Lidocaine Solution Research Articles

Efficacy and safety of intradetrusor abobotulinumtoxinA and incobotulinumtoxinA in women with overactive bladder and the value of local anesthesia: arandomized clinical study.

Anon-inferiority clinical study evaluated the efficacy and safety of abobotulinumtoxinA vs. incobotulinumtoxinA intradetrusor injections in women with overactive bladder and urge urinary incontinence. Also, the effect of local anesthesia on the pain level of the procedure was assessed. Patients were randomized to receive 20intradetrusor injections of either 300 U abobotulinumtoxinA or 100 U incobotulinumtoxinA. They were further randomized to receive either local anesthesia (40 ml 1% lidocaine solution) or placebo before botulinum toxin injection. Before the procedure and 4months after the procedure each patient reported urinary incontinence episodes, frequency, nocturia, completed the Urogenital Distress Inventory (UDI-6) score, Incontinence Impact Questionnaire (IIQ-7), and Incontinence Quality of Life (I-QOL) questionnaire. Each patient completed apatient satisfaction survey 4 months after the procedure. During the procedure, the patients graded the pain intensity of every injection on avisual analog scale (VAS). The total score of each questionnaire was considered. A total of 54patients with amean age of 66 ± 13(SD) years completed the study. Total scores of UDI‑6, IIQ‑7, I‑QOL, patient satisfaction, urinary incontinence episodes, frequency, nocturia and VAS questionnaires did not show differences between the abobotulinumtoxinA (n = 26) or incobotulinumtoxinA (n = 28) group. Urinary retention requiring catheterization was noted in five patients. The VAS and patient satisfaction questionnaire values did not show significant differences between the group receiving bladder instillation with lidocaine solution (n = 28) or the group receiving placebo (n = 26). In women with overactive bladder and urge urinary incontinence where conservative treatment failed, abobotulinumtoxinA vs. incobotulinumtoxinA intradetrusor injections showed comparable results regarding improved clinical outcome and patient satisfaction. Local anesthesia before the procedure did not reduce the pain level in comparison with the placebo.

Efficacy and safety of greater occipital nerve block with a small volume of lidocaine and methylprednisolone in tertiary headache center

Background: The greater occipital nerve block (GON-B) is used in clinical practice for treating different forms of headache. There is no standardized procedure to perform GON-B. This study evaluates the efficacy and feasibility of a low-volume GON-B protocol utilizing a pre-mixed solution of lidocaine (10 mg) and methylprednisolone (40 mg) across various headache disorders. Methods: This observational case series included patients receiving their first GON-B from November 2019 to February 2021. Participants were diagnosed with migraine, cluster headache, cervicogenic headache, or paroxysmal hemicrania. The primary outcome was the degree of response to the GON-B. Results: Thirty-nine patients with migraine underwent a first GON-B. Regarding headache frequency, 26% achieved substantial response and 33% partial response. For headache intensity, 26% reported substantial and 49% partial improvement. Migraine patients experienced a significant reduction in median monthly headache days from 25 to 13 (p=0.001) and in headache intensity from a median of 8 to 6 on the Numerical Rating Scale (NRS) scale (p<0.001). Of the 27 patients receiving a second GON-B, 33% had a substantial response, 48% a partial response, and 19% no response. Results from subsequent sessions were consistent with these findings. Ten patients with cluster headache underwent GON-B, showing a significant reduction in pain intensity from a median NRS score of 10 to 5 (p=0.008). Two patients with cervicogenic headache showed a partial response to GON-B, with pain intensity decreasing from 8 to 6 and 8 to 7 over 30 monthly episodes. A patient with paroxysmal hemicrania received seven GON-B injections, reducing daily attacks from 30 to 10 and pain intensity from 7 to 6 on the NRS scale. Conclusions: These outcomes affirm GON-B potential in interrupting pain pathways, even at a low dose, in a wide range of headache disorders.

Does Addition of a Longer Acting Local Anesthetic Improve Postoperative Pain After Carpal Tunnel Release? A Randomized Controlled Trial

Carpal tunnel release (CTR) is a simple and effective treatment for carpal tunnel syndrome in patients who have failed nonsurgical management. This surgery is often performed in the ambulatory clinic under local anesthesia, with lidocaine, a short-acting agent. Few studies have investigated the use of longer acting agents, such as bupivacaine, for outpatient CTR. Therefore, the aim of our study was to compare the postoperative pain experience after CTR with the use of either our standard lidocaine solution (control) or a mixture consisting of lidocaine and bupivacaine in equal amounts (intervention). Patients undergoing CTR were randomized into control or intervention groups. Postoperative pain severity and numbness were recorded at several timepoints within the first 72 hours. The timing and quantity of postoperative analgesic use (acetaminophen and/or ibuprofen) was also documented. Both patients and assessor were blinded to allocation. Our study cohort included 139 patients: 67 in the control group and 72 in the intervention group. Postoperative pain scores were significantly lower in the intervention group at 6 hours (2.3 vs 3.2) and 8 hours (2.9 vs 3.9). Additionally, patients in the intervention group reported longer time to first analgesic use than those in the control group (5.2 hours vs 3.7 hours). A greater proportion of patients in the intervention group reported postoperative numbness at nearly all time points, compared to the control group. Our study shows that a mixture of bupivacaine and lidocaine improves early postoperative pain but causes prolonged finger numbness when compared to lidocaine alone. As both medications are effective and feasible for outpatient CTR, surgeon and patient preference should guide local anesthetic choice. Therapeutic Ib.

Assessing knowledge of dental house officers regarding dosage calculation and complications of local anaesthesia, in three tertiary care dental hospitals of DUHS, Karachi.

To assess the knowledge and awareness of dental house officers regarding calculation of local anaesthesia dosage, and to evaluate differences in practices at various tertiary care facilities. The cross-sectional study was conducted at three dental hospitals affiliated with Dow University of Health Sciences, Karachi from July to December 2022, and comprised house officers of either gender currently enrolled at the participating centres. Data was collected using a self-administered questionnaire to assess knowledge and awareness of local anaesthesia dosage calculation, administration methods, and common complications. Data was analysed using SPSS 26. Of the 200 subjects approached, 136(68%) responded, and 89(65.4%) of them were females. Knowledge regarding the meaning of 2% lidocaine solution was low 45(33%), and 68(50%) subjects were knowledgeable about the maximum dosage of lidocaine with epinephrine. In terms of practice, lidocaine was the most commonly administered local anaesthetic 115(85%), followed by bupivacaine 15(11%). The majority of subjects administered local anaesthesia with vasoconstrictor 127(94%), but only 36(27%) performed aspiration during administration. Syncope 71(52%) was the most commonly reported complication, followed by lip/cheek/tongue biting by 35(26%). House officers' knowledge level of local anaesthesia administration indicated the need for adequate training.

Effectiveness of methylene blue as a local anesthetic and analgesic in perianal operations: A prospective double-blind randomized control trial

BackgroundPerianal operations often result in significant postoperative pain, which negatively affects patient comfort and recovery. The search for effective pain relief options has led to the investigation of methylene blue, a biological stain with potential analgesic properties. AimsThis study aimed to evaluate the analgesic and anaesthetic effects of a mixture of methylene blue and lidocaine compared to plain lidocaine in the management of postoperative pain after perianal operations. MethodsA prospective, double-blinded, randomized controlled trial was conducted at a single center between 2015 and 2023. A total of 727 adult patients undergoing perianal surgical operations were randomly assigned to two groups: the experimental group received a solution of methylene blue and lidocaine, while the control group received plain lidocaine. Pain levels were assessed using the Visual Analog Scale (VAS), and follow-up visits and phone calls were conducted. The analysis included 727 participants who underwent operations for perianal abscess, fistula, fissure, and haemorrhoid. The participants were divided into the experimental group (N=329) and the control group (N=398). The data were analyzed using SPSS version 28, applying descriptive and inferential statistical methods. ResultsThe study included a total of 727 patients, with a mean age of 47 years (ranging from 18 to 90 years). Among the patients, 56.5% were males and 43.5% were females. The two groups showed significant differences in terms of postoperative analgesic use and pain-free days (p<0.001). Specifically, the methylene blue group had lower Visual Analog Scale (VAS) scores compared to the control group (p<0.05, p<0.001), respectively. No significant differences in immediate complications were observed between the two groups. ConclusionMethylene blue is an effective intervention for reducing postoperative pain after perianal operations, potentially decreasing the need for additional pain medication. The findings of this study suggest that methylene blue has a promising role in pain management without an increase in complications.

Double Postbulbar Block in the Prevention of Postmanipulation Pancreatitis

Abstract The problems of preventing postmanipulation pancreatitis (PMP) remain the subject of debate and a lot of research from leading scientific clinics around the world. The article is devoted to the assessment of prevention methods of PMP in patients with lesion of the pancreaticobiliary zone who underwent transpapillary interventions. Aim of the study Evaluation of the effectiveness of the author’s method of preventing PMP.Material and methods A prospective two-center randomized study included 545 patients treated in the Department of Liver Surgery and General Surgery in 2020–2022, who underwent ERCP and endoscopic papillosphincterotomy. There were 146 (26.8%) male patients, and 399 (73.2%) female patients, aged from 18 to 92 years, the mean age 62.7±7.4 years. Patients were divided into 3 groups according to the method of preventing PMP: in the 1st group, standard drug premedication was supplemented with two postbulbar blocks with a solution of lidocaine 0.5% 10 ml before and after the intervention (RF Patent No. 2779221, 09/05/2022), in the 2nd group standard premedication was combined with placebo was used, and in the comparison group 3 no submucosal injections were performed. The monitoring of clinical manifestations of PMP and the level of amylase was carried out every 12 hours until the parameters normalized. Statistical processing was carried out using program STATISTICA 6.1 for Windows.Results The frequency of mild pancreatitis, corresponding to the criteria for PMP, did not exceed 18% in groups 1 and 3 (p=0.3408), but was lower with pseudo postbulbar block, 9% (χ2=2.83, р=0.0926), the difference was not statistically significant. The incidence of severe pancreatitis was significantly lower in group 1 with double postbulbar block where there were no cases of pancreatic necrosis among 143 patients (χ2=6.19, р=0.0129). The mortality did not differ significantly among groups (χ2=0.15, р=0.7004). The duration of the hospital period had significant differences between groups (Student’s t-test 1.973, p=0.001). The hospital period with double postbulbar block turned out to be significantly shorter.Conclusion 1. Double postbulbar blockade significantly reduces the risk of developing severe postmanipulation pancreatitis, regardless of existing risk factors. 2. Double postbulbar block significantly reduces the duration of the hospital period after endoscopic papillosphincterotomy. 3. Pseudo postbulbar block using saline requires further evaluation as a possible way to prevent mild pancreatitis.

Comparison of pupil dilation in manual small incision cataract surgery using topical versus intracameral mydriatic agents – A randomised controlled trial

Objectives: The purpose of this research is to assess and compare the efficacy of an intracameral mydriatic solution with conventional topical agents in the completion of manual small incision cataract surgery (MSICS) in a black population. Materials and Methods: This randomised controlled trial was conducted among 102 patients undergoing MSICS under sub-tenon’s block. Mydriasis in the topical group was achieved with a pre-operative topical dilating combination of tropicamide 0.8% and phenylephrine 5% while surgery was commenced in patients in the intracameral group without dilation, and mydriasis was achieved intraoperatively with an intracameral solution of lidocaine 0.5% and adrenaline 0.001%. Pupil sizes were measured serially, before, and at four different junctures during surgery. The proportion of patients needing supplementary mydriasis in either group was noted, as well as post-operative pinhole visual acuity (VA). Data analysis was carried out using the Statistical Package for the Social Sciences Statistical Product and Service Solutions(SPSS) version 25.0 (IBM, Chicago, Illinois). The level of statistical significance was set at P &lt; 0.05 at a 95% confidence interval. Results: Mean pupil diameter before dilating and blocking was 2.5 ± 0.6 mm in the topical group and 2.5 ± 0.7 mm in the intracameral group (P = 0.752). This increased to 7.7 ± 1.1 mm and 7.4 ± 0.8 mm, respectively (P = 0.134), after administering either mydriatic agents. After that, mean pupil diameter progressively reduced in both groups but was significantly higher in the intracameral group at each point of measurement (P &lt; 0.05). Postoperatively, there was no significant difference in the VA between the two groups (P &lt; 0.05). Conclusion: Using an intracameral mixture of lidocaine and adrenaline gives adequate mydriasis for the successful completion of MSICS without pre-operative dilation.

Perioperative pain management in thoracic surgery and side effects in the early postoperative period

Aim. To study the impact of various methods of perioperative pain management on the frequency of postoperative complications in patients with lung cancer after thoracotomy. Materials and methods. The study involved 157 patients who were divided into 4 groups. Multimodal analgesia (MA) group: according to the concept of preemptive analgesia, patients received 1000 mg paracetamol IV 1 hour before surgery and 50 mg dexketoprofen IV; in the postoperative period, dexketoprofen and paracetamol were administered every 8 hours as well as epidural analgesia: 40 mg of 2 % lidocaine solution after a catheter was placed and continuous ropivacaine infusion at a dose of 2 mg/ml (6–14 ml/h) in the postoperative period. Thoracic epidural analgesia (TEA) group: epidural analgesia: administration of 40 mg of 2 % lidocaine solution after catheter placement, continuous ropivacaine infusion in the postoperative period at a dose of 2 mg/ml (6–14 ml/h). Preemptive analgesia (PA) group: according to the concept of preemptive analgesia – 1000 mg IV paracetamol 1 hour before surgery as well as 50 mg IV dexketoprofen; in the postoperative period, dexketoprofen and paracetamol were administered every 8 hours. Control group (C): patients received 50 mg IV dexketoprofen for postoperative analgesia. If the severity of the pain syndrome was more than 50 mm according to the visual analogue scale (VAS), patients of all groups were given 10 mg IV morphine. The study involved the registration of side effects in the postoperative period. Results. Among 157 patients, complications in the postoperative period were observed in 61 patients (38.85 %). The frequency of complications in MA group was 10.8 % of the total number of patients, in TEA group – 12.7 %, PA – 6.4 %, and in C group – 8.9 %. The most common complaint among TEA group patients was injection-site itching (13.5 %). PA group patients had a significantly lower number of complications compared to TEA group (p = 0.035). There was no statistically significant difference in the frequency of nausea or urinary retention in patients of all groups (p &gt; 0.05). No difference was noted in the number of pulmonary complications depending on the method of perioperative analgesia (p &gt; 0.05). 31 patients (75.6 %) of PA group did not have any complications, that was significantly different from TEA (p = 0.021) and MA (p = 0.039) patient groups. Conclusions. The use of paracetamol and dexketoprofen combination in the perioperative period allows to reduce (p = 0.035) the total number of postoperative anesthetic complications compared to the use of only thoracic epidural analgesia. The use of a multimodal approach combining epidural analgesia and administration of paracetamol and dexketoprofen does not reduce (p &gt; 0.05) the overall frequency of complications compared to patients without epidural analgesia.

Optimisation of reduction for prolapsed silicone tube after lacrimal intubation.

A common complication of bicanalicular intubation is dislocation of the silicone tube. Eleven patients with prolapsed silicone tubes who had undergone bicanalicular nasal intubation were injected with a 2 per cent lidocaine solution to infiltrate the lacrimal duct mucosa. A memory wire probe was used to pull a 4-0 suture through the lacrimal passage retrogradely, allowing the suture to grab the silicone tube. Paraffin oil was applied to the contact part of the rope and the silicone tube, then the distal end of the silk thread was removed from the nostril until the tube was pulled into place. The prolapsed silicone tubes were restored by surgery in nine patients, with the drainage tube in the correct position in the eye and the lacrimal duct irrigation unobstructed. The optimisations made in this study are considered effective adjustments of reduction surgery for a prolapsed silicone tube.

Роль предоперационной подготовки к кохлеарной имплантации у пациентов с тяжелой сопутствующей патологией

The own experience of managing patients with severe hearing loss and severe somatic concomitant pathology at all stages of cochlear implantation (CI) under local anesthesia is presented. Patients and methods. On the basis of the Center for Otorhinolaryngology, CI was performed under local anesthesia in 25 patients with sensorineural hearing loss grade IV or deafness with concomitant somatic pathology, 25 patients consisted of 17 men (68%) and 8 women (32%). The average age was 53.2±2.6 years. CI was performed under local anesthesia with 2% lidocaine solution using 1 mg adrenaline for 20 mL 2% lidocaine. The operation was performed using the classical method under the control of an OMPI Sensera S8 Karl Zeiss operating microscope. Results. Before the operation, all patients in the conversation were familiarized with each stage of the operation and with visual tables for contact between the doctor and the patient during the operation to monitor their subjective feelings. During the operation, anesthesia was well tolerated, and there were few complications. None of the patients showed feelings of anxiety, worry, or fear during the operation. After surgery, patients were questioned to identify early postoperative symptoms. Pain in the wound area of mild and moderate severity, mainly on the 1st day after the operation, was experienced by all patients; systemic dizziness, 7 patients (28%), hematoma around the implant was noted in 2 patients (8%). These symptoms were relieved by standard therapy by the 3rd day after surgery. Deterioration of the general condition associated with concomitant pathology was not observed in any of the patients. Conclusion. Compliance with the patient management algorithm at all stages of CI under local anesthesia with high-quality psychological preparation ensures good tolerability of the operation, psychological comfort of the patient during the operation, and a small number of complications, both during and after the operation.

A near-infrared spectroscopic study of the conformational equilibria of lidocaine molecules in a highly concentrated lidocaine solution in supercritical CO2

In this work, we studied conformational equilibria of molecules of lidocaine in its highly concentrated solutions in scCO2 at the CO2 density values ranging from ∼1.5 to ∼2.0 of the critical value along the isotherm of 35 °C. The study was based on analyzing the spectral band related to the first overtone of the stretching vibrations of the lidocaine molecule N–H fragment. To determine the key factor affecting the formation of intermolecular hydrogen bonds between the lidocaine molecules in the solution we divided our experiment into two stages. First, in the pressure range of 100–180 bar we analyzed the spectra evolution associated with an increase in the concentration of the saturated solution. Then, in the pressure range of 180–300 bar we analyzed the spectra evolution for a solution, where the lidocaine concentration, which was reached at 180 bar, remained constant.We found that the probability of intermolecular hydrogen bond formation considerably increased with lidocaine concentration growth, which, in turn, led to a rise in the population of lidocaine molecules without an intramolecular hydrogen bond. We concluded that the formation of intermolecular hydrogen bonds caused redistribution of the conformer fractions with and without an intramolecular hydrogen bond. Finally, we showed that the key factor affecting the formation of intermolecular hydrogen bonds between the molecules of lidocaine in its solution in scCO2 is the solute concentration rather than the pressure.

Effectiveness of ultrasound guided interfascial hydrodissection with the use of saline anesthetic solution for myofascial pain syndrome of the upper trapezius: a single blind randomized controlled trial.

Myofascial pain syndrome (MPS) is described as pain that arise from myofascial trigger points (MTrPs) which is a hyperirritable spot within a taut band of skeletal muscle. A newer needling technique called the interfascial hydrodissection (IH), wherein anesthetic saline solution (ASS) is injected between the fascia of the muscles using ultrasound as guide. It is theorized that this technique blocks the nerve branches and improve gliding in between the muscle and fascia. To determine the short and long-term effects of interfascial hydrodissection using 2% Lidocaine and saline solution compared to dry needling with MPS of the upper trapezius on pain and quality of life using. This study is a single-blind randomized controlled trial where ultrasound guided IH with ASS was compared to dry needling (DN) of the MTrPs. Both groups were taught self-stretch exercises (SSE) to be done everyday after the procedure. Outcome measures were pain using the visual analogue scale (VAS) and quality of life assessment with EQ-5D-5l questionnaire. All participants were assessed by a blinded assessor before the intervention, immediately after, 10 and 30 min, one week, two weeks, four weeks, three months, and six months after the procedure. Data Analysis: Two-way mixed ANOVA and follow-up independent T-test were conducted for the outcome measures across several time points between the 2 groups. A total of 46 participants with two dropouts were all included during the final analysis. Both groups demonstrated significant differences in VAS scores between baseline and the different time points, the IH + SSE group demonstrated the more significant effect size at as compared to the DN + SSE group. For EQ-5D-5l, no statistical differences were seen in all dimensions but there was a larger effect size for usual activities, pain/discomfort and anxiety/depression. Interfascial hydrodissection is a technique that can manage both short and long term symptoms of MPS. This could be utilized as an alternative management for those with chronic MPS of the upper trapezius. PHRR221003-005034.

Comparing Efficacy and Safety Aspects of 2% Lidocaine Hydrochloride Combination with 1:80.000 Added Epinephrine Solution versus the Most Commonly Used 2% Lidocaine Hydrochloride Solution in Surgical Procedures on Human Fingers and Toes

The effective management of pain and hemostasis is a pivotal concern in surgical procedures performed on human fingers and toes. The anatomical intricacies and limited tissue volume demand a meticulous approach to ensure both the safety of the patient and the successful outcome of the surgery. The use of vasoconstrictor agents, such as epinephrine, to provide clear surgical field and better surgical outcome further complicates the landscape. While epinephrine is a valuable adjunct to local anesthesia due to its hemostatic properties and ability to prolong anesthetic effects, its application in procedures on fingers and toes necessitates a deep understanding of potential risks and complications. This literature review delves into the comparative analysis of two widely employed local anesthetic solutions which are the 2% lidocaine hydrochloride solution and the 2% lidocaine hydrochloride solution combined with 1:80,000 epinephrine, with specific aim to comprehensively evaluate the efficacy and safety aspects of both local anesthetic solutions. Lidocaine solution alone offers effective pain relief with minimal systemic risks but might lack the extended duration and hemostasis benefits of epinephrine. The lidocaine-epinephrine combination solution provides prolonged anesthesia and reduced bleeding, but clinicians must balance these advantages with the potential for ischemic events and delayed wound healing. Close monitoring, precise dosing, and careful patient selection are paramount in ensuring successful outcomes while minimizing complications.

Treatment of recurrent pilonidal cysts in children: minimally invasive Gips technique

Introduction. Currently, long-term outcomes after surgical treatment of pilonidal disease are not always satisfactory. In particular, relapses can reach 40% by different authors and pose a big problem for operating surgeons. Repeated surgical interventions are technically more complicated, often require extensive excision and often lead to rough scars, which worsen cosmetic results. The minimally invasive Gips method has no abovementioned disadvantages and can be used in pilonidal cyst relapses. Purpose. To assess the Gips surgery effectiveness in relapses of pilonidal cysts in children.Material and methods. 7 children with relapses of pilonidal cysts have been treated with Gips technique in the surgical department of Ivano-Matreninskaya Children's Clinical Hospital (Irkutsk) since January 2020. All surgeries were performed by the generally accepted Gips technique: local infiltration anesthesia with 1% lidocaine solution; fistula excision with a trepan-circular knife and curettage of the pathological cavity. Then, wounds were processed openly with gauze tampons until complete healing.Results. Gender – 71.4% boys and 28.6% girls. The average age is 16.5 years (12–17 years). Previously performed surgical interventions: excision of the pilonidal cyst – 4 and Gips procedure – 3. Restoration of motor activity – on the first day after surgery. Duration of NSAIDs therapy – 2 days after the procedure. No early postoperative complications were registered. The average length of hospital stay – 4.75 days. Complete healing of postoperative wounds – 4.1 weeks, in average. Catamnesis – 9.5 months , in average; early relapses - in one patient (14.3%).Conclusion. Minimally invasive intervention for treating pilonidal cysts by the Gips technique can be used both in primary and recurrent forms of the disease. The discussed technique provides good cosmetic results and has a minimal number of postoperative complications.

Evaluating the Effect of Compound Solution of Papaverine, Lidocaine, and Heparin on Vasodilation of Vessels for Microvascular Anastomosis

Evaluating the Effect of Compound Solution of Papaverine, Lidocaine, and Heparin on Vasodilation of Vessels for Microvascular Anastomosis

Анестетик лідокаїн пригнічує холінергічні скорочення тонкої кишки миші та спричиняє порушення шлунково-кишкового тракту людини

Lidocaine is one of the components of multimodal low-opioid anesthesia, which is commonly used in surgical procedures, especially in cardiac surgery. Lidocaine has been used in medicine for a long time as a local anesthetic, but after the invention of the method of its intravenous administration, questions arose about its possible side effects on the visceral system, in particular on the motility of the gastrointestinal tract. Therefore, the aim of our work was to investigate the main aspects of the use of lidocaine-based opioid-free anesthesia and its side effects and also to study the effect of lidocaine on the contractile activity of small intestine smooth muscle, namely the mouse ileum. We recorded the contractile activity of smooth muscles of the ileum of mice using the tensiometry method and found that lidocaine at the clinically relevant concentration range, i.e. 1.5, 3, and 5 μg/ml, inhibited carbachol-induced contractions by 16, 27 and 37%, respectively (n = 7). To determine the side effects of opioid-free anesthesia, we studied 60 patients with coronary artery disease undergoing coronary artery stenting with the administration of anesthesia based on lidocaine solution at different concentrations (1 and 2 mg/kg). The side effects included nausea and vomiting, which may indicate а disturbance of gastrointestinal motility, as well as numbness of the limbs, cheeks, tongue, etc. These results contribute to a better understanding of the spectrum of action of lidocaine, a popular anesthetic in surgery, on the visceral system and become an important basis for the future development of new schemes for the use of local anesthetics in clinical practice, particularly in surgical procedures.

Patient Reported Outcomes of Transperineal Prostate Biopsy With Tumescent Local Anesthesia

To report the outcomes of performing transperineal prostate biopsy in the office setting using the novel anesthetic technique of tumescent local anesthesia. We report anxiety, pain, and embarrassment of patients who underwent this procedure compared to patients who underwent a transrectal prostate biopsy using standard local anesthesia. Consecutive patients undergoing either a transperineal prostate biopsy under tumescent local anesthesia or a transrectal prostate biopsy with standard local anesthetic technique were prospectively enrolled. The tumescent technique employed dilute lidocaine solution administered using a self-filling syringe. Patients were asked to rate their pain before, during, and after their procedure using a visual analog scale. Patient anxiety and embarrassment was assessed using the Testing Modalities Index Questionnaire. Between April 2021 and June 2022, 430 patients underwent a transperineal prostate biopsy using tumescent local anesthesia and 65 patients underwent a standard transrectal prostate biopsy. Patients who underwent a transperineal biopsy had acceptable but significantly higher pain scores than those who underwent a transrectal prostate biopsy (3.9 vs 1.6, P-value <.01). These scores fell to almost zero immediately following their procedure. Additionally, transperineal biopsy patients were more likely to experience anxiety (71% vs 45%, P<.01) and embarrassment (32% vs 15%, P<.01). Transperineal biopsy using local tumescent anesthesia is safe and well-tolerated. Despite the benefits, patients undergoing a transperineal prostate biopsy under tumescent anesthesia still experienced worse procedural pain, anxiety, and embarrassment. Additional studies examining other adjunctive interventions to improve patient experience during transperineal prostate biopsy are needed.

Наш подход к анестезиологическому сопровождению витреоретинальных вмешательств у пациентов с пролиферативной диабетической ретинопатией на фоне заместительной почечной терапии

Purpose. Identification of the optimal type of anesthetic support and regional anesthesia, the timing of surgery after a hemodialysis session, and also methods of preventing complications in patients undergoing renal replacement therapy (RRT). Methods. The results of surgical treatment under local anesthesia with intravenous sedation of 20 patients with proliferative diabetic retinopathy who are on RRT were analyzed. Results. In all cases, it was possible to achieve improvement/stabilization of visual functions, avoid hemorrhagic complications, maintain nitrogen metabolism indicators, and minimize decompensation of glycemic status. Adequate anesthesia was achieved in 17 cases (85 %) with additional subtenon injection of 2 ml of 2 % lidocaine solution with the duration of surgical intervention of more than 120 minutes in 3 cases, convincing akinesia in 18 cases (90 %). In one case, after performing regional anesthesia we have fixed a lowering in blood pressure to 60/40 mm Hg and decrease in heart rate to 37 beats per minute. Conclusions. The described stereotype in vitreoretinal surgery provided confident akinesia and optimal anesthesia for the duration of surgery and early postoperative period and also allowed minimizing decompensation of the glycemic status. Intervention in18–20 hours after hemodialysis session and correct choice of anticoagulants helped to reduce the risk of hemorrhagic complications. Key words: proliferative diabetic retinopathy; local anesthesia; hemodialysis.

Use of the narcotic analgesic fentanyl to correct violations of the autonomic regulation of childbirth

Background. The problem of effective prolonged epidural analgesia (PEA) in case of hypotonic labor, which allows minimal intervention in the process of labor activity while providing adequate analgesia, remains unresolved. A study was conducted to increase the effectiveness of PEA use during the first state of childbirth in women with hypotonic labor. The purpose: to increase the effectiveness of prolonged epidural analgesia in case of hypotonic labor during vaginal childbirth. Materials and methods. We performed analgesia to 60 women with a diagnosis of stage 1 hypotonic labor who were divided in 2 groups: the main one (n = 35) and the controls (n = 25). ASA status in both groups was I–II. In both groups, the epidural space was punctured at L1-L2. A test 4-ml dose of 2% lidocaine solution was administered and 5 minutes after, the epidural catheter was inserted. Then, in the main group, 1 ml of fentanyl solution and 6 ml of 0.9% NaCl were injected into the epidural space; in the control group, 6–8 ml of 0.125% bupivacaine solution. The effectiveness was evaluated according to the visual analogue scale, hemodynamic changes and the outcome of childbirth (conservative or operative). The condition of the fetus was assessed according to cardiotocography data. Statistical processing of the material was carried out using Excel. Results. The use of fentanyl in 69 % of cases allowed finishing the birth conservatively, the condition of the fetus and newborn was considered satisfactory. In the control group, 72 % of births resulted in cesarean section. Indications for surgery were hypotonic labor and fetal distress. Conclusions. The use of the narcotic analgesic fentanyl for prolonged epidural analgesia in hypotonic labor effectively relieves pain and increases the likelihood of conservative childbirth. It is safe for mother, fetus and newborn.

Intrathecal dopamine and serotonin enhance motor and nociceptive blockades of lidocaine in rats

The study examined the effect of intrathecal injection of dopamine (serotonin) and/or lidocaine. Intrathecal injections of dopamine (serotonin or epinephrine), lidocaine, or their combination were carried out in male Sprague Dawley rats. Neurobehavioral examinations (motor and nociceptive reactions) were performed before and after spinal injection. Intrathecal serotonin (1.5 μmol), dopamine (2.5 μmol), epinephrine (1:40000), and lidocaine (0.75 μmol) produced 29%, 33%, 29%, and 54% nociceptive blockade, whereas serotonin (1.5 μmol), dopamine (2.5 μmol), or epinephrine (1:40000) produced a longer duration of nociceptive blockade than lidocaine (0.75 μmol) (P < 0.05). Serotonin (1.5 μmol), dopamine (1.25 and 2.5 μmol), or epinephrine (1:40000 and 1:80000) prolonged the duration and increased the potency of spinal motor and nociceptive blockades of lidocaine (50% effective dose, ED50) (P < 0.05). The motor and nociceptive blockades caused by lidocaine (ED50) plus dopamine (2.5 μmol) or lidocaine (ED50) plus epinephrine (1:40000) were more outstanding than lidocaine (ED50) plus serotonin (0.75 μmol) (P < 0.05). Our study provides evidence that intrathecal dopamine or serotonin produces spinal nociceptive blockade dose-dependently. Dopamine and serotonin are less potent than lidocaine in inducing spinal nociceptive blockade. When mixed with lidocaine solution, dopamine or serotonin improves spinal motor and nociceptive blockades. The motor and nociceptive blockade caused by lidocaine (ED50) plus dopamine (2.5 μmol) is similar to that caused by lidocaine (ED50) plus epinephrine (1:40000).