Local Anesthetic Activity Research Articles

Axonal sensitivity and block dynamics

The role of differential nerve block in the development of analgesia after erector spinae plane block has been questioned. While highly myelinated nerves are more sensitive to local anesthetics than unmyelinated ones in vitro, factors influencing drug diffusion, particularly pKa, are more relevant in the clinical setting. Bupivacaine (the drug most used for an ‘analgesic’ effect) has a relatively high pKa (8.1), and only 15% of it is present in the lipid permeant, unionized form at pH 7.4 so it will penetrate unmyelinated C fibers relatively easily, but the myelin sheaths around other fiber types are a significant barrier to drug diffusion. The greater sensitivity of myelinated axons to local anesthetic action will only be apparent if the drug can reach their membranes in significant concentrations. In the very dynamic situation pertaining to a local anesthetic injection (no matter the site), diffusion factors mean that the concentration of the drug around the axons is likely to be very low and may result in an effect on unmyelinated fibers only.

STUDY OF PHYSICOCHEMICAL AND BIOLOGICAL PROPERTIES OF A NEW BISPIDINE WITH A MORPHOLINE FRAGMENT

The experimental results obtained during the work enrich modern medicinal chemistry with new information about the development and local anesthetic activity of a promising class of chemical compound - O-benzoyloxime of bispidine. The discovered new properties of the molecule can serve as the basis for the creation of a new domestic safe local anesthetic drug that is effective in models of infiltration and conduction anesthesia and has low toxicity. The aim of this work is to synthesize and study the physicochemical and biological properties of a new morpholino-substituted bispidine derivative. Results and discussion. 3-(3-(Ethan-1-yloxy)propyl)-7-[3-(morpholine-4-yl)propyl]-3,7-diazabicyclo[3.3.1]nonan-9-one was constructed in 56.9% yield. Oximation under the influence of a powerful oximylating agent led to the oxime. O-Benzoyloxime was synthesized by benzoylation of the oxime. The complex of O-benzoyloxime with β-cyclodextrin - LA-180 was studied for local anesthetic activity and acute toxicity. Conclusion. It was established that LA-180 manifested itself as a highly active compound in a series of experiments studying infiltration and conduction anesthesia. The results of a study of acute toxicity after a single subcutaneous administration to white outbred mice showed that LA-180 (925 mg/kg) is a low-toxic compound in comparison with standard drugs such as trimecaine, lidocaine and novocaine.

Effect of Dental Local Anesthetics on Reactive Oxygen Species: An In Vitro Study.

Introduction Oxidative stress, an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, plays an important role in various dental diseases. Local anesthetics are frequently used in dentistry. The potential antioxidant activity of dental local anesthetics can contribute to dental practice. Therefore, this study aimed to investigate the ROS-scavenging activities of three commonly used dental local anesthetics, lidocaine, prilocaine, and articaine, focusing on their effects on hydroxyl radicals (HO•) and superoxide anions (O2 •-). Materials and methods The electron spin resonance (ESR) spin-trapping technique was employed to specifically measure the ROS-scavenging activities of these local anesthetics at varying concentrations. Results Lidocaine, prilocaine, and articaine exhibited concentration-dependent HO•-scavenging activities, with IC50 values of 0.029%, 0.019%, and 0.014%, respectively. Lidocaine and prilocaine showed concentration-dependent O2 •--scavenging activity, with IC50 values of 0.033% and 0.057%, respectively. However, articaine did not scavenge O2 •-. Conclusions The proactive use of dental local anesthetics may mitigate oxidative injury and inflammatory damage through direct ROS scavenging. However, further research is needed to elucidate the specific mechanisms underlying the antioxidant effects of these dental local anesthetics and their potential impact on the dental diseases associated with oxidative stress.

Sustained release local anesthetics for pain management: relevance and formulation approaches.

This review attempted to ascertain the rationale for the formulation of sustained-release local anesthetics and summarize the various formulation approaches designed to date to achieve sustained and localized local analgesic effects. The incidence of pain, which is the concern of patients as well as health care professionals, is increasing due to accidents, surgical procedures, and other diseases. Local anesthetics can be used for the management of moderate to severe acute and chronic pain. They also allow regional analgesia, in situations where the cause and source of the pain are limited to a particular site or region, without the need for loss of consciousness or systemic administration of other analgesics thereby decreasing the risk of potential toxicities. Though they have an interesting antipain efficacy, the short duration of action of local anesthetics makes the need for their multiple injections or opioid adjuvants mandatory. To overcome this problem, different formulations are being designed that help achieve prolonged analgesia with a single dose of administration. Combination with adjuvants, liposomal formulations, lipid-based nanoparticles, thermo-responsive nanogels, microspheres, microcapsules, complexation with multivalent counterions and HP-β-CD, lipid-based nanoparticles, and bio-adhesive films, and polymeric matrices are among the approaches. Further safety studies are required to ensure the safe and effective utilization of sustained-release local anesthetics. Moreover, the release kinetics of the various formulations should be adequately established.

Adrenaline and Anesthesia - Clinical Review

Abstract Adrenaline or epinephrine is one of the primarily important catecholamines in the general stress response and is manufactured in the adrenal medulla. In stress, it is secreted into the blood circulation and evokes many bodily transformations which prepare the body for the fight or flight response, some of which include tachycardia and hypertension, dilation of the air passages, and mobilization of energy reserves. This catecholamine surge can, however, cause myocardial stress, as evidenced during acute ischemia, hence an implication of increased risk of myocardial injury. In terms of functioning at the molecular level, adrenaline interacts with adrenergic receptors, which trigger intracellular processes associated with the readiness of a body to act fast as well as affecting more general forms of cardiac activity. Adrenaline stimulates beta-adrenergic receptors, enhancing heart rate and contractility, vital under stress but harmful with constant exposure. It is metabolized in the liver and may also cause dysrhythmias when used together with some inhaled anesthesia such as halothane. In anesthesia, adrenaline gets used to increase the local anesthetic action of the drug by constricting blood vessels and thereby increasing the duration and extent of analgesia besides reducing the uptake of the anesthetic into the systemic circulation. The common dose schedule is 1 in 2 lakh of adrenaline which means 5 μ/mL. The usual dose should not increase to 3 μ/kg. Preferably, the dose can be supplemented after 10–15 min. The use of adrenaline also creates a plane to dissect. The duration of action of local anesthetic drug is prolonged following the addition of adrenaline. Epidural test doses detect accidental intravascular catheterization. There is evidence that adrenaline belongs to anesthetic protocols, enabling deeper anesthesia, which, in turn, contributes to more effective outcomes of the surgery and easier recovery. Adrenaline by way of its alpha 2 agonism is likely to increase the effects of local anesthetic drugs and inhalational agents. Still, practitioners must address those benefits against possible side effects since minor, albeit significant, changes in the electrocardiographic characteristics have been recorded with lignocaine–adrenaline mixtures. Adrenaline nebulization is used for acute respiratory conditions like croup postextubation. The dose is 0.5 mg/kg, max 5 mg, diluted in 2–3 mL saline, repeated every 30 min if needed, with monitoring for tachycardia and hypertension. For perioperative anaphylaxis, administer 0.5 mg intramuscular for adults, adjusted by age for children. Hence, adrenaline is extremely useful in local anesthesia because of its vasoconstrictive effects, which must, however, be monitored continuously for patient and operational safety.

Comparative Analysis of the Structure and Pharmacological Properties of Some Piperidines and Host-Guest Complexes of β-Cyclodextrin.

Pain and anesthesia are a problem for all physicians. Scientists from different countries are constantly searching for new anesthetic agents and methods of general anesthesia. In anesthesiology, the role and importance of local anesthesia always remain topical. In the present work, a comparative analysis of the results of pharmacological studies on models of the conduction and terminal anesthesia, as well as acute toxicity studies of the inclusion complex of 1-methyl-4-ethynyl-4-hydroxypiperidine (MEP) with β-cyclodextrin, was carried out. A virtual screening and comparative analysis of pharmacological activity were also performed on a number of the prepared piperidine derivatives and their host-guest complexes of β-cyclodextrin to identify the structure-activity relationship. Various programs were used to study biological activity in silico. For comparative analysis of chemical and pharmacological properties, data from previous works were used. For some piperidine derivatives, new dosage forms were prepared as beta-cyclodextrin host-guest complexes. Some compounds were recognized as promising local anesthetics. Pharmacological studies have shown that KFCD-7 is more active than reference drugs in terms of local anesthetic activity and acute toxicity but is less active than host-guest complexes, based on other piperidines. This fact is in good agreement with the predicted results of biological activity.

Experimental study of local anesthetic and antiarrhythmic activities of fluorinated ethynylpiperidine derivatives.

The chemical structure of piperidine has a unique ability to combine with other molecular fragments. This fact makes it possible to actively use it as an effective basis for the creation of new drug-like substances. Thus, the aim of the current investigation was to study the acute toxicity, local anesthetic potency, and antiarrhythmic activity of the two new synthesized piperidine derivatives under laboratory codes LAS-286 and LAS-294 (local anesthetic substances). The Bulbring & Wajda animal model and method of determining the nociception threshold during electrical stimulation was used to investigate the action of the substance during infiltration anesthesia. An antiarrhythmic activity was observed by the aconitine-induced rat arrhythmia model. Additionally, these compounds were studied in relation to molecular docking to delineate the structure-activity relationships. The tested piperidine derivatives had a low toxicity in the subcutaneous and intravenous administration routes. The experimental results showed a higher prolonged and pronounced local anesthetic activity for LAS-286 at a 0.5% concentration, compared to the reference preparations. The low dosage of 0.1 mg/kg of LAS-294 demonstrated a pronounced preventive antiarrhythmic effect in 90% of cases on the development of mixed arrhythmia, caused by aconitine. The results of molecular docking confirmed a higher binding affinity of the tested piperidines with the Nav1.4 and Nav1.5 macromolecules. The results of the present study are very promising, because these piperidines have shown a high biological activity, which can suggest a potential therapeutic application in the future.

Scorpion Sting: A Reason for Failed Local Anesthetic Action

Scorpion Sting: A Reason for Failed Local Anesthetic Action

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.

Effects of Ottonia anisum plant extract on local anesthetic, analgesic, anti-inflammatory and HCl‑induced acute lung injury activities: a study in animal models

Ottonia anisum (O. anisum), belonging to the family Piperaceae, is renowned for its medicinal properties. The plant is rich in alkaloids, terpenoids and flavonoids with recorded bioactivities. The stems, roots, and leaves, of the O. anisum have been extensively used in the folk medicine. Therefore, the present study was conducted to examine the pharmacological activities of O. anisum root extract. Methanolic root extract of O. anisum was assessed for local anesthetic, analgesic, anti-inflammatory and HCl-induced acute lung injury activities in animal models. Local anesthetic activity assessed in frog and guinea pigs through foot withdrawal reflex and intradermal wheal method, respectively, revealed the dose-dependent onset time of anesthesia response. In the case of HCl-induced ALI, the mice group orally administered with O. anisum extract were assessed for bronchoalveolar lavage fluid (BLF) contents, oxidative stress, and proinflammatory molecules. The analysis revealed the reduction in inflammatory molecules, neutrophils, and oxidative stress in the extract treated mice group. In addition, the redox homeostasis, reduced GSH and the catalase activity was found to be restored in the treated groups. Intriguingly, the genes associated with the NFkB expression was found to be downregulated in O. anisum extract treated groups. Moreover, the extract unveiled the significant analgesic and anti-inflammatory activities. Overall, the findings emphasize the clinical applicability of O. anisum extract in the treatment of ALI as well as the potential usage in local anesthetic, analgesic, and anti-inflammatory agents during the treatments.Graphical

Effects of Coffee on Local Anesthesia Failure

Background: There exists a prevalent belief among patients that the use of coffee diminishes the efficacy of local anaesthetic. Caffeine is extensively utilized on a global level through the consumption of coffee, tea, and chocolate. Throughout the duration of the day. Moreover, it is conventionally perceived as a demonstration of communal benevolence, specifically within the context of Saudi Arabia. The mechanism of action of local anaesthetics involves the disruption of sodium channel influx across the neuronal membrane. Methodology: A cross-sectional epidemiological observational study was done in the city of Ha'il. The data was gathered during a two-month period spanning from July 1st, 2022 to September 1st, 2022. The sample population consisted of individuals who sought dental services within the Hail region. The present investigation had a sample size of 131 individuals, with 47.69% representing the female population and 52.31% representing the male population. However, upon conducting an assessment of patients' knowledge and opinions, it was shown that 32% of participants concurred with the notion that coffee possesses the ability to mitigate the occurrence of local anaesthetic failure. A mere 10% of individuals possessed knowledge regarding the scientific evidence that establishes a correlation between the drinking of coffee and the failure of local anaesthetics.Conclusion: Research investigations have demonstrated that caffeine can expedite the recuperation process following anesthesia, exhibiting effectiveness even when administered at elevated levels of anesthesia. Based on the sole existing evidence, it can be inferred that caffeine exhibits a capacity to counteract the effects of general anesthesia. Based on the available scientific evidence, it has been observed that caffeine has the potential to influence cognitive function by enhancing alertness. Additionally, sleep loss has been found to induce worry and anxiety. These findings partially elucidate the challenges faced by individuals who consume coffee when delivering local anesthetics. In order to mitigate the incidence of local anaesthetic failure, it is advisable for dentists to incorporate stress reduction measures into their routine practice.

Bioisosteric Replacement through 1,2,3-triazolyl Linkage Significantly Potentiate Biological Activity in Lidocaine and Etidocaine Analogs: Rational Design and Local Anesthetic Activity

Abstract: Cytochrome P450 3A4, the most abundant form of isoenzyme, in combination with several other isoforms, metabolizes lignocaine into mono-ethylglycine xylidide (MEGX) and glycylxylidide (GX), through N-dealkylation, ring hydroxylation, amide cleavage, and conjugation process which contribute the toxic effects. Inspiring by the rationality, functional approaches, and predictable facts lay by the emerging research groups, we were unquestionably fascinated by the rational development of novel lignocaine and etidocaine compounds, which are highly metabolically stable by applying non-classical bioisosteric principles. Distinctively, we have investigated the efficacy of 1,4- disubstituted-1,2,3-triazoles as metabolically stable trans-amide bond mimics. The 1,2,3- triazoles have been described in the literature as amide bond bioisosteres, which are analogous in stipulations of size, planarity, hydrogen bonding properties, and dipole moment. The systematic replacement of the single amide bonds by the 1,2,3-triazole heterocycle in the backbone of the peptide, often termed a “triazole scan,” provided several stabilized analogs with marked improved in-vivo local anesthetic properties. The analogs were synthesized using azide-alkyne cycloaddition. The 2a-b was coupled with aromatic and aliphatic alkynes using click chemistry in the presence of copper sulfate pentahydrate and L-sodium ascorbate in a Fritsch ball mill under solvent-free conditions at 300 rpm, furnishing the conjugates 4a-n in 80- 85% yields. The study perceptively opened new avenues of systematic replacement of the single amide bonds by the 1,2,3-triazole heterocycle in the backbone of the peptide, thereby providing several stabilized analogs with marked improved in-vivo local anesthetic properties. The best active candidates 4a, 4b and 4g produced analogous local anesthetic activity with that of the lignocaine.

СОЕДИНЕНИЕ N-АЦЕТИЛ-6-АМИНОГЕКСАНОВОЙ КИСЛОТЫ ПОДАВЛЯЕТ НЕРВНУЮ ПРОВОДИМОСТЬ

Local anesthetic effect of N-acetyl-6-aminohexanoate salt (compound LHT-9-17) in the form of a substance with a purity of 99.8% was studied and also assessed the effect of the substance on the conductivity of single sodium channels and the conductivity of the nerve conductor at normal pH values and against the background of acidosis. Experimental ligature periodontitis was modeled in 20 laboratories male Wistar rats weighing 200-220 g. Local anesthetic effects of 2% LHT-9-17 and 2% lidocaine hydrochloride solution induced by infraorbital administration was assessed at day 12 of the pathology development. Conduction of single Na-channels was assessed by patch-clamp method on isolated giant neurons of Limnea stagnalis. Registration of the action potential of Rana radibunda isolated sciatic nerve was carried out in perfusion chamber contained 0.00001 to 0.01 μM LCT-9-17. Experiments included increasing the force of stimulating incentives until the maximum response. Compound LHT-9-17 has local anesthetic activity, including during the inflammatory process. The analgesic effect is due to the suppression of the conductivity of Na-channels of nerve conductors. The activity kept under inflammatory conditions may be due to the action of substances against the inflammatory state.

The effect of local anesthetics against planktonic forms and film formation of S. aureus strains and its dependence on antiseptics activity.

Today surgical site infections (SSIs) remain the second among hospital acquired infections in Europe and the USA. Staphylococcus aureus as a pathogen of nosocomial infections occur more frequently in surgical hospitals. The work was aimed to establish the effect of local anesthetics against planktonic forms and biofilm-formation of S. aureus clinical strains and the relationship between the sensitivity of S. aureus strains to local anesthetics and antiseptics in vitro. The antimicrobial activity of local anesthetics (0.5%, bupivacaine, 2.0% lidocaine, 0.375% ropivacaine) and antiseptics (decamethoxine 0.02%, chlorhexidine 0.05%) against clinical strains of S. aureus was observed and studied their ability to produce biofilms. The antimicrobial effect of local anesthetics was lower compared to antiseptics, but we observed inhibition of growth and reproduction of S. aureus in their presence. The ropivacaine solution and the lidocaine solution demonstrated almost the same activity against the studied microorganism isolates. Along with this, bupivacaine solution had the highest activity against the studied microorganisms. The minimal inhibitory concentration of bupivacaine for S. aureus was 2.2 times lower than the minimal inhibitory concentration of lidocaine and 2.1 times lower than the minimal inhibitory concentration of ropivacaine significantly (p < 0.05). Scientific research on various aspects of the formation of bacterial biofilms is a relevant area that will change approaches to the prophylaxis and treatment of a number of infections, including SSIs.

Micro-pharmacokinetics of lidocaine and bupivacaine transfer across a myelinated nerve fiber

BackgroundThe aim of the present study was to predict the time to onset and duration of action of two local anesthetics (lidocaine and bupivacaine) based on experimental dimensions of a typical nerve and experimental octanol/water partition coefficients. MethodsWe began our compilation of experimental data with a numerical solution of the Smoluchowski equation for the transfer of lidocaine and bupivacaine across the axon membrane in the region of the node of Ranvier (axolemma) and across the Schwann cell. The difference between the aqueous and lipid environments of the neuron was simulated by including the coordinate-dependent chemical potential. In the second step, the permeation rates calculated using the diffusion equation were used to solve a system of four ordinary differential equations. This approach allowed us to simulate the cellular environment for a longer time and to compare our model with pharmacokinetic properties (time to onset and duration of action) of local anesthetics from the literature. The behavior of local anesthetics under physiological conditions and in case of local acidosis was also simulated. ResultsWe demonstrated that local anesthetics cross the axolemma in a time span of less than 1 μs. The time to onset of action, controlled by diffusion from the epineurium to an axon with a typical distance of 500 μm, was 167 s and 186 s for lidocaine and bupivacaine, respectively. The calculated half-life, which is a measure of the duration of action, was 41 min and 328 min for lidocaine and bupivacaine, respectively. ConclusionsDuration of action is controlled by the storage capacity of lipophilic compartments around the axon, which is higher for bupivacaine but lower in local acidosis. For the latter case, the literature, including textbooks, provides a misinterpretation, namely that protonated species cannot penetrate the membrane.

Scorpion Envenomation: The Cause of Inadequate Subarachnoid Block - A Case Series

Background: Failure of neuraxial or regional anaesthesia can result from factors such as drug errors, technical inefficiencies, and poor patient positioning. While these causes are well-known, resistance to local anaesthetic action due to mutations in sodium channels or scorpion sting is a lesser-known contributor to block failure. In India, a tropical country with a significant number of patients presenting for surgical procedures, a history of scorpion bites is not uncommon. Case: We observed seven cases of failed regional anesthesia who had history of scorpion sting. All the patients received intrathecal bupivacaine by experienced anesthesiologists, of seven patients five patients did not develop sensory or motor block. One patient had delayed successful subarachnoid block after second attempt and one patient had successful block at first attempt. Conclusion: Our observations revealed instances of failed spinal blocks, despite adequate drug dosages and experienced anesthesiologists performing the procedures, in patients with a history of scorpion envenomation. Accordingly, our study concludes that obtaining a thorough scorpion sting history during pre-anesthesia check-ups, particularly in endemic areas, can effectively prevent unnecessary repeated pinpricks, escalating dosages, patient and surgeon discomfort, and skepticism towards the skills of anesthesiologists.

A COMPARATIVE STUDY BETWEEN EPIDURAL NALBUPHINE AND FENTANYL WITH BUPIVACAINE FOR POST OPERATIVE ANALGESIA IN LOWER LIMB SURGERIES

Background:The shorter duration of action of typical local anaesthetics used for spinal anaesthesia demands the early need for postoperative analgesia. Epidural analgesic administration reduces the stress reaction to pain and surgery, reduces the requirement for systemic analgesics, and promotes early rehab.1 It was discovered that using opioids as an adjuvant to local anaesthetics has synergistic effects. The advantages of this combination were improved pain alleviation, motor sparing, and less toxicity.2 Objective:To compare the efficacy of epidural analgesia by using fentanyl and nalbuphine as adjuvants along with bupivacaine following lower limb surgeries with respect to Onset, Duration, and side effects. Meterials and Methods:Prospective randomized doubled blind comparative study would be conducted on 60 adult patients of ASA grade I &amp; II in the age group of 18 to 59 years of either sex, posted for lower limb surgeries after taking informed written consent. Patients were randomly divided on an alternative basis into 2 groups of 30 each. In study conducted in AL-AMEEN MEDICAL COLLEGE. VIJAYAPUR, KARNATAKA during the period of April 2021 to December 2022. If visual analogue score is more than one ,GROUP A: Patient received 50ug of fentanyl + 2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). GROUP B: Patient received 5mg of nalbuphine +2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). . Noting onset and duration analgesia also monitoring of patients SBP,DBP,SpO2,RR,VAS score till 15 min followed by 30 min,1hr ,2hr,4hr ,6hr,8hr is done and asked for any side effects like nausea ,vomiting, pruritis ,sedation and urinary retention. Conclusion: Epidural fentanyl has faster onset of action compared to nalbuphine and has longer duration of action compared to nalbuphine , for post operative epidural analgesia. There was no any statistically significant side effects in any of the two groups.

A herbo health care for gums and throat

The use of herbal gum paint in the treatment of dental problems is not very common. Most of the drugs used are synthetic and are in used over the years mainly for antibacterial activity in the oral cavity. It includes various side effects that are always a limit for their use. Natural remedies are always more desirable and acceptable and are more effective with fewer side effects. ThemicroorganismincludesEscherichiacoli, Klebsiella pneumonia, Staphylococcusepidermidis, and staphylococcus aureus which causegingivitisanddent cavities. The current study objective is to formulate and evaluate an herbal gum paint that is useful in the long term and has rheological characteristics and stability too. The local anesthetic activity is studied and the antimicrobial activity of gum paint is examined by disc diffusion method and compared activity between F1-betel leaf oil, F2- clove oil, and an F3 (F1+F2) – both betel leaf and clove oil. F3 shows a synergistic effect on microbes than the other two and has the maximum zone of inhibition.

Magnesium as an adjunct in regional anesthesia: literature review

Neringa Umaraitė1, Audronė Grigaliūnaitė2, Ramūnas Tamošiūnas2 1Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania 2Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Department of Anesthesiology, Kaunas, Lithuania Abstract Background. High-quality regional anesthesia should ensure good operating conditions and effective, long-lasting analgesia after surgery. Ways to prolong analgesia in order to allow early patient mobility and rehabilitation procedures are constantly being sought. Magnesium sulfate (MgSO4) as an adjunct to local anesthetics solutions is an attractive option and is being extensively studied. The aim: to review the scientific literature on usage of MgSO4 as an adjunct in regional anesthesia and to provide clinical conclusions for the application of MgSO4 in this anesthesia. Methods: The search of the scientific literature was performed in PubMed, Google Scholar online databases, using the following keywords and their combinations: ,,magnesium“, ,,peripheral nerve block“, ,,brachial plexus block“, ,,TAP block”, ,,spinal anesthesia“, ,,epidural anesthesia“, ,,neuraxial anesthesia“. 19 publications were included. Descriptive analysis was used to analyze the literature. Results. Regardless of type of regional anesthesia, magnesium combined with a local anesthetic shortens the duration of analgesic onset, prolongs both sensory and motor block durations, alleviates postoperative pain. Furthermore, less analgesics are consumed during surgery and postoperative period. Also, magnesium has advantage over some adjuvants to complement the action of local anesthetics or to avoid certain adverse effects. However, there is no consensus on what concentrations and volumes of MgSO4 solution should be used for different types of regional anesthesia. Conclusions. MgSO4, when used as an adjunct in regional anesthesia, enhances the action of local anesthetics without increasing the frequency of adverse effects. Keywords: magnesium sulfate, regional anesthesia, peripheral blocks, neuraxial anesthesia. Full article https://doi.org/10.53453/ms.2023.2.18

Buffering of Local Anaesthesia in Dentistry: A Review

Background: Local anaesthetics (LA) constitutes one of the most important aspects of pain management in dentistry. It is currently being stored and marketed in an acidic form to maximize stability, and water solubility and prolong shelf life. However, acidic local anaesthetic solution has been associated with certain disadvantages including the slow onset of action and, pain during its administration. Buffering of the local anaesthetics has been documented to decrease the pain of injection and, shorten the onset time of the anaesthesia thereby, providing more comfortable and reliable anaesthesia. Objective: To present a review of local anaesthetic buffering in dentistryData Sources: PubMed, Google Scholar, CINAHL and, MEDLINE databases were searched without a date limit. The phrases “local anaesthetic buffering” and Alkalinisation of local anaesthetics” were used to find articles related to local anaesthetic buffering.Study Selection: A total of 24 publications were included in this review and, buffering agents, mechanisms, methods and, benefits of local anaesthetic buffering were discussed.Finding: There was a paucity of literature on the effect of buffering on the duration of action of local anaesthetics. Conclusion: Dental professionals are advised to adopt chair-side buffering of LA to increase patient confidence and acceptance of dental treatment.&#x0D;