Combination Of Local Anesthetics Research Articles

Paravertebrally-Injected Multifunctional Hydrogel for Sustained Anti-Inflammation and Pain Relief in Lumbar Disc Herniation.

Pain caused by lumbar disc herniation (LDH) severely compromises patients' quality of life. The combination of steroid and local anesthetics is routinely employed in clinics to alleviate LDH-induced pain. However, the approach only mediates transient efficacy and requires repeated and invasive lumbar epidural injections. Here a paravertebrally-injected multifunctional hydrogel that can efficiently co-load and controlled release glucocorticoid betamethasone and anesthetics ropivacaine for sustained anti-inflammation, reactive oxygen species (ROS)-removal and pain relief in LDH is presented. Betamethasone is conjugated to hyaluronic acid (HA) via ROS-responsive crosslinker to form amphiphilic polymer that self-assemble into particles with ropivacaine loaded into the core. Solution of drug-loaded particles and thermo-sensitive polymer rapidly forms therapeutic hydrogel in situ upon injection next to the herniated disc, thus avoiding invasive epidural injection. In a rat model of LDH, multifunctional hydrogel maintains the local drug concentration 72 times longer than free drugs and more effectively inhibits the expression of pro-inflammatory cytokines and pain-related molecules including cyclooxygenase-2 (COX-2) and prostaglandin E2 (PGE2). Therapeutic hydrogel suppresses the LDH-induced pain in rats for 12 days while the equivalent dose of free drugs is only effective for 3 days. This platform is also applicable to ameliorate pain caused by other spine-related diseases.

Retrospective Evaluation of the Effect of Lumbar Sympathetic Blockade on Pain Scores, Fontaine Classification, and Collateral Perfusion Status in Patients with Lower Extremity Peripheral Arterial Disease.

Background and Objectives: The aim of this retrospective study was to evaluate the effect of lumbar sympathetic block (LSB) on pain scores, Fontaine Classification, and collateral perfusion status in patients with lower extremity peripheral artery disease (PAD), in whom revascularization is impossible. Material and Methods: Medical records of 21 patients with PAD who underwent LSB with a combination of local anesthetics, steroids, and patient follow-up forms containing six-month follow-ups between January 2020 and March 2021 were retrospectively reviewed. Numeric Rating Scale (NRS), Pain Detect Questionnaire (PDQ) scores, Fontaine Classification Stages, and collateral perfusion status (collateral diameter and/or development of neovascularization) evaluated by arterial color Doppler Ultrasound (US) from the medical records and follow-up forms of the patients were reviewed. Results: NRS and PDQ scores were significantly lower, and regression of the Fontaine Classification Stages was significantly better after the procedure at the first, third, and sixth month than at the baseline values (p < 0.001). Only four patients (19%) had collaterals before the procedure. An increase in the collateral diameter after LSB was noted in three out of four patients. Before the procedure, 17 patients had no prominent collateral. However, in thirteen of these patients, after LSB, neovascularization was detected during the six-month follow-up period (three patients in the first month, seven patients in the third month, and thirteen patients in the sixth month). The number of patients evolving neovascularization after LSB was found to be statistically significant at the third and sixth months compared to the initial examination (p < 0.001). Conclusions: LSB with the use of local anesthetic and steroids in patients with lower extremity PAD not only led to lower NRS and PDQ scores, but also resulted in regressed Fontaine Classification Stages and better collateral perfusion status.

Endovascular aneurysm repair under local anesthesia through bilateral percutaneous femoral access is a safe strategy to improve early outcomes and reduce hospital stay.

To estimate the impact of anesthetic conduct, alone and in combination with the type of femoral access, on early results after endovascular aneurysm repair (EVAR). A retrospective multicenter analysis on patients undergoing elective standard EVAR at four academic centers was performed. Patients undergoing the procedure through either local or general anesthesia were compared. Comparative subanalyses of the two groups were performed for the type of femoral access to evaluate further impact on outcomes. Five hundred twenty-four patients underwent elective standard EVAR, of which 207 (39.5%) under general anesthesia and 317 (60.5%) under local anesthesia. Patients who underwent general anesthesia had higher 30-day mortality rates (3.4% vs. 0.3%, P=0.005), as well as slightly worse 30-day major systemic complication rates (8.2% vs. 5.4%, P=0.195). There were no differences in terms of reinterventions (2.1% vs. 2.5%, P=0.768) and aneurysm-related mortality (0% vs. 0.4%, P=0.422) at one year. Total intervention times were significantly longer in the general anesthesia group (126 vs. 89 minutes, P=0.001), as well as the total length of hospital stay (7.6 vs. 5.3 days, P=0.007). At subanalyses, the combination of local anesthesia with bilateral percutaneous femoral access further improved 30-day outcomes and determined an additional reduction in total intervention times and ICU stays. EVAR performed under local anesthesia has a significantly better impact on early results when compared to general anesthesia. Combining percutaneous bilateral femoral access to local anesthesia reduced procedural times, ICU stays and consequently improved early results.

Role of General Anesthesia and Rapid On-site Evaluation in the Diagnosis of Lung Cancer with EBUS-TBNA

Lung cancer is a common malignant tumor of respiratory system. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a valuable tool for the diagnosis and staging of lung cancer. EBUS-TBNA is predominantly performed under local anesthesia or conscious sedation. However, the diagnostic performance of EBUS-TBNA under general anesthesia and in conjunction with rapid on-site evaluation (ROSE) remains uncertain. This study aims to investigate the value of general anesthesia and ROSE in the diagnosis of lung cancer with EBUS-TBNA. A retrospective analysis was conducted on 164 patients treated in the Department of Respiratory and Critical Care Medicine of The Affiliated Hospital of Southwest Medical University from January 2018 to December 2022. All patients were preoperatively suspected of lung cancer and underwent EBUS-TBNA. Based on whether they received general anesthesia and ROSE, the patients were divided into three groups: local anesthesia group (LA group)(n=54), general anesthesia group (GA group)(n=67) and general anesthesia with ROSE group (GA-ROSE group)(n=43). The puncture characteristics and diagnostic differences were analyzed among the groups. The number of lymph node puncture needles in the LA group was higher than in GA-ROSE group (P<0.01). The overall diagnostic rates of EBUS-TBNA for the three groups were 87.04%, 89.55% and 90.70%, respectively, with malignant tumor diagnostic rates of 88.24%, 88.89% and 94.74%. No statistically significant differences were observed among the three groups (P>0.05). There were no instances of severe complications or adverse anesthesia reactions in any of the groups. Compared to the combination of local anesthesia with intravenous analgesia and sedation, the implementation of EBUS-TBNA under general anesthesia, with or without ROSE, achieves equally accurate results, and general anesthesia combined with ROSE can reduce in the number of lymph node puncture needles.

Comparative study between rocuronium and magnesium sulfate as adjuvants to local anesthetics for peribulbar block

Background &amp; Objective: Peribulbar anesthesia is frequently used in cataract surgeries. Compared to retrobulbar anesthesia, this approach is associated with less significant consequences. However, the prolonged onset of orbital akinesia and the frequent need for block replenishment are considered drawbacks. We aimed to investigate the impact of adding rocuronium and magnesium sulfate to a commonly used local anesthetic combination on the onset of corneal anesthesia and the degree of lid and globe akinesia during peribulbar block in ocular surgeries.&#x0D; Patients and Methods: This prospective double-blinded randomized study was conducted in the ophthalmic surgery operating theater, Ain Shams University Hospital from January 2019 to April 2020. We enrolled 75 patients from both sexes, with American Society of Anesthesiology (ASA) physical status I–III, ages 40-80 y, and an axial globe length less than or equal to 26 mm planned for cataract surgery under peribulbar block in the study following institutional ethical board approval and written informed patient consents. Patients were randomly divided into three groups, 25 patients per group, based on the drugs they received: Group O (control group): received local anesthetic + 0.9% normal saline (1 ml). Group M: received local anesthetic + magnesium sulphate 50 mg in normal saline. Group R: received local anesthetic + rocuronium at a dose of 0.06 mg/kg (maximum 5 mg) in normal saline.&#x0D; Results: Our study found statistically significant more rapid onset of action (mean time to start surgery) in rocuronium group (7.00 ± 1.22 min) than control group and magnesium sulfate group (9.00 ± 1.47 and 9.00 ± 1.15 min) respectively, (P &lt; 0.001); Moreover, no significant difference was noted between control group and magnesium sulfate group. In addition, no relevant difference was reported regarding duration of surgery between the groups.&#x0D; Conclusion: During cataract surgery, the addition of rocuronium to the local anesthetic mixture in the peribulbar nerve block has been found to enhance ocular akinesia and corneal anesthesia. Furthermore, the use of rocuronium demonstrated a significantly faster onset and shorter time needed to achieve the appropriate conditions to initiate the surgical procedure compared to the use of magnesium sulfate. Addition of magnesium sulfate showed good results regarding akinesia, corneal anesthesia and need for supplementary injections but it did not significantly fasten the onset of block and hence the time to start surgery.&#x0D; Key words: Cataract; Magnesium Sulfate; Peribulbar Block; Rocuronium&#x0D; Citation: Nagy M, Abo El-Ella S, El-Shafey MA, Helal AM, Zekry MR. Comparative study between rocuronium and magnesium sulfate as adjuvants to local anesthetics for peribulbar block. Anaesth. pain intensive care 2024;28(1):55−61; DOI: 10.35975/apic.v28i1.2157&#x0D; Received: February 18, 2023; Reviewed: July 30, 2023; Accepted: December 23, 2023

Effect of dexmedetomidine combined with local infiltration analgesia on postoperative wound complications in patients with total knee arthroplasty: A meta-analysis.

Dexmedetomidine has been demonstrated to be effective in the management of pain in total knee replacement (TKA). Nevertheless, a combination of a local anaesthetic and a dose of dexmedetomidine might be a better choice for post-operative pain management of TKA. The aim of this research is to determine if the combination of a local anaesthetic with dexmedetomidine during a knee replacement operation can decrease the post-operation pain. Furthermore, the effectiveness and security of dexmedetomidine combined with topical anaesthetic were evaluated for the management of post-operative TKA. Based on the research results, the author made a research on the basis of four big databases. The Cochrane Handbook on Intervention Systems Evaluation has also evaluated the quality of the literature. Seven randomized controlled trials have been established from this. It was found that the combination of local anaesthesia and dexmedetomidine had a greater effect on postoperative pain in 4 h (mean difference [MD], -0.9; 95% CI, -1.71, -0.09; p = 0.03), 8 h (MD, -0.52; 95% CI, -0.66, -0.38; p < 0.0001), 12 h (MD, -0.72; 95% CI, -1.04, -0.40; p < 0.0001), 24 h (MD, -0.49; 95% CI, -0.83, -0.14; p = 0.006), 48 h (MD, -0.51; 95% CI, -0.92, -0.11; p = 0.01). Nevertheless, because of the limited number of randomized controlled trials covered by this meta-analysis, caution should be exercised with regard to data treatment. More high quality research will be required to confirm the results.

Study of Dexmedetomidine as an Adjuvant to Bupivacaine- Lignocaine with Adrenaline in Supraclavicular Brachial Plexusblock

Supraclavicular brachial plexus block is a very popular mode of anesthesia for various upper limb surgeries, as it is easiest and most effective and has good post-operative analgesia. It is carried out at the level of trunks i.e7 at the middle of brachial plexus, resulting in homogenou spread of anesthetic agent throughout the plexus with a fast onset and complete block action.9 Dexmedetomidine, is potent, highly selective α2-adrenoceptor agonist, has been used as an adjuvant during regional and local anesthesia because of rapid onset of action and relatively short half-life up to 2 hours. Objective of Study: To compare the effects of addition of Dexmedetomidine to Bupivacaine- Lignocaine with Adrenaline combination for Supraclavicular brachial plexus block with regards to onset and duration of sensory block, motor block. Quality of anesthesia, analgesia and Adverse reactions if any after taking written informed consent. Observations: Onset of sensory as well as motor blockade in Dexmedetomidine group was earlier when compared to plain bupivacaine-lignocaine adrenalin group. The duration of sensory and motor blockade was significantly increased (p&lt;0.05) in Dexmedetomidine group when compared to another group. With respect to hemodynamic parameters Dexmedetomidine group provided a higher Degree of cardiovascular stability with a lesser incidence of hypotension. Result: There is earlier onset of action and longer duration of sensory; Motor block and Duration of analgesia (sensory block) was prolonged in dexmedetomidine group. Hence it is advisable to add dexmedetomidine as an adjuvant to local anesthetic combinations during supraclavicular block for prolonged anesthesia and to provide better analgesia

Regional anaesthesia for ambulatory surgery.

Regional anaesthesia (RA) has an important and ever-expanding role in ambulatory surgery. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available local anaesthetics limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of regional anaesthetics continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural dexamethasone gives the longest and most optimal sensory block. In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia drugs and adjuvants, paediatric RA in ambulatory care and discuss the impact of RA by COVID-19.

Non-Injectable Eutectic Mixture of Local Anesthesia and Its Implementation in Dentistry – A Comprehensive Review

pain management is one of the most important components of contemporary dentistry that may impact a patient's quality of life. Before local anesthetic injection, oral cavity mucosa pain is frequently managed using topical anesthetics in oral and maxillofacial surgery. This review paper aims to learn about the Eutectic mixture of Local Anaesthetics as topical anesthesia and its implementation in dentistry, which is used to numb oral tissues. This paper aims to learn about the various mechanisms of action of the most common topical and local anesthetic agents, pharmacological action, therapeutic uses, and their side effects. Topical anesthetics work on peripheral nerves to lessen pain perception where they are applied. They are employed in dentistry to reduce localized discomfort brought on by needling, the implantation of orthodontic bands, the vomiting reflex, oral mucositis, and rubber dam clamps. The active chemicals in conventional topical anesthetics, which come in the shapes of solutions, creams, gels, and sprays, are lidocaine or benzocaine. These anesthetic agents come in various formulations created for various applications, to reduce unfavorable reactions, and for maximum anesthetic effectiveness. To give patients a pain-free environment, various strategies are offered. One of the most significant developments in dentistry to prevent patient phobia is the advancement of topical anesthetic drugs. Most are risk-free and cause little irritation or adverse reaction when administered to the oral mucosa. Currently, these medications come in a variety of potencies and indications. Topical anesthetics are helpful during dental procedures because they lessen dental fear, especially in kids, by easing pain and discomfort. A commercial anesthetic drug that has gained appeal among dental practitioners is the eutectic combination of local anesthetics (EMLA), which contains prilocaine and lidocaine. The effectiveness of EMLA as a topical anesthetic agent, which is applied while dental treatments are briefly reviewed in this article.

Can stellate ganglion blockage be an alternative treatment for refractory ventricular arrhythmias: Case series.

Ventricular tachycardia (VT) and ventricular fibrillation (VF) are life-threatening conditions which increase in frequency over the years. Electrical storm (ES) is defined as the occurrence of 3 or more continuous ventricular arrhythmia. The sympathetic nervous system has an important role in Ventricular arrythmias (VA) and is the target of treatment. Studies show that stellate ganglion blockade (SGB) can reduce cardiac sympathetic tone and is an alternative bridge therapy in VAs. Among the patients who were admitted to the hospital with the complaints of general condition disorder and palpitation. Patients were referred to the Cardiology department and diagnosed VA and ES. Patients who applied to the Cardiology Department with the diagnosis of VA or ES and did not benefit from antiarrhythmic drug therapy were selected and evaluated by a team of 2 anesthesiologists (cardiothoracic and pain specialists) and 2 cardiologists (1 of whom is an electrophysiology specialist). In our study, ultrasound (USG) guided left SGB was applied to 10 VA and ES patients with implantable cardiac defibrillator (ICD). The 6-month results of the patients were evaluated retrospectively. For blockage, the solution was prepared by adding 8 mg dexamethasone, 40 mg lidocaine and 10 mg bupivacaine to 10 mL with physiological saline. The success of the procedure was evaluated with the development of Horner syndrome in the left eye. Resistant VA developed in 2 of 10 patients who had left SGB due to VF/VT ES and were excluded from the study. One (1) month after the procedure it was seen that there was a statistically significant decrease in the number of shocks in 8 patients in the 6th month controls compared to the pre-procedure. The number of VES in the 1st and 6th months of the patients was also statistically significantly decreased compared to the pre-SSD (P = .01, P = .01, P = .01, respectively). Unilateral USG-guided SGB application is an effective and safe method in patients with ES and VA. Long-term results can be satisfactory in successful responders in whom SGB is performed with a combination of local anesthetic and steroid.

Comparison of Two Different Doses of Nalbuphine With Isobaric Ropivacaine in Patients Undergoing Lower Segment Cesarean Section Under Subarachnoid Block: A Randomized Controlled Trial.

Obstetric analgesia and anesthesia is a challenge in itself. It requires an understanding of the physiological changes during pregnancy and labor and the effect of anesthetic agents on the fetus and newborn. Because neuraxial techniques provide superior analgesia and materno-fetal benefits, their use have increased significantly over the past three decades or so. A combination of local anesthetics like ropivacaine with opioids like nalbuphine has been shown to have additive beneficial effects in subarachnoid block (SAB) in lower segment cesarean section (LSCS). However, the optimal dose combination of ropivacaine and nalbuphine to maximize their benefits and minimize side effects remains to be established. Our study has compared the clinical efficacy and safety of 0.75% isobaric ropivacaine (15 mg) with two different doses of nalbuphine (0.4 mg and 0.6 mg) when given intrathecally for LSCS in terms of quality of sensory and motor blocks, hemodynamic parameters, duration of effective analgesia, Apgar score in newborn, and associated side effects. In this prospective, randomized, double-blind study, a total of 69 parturients between the age of 20-45 years, belonging to American Society of Anesthesiologists (ASA) grade I and II, undergoing cesarean section under SAB were evaluated. Patients were randomly allocated into three groups of 23 each by using the draw-of-lots technique. The patient and the observer were kept blinded as to which dose of drug (intrathecal) was being given to the patient. Patients in Group A received 0.75% isobaric ropivacaine 15 mg (2 ml) + 0.3 ml normal saline; patients in Group B received 0.75% isobaric ropivacaine 15 mg (2 ml) + 0.4 mg of nalbuphine (0.2 ml) + 0.1 ml normal saline; patients in Group C received 0.75% isobaric ropivacaine 15 mg (2 ml) + 0.6 mg of nalbuphine (0.3 ml). The total volume of drug solution in all three groups was 2.3 ml. We found that the time to onset of sensory block was shortest in Group A (5.87±1.290 minutes) followed by Group C (6.00±1.087 minutes) and Group B (6.17±1.696 minutes); time to two-segment regression of sensory block was longest in Group C (101.74±8.996 minutes) followed by Group B (85.87±15.348 minutes) and Group A (65.00±7.071 minutes); duration of effective analgesia was longest in Group C (206.09±18.766 minutes) followed by Group B (183.91±15.880 minutes) and Group A (121.74±11.833 minutes); and time from SAB to complete regression of motor block was longest in Group C (216.52±15.553 minutes) followed by Group B (203.48±20.138 minutes) and Group A (174.78±14.731 minutes). Side effectswere comparable among all three groups. The optimal dose combination in SAB for cesarean section was 15 mg of 0.75% isobaric ropivacaine + 0.6 mg nalbuphine, with minimal side effects.

Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial

IntroductionRecent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete...

Quantitative Review of Anesthesia in Liver Tumor Ablation: A Bibliometric Study from 1999 to 2022.

BACKGROUND Ablation has been developed as a radical surgical procedure for liver tumors. Local anesthesia in combination with general anesthesia or intravenous sedation is needed in ablative procedures. Although many studies have been published, a related bibliometric study is lacking. The present bibliometric analysis aimed to further understand the current situation of anesthesia for liver tumor ablation and discover candidate novel research directions. MATERIAL AND METHODS Web of Science Core Collection (WoSCC) was searched to identify studies associated with anesthesia for liver tumor ablation. Also, countries, journals, authors, and institutes contribution together with co-occurrence relations were analyzed by R, VOSviewer, and CiteSpace software; meanwhile, relevant research hotspots together with potential future trends were identified. RESULTS This work obtained 183 English-language documents during 1999-2022, and the annual growth rate was 8.83%. Most studies were conducted in the United States (24.04%, 44/183). The Oslo Univ Hosp contributed the most publications (n=11, 6.01%). Livraghi T (n=6), De Baere T (n=5), and Goldberg SN (n=4) ranked top in terms of cited authors and top authors. Keywords from that co-cited network were aggregated and identified, which revealed a shift in the liver tumor ablation anesthesia field. Initially, hotspots were predominantly "alcohol injection", "radiofrequency tissue ablation", and "metastases", but hotspots shifted to "efficacy", "ablation", "pain", "microwave ablation", "management", "analgesia", "safety", "irreversible electroporation", and "anesthesia" recently. CONCLUSIONS Anesthesia has received increased attention as liver tumor ablation advances. Bibliometric study findings provide insight into the current state and trends of anesthesia in liver tumor ablation research.

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair.

We aimed to describe our technique for and experience with elective endovascular aneurysm repair using EndoAnchors under local anesthesia. We included seven patients with abdominal aortic aneurysms who underwent endovascular aneurysm repair using EndoAnchors with a standard regimen consisting of local anesthesia, intravenous sedation, and analgesia. The procedural and follow-up details were retrospectively reviewed. Six out of seven infrarenal abdominal aortic aneurysms were successfully treated with endovascular aneurysm repair using primary EndoAnchors under local anesthesia. One patient was converted to general anesthesia due to acute aneurysm thrombosis independent of EndoAnchor deployment during the procedure. Remifentanyl infusions of up to 3.2 mg/min, morphine doses up to 6 mg (median, 0.5 mg), and midazolam doses of up to 4 mg (mean, 1.4 mg) were used. The mean theater time was 83 minutes (range, 60-130 minutes). Two patients were discharged on day 0, and the mean hospital stay was one day. All patients were alive between 484 and 1,128 days post-procedure, with no aneurysm-specific reintervention. The combination of local anesthesia, intravenous sedation, and analgesia is a viable strategy for timely and effective endovascular aneurysm repair using EndoAnchors. This technique may allow endovascular repair of more ruptured aneurysms using EndoAnchors with potential survival benefits.

First-trimester surgical abortion practice in Canada in 2012

To evaluate practices among first-trimester surgical abortion facilities and providers in Canada in 2012 and examine the characteristics of the surgical abortion work force. Self-administered paper or electronic survey adapted from a survey previously fielded in the United States. Canada. Facility administrators and physicians. Descriptive statistics on reported first-trimester surgical abortion practice and provider demographic characteristics. Eighty-three percent of identified facilities (78 of 94) and 178 physicians responded. Of the respondents, 99% of facilities and 96% of physicians provided first-trimester surgical abortions. Responding facilities provided 68,154 first-trimester surgical abortions in 2012. This represented 96% of their reported total (combined medical and surgical) first-trimester abortions. More than half (55%) of responding facilities were community based, while 45% were hospital affiliated. Most physician providers were female (68%) and were family doctors (59%). Preoperatively, 96% of physicians routinely used ultrasound and 89% gave perioperative antibiotics. Almost half (48%) used manual vacuum aspiration, but less than 35% did so beyond 9 weeks after the last menstrual period. At most facilities, most procedures were performed under combined local anesthesia and intravenous sedation (73%); only 7% indicated deep sedation or general anesthesia were used exclusively. Postoperatively, 81% of physicians performed immediate tissue examination and 96% offered postabortion contraception on the same day as the abortion. Other assessed outcomes included medication regimens and cervical preparation, with a high degree of consistency among facilities and physicians. First-trimester surgical abortion providers are mostly family physicians and most are female. Practices across Canada were mostly uniform and followed evidence-based guidelines. Uptake of the most recent Canadian practice guidelines may help further standardize patient care and improve routine perioperative antibiotic use and immediate tissue examination.

The use of the combined anesthesia method using local anesthesia and percutaneous electroneurostimulation for dental implantation

The purpose of the work: to conduct a comparative assessment of the adequacy of pain relief based on the study of the dynamics of pain indicators, the autonomic nervous system and the psycho-emotional status of patients with a combination of local anesthesia and percutaneous electroneurostimulation.&#x0D; Materials and methods. 40 patients aged 38 to 63 years took part in the study. The number of patients in the first group amounted to 20 people aged 38 to 63 years, and they all completed the study. In the first group, only local anesthesia (MA) was used by a 4% solution of articaine with epinephrine in a concentration of 1: 200000. In the second group, the number of patients was 20 people aged 38 to 60 years, and all of them also completed the study. In the second group — a combination of percutaneous electroneurostimulation (Chens) with subsequent local anesthesia (Chens+Ma); Electroneurostimulation was carried out using the EPB50-01 Electronics device (Russia), which generates bipolar asymmetric current pulses of 20 s and a frequency of 10 imp/s. The intensity of electroneurostimulation was selected individually until the patient achieve intense non -pain sensations.&#x0D; Results. The use of percutaneous electroneurostimulation potentiates the analgesic effect of local anesthesia in the intraoperative period and has a prolonged analgesic effect, which manifests itself in a decrease in the intensity of pain throughout the postoperative period. Analysis of the features of the action of percutaneous electroneurostimulation indicates that this effect is due to exacerbation of not pain sensitivity, but by sensitization (exacerbation of sensitivity) of non -column peripheral nerves and oral trigeminal core, transmitting signals from receptors that are excited with no damaging effects (touches, displacement of tissues). This sensitization can develop as a result of prolonged preliminary electroneurostimulation, which was carried out before the injection. Against the background of sensitization of sensation from any mechanical effects on the tissue, more acute will be perceived, which was evaluated by patients as more intense pain. This feature of the action of percutaneous electroneurostimulation must be taken into account when compiling methods of its application in clinical practice.&#x0D; Conclusion. The use of percutaneous electroneurostimulation creates favorable conditions for the period of adaptation and integration of implants in the early stages of the postoperative period.

Combination of Local Anesthetics and Corticosteroids as Pain Management in Supraspinatus Tendinitis: A Case Report

Introduction: This study aimed to report the treatment of tendinitis in combination with local anesthetics and corticosteroids.&#x0D; Case presentation: A man, 34 years old, came to the hospital with complaints of pain in the right shoulder. This pain is felt especially when moving the right shoulder, and the patient also cannot raise his right hand. Pain when moving the right arm appeared after falling off a motorbike about 1 month ago. The intensity of pain has been getting higher for the last 14 days, especially when going to bed, so the patient complains of difficulty sleeping. The patient has been treated at the public health center for a month and has received pain relievers. Physical examination showed vital signs within normal limits and pain intensity of 8/10 based on the visual analogue scale. Examination of the extremity shows the abduction of pain starting at 60°-70° on activity and no pain on passive movement. In the special tests, the Neer test is positive, the Hawkin test is positive, and the Empty Can test is positive. The patient was diagnosed with supraspinatus tendinitis. The treatment for this patient is supraspinatus tendon injection. The anesthetic agent used was 2% lidocaine combined with 20 mg triamcinolone corticosteroids. This procedure is performed under ultrasound guidance for precise injection sites. Evaluation after the action found no side effects. After 1 month of action, the patient felt that the pain was greatly reduced (1/10) and the joint movement was not limited.&#x0D; Conclusion: The use of a combination of triamcinolone and lidocaine is beneficial in reducing pain in cases of supraspinatus tendinitis.

Periarticular Injection of Ranawat Suspension in Combination with Tranexamic Acid Reduces Bleeding and Postoperative Pain in Total Knee Arthroplasty

Objective: The benefits of periarticular injections of local anesthetic agents or tranexamic acid have been previously evaluated in terms of their effects on postoperative pain in a number of orthopedic studies. However, data is lacking on the efficacy of local anesthetic and tranexamic acid combinations that may be used for this purpose. We aimed to investigate the effects of periarticular injection of both tranexamic acid and Ranawat suspension on postoperative pain and bleeding in patients undergoing total knee arthroplasty.&#x0D; Methods: A total of 124 patients who underwent total knee arthroplasty were consecutively enrolled in this study. Patients were divided into two groups: those receiving the periarticular injection of a cocktail containing the combination of Ranawat suspension and Tranexamic acid and those receiving no injections. Postoperative pain, postoperative tramadol requirement and blood loss were compared between groups.&#x0D; Results: Hemoglobin and hematocrit levels were significantly higher at third day postoperatively in recipients of periarticular Ranawat suspension and tranexamic acid combination (p=0.044 and p=0.047, respectively). In addition, the amount of drainage blood loss (p

Local anesthetics and immunotherapy: a novel combination to fight cancer.

Intratumoral injection of oncolytic agents such as modified herpes simplex virus T-VEC or local administration of non-viral oncolytic therapies (such as radiofrequency, chemoembolization, cryoablation, or radiotherapy) can activate an anticancer immune response and hence trigger abscopal effects reducing secondary lesions. Preliminary data suggested that oncolytic treatments modulate tumor-infiltrating immune effectors and can be advantageously combined with the immune checkpoint inhibitors. Recent findings indicate that local anesthetics, which are usually used in the clinics to control surgical pain, also possess antineoplastic effects mimicking oncolytic treatments if they are injected into malignant lesions. Moreover, the association of local anesthetics with systemic immune checkpoint inhibition significantly improved overall survival in several preclinical tumor models. This may be explained by direct cytotoxic activity of local anesthetics and additional immune-related abscopal effects. We also summarize the molecular and cellular mechanisms by which the combination of local anesthetics and immunotherapy improves tumor control by the immune system.

Effects of Low-Concentration Nitrous Oxide Anesthesia on Patient Anxiety During Cataract Surgery: A Retrospective Cohort Study.

PurposeWe investigated the effects of 30% low-concentration nitrous oxide (N2O) anesthesia on anxiety, pain, and vital signs and the patient population that would benefit from low-concentration N2O anesthesia during cataract surgery.Patients and MethodsSixty-three patients who underwent cataract surgery due to visual impairment from cataracts were included in this single-center retrospective cohort study conducted at the Ophthalmology Department of Shinseikai Toyama Hospital, Japan. Fifty eyes of 39 patients received a combination of local and N2O anesthesia (N2O group), and 30 eyes of 24 patients received local anesthesia without N2O anesthesia (Air group). The primary outcome measures were visual analogue scale (VAS) scores for patient anxiety, pain, and vital signs. The secondary outcome measures were the patient population.ResultsThe change in the VAS scores for anxiety and pain decreased significantly (p = 0.002 and p = 0.014, respectively) in the N2O group (−15.6 ± 22.9 and 12.4 ± 14.9, respectively) compared with that in the Air group (1.2 ± 20.6 and 24.2 ± 22.4, respectively). The systolic and diastolic blood pressure changes did not significantly differ between both groups (p = 0.093 and p = 0.23, respectively). The change in heart rate decreased significantly (p = 0.001) in the N2O group (−4.8 ± 4.8 bpm) compared with that in the Air group (−0.6 ± 5.8 bpm). Multivariate analyses demonstrated that the change in anxiety level in the N2O group correlated significantly with patient age (p = 0.045) and preoperative VAS score for anxiety (p = 0.0001), whereas the change in anxiety level in the Air group did not correlate with any factor.ConclusionLow-concentration N2O anesthesia showed beneficial effects on intraoperative anxiety and pain during cataract surgery; this may aid the stabilization of intraoperative vital signs. Moreover, low-concentration N2O anesthesia during cataract surgery could benefit young patients and patients with high levels of preoperative anxiety.