use of a novel barovibrotactile device named Accupal to give painless anesthesia. This device has an additional attachment which works on Vibra-pulse technology thus minimizing pain during injection technique. Materials and methodsA prospective, split mouth, open label, randomized, crossover clinical study was conducted on 50 patients coming to our institute whereby on one side Accupal was used during administration of local anesthesia. And on other side, traditional local anesthetic injection technique was used with one week of time interval. ResultsA statistically significant difference was found as in the pain perception between the two techniques as per Visual Analogue Scale whereas no difference was seen in the anxiety levels as per the physiological parameters recorded by noninvasive blood pressure machine at various intervals. ConclusionThe use of Accupal has thus proved to show better pain control as compared to traditional injection techniques of local anesthesia.

A Comparison of the Injection Rate of Local Anesthetic during Spinal Anesthesia on the Onset of Sensory Block and Incidence of Hypotension in Caesarean Section

Objective: The injection rate of the local anesthetic may affect the level and the time of onset of sensory block. The aim of this prospective study was to investigate the effects of two different injection rates of local anesthetic solution (0.5% heavy bupivacaine) on the onset of sensory block, and the incidence and the onset of hypotension in pregnant women undergoing spinal anesthesia for elective Cesarean delivery. Methods: A total of 67 patients were randomized into two groups: 120-second injection time (Group Slow; n = 33) and 15-second injection time (Group Fast; n = 34). Maximum level of sensory and motor block, time to sensory block at the level of T6, hemodynamic parameters, use of ephedrine and incidence of side effects were recorded at measurement time points. Results: Maximum level of the sensory block was similar in both groups. The time to achieve adequate and maximum sensory block level was shorter in Group Slow(S) (p = 0.004 and 0.037, respectively). Incidence of hypotension was similar, but hypotension occurred earlier in Group Fast(F) (p = 0.011). Requirement for ephedrine and incidence of nausea and vomiting was similar. Conclusions: This study reveals that 120-second injection duration during spinal anesthesia is associated with shorter time to achieve the maximum sensory block level and slower onset of hypotension. It means that prolonging the duration of local anesthetic injection to 120-seconds is advantageous compared with 15-seconds in caesarean section.

Comparison of onset of action of Intrathecal Clonidine vs Intrathecal Fentanyl as an adjuvant with hyperbaric Bupivacaine and Bupivacaine alone under spinal anesthesia for lower limb orthopedic surgeries

Background: Adjuvants are added to a local anesthetic solution to prolong the duration of analgesia. There is a paucity of studies comparing the onset of action of adjuvants like Clonidine and Fentanyl. In this study, the time of onset of action of intrathecal clonidine and intrathecal fentanyl as adjuvants to bupivacaine and bupivacaine alone were compared in the subarachnoid block for lower limb orthopedic surgeries. Materials and Methods: 90 adult patients posted for orthopedic surgery of the lower limb were divided into three equal groups of 30 each. Group A being the control group was given hyperbaric Bupivacaine(3ml) +0.5ml of Normal saline, Group B was given Intrathecal hyperbaric Bupivacaine (3 ml) +30 μg Clonidine and Group C was given Intrathecal hyperbaric Bupivacaine (3 ml) + Fentanyl 25 μg. The primary objective was to compare the time of onset of block and duration of analgesia. The secondary outcomes were the duration of sensory and motor block, duration of analgesia, hemodynamic parameters, and side effects. Results: The time of onset of the sensory blockade was 4.83 ± 0.64, 1.72 ± 1.47, and 3.4 ± 1.43 mins in groups A, B, and C respectively. The time of onset of the motor blockade as estimated by the time to reach level 2 on the Bromage scale, was 6.07 ± 0.55, 2.38 ± 1.32, and 5.06 ± 1.28 mins in groups A, B, and C respectively. The duration of postoperative analgesia was prolonged in the Clonidine group compared to the Fentanyl group. Conclusion: The study reveals that the time of onset of action of sensory and motor block was faster and the duration of analgesia was prolonged with adjuvants like Clonidine when compared to Fentanyl when added to Bupivacaine.

Взаимосвязь анатомии области расположения и особенностей формирования третьего моляра нижней челюсти с частотой развития альвеолита его лунки

INTRODUCTION: Socket alveolitis is the most unpleasant and frequent complication of the tooth extraction operation. According to the data of numerous studies, it most often occurs after extraction of the third mandibular molar. The causes of inflammation of the extracted tooth socket are well known. They include absence (“dry socket”) or decay of a blood clot which forms immediately after the operation and performs protective and reparative function during physiological healing of the socket. In turn, the risk factors provoking “dry socket” formation or blood clot fibrinolysis are mechanical injury of the socket, use of high concentration of adrenaline in local anesthetic solution, inadequate socket curettage, bleeding in the postoperative period, technically complicated surgical procedure and many others. However, all the mentioned factors leading to alveolitis, equally influence the inflammatory activity in the socket of any extracted tooth, including the lower third molar. Consequently, the anatomical location of the lower wisdom tooth, its germ and formation, have some peculiarities. The data analysis was carried out in the following Internet resources: eLibrary, Cyberleninka, disserCat, National Library of Medicine, ResearchGate (48 sources for the time period from 1967 to 2021). In the review article, the collected data of different studies on the frequency of alveolitis after tooth extraction, after the third lower molar extraction, on the main causes of the socket inflammation are given; generalized information of the anatomical characteristics of third molar location, its germ and formation is presented. CONCLUSION: The highest incidence of alveolitis of the mandibular wisdom tooth socket is probably associated with peculiarities of its supply with blood, the existence of high quantity of adipose tissue and loose connective tissue around it, difficult rupture and other anatomical and physiological parameters, which create conditions for development of intensive inflammatory process.

COMPARATIVE EVALUATION OF ALTERNATE EMERGENCY FIXATIVES

Fixation is the cornerstone of histopathology.In order to preserve the morphology of the tissue for further details its essential that all the components are preserved in a life like state. Formalin is the universal fixative but on account of its carcinogenic potential needs to be replaced by the alternate fixatives which are easily available.This study aims to assess and compare the efficacy of alternative fixatives like local anesthetic solution, normal saline , distilled water and life buoy hand sanitizer by using H &amp; E stained sections. Total sample size of 100 sections was obtained from 10 paraffin embedded tissue blocks obtained from Indian goat tongue each fixed in LA solution ,Normal Saline, Distilled water, Hand sanitizer and in Formalin for 12 hour and 24 hour and named as group A and group B respectively. The sections were evaluated on five parameters and then subjected to statistical analysis.Kruskal wallis test, Mann –Whitney U test and Kappa Statistic were used .Significant difference was noted in the four alternate fixatives( &lt; 0.05).On the basis of the results obtained , Local Anesthetic solution was found to be used as an alternate emergency fixative.

Randomized controlled study of intrathecal hyperbaric bupivacaine and hyperbaric bupivacaine with fentanyl in caesarean section, government medical college, Suryapet

Background: Spinal anesthesia with hyperbaric bupivacaine and adjuvants such as Fentanyl is now the preferred technique for spinal anesthesia, and is the gold standard for caesarean section. The common procedure is to add such adjuvants in a two-syringe before intrathecal injection into hyperbaric bupivacaine. Drug mixing may alter anesthetic solution density and baricity and may change the distribution of medication in cerebrospinal fluid (CSF). Objectives: In this study, we aimed to assess the effect of comparing block characteristics, intraoperative hemodynamics, and postoperative pain relief in Caesarean section under the subarachnoid block (SAB), following administration of hyperbaric bupivacaine and Fentanyl as a mixture. Methods: The research population consisted of 100 patients parturient women undergoing elective caesarean section under spinal anesthesia with the age ranges aged 20-52 years. By using computer-generated random numbers to obtain they were allocated to one of the two classes of an evenly sized group (50 each). This is a forward-looking, comparative analysis using an inclusive protocol framework for similarly sized classes. Group A received intrathecally 2ml of 0.5% hyperbaric Bupivacaine (10 mg) and Group B received intrathecally 2ml of 0.5% hyperbaric Bupivacaine (10 mg) + 0.5ml of Fentanyl (25 μg) as a concurrent process.

Is the Erector Spinae Plane block useful for anti-nociception and analgesia in lumbar spine surgery? A narrative review of the literature and opinion paper

We aimed at determining whether the Erector Spinae Plane (ESP) block is useful for providing anti-nociception and analgesia to patients beneficiating from lumbar spine surgery. Using the keywords “Erector Spinae Plane block” and “lumbar” or “spinal surgery” in Pubmed, the Cochrane Library Database, and Google Scholar (end of search in March 2021), we identified 19 relevant papers involving 534 patients. Injection levels, and type, dilution, or volume of local anesthetic agent solution differed between studies. The main studied outcomes were postoperative pain control, and opioid consumption. Only one study compared the ESP block with another loco- regional technique. All published papers conclude that ESP block reduces postoperative pain scores and rescue medication use. As a corollary, ESP block appears promising in this indication for several reasons. First, it is easy to perform and does not have the same adverse effects or complications as neuraxial techniques. Second, even if the best site of injection as not been determined yet, skin puncture can be performed at distance from the surgical site, hence reducing the risk of surgical site infection by the loco-regional technique, and allowing its use as a rescue analgesic technique after surgery. Last, the incidence of ESP block complications seems low even if the number of studied patients is not wide enough to ascertain this fact for sure. Several unresolved questions are still pending. None of the published studies were randomized controlled trials with a group receiving a sham block, length of follow-up was limited to 48 hours, chronic pain was an exclusion criteria, and the pain scores were evaluated at rest. We conclude that the ESP block appears to be a safe and promising technique to be used as part of a multimodal analgesia protocol in lumbar spine surgery. Several studies are needed to precise its superiority and safety as compared to other techniques, its intraoperative opioid sparing effect, and its influence on longer term outcomes such as the development of chronic pain.

Neuraxial labor analgesia: is there a place for neuraxial adjuvants beyond opioids.

Neuraxial labor analgesia is considered the gold standard technique for analgesia. Ideally, a good neuraxial technique uses dilute local anesthetic solutions to produce effective pain relief with no or minimal motor impairment. Adjuvant drugs that are co-administered with the local anesthetic either epidurally or intrathecally are useful in achieving this goal. The current review focuses on the effectivity and side-effect profile of various commonly used or tested adjuvants.