Cent Procaine Research Articles

Retardation of wound healing by procaine.

Lignocaine has previously been shown to retard wound healing; the retardation is directly related to the concentration of the drug used and is enhanced by the addition of adrenaline. The study described in this paper aimed to determine whether procaine has a similar effect and, if so, whether the effect of sterile water alone and of procaine in various concentrations on the tensile strength of skin wounds in rats. 5 and 7 days after operation. At 5 days sterile water had produced a significant retardation of wound healing. All concentrations of procaine produced significant retardation of healing at 5 days and adrenaline enhanced this effect. By 7 days the effect was greatly diminished and only those rats injected with 2 per cent procaine with adrenaline had significantly weaker wounds. The study suggests that 2 per cent procaine with adrenaline is better avoided and even when lower concentrations are used sutures should be retained for 7 days.

The use of epidural steroids in the treatment of lumbar radicular pain. A prospective, randomized, double-blind study.

Seventy-three patients with lumbar radicular pain syndromes were treated in a prospective, randomized, double-blind fashion with either seven milliliters of methylprednisolone acetate and procaine or seven milliliters of physiological saline solution and procaine. All patients had radiographic confirmation of lumbar nerve-root compression, consistent with the clinical diagnosis of either an acute herniated nucleus pulposus or spinal stenosis. No statistically significant difference was observed between the control and experimental patients with either acute disc herniation or spinal stenosis. Long-term follow-up, averaging twenty months, failed to demonstrate the efficacy of a second injection of epidural steroids administered to the patients whose pain did not respond within twenty-four hours to an injection of either eighty milligrams of methylprednisolone acetate combined with five milliliters of 1 per cent procaine or two milliliters of sterile saline combined with five milliliters of 1 per cent procaine. Therefore, a decision to use epidural steroids must be made with the realization that we failed to demonstrate its clinical efficacy in this study and that reports of serious complications of this procedure have been published.

INTRAARTERIAL INJECTION OF PROCAINE

In angiographic procedures, intraarterial injection of 5-10 ml. of 1 per cent procaine has been extensively used prior to withdrawal of the catheter, needle, on cannula in order to minimize arterial spasm. However, the angiographer must be aware of the possibility of cortical irritation if the procaine is injected rapidly. The symptoms are transient, but nevertheless alarming to both the patient and the angiographer.We report 2 patients who had percutaneous transaxillary arteriography, each of whom developed transient symptoms of marked cortical irritation following the rapid intravascular injection of 5 ml. of 1 per cent procaine just prior to the removal of the catheter.We believe that careful attention to slow injection quite near the arterial entry site will avoid such cortical irritation. To our knowledge this minor, but possibly major, complication has not been reported previously.

Evaluation of low back pain by differential spinal block.

Differential spinal blockade using lignocaine is described as a technique to evaluate patients with chronic low back pain. Successive doses of 5, 25, and 50 mg. of lignocaine in isotonic saline introduced into the subarachnoid space produced results comparable to those obtained with 0.2, 0.5, and 1 per cent procaine. Of 46 patients, 27 were found to have pain of organic origin and 19 of non-organic origin. The value of differential spinal blockade is discussed.

Reflex vascular function in unanaesthetized rabbits.

CHANGES in the calibre of vessels in the rabbit ear can be measured by a variety of methods. Assessment of the effect of various procedures on reflex vasomotor control requires direct stimulation of sympathetic nerves or ganglia, however, and is therefore unsuitable for unanaesthetized animals. It would be advantageous to induce predictable reflex vasomotor changes in intact animals which could be detected by a simple method. In man, reflex vasodilatation in the hand can be produced by heating the skin elsewhere1. This test depends on neural afferents from the heated area and sympathetic efferents to hand blood vessels and it has been used to measure autonomic function in diseases of the nervous system2. This test was adapted to the rabbit ear in order to investigate the effect on autonomic function produced by immunization with a variety of nervous antigens3. A diagrammatic representation of the test conditions is shown in Fig. 1. The animals were tested at constant environmental temperatures and silence was maintained throughout the procedure. To ensure that the rabbits were capable of vasodilatation at the time of the tests, 2 c.c. of 2 per cent procaine solution was injected subcutaneously around the base of the right ear. This produced vasomotor paralysis accompanied by a marked rise in temperature of the right ear. Reflex vasomotor changes in the left ear in response to heating the back for 40 sec were then monitored by thermocouples. When no vasodilatation occurred after the injection of local anaesthetic, tho animal was presumed fully vasodilated and not testable. A normal record is shown in Fig. 2. Heating the shaved back produces an initial vasoconstriction in the ear vessels, of varying magnitude, which lasts 2–10 sec. This gives way to a marked vasodilatation which outlasts the stimulus by 10–30 sec before returning to preheating levels. Irradiation of the back can be repeated at 1-min intervals. The vasodilatation is associated with ear temperature changes ranging from 0-4°–1° C. This vasodilatation is independent of the rate of heating and the threshold is at about 225 W. Pretreatment with atropine, 2 mg/kg, abolishes reflex vasodilatation and 0.8 mg/kg of eserine enhances it. The pathways involved in these vasomotor changes are not fully known. It has been shown by Holton and Rand4 that direct electrical stimulation of the superior cervical ganglion causes in rabbit ear vessels an initial vasoconstriction followed by vasodilatation and that the latter was abolished by atropine and enhanced by eserine. This vasodilator phase is presumably, therefore, due to postganglionic sympathetic cholinergic fibres. By analogy, brief heating of the back and direct electrical stimulation of the superior cervical ganglion utilize in the rabbit identical efferent pathways to the ear vessels. On the afferent side, heating the back produces its effect on ear blood flow probably by stimulation of receptors in the exposed skin rather than by warm blood. The short latency, the prompt return to baseline after cessation of the stimulus and the independence of the response on the rate of heating are all in keeping with this interpretation. This new test of vasomotor function in unanaesthetized rabbits was used in a large number of animals for a study of an experimental immunologically induced disorder of autonomic function.

Quantitative Microdetermination of Enzymes in Sweat Gland

Introduction Because of the accessibility of sweat gland in the living patient, this tissue has seemed to provide a favorable approach to identification of the basic defect in cystic fibrosis. This disease is manifested by various exocrine disorders including excessive sodium chloride concentration in the sweat, pancreatic deficiency, and presumably a defect of the bronchial mucous glands which leads to the chronic bronchitis. Particular enzymes have been selected for study on basis of their possible significance in the disordered secretory process and also on basis of their quantitative determinability on a suitable microscale. Methods Isolation of Sweat Gland Tissue .—Skin plugs were taken from the back, just below the iliac crest, by means of a high-speed rotary drill of 3 mm. diameter. 1 One per cent procaine was used to infiltrate the area, and 4 to 8 plugs were taken at once. The plugs were imbedded in partially frozen tragacanth

Local Anesthesia: History; Potential Toxicity; Clinical Investigation of Mepivacaine

Two double-blind clinical investigations of mepivacaine were conducted at the College of Dentistry, Ohio State University. The first study compared 2 per cent aqueous mepivacaine, 3 per cent aqueous mepivacaine, commercially available 2 per cent mepivacaine with 1:20,000 l-nordefrin, and the commercial Ravocaine solution (2 per cent procaine, 0.4 per cent propoxycaine, 1:20,000 1-nordefrin). Approximately 80 inferior alveolar nerve blocks, zygomatic nerve blocks or anterior maxillary infiltrations were made with each of the four solutions. The results appear in Table 1. Owing to the excellent results obtained with 3 per cent aqueous mepivacaine, a second study was made comparing the commercial 2 per cent mepivacaine with 1:20,000 l-nordefrin with another experimental solution containing 2½ per cent mepivacaine with 1:40,000 l-nordefrin. The data from this study indicate that these two solutions were very similar in effect except that the duration of the experimental solution was shorter owing to a smaller concentration of vasoconstrictor. The results of approximately 80 inferior alveolar nerve blocks, zygomatic nerve blocks or anterior maxillary infiltrations of each solution are tabulated in the last two columns of Table 1.

Vertebral arteriography by retrograde injection of the right common carotid artery.

This report describes a simple method for obtaining vertebral arteriograms during the course of carotid arteriography. I t is a modification of a previously described “open” technic in which filling of the vertebral arterial system is accomplished by retrograde injection of contrast media into the right common carotid artery (1). The results of the present study show that vertebral arteriograms of diagnostic quality can be obtained in 70 per cent of the cases investigated. Method Vertebral arteriography by retrograde injection of the right common carotid artery is performed as follows: The patient is placed on the x-ray table, in a supine position, and the neck is hyperextended by folded sheets placed beneath the shoulders. The skin is prepared with a suitable antiseptic (Merthiolate) and a local anesthetic (1 per cent procaine or 1 per cent lidocaine) is injected into the skin and deeper cervical tissues about the common carotid artery. The position of the arteriographer is at the head of the table on th...

Experimental modification of dendritic and recruiting processes and their DC after-effects

The study concerns agents that modify evoked cortical potentials of rabbit and cat in a predictable way and at the same time change the DC accompaniments of the activation process. Recruiting, surface-activated (dendritic) and subcortically activated (radiation) potentials were studied, both as responses to single stimuli and in repetitive series. In one set of experiments a variety of agents (1 per cent procaine, 0.01 per cent veratrine, 0.1 per cent GAB, and boiling water as a control) were applied to the cortical surface. In another, modifications were induced by the increasing injection of a barbiturate into artificially respired cats (immobilized with Flaxedil), leading to very deep anesthesia. Of the agents applied to the cortical surface all occasioned reversal (transcortical lead) of the ordinarily negative sign of the recruiting transient to positive, the summated after-effects evident during stimulation being augmented at the same time. Reversal in sign occurred in the transcortical lead even though the negative potentials remained in a lead from a superficial intracortical position to the subcortical white matter. Thus, the reversal could be attributed to a block in activity very close to the cortical surface, with continuation of activity of usual sign in the deeper cortical fraction. Dendritic and radiation activated responses behaved similarly. In the cat prior to the intravenous injection of Nembutal (0.15 – 0.3 g.), the negative dendritic response shows a short-lived negative after-effect followed by a longer lasting positive one. With repetitive stimulation the positive after-effect disappears, the negative one increasing and showing summation. Intravenous Nembutal occasions the disapperance of the positive after-effect which follows the response to a single stimulus and also augments the negative one which then lasts for a much longer time. With deepening anesthesia and repetitive stimulation transients no longer follow each of successive stimuli, a series of shocks then giving rise to a summation of negative after-effect alone. This is comparatively large and outlasts the stimulus series by several seconds. During deepening anesthesia the recruiting response fails earlier than the dendritic and radiation activated ones, the latter two being lost nearly simultaneously.

Observações preliminares sobre o emprego da anestesia epidural lombar em bovinos

Based on anatomical studies, the authors describe some changings for the purpose of furthering the technique of the segmental lumbar epidural anesthesia in cattle. The improved technique has shown that: 1) A single injection (3 to 10 cc) of a 5 per cent procaine hydrochloride solution with renaleptine is effective to produce a complete anesthesia of both flanks, ventral abdominal wall and the udder (except the posterior part). This anesthesia provides excellent operating conditions in all regions concerned. 2) The authors, during or after the anesthesia, have observed no accidents and complications.

The technic of cervical discography.

The following simple technic for discography has been found useful by the authors in the study of cervical disk disorders. Ninety-six milligrams of sodium luminal and 16 mg. of morphine sulfate are given forty-five minutes prior to the procedure. The patient is placed in the supine position on the x-ray table, with two folded sheets directly under the shoulders to give hyper-extension to the neck. The head is turned approximately 10° to the side opposite the site of injection (Fig. 1). The anterolateral aspects of the cervical region are prepared with ether and Zephiran and 0.5 ml. of 1 per cent procaine is injected into the skin and subcutaneous tissues at the level of the thyroid cartilage, 4 cm. from the mid-line. A 9-cm., 21-gauge spinal needle is then introduced anteriorly in the cervical region at an angle of approximately 30°, toward the mid-line, until the anterolateral surface of the sixth cervical vertebra is encountered. The needle is then “walked” cephalad to the fifth interspace, which is rec...

USE OF DUOCAINE IN ORAL SURGERY

Duocaine, which is a combination of 2 per cent procaine and 1.25 per cent butethamine with epinephrine 1:65, 000, was used with favorable results in the following minor and major oral surgery: 115 tooth extractions, 5 pulp exstirpations, 7 abscess incisions, 4 apicoectomies, 2 each of resection of the mandible and enucleation of cyst, one each of alveolectomia, plastic surgery of the lower lip and reduction of the mandible.Particularly in case of tooth extraction about 80 per cent showed successful anesthetic effect within minutes after within 3 minutes after injection.In addition, two comparative studidies of duocaine with xylocaine or procaine were made.1. One cc each of duocaine and xylocaine or procaine was injected in the forearms and the anesthetized areas of the skin were measured and compared, as shown in Fig. 1.2. The effect of these anesthetics upon the sciatic nerve of rana nigromaculata was compared in the nerve and muscle specimen, as shown in Figs. 2 and 3.The results obtained in these expriments showed that duocaine has more favorable effect than procaine and has similar effect with xylocaine.(Authors' abstract)

Transvaginal pudendal nerve block: A Simple Procedure for Effective Anesthesia in Operative Vaginal Delivery

In over 97 per cent of 156 patients who had transvaginal pudendal block, the anesthesia was considered good or excellent. Results were best when hyaluronidase was combined with 1 per cent procaine and epinephrine. At this point it is well to remember, however, the caution of Eckenhoff and Kirby13 that “addition of hyaluronidase to a local anesthetic is not a substitute for the proficiency of the anesthetist or surgeon in performing regional nerve blocks”.The transvaginal procedure for obtaining a pudendal nerve block has the following advantages: 1.1. Simplicity of performance. It can be carried out without aid.2.2. The site of injection is nearest to the nerve to be blocked, affording greater accuracy in direct nerve infiltration.3.3. The method is safe for mother and infant. No hematoma, infection, or other complication has been encountered in the past five years while this procedure has been used.

Atypical neuralgias of the head: Headaches, so-called migraine and complications of whiplash injuries and other cervical trauma

Relief of atypical neuralgias of the head and face, occipital neuralgia and migrainous headache may be secured by painstaking and accurate injection of 2 per cent procaine into the sensitized trigger points, repeating the injections if necessary until all trigger spots have been abolished. The sensitized trigger points are caused by trauma, toxins or compression of the small unmyelinated sympathetic fibers in and accompanying blood vessels, and in the subcutaneous tissues, muscles, fascia, ligaments and attachments of muscles to bone. The usual location of these trigger points for the various types of neuralgias of the head and neck has been described and illustrated. Sensitized areas from strains or sprains, such as occur in whiplash injuries, involve the deeper posterior rotator neck muscles, and trigger points are found in the interspinous ligament and its bursae, between the spines of the cervical vertebrae and the strained attachments of muscles to the transverse processes of these vertebrae. From these locations may originate the referred pain to the occipital and frontal parts of the head, face, shoulders and even down the back. To prevent recurrence of the neuralgia after injections of the trigger points, especially in patients depleted from long-continued pain causing repeated mild alarm reactions, vitamins and adrenal cortex and/or anterior pituitary preparations in particular are given. Recently the use of the Rauwolfia root or its alkaloid, reserpine, for suppression of the sympathetic predominance at the hypothalamic level has served better than anterior pituitary substances in relieving headache, crying or the profuse perspiration that some patients experience.

Hyaluronicase in intramuscular excretory urography.

Intramuscular excretory urography (1, 7) is one of the simpler and easier methods of studying the upper urinary tract in children. With the discovery of hyaluronidase (6, 8), the “spreading factor,” extravascular administration of solutions has been facilitated (5). Several articles have appeared concerning the use of hyaluronidase in subcutaneous excretory urography (2, 3, 10). Since the technic of intramuscular is less difficult than that of subcutaneous urography (9, 11), the effect of hyaluronidase on the rate of absorption of Diodrast and Neo-Iopax administered intramuscularly was tested clinically. Technic Into one buttock we injected either Diodrast 35 per cent or Neo-Iopax 50 per cent2 in amounts varying from 6 to 10 c.c, plus 1 c.c. of 2 per cent procaine solution. Into the other buttock we injected the same mixture, to which had been added hyaluronidase in quantities from 150 to 750 TRU (turbidity reducing units). Thus each patient acted as his own control. Nine patients were tested in this mann...

Ocular penetration of procaine following subconjunctival injection.

THIS REPORT concerns one phase of a long-range investigation which has been directed toward development of more effective local anesthetic drugs and improved methods of their administration in ophthalmologic practice. In this particular study it has been our purpose to determine factors influencing the ocular penetration and distribution of procaine following subconjunctival injection. By ``subconjunctival" we refer to the issue which is under the epithelium of the bulbar conjunctiva but is external to Tenon's capsule. The distribution of anesthetic drugs following subcapsular injections will be investigated later. Subconjunctival injections of procaine hydrochloride commonly are made if manipulation of the iris is to be required during ocular surgery; however, a review of the literature reveals no unanimity of opinion regarding the efficacy of such injections. Many surgeons advocate this method of anesthesia, whereas others feel that retrobulbar injection is superior for such operative procedures as iridectomy One per cent procaine hydrochloride

Minor surgical aspects of closed wounds

Basic surgica1 principIes are appIicabIe in any situation but there is much to be considered in the attempt to restore the injured tissue, member, organ or individua1 to its pre-trauma function. Christopher2 defines a wound as an injury or forcible soIution of continuity of any tissue of the body caused by external violence. A cIosed wound is a wound without a break in the skin or mucous membrane. AIthough the term viotence generaIIy indicates physica force, thermal or chemica1 disturbances are incIuded. (TabIe I.) A contusion or bruise is a traumatic soIution of continuity of tissue without compIete anatomic separation. It is accompanied by an effusion of bIood or Iymph by sweIIing and occasionaIIy by the formation of blebs. When the skin is unbroken, the fluid collection can be considered steriIe and severa methods may be applied to hasten reabsorption of the effusion. In general, the time-honored treatment of bruises or contusions has been a preIiminary attempt to IocaIize and prevent edema by the immediate appIication of coId, be it a coId tabIe knife, ice packs or ethy1 chIoride spray. KessIer and Van Emburgh treated 198 cases of trauma with antihistamines on the theory that the edema was on the basis of JocaJIy liberated histamine. They were greatIy impressed with their resuIts and found that pain and IocaI edema were markedly decreased. After gathering their materia1, Kessler and Van Emburgh were somewhat dismayed by Mayer’s6 report which indicated that the inffammatory reaction in tissue produces a high hyaIuronidase concentration. As it is known that the antihistamines have the capacity to destroy or Jimit the action of hyaluronidase, it was their amended conclusion that the action of the antihistamines was that of destroying the hyaIuronidase-spreading factor. When the initial phase of edema and vasospasm has been controIIed by coJd applications or the use of antihistamines, some methods of removing IocaI Auid accumuIations is indicated. Needle aspiration wiJ1 frequentIy be sufficient, but contaminated or infected hematomas may require incision and drainage. Hyaluronidase can be used in aseptic conditions in an attempt to disseminate ffuid accumuIations under tension. The usuaJ dose, $00 viscosity units aIidase@* mixed in a small amount of normal saline, is injected into the localized Auid. Mixing the hyaluronidase in I per cent procaine soIution wiI1 aIso produce IocaI vasodilatation, relief of IocaI pain and more rapid absorption of the fluid mass. This method can aIso be applied to traumatized bursae or synovia1 spaces which do not respond to repeated aspirations. The treatment of sprains and strains can be considered as a single entity. They both consist of incompIete tears or overstretching of the invoIved structure, producing spasm and Iimited function. The initia1 concept of treatment of a torn muscIe or Iigament was that of immobiIization and rest unti1 the injured tissue healed. It is surprising that this misconception has persisted with the use of adhesive tape strapping, pIaster casts and compIete disuse being the most wideIy accepted method of treatment for a sprained joint or strained back, shouIder or hip. Leriche and ArnuIf6 described

The intestinal phase of gastric secretion.

1. In dogs provided with Heidenhain gastric pouches and Thirty‐Vella loops of duodenum and jejunum, gastric secretion was stimulated both by distending the intestinal loop and by perfusion with (a) intestinal chyme or (b) dilute hydrochloric acid or (c) acetylcholine.2. The gastric secretory response was abolished by the prior application to the mucosa of the intestinal loop of 5 per cent procaine solution for 15–30 min., but not by 3 per cent procaine solution.3. The secretory responses to distension and perfusion of the loop with intestinal chyme or dilute acid persisted after denervation of the vascular pedicle of the gastric pouch.4. The secretory responses did not appear for 15‐30 min. after the commencement of mechanical or chemical stimulation of the intestinal loop, and they often persisted for 30–45 min. after cessation of stimulation.5. These findings indicate the existence in the small intestinal mucosa of a hormonal mechanism for the stimulation of gastric secretion by meals.

Fatal and near-fatal penicillin anaphylaxis: Three new cases with a note on prevention

1. 1. One death and two cases of nonfatal anaphylactic shock due to penicillin are described. 2. 2. The fatality occurred in a patient with bronchial asthma. Three other known deaths attributable to penicillin anaphylaxis have also occurred in asthmatics. 3. 3. Two of these patients, including the one with a fatal reaction, had received penicillin many times before without indication of allergy. The third patient responded previously with immediate reactions to penicillin which went unheeded as a warning of anaphylaxis. 4. 4. A direct scratch test with aqueous crystalline penicillin was positive in one case, whereas similar tests were negative with aqueous procaine penicillin and 2 per cent procaine. Passive transfer tests were negative. 5. 5. Detailed precautions are suggested toward the prevention of penicillin anaphylaxis, particularly for asthmatic and penicillin-allergic persons. The avoidance of the indiscriminate use of penicillin, particularly by injection, is emphasized. The value of a systematic inquiry as to previous penicillin treatment and reactions as well as of the general allergic status is stressed. Certain refinements in the method of penicillin injection are suggested. The technique and interpretation of preliminary penicillin skin tests are discussed.

Continuous-drop subarachnoidal block with dilute procaine solution for labor and delivery

1.1. A new method of continuous-drop subarachnoidal block for labor and delivery with an 0.5 per cent procaine solution has been described.2.2. By means of this “differential” technique, complete pain relief can be afforded early to parturients without significant interference with the process of labor and delivery.3.3. Because the method allows a great latitude in the level of analgesia, the continuous presence of the anesthesiologist is not necessary.4.4. The technique is safe. Maternal and fetal complications attributable to the method were negligible.