Effects Of Local Anesthetics Research Articles

ОСЛОЖНЕНИЯ ПРИ МЕСТНОЙ АНЕСТЕЗИИ ПОСЛЕ СТОМАТОЛОГИЧЕСКИХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. This definition is widely accepted worldwide by medical practitioners, medical professionals, and public health representatives. The use of local anesthesia allows dental manipulations to be performed painlessly, reversibly blocking the conduction of sensory nerves. Complications related to local anesthesia are an important aspect in dental surgery. The purpose of this literature review is to study the complications associated with the use of local anesthesia in maxillofacial surgery, as well as to investigate methods and procedures for the successful treatment of these complications. This review presents the largest scientific studies conducted in search of the definition of the most common complications and their treatment, since the safety and effectiveness of local anesthesia in dental operations are key aspects in achieving positive results and meeting the needs of patients. Various complications have been identified, including allergic reactions, hematomas, infections, and nerve damage. Regional analgesia is too important to be denied to patients based on a dubious allergic history. Often, adverse reactions can be directly related to the pharmacological properties of the agents involved. The dentist must adequately distinguish these reactions from those that are directly related to allergic phenomena. For the comprehensive management of patients with an allergic history, it is necessary to take into account the importance, as well as the limitations of intradermal skin tests. Most studies have confirmed the relative safety and effectiveness of local anesthesia, but some risks have been noted that require special attention when planning and performing surgical procedures.

Anesthesia-mediated neuroinflammatory sequelae in post operative cognitive dysfunction: mechanisms and therapeutic implications

Post-operative cognitive dysfunction (POCD) is an iatrogenic cognitive decline with unclear etiology. While current hypotheses include surgical and pharmacological-induced neuroinflammatory mechanisms, the growing prevalence, especially amongst the geriatric population, emphasizes the ambiguity of the dysfunction. Recent studies have highlighted the potential role of general and regional anesthesia in the pathogenesis of POCD; these pharmacological effects have been demonstrated to disrupt blood-brain barrier integrity, influence microglial polarization, and have been linked to worsening prognoses in cognitive decline. Moreover, mechanical stress from surgical intervention and reperfusion injury may exacerbate the generation of reactive oxygen species (ROS), thereby increasing oxidative stress to the brain synergistically with blood-brain barrier disruptions. In previous studies, factors for the variable incidence and various risk factors have been explored. In this review, we examine the pharmacological effects of local, regional, and general anesthesia on molecular and cellular glial response, along with its intercellular interactions and previously reported clinical outcomes.

Impact of Temperature on the Quality of Local Anesthetic Effect during Subarachnoid Block

In contrast to general anesthesia, which affects the entire body, spinal anesthesia specifically targets a limited area, leading to a temporary loss of sensory and motor function. The duration of the effect varies on many factors depending on the specific anesthetic agent used, level of injections given and, baricity, dose, temperature and, many more factors. The temperature of the administered bupivacaine solution has been recognized as a potential modulator of its onset of action, influencing factors such as speed, depth, and duration of anesthesia. The temperature of the medication can influence the speed at which the local anesthetic takes effect. Warmer solutions may have a faster onset of action compared to colder ones. The duration of anesthesia may also be affected, with warmer solutions potentially providing a more prolonged effect. The temperature of the injected medication can influence the patient's comfort during the administration of spinal anesthesia. The present analysis indicates that there is a definite relationship between the temperature of the injected local anesthetic and the quality of the block achieved.

Complications and side effects of Wide-Awake Local Anaesthesia No Tourniquet (WALANT) in upper limb surgery: a systematic review and meta-analysis

PurposeWide-Awake Local Anaesthesia No Tourniquet (WALANT), a groundbreaking anaesthetic technique resurging in practice, warrants a comprehensive safety analysis for informed adoption. Our study aimed to identify complications/side effects of WALANT upper limb procedures through a systematic review and meta-analysis.MethodsThis PROSPERO-registered study was performed with strict adherence to PRISMA guidelines. Embase, OVIDMedline, Cochrane, Web of Science, and Scopus databases were searched until February 2023. Inclusion criteria involved English articles, reporting complications/side effects in primary WALANT upper limb surgeries. Outcomes included all complications and side effects, data on the anaesthetic mixture, publication year/location, study type, and procedures performed. The meta-analysis employed the Freeman-Tukey Double Arcsine Transformation, computed I2 statistics, and utilized common or random effects models for pooled analysis.Results2002 studies were identified; 79 studies met the inclusion criteria representing 15,595 WALANT patients. A total of 301 patients had complications, and the meta-analysis using a random effects model provided a complication rate of 1.7% (95% CI: 0.93–2.7%). The most reported complications were superficial infection (41%, n = 123/300), other/specified (12%, n = 37/300), and recurrent disease (6.7%, n = 20/300). A decade-by-decade analysis revealed no statistically significant difference in complication rates spanning the last three decades (p = 0.42). Adding sodium bicarbonate to the anaesthetic solution significantly reduced postoperative complications (p = 0.025).ConclusionWALANT has a low overall complication rate of 1.7%, with no significant temporal variation and a significant reduction in complications when sodium bicarbonate is added to the anaesthetic solution. Our findings support the safety of WALANT in upper limb procedures.RegistrationPROSPERO: CRD42023404018.

Evaluation of the effects of the local anesthetics on immunity during mastectomy

Background & objective: Surgery and some anesthetic techniques can contribute to tumor cells dissemination. It is known that the use of local anesthetics and regional blocks during mastectomy preserved the immune function. We evaluated and compared, the levels of some cytokines (IFNγ, TNFα, IL2, IL12) responsible for immune function, as well as the level of leukocytes before and after breast carcinoma surgery; and to find out and compare the effects of local anesthetics on blood pressure (BP) and on postoperative complications, e.g., pain, vomiting, headache, the need for analgesia and surgical complications. Methodology: In this randomized prospective study, 45 patients were allocated in 3 equal groups: Group GA (n = 15) for standard general anesthesia; Group LA (n = 15) for general anesthesia and infusion of lidocaine; Group PECS (n = 15) for pectoralis I/II block with bupivacaine and general anesthesia. Blood samples were taken to ascertain cytokines and leukocytes levels before surgery and 24 h after surgery. Results: Lidocaine caused fall of BP (P = 0.002t), but bupivacaine (PECS I/II block) produced stable BP during mastectomy (P = 0.1). A significant increase of leucocytes after surgery was seen in Group PECS compared to Group GA (P = 0.033). In 24-h intervals after surgery, lidocaine and bupivacaine produced an increase of TNFα (P < 0.05). Bupivacaine showed a significantly low intensity of postoperative pain compared to other techniques and zero postoperative complications. Conclusion: Local anesthetics lidocaine and bupivacaine enhance the immune response and produce more stable hemodynamics compared to general anesthesia alone during mastectomy in patients with breast carcinoma. Abbreviations: CTL- Cytotoxic T Lymphocytes; IFNγ- Interferon Gamma; TNFα- Tumour Necrosis Factor α, IL2- Interleukin-2; NKCs- Natural Killer Cells; Th1- Type 1 T Helper Cells; VAS- Visual Analog Scale Keywords: Breast Carcinoma; Lidocaine; Bupivacaine; PECS I/II block; Cytokines Citation: Angjushev DL, Sholjakova MV, Kartalov A, Kuzmanovska B, Kishman A, Demjanski V, Srceva MJ, Kokareva A, Angjushev MK. Evaluation of the effects of the local anesthetics on immunity during mastectomy. Anaesth. pain intensive care 2024;28(1):108−114; DOI: 10.35975/apic.v28i1.2383 Received: November 14, 2023; Reviewed: November 17, 2023; Accepted: December 09, 2023

A Bilayer Microneedle for Modulated Sequential Release of Adrenaline and Lidocaine for Prolonged Local Anesthesia.

Chronic pain emerges as a major global health issue, significantly impacting individuals' health and quality of life. In this study, we designed a bilayer microneedle loaded with lidocaine nanocomposites in the inner layer and adrenaline (Adr) in the outer layer (HCP MNs) for modulated sequential release to achieve prolonged local anesthesia. The obtained HCP MNs featured an intact structure with adequate mechanical strength for efficient skin penetration. The bilayer structure of MNs was evidenced by loading two fluorescent dyes in each layer. Furthermore, these HCP MNs were capable of inducing rapid as well as prolonged local anesthetic effects in guinea pigs. Hence, the bilayer MN coloaded with Adr and lidocaine nanocomposite serves as a promising transdermal delivery platform for chronic pain management.

Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty

To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05). The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Local anesthetic effect and safety of ropivacaine oily solution

Purpose: To investigate the effectiveness and safety of ropivacaine oily solution (ROPOS).&#x0D; Methods: After effecting nerve block in postoperative rats by injection of ROPOS near the sciatic nerve, the expression levels of sodium-potassium-chloride co-transporter 1 (NKCC1) and potassium-chloride co-transporter 2 (KCC 2) in the spinal dorsal horn, were assayed. The safety of ROPOS in beagle dogs was evaluated through subcutaneous injection.&#x0D; Results: The duration of anesthetic effect of ROPOS was 5 times longer than that of ropivacaine hydrochloride injection. The analgesic effect occurred via downregulation of the expression of NKCC1. Dogs administered ROPOS had acute inflammatory reactions at the injection sites within 3 days, but they recovered after 14 days. No other toxic reactions were observed. The Tmax values for dogs subcutaneously injected with ROPOS at doses of 15, 30 and 60 mg/kg were 2.15 ± 3.09, 6.25 ± 9.62 and 14.85 ± 11.82 h; with the Cmax values of 0.78 ± 0.51, 1.35 ± 0.38 and 2.09 ± 0.53 µg/mL, while the AUC(0-48h) values were 15.88 ± 5.41, 31.46 ± 11.45 and 66.10 ± 17.81 h·µg/mL, respectively. The values of Tmax, Cmax and AUC(0-48h) were positively correlated with ROPOS dose.&#x0D; Conclusion: Ropivacaine oily solution has a longer duration of local anesthetic effect than ropivacaine hydrochloride injection and it also possesses a good safety profile. The acute inflammatory reactions are noteworthy and will be further investigated in subsequent studies.

Fabrication of lidocaine-loaded polymer dissolving microneedles for rapid and prolonged local anesthesia.

There is an urgent need for research into effective interventions for pain management to improve patients' life quality. Traditional needle and syringe injection were used to administer the local anesthesia. However, it causes various discomforts, ranging from brief stings to trypanophobia and denial of medical operations. In this study, a dissolving microneedles (MNs) system made of composite matrix materials of polyvinylpyrrolidone (PVP), polyvinyl alcohol (PVA), and sodium hyaluronate (HA) was successfully developed for the loading of lidocaine hydrochloride (LidH). The morphology, size and mechanical properties of the MNs were also investigated. After the insertion of MNs into the skin, the matrix at the tip of the MNs was swelled and dissolved by absorption of interstitial fluid, leading to a rapid release of loaded LidH from MNs' tips. And the LidH in the back patching was diffused into deeper skin tissue through microchannels created by MNs insertion, forming a prolonged anesthesia effect. In addition, the back patching of MNs could be acted as a drug reservoir to form a prolonged local anesthesia effect. The results showed that LidH MNs provided a superior analgesia up to 8h, exhibiting a rapid and long-lasting analgesic effects. Additionally, tissue sectioning and in vitro cytotoxicity tests indicated that the MNs patch we developed had a favorable biosafety profile.

Improving the effectiveness of local anesthesia in patients with arterial hypertension in the provision of emergency dental care

Was to evaluate the use of Ketorol Express as a preventive analgesia to increase the effectiveness of local anesthesia in providing emergency dental care to patients with arterial hypertension. The study was conducted on the basis of the state autonomous healthcare institution of the Moscow region «Royal Dental Clinic» with the participation of 83 people. The patients were divided into two groups. In group 1, Ketorol Express was prescribed as a preventive analgesia in a dosage of 20 mg before local anesthesia. Patients of group 2 underwent dental interventions without the use of preventive analgesia. A 3% solution of mepivacaine was used as a local analgesic solution. For a subjective assessment of the effectiveness of anesthesia, use a visual analog scale. All patients had their blood pressure and heart rate measured before and after the interventions and hemodynamic parameters were continuously monitored during emergency dental care. In group 1, the effectiveness of combined anesthesia with the infiltration method of local anesthetic administration was 93±1.17%, according to the patient, 94±1.47%, according to the doctor, with the conductive method of anesthesia at the mandibular orifice - according to the patient it was 91±1.01%, according to the doctor 92± 1.36%. In group 2, when providing emergency dental care with the infiltration method of administration of 3% mepivacaine the anesthesia was effective in 80±1.97% of cases according to the patient and in 80±1.17% of cases according to the doctor, with the conductive method of anesthesia at the mandibular orifice, the effectiveness of anesthesia according to the patient was 82±1.11%, according to the doctor 85±1.23%. The results of the study demonstrated a statistically significant increase in the effectiveness of local anesthesia performed with a 3% solution of mepivacaine in patients with arterial hypertension due to the use of preventive analgesia with Ketorol Express at a dosage of 20 mg (2 tablets of 10 mg) in emergency dental care with registration and analysis of changes in hemodynamic parameters.

A comparison of conscious sedation and local anesthesia for thrombectomy in acute ischemic stroke: a multicenter study.

Ischemic cerebrovascular disease (ICVD) is a serious health problem in which brain tissue suffers from hypoxic damage due to obstruction in cerebral vessels. Mechanical thrombectomy is a commonly used method in the treatment of these patients. However, the effects of local anesthesia (LA) and conscious sedation (CS) during thrombectomy are still unclear. We evaluated whether there was a relationship between the two anesthesia regimens in terms of 90-day modified Rankin Scale (mRS) scores. In this study, a retrospective observational study was conducted to evaluate the effects of LA and CS used during mechanical thrombectomy in four comprehensive stroke centers among ICVD patients. Patients were divided into the LA group and the CS group. Statistical analysis was performed before and after 1:1 matching under propensity score matching (PSM) analysis. The primary outcome measure was an mRS score of 0-2 at 90 days. Secondary outcomes were procedure times, recanalization rates, symptomatic and asymptomatic hemorrhage rates, and procedural complications. A total of 193 patients (118 patients with LA and 75 patients with CS) were included in the final analysis before PSM. After 1:1 PSM, 98 patients-49 patients from each group-were included in the study. There was no difference in clinical outcomes between the LA- and CS-applied groups (p = 0.543). When blood pressure (BP) values at follow-up after endovascular treatment (EVT) were compared, the lowest systolic and lowest diastolic BP were found to be lower in the CS group (p = 0.001 and p = 0.009). There was no significant difference between the two groups in terms of recanalization rates, symptomatic intracranial hemorrhage (sICH) rates, 90-day mRS, and procedure-related complication rates (p = 0.617, p = 0.274, p = 0.543, and p = 1.000). This study did not reveal the superiority of CS applied during EVT on 90-day mRS, sICH, recanalization rates, or procedural complications. However, the risk of developing hypotension during the CS application was found to be high.

Is there any effect of lidocaine on ischemia/reperfusion injury in testicular torsion? An experimental study.

This experimental study aimed to evaluate the potential protective effects of lidocaine on ischemia-reperfusion injury resulting from testicular torsion/detorsion in rats. A total of 18 male rats were randomized into three groups. Group 1 served as the control group. Group 2 was designed to evaluate testicular ischemia-reperfusion injury using a torsion/detorsion model. In Group 3, the treatment group, a similar ischemia-reperfusion model was used as in Group 2. Additionally, lidocaine at a dose of 15 mg/kg was administered intraperitoneally five minutes before reperfusion. Blood biochemical analyses and testicular histopathological evaluations were conducted. Blood biochemical analysis showed that malondialdehyde (MDA) and protein carbonyl (PC) levels were significantly higher in Group 2 compared to the other groups (p<0.001 and p=0.008, respectively). Proinflammatory cytokine levels, including interleu-kin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), were lower in Group 3 than in Group 2 (p<0.001, p=0.007, and p=0.026, respectively). Antioxidant enzyme activities, including glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), were higher in Group 3 compared to Group 2 (p=0.005 and p=0.025, respectively). Histopathological evaluations revealed significant improvements in all testicular damage scores, including hemorrhage, edema, vasocongestion, and inflammation in Group 3 compared to Group 2 (p=0.015, p=0.035, p=0.015, and p=0.034, respectively). Additionally, there was a notable improvement in the Johnsen score in Group 3 compared to Group 2 (p=0.034). Lidocaine, an effective local anesthetic, significantly alleviates the effects of testicular ischemia-reperfusion injury.

Minimizing the Pain of Local Anesthesia Administration in Interventional Radiology with an Anesthetic Portal Technique

Abstract Objective This article assesses the effectiveness of a standardized local anesthetic (LA) technique designed to minimize the pain of local anesthesia administration in interventional radiology (IR). Materials and Methods A prospective study compared participants' experience in a control group (n = 63) of random LA administration techniques to a separate experimental group (n = 60) with a standardized technique based on known methods to minimize the pain of LA. Participants in each group were surveyed after LA administration to assess perceived pain and number of times a painful stick was felt. Participants were also asked to compare LA pain to prior experiences with LA, and to compare the overall pain experienced during the procedure to expected pain. Statistical Analysis Ordinal variable distribution analyses were performed using the Wilcoxon rank sum test. Categorical variable analyses were performed with the Pearson's global exact chi-square test. Results Pain of LA (mean 1.1 vs. 3.3 on a 0–10 scale, p &lt; 0.001), number of times a painful stick was felt (mean 0.8 vs. 1.9 times, p &lt; 0.001), and overall pain during the procedure (mean 1.5 vs. 3.4 on 0–10 scale, p &lt; 0.001) were significantly less using the standardized versus random techniques. Compared with prior experiences of LA, pain using the standardized technique was less in 77.6%, the same in 22.4%, and more in 0% of patients while pain using the random technique was less in 46.4%, the same in 39.3%, and more in 14.3% of patients (p &lt; 0.05). Conclusion Severity and frequency of pain from LA administration in IR procedures is minimized using a standardized anesthetic portal technique. This technique may also decrease overall pain experienced during IR procedures as well.

Studying the local anaesthetic effects of lidocaine, remifentanil (with and without adjuvants), and tramadol in rabbits

Studying the local anaesthetic effects of lidocaine, remifentanil (with and without adjuvants), and tramadol in rabbits

Evaluation of the analgesic and anesthetic properties of silver nanoparticles supported over biodegradable acacia gum-modified magnetic nanoparticles

Abstract An ecofriendly and green procedure was adopted to immobilize Ag NPs over acacia gum (GA)-modified magnetic nanoparticles (Fe3O4-GA/Ag NPs) with analgesic and anesthetic properties. In the stepwise modification method, the pre-synthesized Fe3O4 NPs were coated by the gum acacia (GA) that has hydroxyl groups on its backbone and can be used for as a capping, reducing, and stabilizing agent for immobilized Ag nanoparticles. The capped Ag ions were reduced and immobilized over the acacia gum because of hydrogen bonding of the hydroxyl groups. The final bio-material was characterized by various analytical techniques such as X-ray diffraction, energy dispersive X-ray spectroscopy, inductively coupled plasma-optical emission microscope, transmission electron microscopy, field emission scanning electron microscopy, and fourier transformed infra red spectroscopy. In the in vivo design, the results of anesthetic activity indicated that the Fe3O4-GA/Ag NPs made local anesthetic effects in guinea pig and frog models. After oral administration of Fe3O4-GA/Ag NPs, paw edema was significantly decreased in mice. Acetic acid-induced writhing episodes were dose-dependently and significantly decreased in all groups treated with Fe3O4-GA/Ag NPs. In addition, the analgesic and anti-inflammatory properties were determined in several doses of Fe3O4-GA/Ag NPs. The above results protect the analgesic and anesthetic properties of silver nanoparticles supported over biodegradable acacia gum-modified magnetic nanoparticles for the next research or clinical trial studies in human.

Anesthetics Used In Therapeutic Dentistry

Effective local anesthesia is the basis for pain control in endodontics and therapeutic dentistry. Regardless of the doctor's skills, treatment and management of the patient are difficult or impossible without effective anesthesia. This chapter discusses the pharmacological properties of local anesthetics, the comparative advantages and limitations of various anesthetics and how they are administered. Other chapters of this article provide information on the use of local anesthetics in the diagnosis and treatment of patients with urgent conditions

Comparative Evaluation of the Local Anesthetic Action of Tramadol Hydrochloride With Adrenaline Versus Lidocaine Hydrochloride With Adrenaline for Maxillary Exodontia: A Randomized Control Trial

Tramadol hydrochloride (T-HCl) has demonstrated to have a local anesthetic effect similar to lidocaine hydrochloride (L-HCl) when administered locally for minor oral surgical procedures. Our study aimed to compare the anesthetic effect of T-HCl versus L-HCl in maxillary premolar extraction. The study is a split-mouth, double-blind randomized clinical trial at the Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India. The study sample was composed of patients referred for maxillary bicuspid extraction. Patients were excluded from the sample if, allergic to the study drugs, pregnant or lactating females, and smokers. The variable is an anesthetic drug administered for local anesthesia and it is grouped into 2 categories, T-HCl and L-HCl. A supraperiosteal infiltration of T-HCl with adrenaline on one side and L-HCl with adrenaline on the contralateral side was injected. The primary outcome variable was profound anesthesia of T-HCl, where the patient sensed the loss of sensation of touch, temperature, and pain. Secondary outcomes were onset and duration of anesthesia, intraoperative pain, postoperative analgesia, and adverse reactions, were recorded. Inferential statistics, the χ2 Test, the Mann-Whitney Test, and the Wilcoxon signed-rank test were used to compare the parameters. The level of significance was set at ≤ 0.05. A total of 40 patients were included, and 80 teeth were extracted. Profound anesthesia was achieved in all the cases. The mean subjective duration of anesthesia in the T-HCl and L-HCl groups was 130.80±20.01minutes and 111.40±14.87minutes, respectively, with a P value of .001. The mean Visual Analogue Scale (VAS) score for pain during the procedure in the T-HCl and L-HCl groups was 0.60±0.67 and 1.10±0.71, respectively, with a P value of .002. The mean Visual Analogue Scale score for pain postoperatively in the T-HCl and L-HCl groups was 0.70±0.72 and 1.40±0.67, respectively, with a P value of .001. Six patients in T-HCl required postoperative analgesia when compared to 18 patients in L-HCl (Pvalue < .003). T-HCl provides similar anesthetic outcomes in the extraction of maxillary bicuspids as L-HCl.

TOXIC EFFECT OF LOCAL ANESTHETICS

In the course of this study, an analysis was made of the current foreign and domestic literature on the problem of the toxic effect of local anesthetics on the human body. Literature search was carried out in such databases as PubMed, eLibrary, CyberLeninka. Local anesthetics are widely used in modern clinical practice to anesthetize the area of surgical intervention, as well as symptomatic treatment of some pathologies that are characterized by severe pain. In today's world, an average of 10% of patients develop adverse reactions when using drugs. The level of toxicity of a particular compound is determined by the level of its toxic dose – the amount of a substance that causes some toxic effect. Thus, the greater the toxicity of a chemical, the lower its toxic dose will be. At present, a wide range of drugs for local anesthesia has been developed that have minimal side effects, despite this, we must not forget about the toxic effect on the body of this group of drugs, and therefore it is necessary to apply a personalized approach to each specific patient when performing local anesthesia, regardless of complexity. performed surgical intervention.

Retrospective Analysis of Spontaneous Reports of Fatal Adverse Reactions Associated with Lidocaine

SCIENTIFIC RELEVANCE. Pain and pain relief are among the most important problems that arise during medical procedures. Lidocaine is used not only as an anaesthetic during interventions but also as a diluent for other medicinal products. Analysis of adverse drug reactions (ADRs) associated with lidocaine contributes to studying lidocaine toxicity and, as a result, developing measures to reduce side effects.AIM. The authors aimed to conduct a retrospective analysis of spontaneous reports of fatal ADRs associated with lidocaine.MATERIALS AND METHODS. This study analysed spontaneous ADR reports of fatal outcomes associated with lidocaine submitted to the federal ADR database in the Automated Information System of the Federal Service for Surveillance in Healthcare of the Russian Federation (Pharmacovigilance, versions 1.0 and 2.0) from 1 January 2008 to 31 December 2020.RESULTS. The ADR reports included 102 fatal outcomes associated with lidocaine. Most often, lidocaine was prescribed as a local anaesthetic or as a diluent for antibacterials. Studying the administered lidocaine doses, the authors identified several overdose cases. Most life-threatening conditions were due to hypersensitivity reactions of anaphylactic shock (54 cases, 52.9%). Lidocaine administration was accompanied by loss of consciousness, respiratory failure, and cardiac arrest in 10 cases (9.8%). Convulsions were a significant clinical sign in 9 cases (8.8%).CONCLUSIONS. Awareness of the risks of systemic toxic effects of local anaesthetics, including lidocaine, necessitates the practical implementation of certain safety measures, such as allergy skin tests before administration and mandatory monitoring of doses and patients’ well-being after administration.

Defective autophagy contributes to bupivacaine-induced aggravation of painful diabetic neuropathy in db/db mice

Current evidence suggests that hyperactivated or impaired autophagy can lead to neuronal death. The effect of local anesthetics on painful diabetic neuropathy (PDN) and the role of autophagy in the above pathological process remain unclear, warranting further studies. So, PDN models were established by assessing the paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) in leptin gene-mutation (db/db) mice. Wild type (WT) and PDN mice received intrathecal 0.75% bupivacaine or/with intraperitoneal drug treatment (rapamycin or bafilomycin A1). Subsequently, the PWT and PWL were measured to assess hyperalgesia at 6 h, 24 h, 30 h, and 48 h after intrathecal bupivacaine. Also, sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) were measured before and 48 h after intrathecal bupivacaine treatment. The spinal cord tissue of L4-L6 segments and serum were harvested to evaluate the change of autophagy, oxidative stress, oxidative injury, and apoptosis. We found that bupivacaine induced the activation of autophagy but did not affect the pain threshold, SNCV and MNCV in WT mice at predefined time points. Conversely, bupivacaine lowered autophagosome generation and degradation, slowed SNCV and aggravated spinal dorsal horn neuron oxidative injury and hyperalgesia in PDN mice. The autophagy activator (rapamycin) could decrease spinal dorsal horn neuron oxidative injury, alleviate the alterations in SNCV and hyperalgesia in bupivacaine-treated PDN mice. Meanwhile, the autophagy inhibitor (bafilomycin A1) could exacerbate spinal dorsal horn neuron oxidative injury, the alterations in SNCV and hyperalgesia in bupivacaine-treated PDN mice. Our results showed that bupivacaine could induce defective autophagy, slowed SNCV and aggravate spinal dorsal horn neuron oxidative injury and hyperalgesia in PDN mice. Restoring autophagy may represent a potential therapeutic approach against nerve injury in PDN patients with local anesthesia and analgesia.