Local Anesthetic Test Research Articles

Urticaria after Local Anesthetic Skin Testing with a History of Local Anesthetic Anaphylactic Reaction

Urticaria after Local Anesthetic Skin Testing with a History of Local Anesthetic Anaphylactic Reaction

Obstetric epidural test doses: a survey of UK practice

With the advent of low-dose epidural analgesia in labour, the content of the test dose has once again become the subject of debate. A postal survey of 500 members of the Obstetric Anaesthetists' Association was conducted in 1999-2000, assessing the use of test doses during epidurals in labour and for caesarean section. There was a 67% response rate. Test doses are used in labour, at elective caesarean section and before epidural top-up for emergency caesarean section, by 90%, 93% and 37%, respectively. There was large variation in both drugs and doses. During labour, doses of bupivacaine range from 3 to 20 mg and of lidocaine 15 to 90 mg. There has been a three-fold increase in the use of low-dose local anaesthetic test doses since a previous national survey in 1997. The size of local anaesthetic test doses used at caesarean section is also variable. Epinephrine is used in 5% of labour, 14% of elective and 34% of emergency caesarean sections. Signs and symptoms that are commonly sought after test doses include somatic motor block, blood pressure change, sensory effect and symptoms from systemic local anaesthetic. The effect of the test dose is usually assessed after 5 min. There is no consensus about the nature of the ideal test dose in obstetric anaesthesia. There is a trend to use less concentrated test doses during labour. Doses that risk a high block if given spinally are still used. Epinephrine, aspiration testing and cardiovascular monitoring are uncommon.

Methylparaben immediate hypersensitivity is a rare cause of false positive local anesthetic provocative dose testing

Methylparaben immediate hypersensitivity is a rare cause of false positive local anesthetic provocative dose testing

Response to local anaesthetic injection as a predictor of successful hip surgery

AIM: To compare the outcome of hip therapy with the response to local anaesthetic into the hip. MATERIALS AND METHODS: A retrospective hip arthrographic study of 60 patients complaining of hip pain was performed. The average age of the patients was 58 +/- 20 years with ratio of men to women of 11:19. Thirty-eight of these patients underwent local anaesthetic intracapsular injection. Twenty-three (61%) obtained relief from pain whereas two (5%) experienced worsened pain. RESULTS: Of the 23 patients who experienced pain relief 17 (74%) had a positive post-operative course, in comparison with eight (44%) who had a positive post-operative course from the group where intra-articular local anaesthetic was not used. It was also noted that patients over 30 years of age had favourable post-operative results in the presence or absence of local anaesthetic testing. CONCLUSION: These results indicate that hip arthrography with a pain relieving intracapsular local anaesthetic injection, is a positive post-operative prognostic factor in a patient group of disparate disorders. A positive response to local anaesthetic injection into a hip may predict which patients are likely to respond well to surgery. We advise alterations to the consent procedure to add a warning concerning the small risk of increased hip pain. If further studies were to confirm our results it may be wise to recommend that local anaesthetic intracapsular injection and judgement of its efficacy should precede many surgical procedures involving the hip.

Intrathecal Sufentanil Versus Epidural Lidocaine with Epinephrine and Sufentanil for Early Labor Analgesia

Intrathecal sufentanil provides approximately 2 h of excellent labor analgesia with minimal motor blockade.Epidural sufentanil has received less scrutiny but may provide the same benefits as intrathecal sufentanil. In this study, we compared epidural sufentanil 40 [micro sign]g after a lidocaine with an epinephrine test dose with intrathecal (IT) sufentanil 10 [micro sign]g with respect to onset and duration of analgesia, degree of motor block, side effect profile, and mode of delivery. Seventy ASA physical status I or II parturients in early labor (<or=to4 cm cervical dilation) were randomized to receive either IT sufentanil 10 [micro sign]g with a combined spinal-epidural technique (CSE) or epidural sufentanil 40 [micro sign]g (EP) after epidural catheter placement and testing with 3 mL of 1.5% lidocaine with epinephrine (15 [micro sign]g). After the administration of analgesia, pain scores and side effects were recorded for each patient at 5, 10, 15, 20, and 30 min, and every 30 min thereafter, by an observer blinded to the technique used. The study period was completed when the patients requested additional analgesia. All patients, except one, achieved adequate analgesia with the initial study dose and satisfactorily completed the study. There were no demographic differences between the two groups. Pain relief was rapid for all patients; pain scores were significantly lower at 5 and 10 min in the IT group versus the EP group. The mean duration of analgesia was similar between the EP group (127 +/- 40 min) and the IT group (110 +/- 48 min). No patient experienced any motor block. Side effects were similar between the two groups, except for pruritus-both the incidence and severity were significantly more profound at 5, 10, 15, 20, and 30 min in the IT group. There was no difference in time from analgesic to delivery, incidence of operative or assisted delivery, or cervical dilation at the time of redose. For early laboring patients, epidural sufentanil 40 [micro sign]g after a lidocaine test dose provides analgesia comparable to that of IT sufentanil 10 [micro sign]g with less pruritus. Implications: We compared the efficacy and side effects of intrathecal sufentanil with epidural sufentanil with a local anesthetic test dose for analgesia during labor. Analgesia was equally good, although the intrathecal group experienced more itching. (Anesth Analg 1998;87:331-5)

What is the Effect of Intrathecal Labor Analgesia on the Reliability of a Subsequent Epidural Local Anesthetic Test Dose?

What is the Effect of Intrathecal Labor Analgesia on the Reliability of a Subsequent Epidural Local Anesthetic Test Dose?

Detection of intravascular injection of regional anaesthetics in children.

Detection of intravascular injection of local anaesthetic during placement of regional blocks in children by using epinephrine-induced tachycardia or hypertension may produce false positive and false negative findings. This study evaluates ECG changes as markers of intravascular injection of local anaesthetics with epinephrine, during placement of epidural blocks in children. Observational study in a teaching hospital of all epidural anaesthetics administered to paediatric patients during one year. General anaesthesia, where used, was not controlled. An ECG rhythm strip was recorded during test dose injection and analyzed for changes in rate, rhythm, and T-wave configuration. During the study period, 742 paediatric epidural blocks were administered. There were 644 caudal (284 without catheters), 97 lumbar, and one thoracic epidural anaesthetics. Satisfactory placement was achieved in 97.7% of patients. Intravascular injection was detected in 42 (5.6%) of epidural anaesthetics (3.8% and 6.7% of straight needle and catheter injections, respectively). Detection was by immediate aspiration of blood in six patients, and by heart rate increases > 10 bpm in 30. Five had heart rate decreases suggesting a baroreceptor response. Five had heart rate increases < 10 bpm that were possible responses to noxious stimuli. Of 30 patients with known intravascular injection and for whom ECG strips were available, 25 (83%) had T-wave amplitude increases > 25%, and 29 (97%) had ECG changes in T-wave or rhythm in response to the epinephrine injection. There were no false positives. In order to reduce risks associated with epidural anaesthesia in children, epinephrine should be added to the local anaesthetic test dose, the ECG should be monitored continuously for changes in heart rate, rhythm, and T-wave amplitude. Epidural injections should be given in small increments.

Local Anesthetic Test Dose to Predict Effective Epidural Opioid Analgesia

Local Anesthetic Test Dose to Predict Effective Epidural Opioid Analgesia

Local Anesthetic Test Dose to Predict Effective Epidural Opioid Analgesia

Local Anesthetic Test Dose to Predict Effective Epidural Opioid Analgesia

Local Anesthetic Test Dose to Predict Effective Epidural Opioid Analgesia

Local Anesthetic Test Dose to Predict Effective Epidural Opioid Analgesia

診断・治療に難渋した外傷性神経腫による肩関節拘縮の１例

We experienced a rare case of stiff shoulder with traumatic neuroma. The patient was a 52 year old male who presented complaining of pain and motion disturbance in his shoulder joint. In May 1994 he fell down the stairs hitting the upper side of his right shoulder and developed a bruise and shoulder pain. When he came to our hospital, active flexion of his shoulder was 95 degrees and active abduction was 80 degrees. Arthrogram and MRI did not show a rotator cuff tear, except for a contrast finding on the arthrography. 50% of his shoulder pain was relieved by injection into the glenohumeral joint, subacromial bursa and acromio-clavicular joint with local anesthetic. In March 1995 arthroscopic surgery which released the coraco-acromial ligament and the joint capsule was performed. However, post-operatively, his shoulder discomfort continued and he could not tolerate the rehabilitation program. One month after his first surgery, the local anesthetic test was repeated. His pain was not relieved by injection into the joint capsule and the subacromial bursa. The injected agent flowed out from the acromio-clavicular joint. In 1995 surgery was performed and a traumatic neuroma recognized outside of the clavicle. After resection of the neuroma, his shoulder discomfort significantly improved and it was possible for him to perform the rehabilitation program.

Tenodesis of the long head of biceps brachii in the painful shoulder: Improving results in the long term

Fifteen shoulders of 14 patients with a keyhole tenodesis of the long head of the biceps were reviewed at an average follow-up of 7 years (3 years, 1 month to 13 years, 2 months). In 13 cases additional shoulder disease was noted during the operation. Eight patients had undergone rotator cuff decompression before the reference biceps tenodesis was performed. Eight (53%) cases achieved an excellent result; one was rated as good, four were rated as fair, and two had failures. Seven shoulders had an improved result from short to long term, and only two deteriorated. An upward migration of the humeral head on x-ray evaluation was noted but was without clinical significance. A local anesthetic test to the long head of the biceps before the operation seemed to be valuable in assessing chances of a good long-term result.

Local anesthetic test dose as a predictor of effective epidural opioid analgesia.

When local anesthetic is used to produce epidural anesthesia intraoperatively, epidural catheter placement is confirmed. However, when epidural catheters are placed intraoperatively only to provide postoperative opioid analgesia, correct catheter placement may not be confirmed by administration of a local anesthetic. The current study tests the hypothesis that the extent of sensory blockade produced by a 10-ml dose of 1.5% lidocaine can be used to predict the adequacy of epidural opioid analgesia. Forty-nine patients undergoing major abdominal surgery in whom a lumbar epidural catheter was placed intraoperatively were studied, but no more than 3 ml 1% lidocaine had been injected. Placement of the epidural catheter was assessed in the postanesthesia care unit by administration of a 10-ml dose of 1.5% lidocaine. The extent of sensory blockade was determined using the pinprick technique: All dermatomes, T2 and below, were assessed and scored using 1 point per dermatome per side from L1 to T2 to a maximum of 24 points. Scores were arbitrarily divided into three groups, where group 1, 0-7 points; group 2, 8-15 points; and group 3, 16-24 points. Epidural morphine infusion was initiated independently of the extent of the sensory blockade and adjusted using predetermined guidelines. Adequacy of opioid-induced analgesia was determined using the visual analog scale. Significantly lower visual analog scale scores for pain at rest and with movement from epidural morphine infusion were associated with sensory blockade score of 16-24 points. Seven patients failed to obtain a detectable sensory block. No patient requested alternative analgesia. None of the epidural catheters was removed because of inadequate pain relief, even in patients who failed to obtain a detectable sensory block. Extensive sensory block from 10 ml 1.5% lidocaine was associated with excellent epidural opioid analgesia. Extent of analgesia after a 10-ml test dose of 1.5% lidocaine can be used to predict the adequacy of analgesia resulting from an epidural opioid infusion. The failure of a local anesthetic dose to produce sensory blockade does not necessarily predict a failure to produce analgesia from an epidural opioid infusion, as indicated by the presence of analgesia in several patients without detectable sensory block.

Time Course of Sympathetic Blockade During Epidural Anesthesia

We studied the time course of sensory and sympathetic blockade in response to epidural local anesthetic test and bolus doses in 11 patients. Sympathetic activity was measured by monitoring cutaneous perfusion in the foot and the reflex vasoconstrictive response to deep inspiration (IGVR) using laser Doppler flowmetry. Sensory tests included the detection of touch, cold and painful stimuli. Following the 3-mL test dose perfusion increased to 192 +/- 38% (mean +/- SEM) of baseline (P < 0.05) in the patients with successful epidural anesthesia (9 of 11). In 8 of these patients, IGVR decreased to 73 +/- 10% of baseline (P < 0.05) within 6 min of the test dose, and preceded changes in sensation to cold, pin-prick, and light touch by 3.8 +/- 3.5 min (P < 0.2), 9.6 +/- 3.1 min (P < 0.01), and 11.6 +/- 2.7 min (P < 0.01), respectively. Five control patients who received only 60 mg of lidocaine intravenously and the two patients with failed epidurals did not show any perfusion or IGVR changes. This study confirms that sympathetic block precedes sensory block in sacral dermatomes after epidural anesthesia. Perfusion and IGVR changes are sensitive measures of sympathetic blockade and may predict successful epidural catheter placement.

Thoracic versus lumbar epidural fentanyl for postthoracotomy pain

Thirty patients were prospectively randomized to receive either thoracic or lumbar epidural fentanyl infusion for postthoracotomy pain. Epidural catheters were inserted, and placement was confirmed with local anesthetic testing before operation. General anesthesia consisted of nitrous oxide, oxygen, isoflurane, intravenous fentanyl citrate (5 μg/kg), and vecuronium bromide. Pain was measured by a visual analogue scale (0 = no pain to 10 = worst pain ever). Postoperatively, patients received epidural fentanyl in titrated doses every 15 minutes until the visual analogue scale score was less than 4 or until a maximum fentanyl dose of 150 μg by bolus and an infusion rate of 150 μg/h was reached. The visual analogue scale score of patients who received thoracic infusion decreased from 8.8 ± 0.5 to 5.5 ± 0.7 (p ≤ 0.05) by 15 minutes and to 3.5 ± 0.4 (p ≤ 0.05) by 45 minutes. The corresponding values in the lumbar group were 8.8 ± 0.6 to 7.8 ± 0.7 at 15 minutes and 5.3 ± 0.9 at 45 minutes (p ≤ 0.05). The infusion rate needed to maintain a visual analogue scale score of less than 4 was lower in the thoracic group (1.55 ± 0.13 μg · kg−1 · h−1) than in the lumbar group (2.06 ± 0.19 μg · kg−1 · h−1) during the first 4 hours after operation (p ≤ 0.05). The epidural fentanyl infusion rates could be reduced at 4, 24, and 48 hours after operation without compromising pain relief. Four patients in the lumbar group required naloxone hydrochloridc intravenously. Three of these patients had respiratory rates of less than 6/min and were difficult to arouse. The fourth patient was difficult to arouse and had an arterial carbon dioxide tension of 83 mm Hg. We conclude that thoracic epidural fentanyl infusion is better than lumbar infusion for postthoracotomy pain control because of more rapid onset, smaller dose requirements, and less respiratory depression.

I. VE II. GRUP LOKAL ANESTEZİKLERİN ALLERJİ YÖNÜNDEN KARŞILAŞTIRILMASI-COMPARAMENT OF 1st AND 2nd GROUP LOCAL ANESTHETICS IN ASPECT OF ALLERGIC REACTIONS

Anahtar sozcukler: Lokal anestezi, Allerji. Bu arastirmada daha once lokal anestezi yaptirmamis 100 hastaya I. Grup lokal anestezi maddesi olarak II. Grup lokal anestezi maddesi olarak da Citanest, lokal anestezi testi yapilarak, meydana getirdikleri asiri duyarlilik reaksiyonlari yonunden karsilastirildi. 100 hastanin 21 (% 21)'inde Ultracaine karsi asiri duyarlik saptandi. Citancsf'e karsi asin duyarlik reaksiyonu saptanmadi. Bu calismanin isiginda pratikte II. Grup lokal anestezik maddelerin kullanilmasinin daha guvenli olacagi kanisina varildi. Key words: Local Anesthesia, Allergy. 100 patients who have never had any lokal anesthesia were included in the study. As the 1. group lokal anesthetic Ultracain, and as the II'nd group lokal anesthetic material Citanest were applied to the patients after the local anesthetic test were performed. And the result were compared due to the hypersenitivity reactions induced. In 21 of the 100 patients (9 21) hypersensitivity reaction against Ultracain were determined. But no hypersensitivity reaction against Citanest was observed. In the light of this study, it was concluded that, the usage of II'nd group local anesthetic materials would be more secure in practice.

Does Labor Affect the Variability of Maternal Heart Rate During Induction of Epidural Anesthesia?

During the production of an epidural anesthetic, the use of an epinephrine-containing local anesthetic test dose is recommended to rule out accidental intravenous or subarachnoid injection. The end point sought for inadvertent IV injection is an increase in maternal heart rate (MHR) but the possibility that labor itself might produce fluctuations in heart rate have led some to question if this variable is a good means of testing for intravascular injection. Thus the current study was designed to determine normal MHR variability during labor.

The Pharmacological Activity of a Series of Basic Esters of Mono- and Dialkylmalonic Acids

A homologous series of twenty basic esters of mono- and dialkylmalonic acid has been pharmacologically investigated. The preliminary testing included antispas-modic testing against spontaneous contractions, barium-induced spasms, and metha-choline-induced spasms of the isolated guinea pig ileum; local anesthetic testing employing the rabbit cornea and the guinea pig wheal; and anti-secretory testing employing pyloric ligation in the rat. The monobasic esters possess greater anti-spasmodic, local anesthetic, and antisecretory activity than the dibasic esters. Activity increased with the length of the side chains. The most active compound of the series is a more active spasmolytic than papaverine hydrochloride, is equal to the local anesthetic activity of cocaine hydrochloride, and is less active than atropine sulfate in inhibiting unstimulated gastric secretions.