Effects Of Local Anesthetics Research Articles

ANALYSIS OF THE CLINICAL EFFECTIVENESS OF LOCAL ANESTHESIA IN THE TREATMENT OF ACUTE FORMS OF CARIES AND PULPITIS IN ADOLESCENTS

Local anesthesia in dentistry, as a way to block the pain syndrome, is one of the most common procedures at a dental appointment, and local anesthetics are among the most frequently used drugs in the daily practice of a dentist. In many cases, treatment is impossible without following most modern protocols. Painful sensations limit the volume of therapeutic measures and reduce the quality of treatment. In addition, the pain that a child may feel during a visit to the dentist leads to refusal of treatment and creates a fear of visiting doctors of any specialty. The child's behavior is controlled by emotions, which increase the physiological intolerance of pain in children. The doctor must help the patient get rid of the feeling of fear, create a situation of safety and painlessness during the examination and treatment. The peculiarities of the body in different age periods should be the basis of differentiated dental care for children.
 The effectiveness of anesthesia in teenagers largely depends on the patient's level of basic anxiety, these factors are directly dependent.
 The aim of the study. To determine the effectiveness of local anesthesia in the treatment of acute medium caries, acute deep caries and acute pulpitis in adolescents with different levels of basic anxiety.
 Materials and methods. Patients aged 11 to 17 years were selected for analysis, in particular, 126 cases of acute medium caries (55 on the upper jaw and 71 on the lower), 128 cases of acute deep caries (63 on the upper jaw and 65 on the lower) and 98 cases of acute pulpitis (42 teeth on the upper jaw and 56 on the lower). All pathologies required treatment under local anesthesia. Dental pathologies were verified according to the main diagnostic criteria.
 Drugs belonging to the group of substituted acetanilide amides were used as local anesthetics.
 In all patients, the level of reactive and personal anxiety was assessed according to the method of Ch.D. Spielberger (adapted by Yu.L. Khanin).
 Statistical analysis of the obtained data was carried out on a personal computer using licensed programs ˝MS Excel 7˝ for the operating system˝ Windows˝ and the standard program package "STATISTICA" v. 6.0.
 All participants were informed about the goals, organization, methods of the study and signed an informed consent to participate in it, and all measures are taken to ensure patient anonymity.
 Conclusions. In teenagers, pain during the treatment of dental diseases, such as acute caries or acute pulpitis, is directly proportional to the severity of the pathology and the level of basic anxiety of the individual.
 In the treatment of acute forms of medium and deep caries and pulpitis, a significant decrease in the percentage of pain syndrome intensity was observed in all clinical groups, however, in the group with a low level of anxiety, 100% disappearance of pain syndrome was noted in all patients after 15 minutes.
 In adolescents with a high level of anxiety, the reduction in the intensity of the pain syndrome was reliable in comparison with the indicators before the manipulation, the complete disappearance of the pain syndrome was noted 15 minutes after anesthesia in 43.8% (56 patients) in the treatment of acute deep caries, in 56.9% (45 patients) in the treatment of acute medium caries and in 45.2% (28 patients) in the treatment of acute pulpitis.

Injectable Hydrogel Containing Bupivacaine-Loaded Mesoporous Silica Nanoparticles for Local Anesthetic Therapy

Developing a sustained drug delivery system with effective administration ruts is a central demand for local anesthesia applications. Moreover, the fast systemic absorption of the approved local anesthetics due to their low molecular weight have highlighted these demand. The main objective of the current study is to develop a sustained drug delivery system with effective administration ruts based on the combination of injectable hydrogel with mesoporous silica nanoparticles (MSNPs). The MSNPs were synthesized by combining the one-pot sol-gel reaction and the templating micelle system. Bupivacaine was loaded into the pores of MSNPs, and the nanoparticles were characterized using DLS, Zetasizer, SEM, TEM, encapsulation efficacy and drug loading capacity. The synthesized bupivacaine-loadedMSNPs were incorporated into a hydrogel based on alginate and characterized. The characterizations revealed that the formulation exhibited proper physicochemical properties beneficial for injectable hydrogel applications. The biological studies showed excellent encapsulation efficacy, drug loading efficacy, and local anesthetic effects. In conclusion, these results showed that the synthesized injectable hydrogel containing bupivacaine-loaded MSNPs could be considered an effective drug delivery system for local anesthetic therapy.

Evaluation of the effectiveness of local anesthetics during septoplasty and tonsillectomy.

Surgical trauma provokes body's stress response with activation of inflammatory, endo-crine, metabolic, and immunological factors, which is believed to be necessary and beneficial response. Aim of the study was to compare the effectiveness of local anesthetics lidocaine and articaine in septoplasty and tonsillectomy in terms of assessing the severity of stress reactions. Patients and Methods: 125 patients with nasal septum deviation (NSD) and chronic tonsillitis (CT) were observed. Patients with NSD were divided into 2 groups: 1A – 32 patients treated by 2% lidocaine local infiltration analgesia (LIA); 1B – 30 patients treated by 2% articaine LIA. Corresponding groups of patients with CT were 2A (32 patients) and 2B (31 patients). For all patients, heart rate variability (HRV), high, low and very low frequency components were measured. Results: Estimation of group variances of HRV showed there were some disadaptation in groups 1B and 2A. High dispersion of SDANN, SDNN index and rMSSD in 1B group, SDANN values in 2A group indicate the sympathetic/parasympathetic imbalance. High frequency component were augmented in 2B group which pointed out prevailing parasympathetic tone but its high dispersion was indicative of disadaptation as well. Conclusion: Thus, with the local infiltration application of an articaine solution during septoplasty, the autonomic nervous system dystonia is observed in the early postoperative period. When anesthesia with lidocaine solution during tonsillectomy, there is also a breakdown of adaptive responses against the background of surgical stress. Based on the above data, of the presented local anesthetics, lidocaine is more effective in septoplasty, and articaine in tonsillectomy.

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review.

Laparoscopic appendectomy (LA) is one of the most commonly performed surgical procedures in children and is associated with extreme postoperative discomfort due to peritoneal inflammation and infection. The main objective of this study was to investigate the effects of postoperative pain (POP) in children after laparoscopic appendectomy. Articles describing or evaluating the control of POP in children with LA were considered eligible. All available literature such as randomized controls, prospective controls, retrospective as well as clinical studies were considered. A comprehensive search was performed in PubMed, Medline, Embase, Cochrane Library, Clinical trials.gov, and Google scholar. The initial search took place on 23 April 2021, and was updated on 24 August 2021. There were no language or date restrictions. Each of the included articles was evaluated separately by two independent reviewers. Additional papers were found by searching the reference lists of eligible studies. Eighteen papers were considered. All papers, and many of them used different methods to treat POP in children undergoing LA, such as lidocaine infusion, different analgesic approaches, ultrasound-guided transverse abdominis blockade (UGTAP), ultrasound-guided quadratus lumborum blockade (UGQLB), and comparison of open appendectomy (OA) with local anesthetics in relation to POP management in children. Laparoscopic appendectomy is the surgical procedure preferred by clinicians compared with open appendectomy in children. A multimodal analgesic approach is optimal and efficient surgical techniques such as UGBRSB, UGQLB, and UGTAP block might significantly impact POP in children except that there are contraindications. Dexmedetomidine proved to be an effective adjuvant that can enhance the effect of local anesthetics. The lack of a sufficient number of studies may be a factor affecting our confidence in the results of this study. Therefore, further evidence-based randomized control trials with a large sample size are needed to provide clarity.

Deep Eutectic Liquids as a Topical Vehicle for Tadalafil: Characterisation and Potential Wound Healing and Antimicrobial Activity.

Deep eutectic solvents (DESs) and ionic liquids (ILs) offer novel opportunities for several pharmaceutical applications. Their tunable properties offer control over their design and applications. Choline chloride (CC)-based DESs (referred to as Type III eutectics) offer superior advantages for various pharmaceutical and therapeutic applications. Here, CC-based DESs of tadalafil (TDF), a selective phosphodiesterase type 5 (PDE-5) enzyme inhibitor, were designed for implementation in wound healing. The adopted approach provides formulations for the topical application of TDF, hence avoiding systemic exposure. To this end, the DESs were chosen based on their suitability for topical application. Then, DES formulations of TDF were prepared, yielding a tremendous increase in the equilibrium solubility of TDF. Lidocaine (LDC) was included in the formulation with TDF to provide a local anaesthetic effect, forming F01. The addition of propylene glycol (PG) to the formulation was attempted to reduce the viscosity, forming F02. The formulations were fully characterised using NMR, FTIR and DCS techniques. According to the obtained characterisation results, the drugs were soluble in the DES with no detectable degradation. Our results demonstrated the utility of F01 in wound healing in vivo using cut wound and burn wound models. Significant retraction of the cut wound area was observed within three weeks of the application of F01 when compared with DES. Furthermore, the utilisation of F01 resulted in less scarring of the burn wounds than any other group including the positive control, thus rendering it a candidate formula for burn dressing formulations. We demonstrated that the slower healing process associated with F01 resulted in less scarring potential. Lastly, the antimicrobial activity of the DES formulations was demonstrated against a panel of fungi and bacterial strains, thus providing a unique wound healing process via simultaneous prevention of wound infection. In conclusion, this work presents the design and application of a topical vehicle for TDF with novel biomedical applications.

Histological and Biomechanical Effects of Local Anesthetics and Steroids on Achilles Tendon: A Study in Rats

Background: Peritendinous injection of local anesthetics, alone or in combination with corticosteroids, is widely used in the treatment of tendinopathies. Toxicity of local anesthetics has been demonstrated in many cells, including myocytes, chondrocytes, and neurons. Bupivacaine and lidocaine are known to have time- and dose-dependent cytotoxicity in these cells. The effects of these agents on the tendon remain unknown. Purpose: To show histological and biomechanical effects after the injection of different local anesthetics and steroids, both single and combined, at different concentrations into the peritendinous sheath of rat Achilles tendon. Study Design: Controlled laboratory study. Methods: In the study, 100 rats were divided into 10 groups with equal body weights. Inflammation was induced in both Achilles tendons of each rat by means of the ball drop technique; 7 hours later, injections were made into the peritendinous sheaths of both Achilles tendons using lidocaine, bupivacaine, and dexamethasone as appropriate for the rat’s group. At the end of the first week, the right Achilles tendons of the rats were removed for histological study. Left Achilles tendons were evaluated in terms of biomechanics. Results: Histological findings demonstrated that the group with the most toxicity to the tendon was the group that received injection of dexamethasone alone. The groups with the least toxicity were those receiving dexamethasone combined with low- or high-dose bupivacaine. Biomechanical findings showed that the experimental groups had similar results to each other with the exception of the groups receiving 0.25% bupivacaine alone and dexamethasone alone, in which tendons revealed higher tensile strength. Conclusion: Local anesthetic and steroid applications have different histological and biomechanical effects on the tendon. Although the dexamethasone-injected group was the most affected in terms of histology, these changes could not be demonstrated biomechanically. Clinical Relevance: In future clinical studies, the effect of steroids on the tendon should be investigated more comprehensively. Whether biomechanical results overlap with histological results should be investigated further.

Tramadol as a Voltage-Gated Sodium Channel Blocker of Peripheral Sodium Channels Nav1.7 and Nav1.5

Tramadol is an opioid analog used to treat chronic and acute pain. Intradermal injections of tramadol at hundreds of millimoles have been shown to produce a local anesthetic effect. We used the whole-cell patch-clamp technique in this study to investigate whether tramadol blocks the sodium current in HEK293 cells, which stably express the pain threshold sodium channel Nav1.7 or the cardiac sodium channel Nav1.5. The half-maximal inhibitory concentration of tramadol was 0.73 mM for Nav1.7 and 0.43 mM for Nav1.5 at a holding potential of -100 mV. The blocking effects of tramadol were completely reversible. Tramadol shifted the steady-state inactivation curves of Nav1.7 and Nav1.5 toward hyperpolarization. Tramadol also slowed the recovery rate from the inactivation of Nav1.7 and Nav1.5 and induced stronger use-dependent inhibition. Because the mean plasma concentration of tramadol upon oral administration is lower than its mean blocking concentration of sodium channels in this study, it is unlikely that tramadol in plasma will have an analgesic effect by blocking Nav1.7 or show cardiotoxicity by blocking Nav1.5. However, tramadol could act as a local anesthetic when used at a concentration of several hundred millimoles by intradermal injection and as an antiarrhythmic when injected intravenously at a similar dose, as does lidocaine.

Drug Permeability: From the Blood-Brain Barrier to the Peripheral Nerve Barriers.

Drug delivery into the peripheral nerves and nerve roots has important implications for effective local anesthesia and treatment of peripheral neuropathies and chronic neuropathic pain. Similar to drugs that need to cross the blood-brain barrier (BBB) and blood-spinal cord barrier (BSCB) to gain access to the central nervous system (CNS), drugs must cross the peripheral nerve barriers (PNB), formed by the perineurium and blood-nerve barrier (BNB) to modulate peripheral axons. Despite significant progress made to develop effective strategies to enhance BBB permeability in therapeutic drug design, efforts to enhance drug permeability and retention in peripheral nerves and nerve roots are relatively understudied. Guided by knowledge describing structural, molecular and functional similarities between restrictive neural barriers in the CNS and peripheral nervous system (PNS), we hypothesize that certain CNS drug delivery strategies are adaptable for peripheral nerve drug delivery. In this review, we describe the molecular, structural and functional similarities and differences between the BBB and PNB, summarize and compare existing CNS and peripheral nerve drug delivery strategies, and discuss the potential application of selected CNS delivery strategies to improve efficacious drug entry for peripheral nerve disorders.

Behavior of Piglets in an Observation Arena before and after Surgical Castration with Local Anesthesia.

Surgical castration of piglets is generally recognized as a painful procedure, but there is currently no gold standard for the assessment of pain behavior in piglets. However, pain assessment is essential for evaluating the effectiveness of local anesthetics. In this study, we investigated the efficacy of four local anesthetics in terms of pain relief during and after surgical castration in three sequential study parts. To do so, we filmed 178 piglets before the applied procedures, after injection of the local anesthetic, and up to 24 h after castration (five observation times in total) in an observation arena and compared their behavior before and after castration and between treatments and control groups. The results showed significant differences in the behavior of the piglets before and after castration and between the sham-castrated control group and the control group castrated without anesthesia. The different local anesthesia treatment groups showed diverging differences to the control groups. The most frequently shown pain-associated behaviors of the piglets were changes in tail position and hunched back posture. We observed a reduction but no complete elimination of the expressed pain-associated behaviors after local anesthesia. Several behavioral changes-such as changes in tail position, hunched back posture or tail wagging-persisted until the day after castration. Owing to the limited duration of the effects of the local anesthetics, local anesthesia did not influence long-term pain.

Cytotoxicity of Local Anesthetics on Bone, Joint, and Muscle Tissues: A Narrative Review of the Current Literature.

Local anesthetics are commonly used in surgical procedures to control pain in patients. Whilst the cardiotoxicity and neurotoxicity of local anesthetics have received much attention, the cytotoxicity they exert against bone, joint, and muscle tissues has yet to be well recognized. This review aimed to raise awareness regarding how local anesthetics may cause tissue damage and provide a deeper understanding of the mechanisms of local anesthetic-induced cytotoxicity. We summarized the latest progress on the cytotoxicity of local anesthetics and the underlying mechanisms and discussed potential strategies to reduce it. We found that the toxic effects of local anesthetics on bone, joint, and muscle tissues were time- and concentration-dependent in vitro. Local anesthetics induced apoptosis, necrosis, and autophagy through specific cellular pathways. Altogether, this review indicates that toxicity of local anesthetics may be avoided by rationally selecting the appropriate anesthetic, limiting the total amount, and determining the lowest effective concentration and duration.

The effect of hamstring donor-site block for functional outcomes and rehabilitation after anterior cruciate ligament reconstruction.

To determine the effect of local infiltration anesthesia (LIA) at the donor site combined with a femoral nerve block (FNB) on short-term postoperative pain, functional outcomes, and rehabilitation after arthroscopic hamstring tendon autograft anterior cruciate ligament reconstruction (ACLR). This study was a single center, randomized controlled trial. Seventy-three subjects with ACL rupture were enrolled. Participants were randomly allocated to two groups, 47 in the experimental group (Group A) and 26 in the control group (Group B). All operations were performed under FNB. In Group A, 10 ml of 1% ropivacaine was injected precisely at the hamstring donor site. Patients in Group B were treated with the same amount of saline. Preoperatively and postoperatively, pain scores based on the numerical rating scale (NRS) and consumption of opioids were recorded. In addition, knee functions were assessed by the International Knee Documentation Committee Subjective Knee Form (IKDC), the Lysholm score, and the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and postoperatively at 1 and 3 months. In addition, we applied the KNEELAX3 arthrometer to evaluate the stability of the knee preoperatively and postoperatively so that subjective and objective knee conditions were obtained to help us assess knee recovery in a comprehensive manner. The hamstring donor-site block reduced pain within the first 12 postoperative hours. There were no significant differences between two groups in pain intensity preoperatively and equal to or greater than 24 hours postoperatively. Furthermore, there were no differences between the groups concerning knee functions preoperatively or in the short-term follow-up at 1 and 3 months. LIA at the donor site can effectively improve the early postoperative pain of patients after ACLR and reduce the use of opioids without affecting the functional outcomes of the surgery.

Does Topical Anesthesia Alter the Outcomes of Vascular Laser Procedures? Review of Vasodynamic Effects and Clinical Outcomes Data.

Topical anesthesia has vasodynamic effects within the skin and therefore has the potential to change the presence of hemoglobin as a chromophore before intense pulsed light (IPL) and vascular laser treatments. It is unclear whether this is clinically relevant. Global consensus on the use of topical anesthetics in this context is lacking. Review the effects of topical anesthetics on the skin microvasculature and the clinical implications of such effects on vascular treatments. PubMed and Medline searches were performed to identify studies examining the vasodynamic effects of topical anesthesia on skin and evaluating differences in efficacy of IPL and vascular laser treatments with or without topical anesthetic use. Published studies reveal variable effects of different topical anesthetic agents on skin microvasculature. Only 3 controlled studies that directly examined the effect of topical anesthesia on clinical outcomes for pulsed dye laser (PDL) treatment of vascular conditions were identified. They did not support a difference in clinical outcomes with or without the use of topical anesthesia before PDL treatment. Although topical anesthetic agents have vasodynamic effects within the skin, there is currently insufficient evidence to advise against their use before light and laser-based vascular treatments.

Formulation and In Vivo Pain Assessment of a Novel Niosomal Lidocaine and Prilocaine in an Emulsion Gel (Emulgel) of Semisolid Palm Oil Base for Topical Drug Delivery.

This study aimed to formulate semisolid niosomal encapsulated lidocaine and prilocaine using the patented palm oil base Hamin-C® for further characterization and in vivo pain assessment. Seven formulations were initially studied with various chemical compositions. A thin-layer film hydration method was used to produce niosome using a mixture of surfactant (Span® 40 or Span® 60) and cholesterol (CHOL) at a 1:1 ratio, with/without a charge-inducing agent (diacetyl phosphate) (DCP) and with/without labrasol®. Niosome F1 formulation had been identified as the highest %EE achieved, at 53.74 and 55.63% for prilocaine and lidocaine, respectively. Furthermore, NIO-HAMIN F1 emulgel indicated the best formulation with higher permeability of prilocaine and lidocaine compared to the rest of the formulations. The reformulation of optimization of NIO-HAMIN F1 emulgel using a cold process to NIO-HAMIN F1-C emulgel to improve the viscosity resulted in higher diffusion of prilocaine and lidocaine by 5.71 and 33.38%, respectively. In vivo pain perception studies by verbal rating score (VRS) and visual analogue score (VAS) on healthy subjects show a comparable local anesthetic effect between NIO-HAMIN F1-C emulgel and EMLA® cream.

Optimizing the Use of Operating Rooms by Transitioning Common Hand Surgeries Into the Office Setting

The purpose of this study was to examine the true monetary implications, at the health system level, of moving simple hand procedures, performed with wide-awake local anesthesia no tourniquet surgery, from the ambulatory surgery center (ASC) to office setting. We analyzed the costs, revenues, case times, and patient demographics for 2 cohorts of patients who underwent hand and non-hand surgical procedures over a 2-year period. We calculated the mean margin per minute for the top 5 procedures in non-hand orthopedic surgery subgroups, complex plastics hand, and non-hand plastic surgery. We then calculated the following: (1) hours operating room or ASC time gained by moving hand procedures to the office, (2) additional subgroup patients theoretically treated by using the ASC hours gained, and (3) net margin (in dollars) because of additional procedures. Six board-certified hand surgeons performed 623 simple ASC and 808 in-office procedures, consisting of 795 carpal tunnel releases, 84 first dorsal compartment releases, and 446 trigger finger releases. The net margin per minute for simple ASC and in-office hand procedures was $25.01/min and $5.63/min, respectively. In the office setting, hand surgery freed up 821 hours of ASC time, which could be theoretically used to treat over 300 additional patients awaiting outpatient orthopedic hand or plastic surgery. Depending on the subspecialty and type of substituted cases, the theoretical net margin varied from-$150,413 to $3.9 million. Transitioning simple hand operations out of ASCs realized a mean cost savings of 82% per case ($1,137 vs $206) and effectively opened 821 additional hours of operating room time over a 2-year period. Transitioning simple hand operations out of the operating room setting and into the office setting reduces the cost of hand surgical care, improves operating room access for alternate procedures or patients, and validates the sustainability of safe and effective wide-awake local anesthesia no tourniquet surgery from a hospital system's financial standpoint.

Comparison of Safety and Effectiveness of Local or General Anesthesia after Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis.

It remains controversial to choose anesthesia for transcatheter aortic valve implantation (TAVI). A meta-analysis of cohort studies was conducted to assess the efficacy and safety of local anesthesia (LA) compared to general anesthesia (GA) in TAVI. All relevant studies published from 1 January 2002, to 31 June 2022, were searched in Ovid, PubMed, Embase, Web of Science, and Cochrane Library. A total of 34 studies involving 23,480 patients were included in the meta-analysis. TAVI with LA was associated with a significant reduction in hospital stay [WMD = −2.48, 95% CI (−2.80, −2.16), p < 0.00001], operative [WMD = −12.25, 95% CI (−13.73, −10.78), p < 0.00001] and fluoroscopy time [WMD = −3.30, 95% CI (−5.40, −1.19), p = 0.002], and an increased risk of acute kidney injury [OR = 1.31, 95% CI (1.01, 1.69), p = 0.04] and a reduced incidence of major bleeding [OR = 0.59, 95% CI (0.46, 0.75), p < 0.0001] and the use of cardiovascular drugs [OR = 0.17, 95% CI (0.05, 0.57), p = 0.004]. No differences were found between LA and GA for 30-day mortality, procedural success rate, myocardial infarction, permanent pacemaker implantation, paravalvular leak, shock, and cerebrovascular events. Overall, 4.4% of LA converted to GA. Based on current evidence, our results suggested that LA strategies reduced hospital stay, operative time, fluoroscopy time, cardiovascular drug consumption, and major bleeding rates in patients undergoing TAVI but led to increased acute kidney injury rates. Further studies and randomized trials are required to verify the presented findings and to identify patients who might benefit from LA.

The effects of local anesthetics on cancer cells.

During cancer surgery, the perioperative period is characterized by stress response and immunosuppression that can lead to further worsening of the disease and metastatic spread. Local anesthetics have antiproliferative, cytotoxic and antimetastatic effects on cancer cells in vitro. There is scientific evidence that local anesthetics possess anti-inflammatory effects, help to preserve normal immune function and reduce the possibility of metastatic spread. Anesthetic care affects pain, inflammation, and immunosuppression, which may have a great impact on the outcome of oncological patients. The use of local anesthetics during the perioperative period in oncological patients may have a beneficial effect on their survival and cancer recurrence. This article summarizes the effects of local anesthetics in vitro (Tab. 1, Fig. 1, Ref. 36). Keywords: local anesthetics, cancer cells.

Effect of local anesthesia on postoperative pain and hemostasis after dental rehabilitation under general anesthesia in pediatric patients: a randomized control trial

Effect of local anesthesia on postoperative pain and hemostasis after dental rehabilitation under general anesthesia in pediatric patients: a randomized control trial

Analgesic protocol for procedural pain treatment of second-degree burns in children

Background/Aim. Children with burns are submitted to multiple painful and anxiety-related procedures during the change of wound dressing, treatment, and rehabilitation. The objective of analgesic treatments for procedural pain is the safe and efficient management of pain and emotional stress, which requires a careful, balanced, and systematic approach. The aim of this study was to determine the effectiveness of analgesic and/or local anesthetic in relieving the intensity of procedural pain. Methods. The study included 120 pediatric patients with second-degree burns who were allocated into four groups of 30 children (control group, groups I, II, and III). During the change of wound dressings, children in the control group did not receive any analgesics, while in the remaining three groups, 30 minutes prior to the change of wound dressing, oral nonsteroidal anti-inflammatory drug (group I), local anesthetic (group II), or both medications (group III) were administered. Results. The average visual analog scale (VAS) score for assessing pain was statistically significantly higher in the control group on all tested days compared with children in the other three treated groups. On the first test day (24 hrs after sustaining the burn injuries), all children had high VAS scores, and ac-cording to the receiver operating characteristics (ROC) analysis, the boundary value was 89.50/100. There was a remarkable difference in the VAS score between the groups on the fifth day of dressing change with the boundary value of 57.50/100 and on the seventh day when the boundary value was 43.50/100. Children who experienced the lowest intensity pain during dressing changes of burn wounds for all test days were those from the group who received both systemic analgesic and local anesthetic. Conclusion. The study confirmed the importance of introducing the complex polymodal protocol in treating procedural pain in second-degree burns. The protocol should include analgesics as well as anesthetics since they both contribute to achieving the best results in pain reduction and treatment outcomes.

超声引导下局麻药物复合辅助药物用于臂丛神经阻滞效果研究

超声引导下局麻药物复合辅助药物用于臂丛神经阻滞效果研究

A Clinical Trial to Determine the Efficacy of Abhaya Nagara Churna in the Management of Tamaka Swasa~Bronchial Asthma

Introduction: In the 19th century, surgery underwent a transformative moment with the discovery of the first anesthetic. Ayurvedic pioneers like Susrutha and Caraka described surgical techniques devoid of anesthetics, relying on substances such as wine. Recognizing the limited effectiveness of herbal local anesthetics like Akarakarabha and Giri Ardraka, researchers began exploring Aparajitha (Clitorea ternatea) as a potential potent local anesthetic.Methods: To assess Aparajitha as a local anesthetic, water and alcohol extracts were obtained from finely powdered white Clitoria ternatea leaves. These extracts underwent testing at different concentrations using anesthesia methods like the frog’s web, frog pouch, and guinea pig’s wheel.Results: The alcohol extract of Aparajitha acted as an effective anesthetic, with onset from the 7th to the 20th minute, waning by the 35th minute. Both water and alcohol extracts were employed for a comprehensive assessment based on compound solubility. In frog pouch experiments, the test substance induced anesthesia in 10 minutes, while the standard took 3 minutes. Concentrations of 0.2%, 0.4%, and 0.8% had no significant impact, but concentrations of 0.8%, 1%, and 2% showed noticeable anesthesia effects. The 2% alcohol extract achieved the desired effect within 10 applications, matching the standard’s performance, although the standard surpassed the test samples in guinea pig infiltration anesthesia.Discussion: The study indicates that Aparajitha possesses local anesthetic properties, despite limited literature references. Further evaluation, including toxicity studies and clinical trials, is needed to assess its viability as a clinical anesthetic. This research serves as an initial exploration of Ayurvedic anesthesia potential contributions to modern surgery.