Bupivacaine Research Articles

Comparison of combined spinal-epidural anesthesia versus lumbar plexus-sciatic nerve block in elderly patients undergoing internal fixation of hip fractures

Objective To compare combined spinal-epidural anesthesia(CSEA)versus lumbar plexus-sciatic nerve block(LPSB)in elderly patients undergoing internal fixation of hip fractures. Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 66-94 yr, with body mass index of 15.2-28.0 kg/m2, scheduled for internal fixation of hip fractures, were randomly assigned into CSEA group and LPSB group using SPSS 18.0 software, with 30 patients in each group.In CSEA group, intrathecal catheter was successfully placed at L3, 4 interspace, 0.5% hyperbaric bupivacaine 8-10 mg was injected into the subarachnoid space and then an epidural catheter was placed.In LPSB group, posterior lumbar plexus block was performed with 0.4% ropivacaine 25-30 ml and parasacral sciatic nerve block with 0.4% ropivacaine 15-20 ml.Dexmedetomidine 0.4-0.6 μg·kg-1·h-1 was infused during the procedure to maintain the Observer′s Assessment of Alertness/Sedation Scale score of 3 or 4 in two groups.Patient-controlled intravenous analgesia was performed with sufentanil and lasted for 48 h. The anesthesia time, volume of intraoperative fluid infused, blood loss, consumption of dexmedetomidine, requirement for vasoactive agents, cardiovascular events, consumption of sufentanil within 24 and 48 h after surgery, rescue analgesia and postoperative adverse reactions were recorded. Results Compared with CSEA group, the anesthesia time was significantly prolonged, the volume of intraoperative fluid infused and consumption of ephedrine were reduced, the consumption of dexmedetomidine was increased, the incidence of bradycardia was decreased, the postoperative consumption of sufentanil was reduced, the rescue analgesia rate was decreased, and no significant change was found in the incidence of postoperative adverse events in LPSB group(P>0.05). Conclusion LPSB can maintain hemodynamics stable and provide postoperative analgesic effect, with better anesthetic efficacy than CSEA when used for internal fixation of hip fractures in elderly patients. Key words: Anesthesia, spinal; Anesthesia, epidural; Nerve block; Hip fracture; Aged

Effect of adding midazolam to bupivacaine during rectus sheath block: a randomised controlled trial.

Various adjuvants have been tried to improve quality and increase duration of local anaesthetics during various nerve blocks. We aimed to evaluate the effect of adding midazolam to bupivacaine on rectus sheath (RS) block in patients undergoing umbilical or epigastric hernia repair. In all, 60 adult patients were divided into two equal groups, each group included 30 patients. Group I received 20ml of bupivacaine hydrochloride 0.25% + midazolam 50μg/kg in 2ml saline 0.9% (Midazolam group, n=30), whereas Group II received 20ml of bupivacaine hydrochloride 0.25% + 2ml saline (Control group, n=30) for RS block on each side. The primary outcome was post-operative 48h morphine consumption, whereas secondary outcomes included analgesia duration, post-operative pain, as evaluated by visual analogue scale (VAS) for pain scoring at 1, 2, 6, 12, 24 and 48h post-operatively, reported post-operative nausea and or vomiting (PONV), somnolence or any adverse drug reactions. The current study showed that addition of midazolam to bupivacaine for RS blockade provided good analgesia as evidenced by a statistically significant less morphine consumption in the post-operative 48h [11.2 (5.3-18.3) vs. 25.9 (15.2-31.0) mg, P=0.002], longer duration of analgesia, lower VAS during post-operative 48h, lower incidence of PONV, somnolence and pruritus. Midazolam addition to bupivacaine for RS blockade provided adjuvant analgesia as supported by less morphine consumption, longer duration of analgesia, and lower VAS score.

Antibiotic and anesthetic drug release from double-setting α-TCP cements

The alpha phase of tricalcium phosphate (α-TCP) can form calcium-deficient hydroxyapatite (CDHA), similar to bone hydroxyapatite. α-TCP can be employed as a biocompatible cement and used as a drug vehicle. Double-setting α-TCP cement composed of acrylamide (α-TCP DS) has better mechanical properties than traditional α-TCP cement. However, no studies on the use of α-TCP DS-based systems for drug release have been reported. In this study, we prepared α-TCP- and α-TCP DS-based samples containing gentamicin sulfate, lidocaine hydrochloride, bupivacaine hydrochloride and levobupivacaine hydrochloride. The properties of the samples were characterized, and the use of the samples as vehicles for these drugs was evaluated. The cements were characterized using X-ray diffraction, Fourier transform infrared spectroscopy, mechanical property tests and apparent porosity evaluation. The drug release in vitro was determined using ultraviolet–visible absorption spectroscopy. For statistical analysis, a confidence interval of 95% with a significance level < 5% was used. Neither the hydrogel nor the drugs interfered with the formation of CDHA, but they increased the mechanical strength of the studied cement. The Peppas–Sahlin model described the mechanisms involved in the drug-release kinetics process, revealing that Fickian diffusion was the main drug-release mechanism with a small influence from the Case II mechanism.

Molecular Characterization, Spatial–Temporal Expression Profiles, and Injury‐responsive Regulation of Myocyte‐specific Enhancer Factor 2 Gene Family in the Ricefield Eel, Monopterus albus

AbstractThe myocyte‐specific enhancer factor 2 (MEF2) gene family members are well‐established regulators in the control of muscle repair, regeneration, and development. In this study, we cloned the CDS sequences of the four MEF2 family members in the ricefield eel, and their coding sequences (CDS) lengths were 1449 bp, 1419 bp, 1431 bp, and 1608 bp, respectively. Sequence analysis demonstrated that three of them shared four conserved protein domains, including a MADS‐Box, inside SRF‐TF domains, adjacent conserved MEF2 domains, the HJURP‐C domains, while MEF2B have no HJURP‐C domains. Phylogenetic tree analyses indicated that the MEF2 family members were clustered together with those of fish species, and MEF2A, MEF2C, and MEF2D were closely clustered together and kept away from MEF2B. Spatial–temporal expression profiles displayed that the messenger RNA (mRNA) levels of MEF2 were upregulated with the developmental stage and were especially highly expressed significantly in skeletal muscles. After subcutaneous injection of bupivacaine hydrochloride, mRNA levels of MEF2 family and rapidly performed injury‐responsive regulation after damage that firstly increased, then decreased until normal levels were recovered, the same as the change in muscle fiber cells. In conclusion, the MEF2 gene family plays a central role in muscle repair, regeneration, and development in fish, at least in the ricefield eel.

Safety and efficacy of intra-articular injection of the hip.

The aim of the present study was twofold: a) to establish the therapeutic efficacy of the hip injection with marcaine and steroid; (b) to establish the safety of the procedure with respect to possible bacterial contamination at the time of passage of needle into the hip joint. Thirty-five patients with osteoarthritis of the hip were injected. All patients were admitted as day cases and the procedure was performed in a laminar flow theatre under full aseptic conditions. The hip was aspirated before injection. Aspirate and injecting needles were sent for microbiological examination. Both aerobic and anaerobic cultures were performed. All patients were followed up for three months after hip injection. Microbiology results were not revealed to reviewing clinicians. All patients were reviewed at two weeks and at twelve weeks. Thirty-three patients (94.3%) had no growth in the samples. Two cases out of thirty-five hips had a positive culture but none of the patients went on to develop clinical sepsis. Patient response for pain in the hip was graded using a 10 point visual analogue scale (VAS) with 10 point as maximum pain and 0 points as no pain. Pre-injection the patient VAS for pain was a mean value of 6.4 0.77 (median, 6). The mean value of VAS score at 2 weeks dropped to 2.6 2.7 with median of 2. This difference was highly significant (p=0.003). At 12 weeks mean VAS score was 2.7 2.5 with median value of 2 (p=001). Three patients were worse after the injection. We found the hip injection to be safe. The risk of bacterial contamination is low provided a strict aseptic protocol is observed. In this study, one third of the patients had excellent pain relief for 3 months after the injection but in two thirds of cases it failed to provide complete, long-term pain relief (> 3 months). (Hip International 2002; 4: 378-82).

Development of bupivacaine decorated reduced graphene oxide and its local anesthetic effect—In vivo study

The present works aims to develop bupivacaine modified reduced graphene oxide (BPV/RGO), and comparative evaluation of their anesthetic effect with free bupivacaine (BPV). The prepared BPV/RGO was studied by using various spectroscopic and microscopic characterization studies. In vitro drug release from BPV/RGO was studied using HPLC analysis. The cytotoxicity of BPV/RGO was studied against fibroblast (3T3) cells. In vivo evaluation of anesthetic effects was performed on animal models. BPV/RGO showed a prolonged in vitro release and lower cytotoxicity when compared to free BPV. Also, BPV/RGO showed a significantly prolonged analgesic effect when compared to free BPV. Further, the prepared BPV/RGO drug delivery system demonstrated to function as gifted to overcome the drawbacks of free BPV and other available drug delivery systems by prolonging the anesthetic effect with poor cytotoxicity.

Analgesic Effect of Intraperitoneal Bupivacaine Hydrochloride After Laparoscopic Sleeve Gastrectomy: a Randomized Clinical Trial

BackgroundThe indications for sleeve gastrectomy as a primary procedure for the surgical treatment of morbid obesity have increased worldwide. Pain is the most common complaint for patients on the first day after laparoscopic sleeve gastrectomy. There are various methods for decreasing pain after laparoscopic sleeve gastrectomy such as the use of intraperitoneal bupivacaine hydrochloride. This clinical trial was an attempt to discover the effects of intraperitoneal bupivacaine hydrochloride on alleviating postoperative pain after laparoscopic sleeve gastrectomy. MethodsIn general, 120 patients meeting the inclusion criteria were enrolled. Patients were randomly allocated into two interventions and control groups using a balanced block randomization technique. One group received intraperitoneal bupivacaine hydrochloride (30 cm3), and the other group served as the control one and did not receive bupivacaine hydrochloride. Diclofenac suppository and paracetamol injection were administered to both groups for postoperative pain management. ResultsThe mean subjective postoperative pain score was significantly decreased in patients who received intraperitoneal bupivacaine hydrochloride within the first 24 h after the surgery; thus, the instillation of bupivacaine hydrochloride was beneficial in managing postoperative pain. ConclusionsThe intraoperative peritoneal irrigation of bupivacaine hydrochloride (30 cm3, 0.25%) in sleeve gastrectomy patients was safe and effective in reducing postoperative pain, nausea, and vomiting (IRCT2016120329181N4).

Hyaluronic acid modified nanostructured lipid carriers for transdermal bupivacaine delivery: In vitro and in vivo anesthesia evaluation

For effective transdermal local anesthetic therapy, to reduce the barrier of stratum corneum and improve the antinociceptive effect, hyaluronic acid (HA) modified, bupivacaine (BPV) loaded nanostructured lipid carriers (NLCs) were designed. HA and linoleic acid (LOA) conjugated propylene glycol (PEG) was synthesized (HA-PEG-LOA). HA-PEG-LOA was added during the preparation process of NLCs, thus LOA was inserted into the NLCs, The physicochemical properties of NLCs, particle size, zeta potential, drug loading capacity, in vitro skin permeation, drug release profiles and in vivo therapeutic effect were evaluated. HA-BPV/NLCs have small particle size of 150 nm, with a zeta potential of −40 mV. Nearly 90% high drug encapsulation efficiency and good stability were also observed. In vitro release rate of BPV from HA-BPV/NLCs was complying with a sustained behavior until 72 h of study. HA-BPV/NLCs and BPV/NLCs exhibited 2.5 and 1.6 fold of percutaneous penetration improvement than free BPV. BPV loaded NLCs produced a more prolonged antinociceptive effect when compared with free BPV. In vitro and in vivo results pointed out HA modified NLCs have the capability to act as effective drug carriers, thus prolonging and enhancing the anesthetic effect of BPV. The NLCs developed in this study might provide a useful platform for developing a sophisticated dermal delivery system for analgesic.

Transversus abdominis plane block for postoperative analgesia after abdominal surgeries in morbidly obese

Background Pain is a significant problem for many patients after major surgery. The transversus abdominis plane (TAP) block is a new technique that provides analgesia following abdominal surgery. TAP block can be done blindly or by using ultrasound that include posterior and subcostal approach. Aim The primary aim was to study the clinical utility of TAP block as analgesia after lower abdominal surgeries in morbidly obese. The secondary aim was to assess the advantages and disadvantages of the same. Patients and methods A total of 60 patients fulfilling inclusion criteria who were undergoing elective lower abdominal surgeries were divided into two equal groups. Group T (TAP group), which received bilateral ultrasound-guided subcostal TAP block at the end of the surgery before emergence, and group C (control group) that received general anesthesia, with no further narcotic administration. Postoperative mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough, PaCO2, time to first request of analgesia, average frequency of analgesia, average total analgesics consumption, average total local anesthetic (bupivacaine) consumption, postoperative complications, and frequency of antiemetic were recorded. Bromage score was assessed at 20 min postoperatively. Results There were significant decrease in mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough in group T than group C at 10, 20 min. There wasa high significant decrease in peak expiratory flow rate and significant increase in PaCO2 in group C than group T at 2, 6 h postoperatively. There was a high significant increase in the time to first request of analgesia, and a high significant decrease of both frequency of analgesia and average total consumption of analgesia. A high significant increase was observed in local anesthetic consumption in the first 24 h postoperatively in group T than group C. There were significant differences in nausea, vomiting, and frequency of antiemetic, whereas they did not occur in group T. There were no significant differences in the grade of motor block between two groups at 20 min or any other time. Conclusion TAP block was safe, and easy to perform, and more effective in the early postoperative period with significant reductions in opioid requirement, pain score, and complications, and did not produce motor block.

Comparison of Intra-Peritoneal Instillation of Bupivacaine and Morphine Hydrochloride versus Bupivacaine and Magnesium Sulfate for Post-Operative Pain Relief after Laparoscopic Cholecystectomy, A Randomized Double-Blind Comparison Study

Background: Surgical and laparoscopic techniques are two different methods for the removal of gall bladder. Today, laparoscopic cholecystectomy is a preferred method for short-term hospitalization and early return to function related to minimal invasive surgical technique. However, patients still complain of significant postoperative pain, secondary inflammation of the diaphragm and the nociceptive genus of the annoying membrane's peritoneum. Multimodal analgesia is necessary for managing pain after laparoscopic cholecystectomy. Magnesium sulfate is a new emerging medication for the management of acute pain. There are no previous reports to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride and bupivacaine plus magnesium sulfate for postoperative pain after laparoscopic cholecystectomy. Aim: The purpose of this study is to compare the analgesic effect of intraperitoneal instillation of bupivacaine plus morphine hydrochloride versus bupivacaine plus magnesium sulfate in patients undergoing laparoscopic cholecystectomy under general anesthesia for better pain relief and less opioid consumption during the first 24 hours. Methods: Following the approval of the Institutional Review Board of An-Najah National University and written informed consent from patients undergoing laparoscopic cholecystectomy, hundred patients between 18 and 60 years old, American Society of Anesthesiologist (ASA) Grades I and II, were randomized to one of the following groups by the sealed envelope: (Mo group) (n=50) receiving intraperitoneal instillation of 30 ml 0.25% bupivacaine and 3 mg morphine and (Mg group) (n=50) receiving intraperitoneal instillation of 0.25% bupivacaine plus 50 mg/kg magnesium sulfate to a total volume of 30 ml. Medications were given after peritoneal wash and suctioning through intraperitoneal instillation. A drug solution is prepared by a doctor who does not participate in the study. All patients received the same anesthesia method, general anesthesia was administered. The induction protocol was standard for all patients. Patients were monitored for electrocardiogram (ECG), heart rate, blood oxygenation (SpO2%) and noninvasive blood pressure (NIBP). Postoperative pain was evaluated using visual analog scale (pain score of 0-10). The participants were evaluated for 24 hours after the operation with the registration of abdominal pain. The postoperative pain outcome was reported at 0 and 30 min, 1, 4, 8, 12, 16 and 24 hours. The cut-off value for VAS is 4 for indication of rescue medication. At VAS ≥ 4, rescue analgesics were administered on request (20 mg of pethidine) intravenously in Post Anesthetic Care Unit (PACU) and 50 mg intramuscularly in the surgical ward. Results: Patients' characteristics of age, gender and BMI were comparable in the two groups. There was no significant difference between the groups regarding the duration of the surgery. The demographic parameters (age, gender and BMI) have no effect on the mean of VAS (p value>0.05). There are significant differences between Mo and Mg groups in the total VAS score (p value<0.05). In the Mo group, the mean of total VAS (2.09) was significantly lower than the mean of total VAS in the Mg group (2.71); which means that patients in the Mo group had significantly less intensity of pain than patients in the Mg group (p=0.006). There is a significant difference between the number (percent) of patients complaining of moderate to severe postoperative pain in Mo group 15/50 (30%) compared to Mg group 25/50 (50%) (p=0.0423). When estimating the size of the treatment effect of morphine hydrochloride plus bupivacaine, found that the relative risk reduction of moderate to severe pain postoperatively is 0.40. There is also a significant difference between the number (percent) of patients complained of drowsiness in Mo Group 7/50 (14%) compared to Mg group 18/50 (36%) (p=0.0115). There are no significant differences between the two study groups regarding nausea, vomiting, dizziness and urinary retention. Patients in Mo group consume less rescue analgesic dose M (± SD) (64.29 mg+22.04) compared to patients in Mg group M (± SD) (74.40 mg+25.67) without significant relationship between both doses (p-value=0.163). Blood pressure, heart rate and oxygen saturation were examined as hemodynamic parameters. The result showed that no significant relationship between these parameters and VAS (p-value>0.05). Conclusion: Intraperitoneal instillation of combination of bupivacaine with morphine hydrochloride is superior to bupivacaine plus magnesium sulfate to reduce the intensity and incidence of postoperative pain in patients undergoing laparoscopic cholecystectomy surgery without significant increase of side effects. This peripheral effect of opioid provides a new approach to pain relief that can have major clinical benefits. Recommendation: Based on the results of this study, it is recommended to consider the intraperitoneal instillation of morphine hydrochloride with bupivacaine as a standard application for laparoscopic cholecystectomy surgery to reduce postoperative pain.

Efficacy of perianal nerve blockfor day care ano-rectal procedures

Aim of this study was to assess patient safety, comfort, satisfaction level and quality of anaesthesia in patients undergoing day care ano-rectal procedures performed under Perianal Nerve Block (PNB) in comparison with Spinal Anaesthesia (SA) in peripheral medicare settings. MATERIAL AND METHODS: The study was a prospective, single centre study performed over a period of two years on 65 patients scheduled for various day care ano-rectal procedures. The patients were randomized to receive PNB or SA. The PNB was established using a mixture of 20ml of 2% lignocaine Hydrochloride (plain) and 20ml of 0.5% Bupivacaine Hydrochloride (plain) by four point perianal injection with Perianal subcutaneous infiltration augmentation technique whereas in all SA patients, the spinal block was established using 2 ml of 0.5% Bupivacaine (heavy) using 25G spinal needle in sitting position. All patients received premedication in the form of Inj Glycopyrrolate 0.2mg/iv and Inj Ondansetrone 8mg/iv. Patients were thereafter evaluated for pain and discomfort during the establishment of anesthesia, per-operatively and postoperatively for three days using a 10 point Visual Analogue Scale (VAS) and patient satisfaction level (1-5 point score). RESULTS: A total population of 65 patients out of 90 was found eligible for the study and were divided into two groups to either receive spinal anaesthesia (SA group, n=33) or Perianal nerve block (PNB group, n=32). Mean VAS during establishment of nerve block was 3.625 in PNB group and 1.2424 in SA group. Intra-operatively, VAS score was not very significantly variable in both the study groups. Mean VAS for post-operative pain during initial 12 hrs was 2.437 in PNB group and 5.878 in SA group.(P

Comparison of Postoperative Analgesic Effect of Ropivacaine Hydrochloride with Bupivacaine Hydrochloride in Transversus Abdominis Plane Block after Total Abdominal Hysterectomy

Comparison of Postoperative Analgesic Effect of Ropivacaine Hydrochloride with Bupivacaine Hydrochloride in Transversus Abdominis Plane Block after Total Abdominal Hysterectomy

Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: A prospective randomized controlled study.

Background:Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation.Methods:A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers.Results:Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, P = 0.03), numbers of morphine intake (P = 0.04), morphine requirement (P = 0.03), and first time of analgesia intake (P = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - P = 0.001, NAS 1 - P = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect.Conclusion:Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.

A comparative study between combined spinal anesthesia with bilateral thoracic paravertebral block and general anesthesia in laparoscopic cholecystectomy

Background Paravertebral block is a common regional anesthetic technique such as intraoperative anesthesia and perioperative analgesia used in multiple surgical procedures. Many studies have demonstrated that laparoscopic cholecystectomy (LC) with the patient under spinal anesthesia (SA) was feasible and safe and was associated with stable hemodynamics and better postoperative pain control. Aim The aim is to compare the anesthetic effect of combined SA with bilateral thoracic paravertebral block and general anesthesia in LC. Patients and methods Sixty patients undergoing LC were randomized into two groups: group I receiving general anesthesia and group II receiving SA with bilateral thoracic paravertebral block at the level of T7 with a catheter on the right side, and then injecting 10 ml plain bupivacaine 0.5% on the left side through the epidural needle without catheter as a single shot. Patients were still in the sitting position, and then SA was performed using a 25 G spinal needle at L2–L3 intervertebral space. 2 ml=10 mg of hyperbaric bupivacaine hydrochloride (0.5%) was injected intrathecally. Results Intraoperatively, there was significant increase in stress response including mean arterial blood pressure and heart rate in group I than in group II at 30 min and at the end of operation. Significant decrease in intraoperative opioid requirement as fentanyl in group II than in group I was observed. The time of first analgesic requirement within 8 h in the postoperative period if the Visual Analogue Scale more than 3 was significantly increased in group II than in group I. As regards intraoperative end tidal CO2, oxygen saturation, operative time, nausea, vomiting, headache and patient satisfaction, there was insignificant difference between the two groups. Conclusion LC can be performed under SA and bilateral thoracic paravertebral block at low pressure pneumoperitoneum, providing hemodynamic stability and with no respiratory complications.

The application of thoracic paravertebral blockade

Background Thoracic paravertebral blockade(TPVB) is a regional nerve blocking technique by injecting local anesthetics into thoracic paravertebral space, adjacent to the intervertebral foramina, to block the roots of thoracic nerves. This technique can be performed under the guidance of anatomical markers or ultrasound, and has been widely applied in thoracic and abdominal surgeries for postoperative pain management. Objective To summarize anatomical basis and clinical application of TPVB. Content The injection sites of TPVB are located near thoracic paravertebral space(TPVS), which can be identified with traditional and ultrasound-assisted methods. The local anesthetics including bupivacaine, lidocaine, and ropivacaine, were administered with TPVB to relieve pain in one-sided thoracic and abdominal surgeries and chronic pain syndromes, and also to perform anesthesia in breast surgery. With satisfying analgesic and anesthetic effects, TPVB has less adverse effects than epidural and intravertebral anesthesia, and interpleural blockade. Trend TPVB under the guidance of ultrasound provides a safe drug injection technique for multimodal analgesia with similar efficacy to epidural and intravertebral injection, but less adverse effects. Further investigations are required to expand its application and to prevent related complications. Key words: Thoracic paravertebral block; Regional anesthesia; Technique pharmacokinetics; Complication

Lin28a functionally modulates bupivacaine-induced dorsal root ganglion neuron apoptosis through TrkA activation

PurposeLin-28 Homolog A gene (Lin28a) is an important regulator in nerve system. In this study, we investigated the functional mechanism of Lin28a during the process of bupivacaine (BUP)-induced neuronal apoptosis of spinal cord dorsal root ganglion neurons (DRGNs). MethodsYoung mouse DRGNs were cultured in vitro and treated with series concentrations of BUP. Apoptosis was evaluated by TUNEL assay. Corresponding Lin28a mRNA and protein expressions were evaluated by qRT-PCR and western blot (WB) assays. Lin28a was downregulated by siRNA and its effect on BUP (5 mM)-induced DRGN apoptosis was measured by qRT-PCR, WB and TUNEL assays, respectively. Alternatively, Lin28a was upregulated in DRGNs. It’s effect on BUP (0.1 mM)-induced DRGN apoptosis was also measured. Finally, WB was used to examine Caspase-3/9 and TrkA protein expressions in Lin28a-downregualted and BUP-injured DRGN to explore Lin28a-associated signaling pathways. ResultsIn DRGN in vitro culture, 0.1 mM BUP induced moderate neuronal apoptosis while 5 mM BUP induced significant apoptosis. Lin28a mRNA and protein were both upregulated by BUP, in concentration-dependent manner. Functional assays showed that Lin28a downregulation rescued 5 mM BUP-induced neuronal apoptosis, whereas Lin28a upregulation aggravated 0.1 mM BUP-induced neuronal apoptosis in DRGNs. WB showed that Lin28a downregulation reduced Caspase-3/9 proteins and activated TrkA through phosphorylation in BUP-injured DRGNs. ConclusionLin28a is a potent regulator in BUP-induced neuronal apoptosis in DRGNs. The apoptotic protection by Lin28a inhibition is likely through the activation of TrkA signaling pathway.

Evaluation of the effects of epidural bupivacaine on coagulation system by using thromboelastometry in women with gynecologic malignancies

Evaluation of the effects of epidural bupivacaine on coagulation system by using thromboelastometry in women with gynecologic malignancies

Injectable in situ forming gel based on lyotropic liquid crystal for persistent postoperative analgesia.

To address the issue of insufficient postoperative analgesia associated with short half-lives of local anesthetics after single injection, an in situ forming gel (ISFG) based on lyotropic liquid crystal was developed to deliver bupivacaine hydrochloride (BUP) for postoperative analgesia over three days. The results demonstrated that persistent analgesia effect in vivo was achieved with single injection of BUP-ISFG, and the plasma BUP concentration was found to be steadier compared to commercially available BUP injection. The BUP-ISFG possessed a lamellar-hexagonal-cubic phase transition with corresponding crystal change in 3D nanostructure during the in situ gelation. The relationship between crystal nanostructure and carrier function, might provide some insights to the design and clinical applications of the drug delivery systems based on lyotropic liquid crystal.

A Prospective Randomized Study Comparing Bupivacaine Hydrochloride Versus Bupivacaine Liposome for Pain Management After Distal Radius Fracture Repair Surgery

To compare pain experience and opioid use after distal radius fracture repair surgery performed with perioperative infiltration of the local anesthesia bupivacaine hydrochloride (Marcaine; Pfizer, New York, NY) or bupivacaine liposome (Exparel; Pacira, Parsippany, NJ).We conducted a prospective comparison of consecutive patients scheduled to undergo distal radius fracture repair surgery. Patients were randomized to either Marcaine or Exparel. Patients in the Marcaine group received 20 mL 0.5% bupivacaine without epinephrine into the incision and surgical site before incision. Patients in the Exparel group first received 10 mL 0.5% Marcaine with no epinephrine into the incision and surgical site before incision; then, upon completion of the surgery and wound closure, they also received 10 mL Exparel into the same site that had been preinjected with Marcaine. All operations were performed with the same surgical technique. Daily opioid pill consumption, pain levels, and any adverse reactions were recorded from postoperative days 0 to 5.On the day of surgery, patients in the Exparel group reported significantly lower pain levels (3.9 vs 5.8) and consumed significantly fewer prescribed opioid pills (1.2 vs 2.0) compared with patients in the Marcaine group. However, there were no other significant differences between the Exparel and Marcaine groups on any subsequent days or in the total number of pills consumed at the end of the study period (7.5 vs 8.9 pills, respectively). No major adverse reactions were noted in either group.Exparel use was found to result in decreased pain and opioid consumption only on the day of surgery and not thereafter.Therapeutic II.

A comparison between 0.25% bupivacaine and 0.25% ropivacaine in caudal anaesthesia in paediatric patients undergoing lower abdominal surgeries

Aims and Objectives: The present study was undertaken to compare the onset time, duration of action of sensory and motor blockade and postoperative pain relief between 0.25% bupivacaine and 0.25% ropivacaine in caudal block for children undergoing lower abdominal surgeries. Method: In a double blind study, 50 patients of (age 2-8 years) ASA grade I and II were randomly allocated in two equal groups to received 0.75ml/ kg of either 0.25% bupivacaine (Group I) or 0.25% ropivacaine (Group II) via caudal epidural route. Caudal block was performed in all patients after induction of anesthesia with sevoflurane and oxygen. All the results were tabulated and analyzed statistically. For all statistical analysis, the level of significance was P 0.05). The duration of motor block in group I was 142.227.77 minutes while in group II it was 120.623.51 minutes (p 0.05). The mean pain score of patients in both groups were comparable. Conclusion: Bupivacaine and Ropivacaine provides almost similar duration of pain relief postoperatively but ropivacaine provides less motor blockade as compared to bupivacaine, making it a suitable agent for day care surgery with increase safety margin particularly in younger children.