Injection Of Local Anesthetic Solution Research Articles

Effects of Local Anesthetics With Vasoconstrictors on Dental Pulp Blood Flow and Oxygen Tension.

The aim of this study was to investigate the changes in pulpal blood flow (PBF) and pulpal oxygen tension (PpulpO2) after injecting local anesthetics with vasoconstrictors. Under general anesthesia, male Japanese White rabbits were injected with 0.6 mL of 2% lidocaine with 1:80,000 epinephrine (LE) or 3% propitocaine (prilocaine) with 0.03 IU felypressin (PF) at the apical area of the lower incisor. Relative to baseline, PBF and PpulpO2 significantly decreased 5 minutes after LE or PF injection as compared with saline. The decrease in PBF was significantly lower in the LE group than in the PF group. Although the LE group had a larger decrease in PpulpO2 relative to baseline than the PF group did, that difference was not significant. PBF and PpulpO2 recovered to baseline faster in the PF group than in the LE group. The injection of local anesthetic solutions containing vasoconstrictors (LE or PF) transiently caused significant decreases in PBF that resulted in significant decreases in PpulpO2. The recovery of PpulpO2 was faster than PBF regardless of the vasoconstrictor used.

Difficult subarachnoid anaesthesia Prediction and Performance

Spinal anaesthesia (SA) has enjoyed a long history of success, celebrating soon its 125th anniversary. Puncturing the dura mater is considered a simple procedure, followed by a subarachnoid injection of a local anaesthetic (LA) agent into the cerebrospinal fluid (CSF). Even when the technique is performed perfectly, there is no guarantee that the block sits perfectly. Failure is not uncommon and encompasses a range from total absence of any neuraxial blockade, a partial block (insufficient height, quality or duration) or a patchy block. Table 1 lists a large number of potential causative factors that may result in a failed spinal anaesthetic, providing suggestions of solutions. Analysing each distinct phase of the procedure, i.e., spinal puncture, injection of local anaesthetic solution, spread of the local anaesthetic solution through the cerebrospinal fluid, action of the drug on subarachnoid neural tissue and patient management, are the keys to success at each stage. Mechanisms of failure of spinal anaesthesia include insufficient preparation and check of equipment and drugs, suboptimal positioning of the patient, unsuccessful puncture due to inadequate training or experience and inadequate use of needles and local anaesthetic solution.1-5 Besides operator, preparation, technique-dependent and patient-related factors (anatomical variations), there are also organisational factors (lack of block room, lack of adequate monitoring and trained personnel, insufficient time between block and onset of surgery, subsequent management following block). The use of the correct local anaesthetic (dose, volume, concentration) injected at the correct lumbar interspace is of paramount importance to produce an adequate spinal block for the right surgical intervention. Nevertheless, failures may still occur. Therefore, the anaesthetist should always have a contingency plan for a failed spinal block. Indeed, patients expect reliable surgical anaesthesia when undergoing an operation

Cooling the soft tissue and its effect on perception of pain during infiltration and block anesthesia in children undergoing dental procedures: A comparative study.

Background. This study assessed the effect of cooling the soft tissue site on the perception of pain in children undergoing local anesthesia for routine dental procedures. Methods. One hundred children, 6‒14 years of age, were assigned to either of the two study groups, i.e., group 1 (infiltration) and group 2 (block anesthesia). One side of the arch served as the test side, where an ice pretreatment (IP) of the soft tissue of the injection site was carried out using a tube of ice for one minute, whereas the opposite side served as the control, where no ice pretreatment (WIP) was carried out. This was followed by the gradual injection of local anesthetic solution. The children’s pain perception was assessed by VAS, WB-FPRS and SEM scales. The data were analyzed statistically. Results. WBS, VAS and SEM scores were significantly different between the WIP and IP in both groups, indicating that ice was effective in reducing the pain perception in children. Intergroup comparison revealed no significant differences (P>0.05), indicating that cooling was equally effective in infiltration and block anesthesia. Conclusion. Cooling the soft tissue site helped decrease pain perception during injection in children.

INFLUENCE OF LOCAL INFILTRATION ANALGESIA ON POSTOPERATIVE PAIN IN ABDOMINOPLASTY PATIENTS.

SUMMARYThe aim of this study was the influence of local infiltrating analgesia with levobupivacaine on acute postoperative pain in patients that underwent abdominoplasty in day surgery. Local infiltration anesthesia is an injection of local anesthetic solution in painful areas. General anesthesia and tumescent fluid solution were performed in all patients. The study included 55 patients within age range from 20 to 72 years old. Study was conducted from January 2016 to February 2019.Postoperative pain after abdominoplasty was evaluated. LIA were performed before closure of abdominal wall after resection of skin and subcutaneous fat in lower part of abdominal wall. Infiltration was performed after plication of rectus abdominis muscles with single shot of 40 ml 0.25% Bupivacaine. Postoperative pain was reduced in the abdominal wall and in the wound area around umbilicus and in lower abdomen scar after waking from general anesthesia. Occurrence of acute postoperative was noticed in all participants. 85% of patients required an additional dose of analgesics and only in 3% of patients was required during the first postoperative day discharged during 48 hours. The research has shown that the appearance of acute postoperative pain did not lead to prolonged stay in the facility for day surgery.

Role of ultrasound guided transversus abdominis plane block as a component of multimodal analgesic regimen for lower segment caesarean section: a randomized double blind clinical study

BackgroundWhile opioids are the mainstay for post-operative analgesia after lower segment caesarean section, they are associated with various untoward effects. Ultrasound guided transversus abdominis plane (TAP) block has been postulated to provide effective analgesia for caesarean section. We evaluated the analgesic efficacy of this block for post caesarean analgesia in a randomised controlled trial.MethodsOne hundred thirty-nine mothers undergoing caesarean delivery were randomised to receive TAP block with either 20 ml 0.375% ropivacaine or 20 ml saline after obtaining informed consent. All the subjects received a standard spinal anaesthetic and diclofenac was administered for post-operative pain. Breakthrough pain was treated with tramadol. Post-operatively, all the subjects were assessed at 0, 2, 4, 6, 8, 10, 12, 18 & 24 h. The primary outcome was the time to first analgesic request. The secondary measures of outcome were pain, nausea, sedation, number of doses of tramadol administered and satisfaction with the pain management.ResultsThe median (interquartile range) time to first analgesic request was prolonged in the TAP group compared to the control group (p < 0.0001); 11 h (8,12) and 4 h (2.5,6) respectively. The median (interquartile range) number of doses of tramadol consumed in the TAP group was 0 (0,1) compared to 2 (1,2) in the control group (p < 0.0001). At all points in the study, pain scores both at rest and on movement were lower in the study group (p < 0.0001). Maternal satisfaction with pain relief was also higher in the study group (p 0.0002). One subject in the TAP group had convulsions following injection of local anaesthetic solution. She was managed conservatively with supportive treatment following which she recovered.ConclusionTAP block reduces pain, prolongs the duration of analgesia and decreases supplemental opioid consumption when used for multimodal analgesia for pain relief after caesarean section. However, the risk of local anaesthetic systemic toxicity remains unknown with this block. Hence larger safety trials and measures to limit this complication need to be ascertained.Trial registrationThe trial was registered with the Clinical Trial Registry of India (CTRI/2017/03/008194) on 23/03/2017 (trial registered retrospectively).

Ethyl chloride spray for musculoskeletal ultrasound-guided injections: An alternative to subcutaneous injection of local anesthetic solution.

Ultrasound-guided injections such as steroid injections are common procedures involving the musculoskeletal system. They are usually performed after a subcutaneous injection of local anesthetic (LA), which can be painful. In 126 consecutive patients, local anesthesia was performed using ethyl chloride spray prior to a therapeutic ultrasound-guided injection in joints, tendons, or bursae. Ninety-nine (78.5%) patients found the use of ethyl chloride spray helpful. The use of ethyl chloride spray is an effective, patient-friendly alternative to the standard injection of local aesthetic for ultrasound-guided therapeutic musculoskeletal injections with the advantage of a lower cost of $0.18 per procedure.

Evaluation of a caudolateral approach for arthrocentesis and injection of the equine elbow joint

The objectives of this study were to evaluate the likelihood of successful arthrocentesis of the equine elbow joint using the caudolateral approach and to determine if the deep branch of...

‘Plain lignocaine’ vs ‘Lignocaine with vasoconstrictor’—Comparative evaluation of pain during administration and post-extraction wound healing by a double blinded randomized controlled clinical trial

Objectives: The aim of this double blinded randomized controlled clinical trial was to evaluate the efficacy of two local anaesthetic solutions, ‘Plain lignocaine’ and ‘Lignocaine with vasoconstrictor’, on pain during administration and post-extraction wound healing in patients undergoing therapeutic extractions.Materials and methods: Fifty patients indicated for therapeutic extraction of upper and lower premolars for orthodontic purpose were recruited for the study. Using a split-mouth study design, anaesthesia was achieved using lignocaine with adrenaline on the control side and plain lignocaine on the study side. Pain perception was measured by modified visual analogue scale and wound healing was assessed by Landry’s Wound Healing Index. Sample allocation was done by simple randomization. The outcome parameters compared were (1) pain during administration of LA and (2) post-operative healing after extraction. Data analysis involved Chi-square test to compare proportions between treatment groups and independent sample t-test to compare mean values between treatment groups. SPSS version 22.0 was used to analyse the data.Results: The study group demonstrated a statistically significant wound healing on day1 and day 3 between the study and control group with p < 0.001. In the control group 68% had severe pain, whereas only 2% had severe pain in the study group. The proportions between the two groups were statistically significant (p < 0.001).Conclusion: The patients who received Plain Lignocaine perceived less pain during injection of local anaesthetic solution when compared to patients who received lignocaine with vasoconstrictor. The early post-operative wound healing was better in patients anaesthetized by Plain Lignocaine.

An Unforeseen Complication Arising From Inferior Alveolar Nerve Block

Complications after administration of local anesthesia for dental procedures are well recognized. We present here 2 cases of patients with anemic areas on their faces resulting from inferior alveolar nerve block (IANB). The precise cause of this complication is unknown; however, it may be derived from anastomosis of the maxillary artery, rapid injection of local anesthetic solution, misdirection of the needle, and spread of the solution to the upper region of the mandible. Although neurologic occurrences resulting from IANB are rare, dentists should keep in mind that certain dental procedures such as administering IANB could cause anemic areas on the face. Henceforth, dentists should consider the possibility of anemia after administration of IANB and pay attention to avoid complications during the procedure.

INADVERTANT PENETRATION OF BLOOD VESSELS DURING INFERIOR ALVEOLAR NERVE BLOCK TECHNIQUES

ABSTRACT Background The blood aspiration technique before the injection of local anesthetic solution is an essential procedure, because it prevents possible systemic’ complications. The purpose of this study is to evaluate the incidence of intravascular injection in different techniques of inferior alveolar nerve block and to know the technique which has very low incidence of vascular penetration. Methods Fifty patients in the ages of 17-70 years irrespective of sex, who were indicated for bilateral extractions of mandibular teeth were selected for this study. Patients were randomly divided into two divisions consisting of 25 patients requiring bilateral extraction procedures. In first division classical technique of inferior alveolar nerve block was administered on one side and on 2nd appointment Angelo Sargenti technique was administered on the other side. In the second division of 25 patients, indirect technique was administered on one side in 1st appointment and Clark and Holmes technique was administered on the other side in next appointment. Incidence of positive aspiration due to inadvertent penetration of inferior alveolar vessels was recorded. Results In group I positive aspiration rate was 8%, group II it was 4%, group III it was 4% and group IV it was 8%. Chi-square and fisher exact test was used and statistically there was no significant difference in the incidence of positive aspiration in all four groups. We found an overall aspiration rate of 6% in all four groups. Conclusion The incidence of positive aspiration was evaluated in all the 4 groups. There was no statistical significance in the rate of positive aspiration in all the groups included in our study.

Comparison of Percutaneous Nephrolithotomy Under Spinal Versus General Anesthesia: A Randomized Clinical Trial

To evaluate the safety and efficacy of spinal anesthesia compared with general anesthesia in patients who underwent percutaneous nephrolithotomy (PCNL). One hundred patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia. Spinal anesthesia was performed using an injection of 0.25 mg/kg bupivacaine 0.5% in the intrathecal space; no opium (fentanyl) agent was used. All procedures were performed with the patient in the prone position. Stone access was made by using fluoroscopic guidance, and the tract was dilated using a single-stage technique. All patients received a solution including 1 mg/kg morphine in every 100 mL physiologic saline through the volumetric pump during the 3-hour post-PCNL period in the recovery room. Afterward, morphine (0.05 mg/kg) was injected only according to the verbal rating scale greater than 3 after discharge from the recovery room until 24 hours after surgery. The two groups were matched by mean age, distribution of stone location, and stone burden. Mean operative time, hospital stay, stone-free rate and mean hemoglobin drop were comparable between the two groups. The rate of complications according to the Clavien grading system was nearly similar in both groups. Mean analgesic requirement during 24 hours after PCNL was 6.8 mg in the spinal group and 13.2 mg in the general group (P<0.001). It seems that using spinal anesthesia by intrathecal injection of local anesthetic solutions vs general anesthesia has comparable surgical outcomes and reduces the requirement for analgesia after PCNL in the early postoperative period.

Simulators for training in ultrasound guided procedures

The four major categories of skill sets associated with proficiency in ultrasound guided regional anaesthesia are 1) understanding device operations, 2) image optimization, 3) image interpretation and 4) visualization of needle insertion and injection of the local anesthetic solution. Of these, visualization of needle insertion and injection of local anaesthetic solution can be practiced using simulators and phantoms. This survey of existing simulators summarizes advantages and disadvantages of each. Current deficits pertain to the validation process.

Experimental research A novel ropivacaine-loaded in situ forming implant prolongs the effect of local analgesia in rats

IntroductionProlonged postoperative analgesia cannot be achieved by a single injection of local anesthetic solution. The objective of this study was to optimize the formulation of a ropivacaine hydrochloride (Ropi-HCl) loaded in situ forming implant (ISI) by addition of different co-solvents, and evaluate the in vitro release of Ropi-HCl, and the analgesic effect and toxicity of the optimized formulation in rats.Material and methodsTriacetin (TA), benzyl benzoate (BB) and polyethylene glycol 400 (PEG 400) were used as additives and added to the solvent of N-methyl-2-pyrrolidone (NMP). Drug release to the surface and inner structural properties of the formed implant were evaluated by scanning electron microscopy (SEM). The analgesic effect was determined by injection near the rat sciatic nerve.ResultsThe solvent system added with TA or BB significantly decreased the burst release, whereas PEG 400 increased the Ropi-HCl burst release from the formulation. Over 70% of the incorporated Ropi-HCl was released from all formulations in 14 days in the in vitro assay. The SEM showed that the surface of NMP-BB formulation was less porous and more homogeneous, compared with the other formulations. Compared with Ropi-HCl injection, the optimized formulation (NMP-BB) significantly prolonged the analgesic effect in 48 h (p < 0.05), with a mild degree of motor block from 3 h to 12 h. Histological evaluation of the injection site revealed only mild inflammatory infiltration without obvious pathological nerve alterations.ConclusionsThe biodegradable Ropi-HCl-loaded ISI system with NMP-BB may prove to be an attractive and safe alternative for the delivery of parenteral local anesthetics to prolong pain relief.

New anesthetic technique in periodontal procedures

Periodontal procedures require injection of local anesthetic solution to avoid patient discomfort. Multiple injections are required to anesthetize the anterior maxilla in the region of the premolars to incisors. Anterior middle superior alveolar nerve block is a single palatal injection technique, which anesthetizes the facial and palatal gingiva as well as pulp in the region of the maxillary central incisors to the premolars without any collateral facial anesthesia. This case series presents the application of the anterior middle superior alveolar nerve block in periodontal therapy.

Ultrasonographic Appearance of Intraneural Injections in the Porcine Model

Ultrasonographic (US) images of apparent intraneural injection of local anesthetic solutions have been reported. We aimed to define US signs of intraneural (ie, subepineural) injection using a histologic standard in an animal model and compare these signs with other potential markers of intraneural injection, including low nerve stimulation current thresholds and high injection pressures. In 6 anesthetized adult swine, bilateral brachial plexus and femoral nerves were contacted by needles and penetrated. India ink was injected intraneurally under US monitoring. The minimum current that elicited a motor response was recorded. Injection pressures were measured using a digital manometer. Nerves were then excised, processed, and subjected to histologic analysis. Nerve expansion during injection was visualized under ultrasonography in all procedures. Electrical current intensity to elicit motor response to nerve stimulation varied between 0.2 and 3.3 mA with the needle tip positioned intraneurally. The mean injection pressure was 7.40 +/- 8.07 psi (range, 0.07-31.5 psi), with 80% of injections between 0.61 and 15.0 psi. None of 24 intraneural injections resulted in histologic evidence of intrafascicular injection (95% confidence interval, 0.0%-16.3%). Ultrasonographic images compatible with nerve swelling during an injection are consistent with true intraneural injections as demonstrated by histologic analysis. Under the conditions studied, intensity of the stimulating current required to elicit motor response was not associated with intraneural needle placement. In the absence of fascicular injury, intraneural injections were associated with low injection pressure, although false-positive results can occur.

Measurement of the puncture profile and extradural pressure of cattle during extradural anaesthesia

ObjectiveTo measure the pressure profile during caudal extradural puncture and subsequent extradural anaesthesia in cattle and to investigate the presence of extradural pressure waves. Study designProspective experimental study. AnimalsEleven cattle aged 4.1 ± 2.5 years (range 0.8 to 8.8 years), with a body weight of 613 ± 162 kg (range 302–840 kg). MethodsCaudal extradural puncture was performed. To measure the extradural pressure profile, the needle was connected to an electronic pressure transducer placed at the height of the base of the tail. The pressure profile was recorded for 3 minutes following extradural puncture. Lack of resistance to injection of saline was assessed. One minute and 10 minutes after extradural anaesthesia with procaine extradural pressure was recorded. Correct extradural needle placement was assessed by clinical response. ResultsThree minutes after extradural puncture the median pressure was −16 (range −25 to 25) mmHg. Pressure in the extradural space 1 minute after the lack of resistance, 3 seconds after injection, and 10 minutes after injection was −15 (−24 to 33) mmHg, 8 (−17 to 84) mmHg, and −7 (−25 to 27) mmHg respectively. Pressure waves were visible after puncture, after lack of resistance, 3 seconds and 10 minutes after injection, in 4, 6, 8 and 7 cattle respectively. Pressure after testing lack of resistance, after the injection of local anaesthetic, as well as at the end of the measurement, period was significantly higher than baseline. All cattle showed clinical signs indicative of successful extradural needle placement.Conclusion and clinical relevance Extradural pressure was sub-atmospheric in 82% of the animals. Pressure waves were not consistently present before or after extradural injection, which limits their usefulness to confirm correct extradural needle placement. Extradural pressures increase significantly after injection of local anaesthetic solution. However, the clinical significance of the increase in extradural pressures was not clear.

In Ultrasound-guided Interscalene Block, Do We Know Where the Epineurium Is?

In Ultrasound-guided Interscalene Block, Do We Know Where the Epineurium Is?

Detecting intravascular injection during caudal anaesthesia in children

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Comparison of the Gow-Gates Mandibular Block and Inferior Alveolar Nerve Block Using a Standardized Protocol

Although several previous studies have compared the efficacy of Gow-Gates mandibular block (GGMB) and inferior alveolar nerve block (IANB), the results remain controversial. This study used an objective, standardized and precise protocol to evaluate and compare the effectiveness and success rate of GGMB and IANB. The study group consisted of 162 patients (93 males and 69 females) who were randomly allocated to receive GGMB or IANB for extraction of third molars. Both methods used 2.7 mL of 2% xylocaine for each patient. Pulpal and gingival tissue anesthesia of mandibular central incisors, canines, first premolars and first molars were evaluated at 0, 5, 10, 15 and 60 minutes after injection of local anesthetic solution using both an electric pulp tester and a sharp explorer. The success rates of pulpal anesthesia in the IANB group (central incisor, 6%; canine, 37%; first premolar, 54%; first molar, 88%) were not significantly different from the GGMB group (central incisor, 8.1%; canine, 37.1%; first premolar, 54.8%; first molar, 83.9%). All subjects achieved 100% lip numbness with both methods. At 60 minutes after injection, the success rates of gingival tissue anesthesia in canine buccal and lingual areas were higher in the IANB group (100% and 100%, respectively) than in the GGMB group (91.9% and 93.5%, respectively). In the molar buccal area, the success rates at 5 and 60 minutes after injection were higher in the IANB group (97% and 100%, respectively) than in the GGMB group (88.7% and 91.9%, respectively). Furthermore, the success rates in the molar lingual area at 10, 15 and 60 minutes after injection were higher in the IANB group (100%, 100% and 100%, respectively) than in the GGMB group (91.9%, 93.5% and 91.9%, respectively). Although IANB achieved higher success rates of gingival tissue anesthesia in some gingival areas, no significant difference between the two methods was found in overall efficacy. This study demonstrated that the efficacy of pulpal and gingival tissue anesthesia are not significantly different between the GGMB and IANB methods.

Acute respiratory distress after cervical plexus block caused by acute brainstem anaesthesia

Abstract A 50-year-old man was scheduled for left carotid endarterectomy under deep and superficial cervical plexus blockade. At the end of the third injection into the deep cervical plexus, he suffered from respiratory distress and hypotension. Surgery was interrupted and he was admitted to the Intensive Care Unit with acute brainstem anesthesia from unintentional injection of local anesthetic solution into the subarachnoid space.