Local Injection Of Bupivacaine Research Articles

The effect of local injection of bupivacaine with and without fentanyl at the operative site in mandibular open reduction on acute pain intensity and opioid requirement: a randomized clinical trial.

The aim of this study is to investigate the effects of bupivacaine local injection with and without fentanyl at the operative site in mandibular open reduction surgeries on the severity of acute pain and the need for opioids. This randomized clinical trial, age-sex-matched double-blind study included 44 patients with isolated mandibular fractures who would be candidates for open reduction. They were divided into two groups (intervention using fentanyl and control not using fentanyl). In both groups, the amount of opioid used, hemodynamic indices, oxygen saturation, and pain intensity were collected based on the Visual Analogue Scale (VAS) every 4 h for 24 h. As for basic and demographic variables such as gender, age, ASA class, and duration of surgery (P > 0.05), there was neither a significant difference between the two groups nor was there any difference in nausea and vomiting and subsequent anti-nausea medication (P > 0.05). The need for a post-operative opioid in the bupivacaine + fentanyl group (13.6%) was significantly less than in those who received only bupivacaine (45.5%) (P < 0.05). Changes in pain scores over time were significantly different in the two groups, and bupivacaine + fentanyl reduced pain more than bupivacaine (P < 0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation, heart rate, systolic blood pressure, and diastolic blood pressure (P > 0.05). The addition of fentanyl to bupivacaine for supraperiosteal injection in the open reduction surgery site reduces post-operative pain in the first 24 h and reduces the need for opioids without causing complications such as nausea and vomiting.

The Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient Reported Outcomes: A Randomized Controlled Trial.

To determine if a peri-operative pain cocktail injection improves post-operative pain, ambulation distance and long-term outcomes in hip fracture patients. Prospective, single-blinded, randomized controlled trial. Academic Medical Center. Patients with OTA/AO 31A1-3 and 31B1-3 fractures undergoing operative fixation, excluding arthroplasty. Multimodal local injection of bupivacaine (Marcaine), morphine sulfate (Duramorph), ketorolac (Toradol) given at the fracture site at the time of hip fracture surgery (Hip Fracture Injection, HiFI). Patient-reported pain, American Pain Society Patient Outcome Questionnaire (APS-POQ), narcotic usage, length of stay, post-operative ambulation, Short Musculoskeletal Function Assessment (SMFA). 75 patients were in the treatment group and 109 in the control group. Patients in the HiFI group had a significant reduction in pain and narcotic usage compared to the control group on post-operative day (POD) 0 (p<0.01). Based on the APS-POQ, patients in the control group had a significantly harder time falling asleep, staying asleep, and experienced increased drowsiness on POD 1 (p<0.01). Patient ambulation distance was greater on POD 2 (p<0.01) and POD 3 (p<0.05) in the HiFI group. The control group experienced more major complications (p<0.05). At six-weeks post-op, patients in the treatment group reported significantly less pain, better ambulatory function, less insomnia, less depression, and better satisfaction than the control group as measured by the APS-POQ. The SMFA bothersome index was also significantly lower for patients in the HiFI group, p<0.05. Intraoperative HiFI not only improved early pain management and increased ambulation in patients undergoing hip fracture surgery while in the hospital, it was also associated with early improved health related quality of life following discharge. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Analgesic Efficacy of Bupivacaine as an Infiltration Injection Technique after Extraction of Impacted Mandibular Third Molars: A Randomized Controlled Study

Background: Pain after surgery is a common adverse effect that patients experience after having their lower third molars surgically removed. Objective: To assess how well local injection of bupivacaine reduces pain after surgical extraction of an impacted mandibular third molar. Methods: A single-blinded, randomized, controlled clinical trial included a total of 56 patients that were randomly selected according to Microsoft Office Excel sheets and divided into two groups. The study includes 29 patients who received a 2 ml dose of bupivacaine 0.5% through local infiltration near the extraction site using an insulin syringe to avoid intravenous or intraneural infiltration. The other 27 patients who served as the control group received a 2 mL dose of normal saline using the same administration technique. Both groups underwent a surgical procedure to remove their impacted mandibular third molars while under the influence of local anesthesia. Pain was evaluated using a numeric rating scale (NRS) at 4, 8, 12, and 24 hours post-operatively. Results: The study group exhibited significantly lower pain scores compared to the control group at 4, 8, 12, and 24 hours following the surgical procedure (p=0.0001). Conclusions: There were no major problems associated with the local injection of bupivacaine; it lowers postoperative pain 4, 8, 12, and 24 hours after the surgical extraction of impacted mandibular third molars.

COMPARISON OF LOCAL METHYLCOBALAMINE INJECTION VERSUS LOCAL BUPIVACAINE INJECTION FOR THE TREATMENT OF ACUTE HERPETIC NEURALGIA

Objective: To compare the reduction in mean pain score with local Methylcobalamin injection versus local Bupivacaine injection in patients with acute herpetic neuralgia.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Dermatology Outpatient Department, Pak Emirates Military Hospital, Rawalpindi, from Jun to Dec 2019.&#x0D; Methodology: Total 100 patients, having pain score more than 3, fulfilling the selection criteria were divided into two groups. Group A was treated with daily subcutaneous injection Bupivacaine, whereas Group B was treated with daily subcutaneous injection Methycobalamin at the site of neuralgia. Patients were followed up for 4 weeks. The pain score was noted. All the data was entered and analyzed on SPSS version 21.&#x0D; Results: In this study mean age of patients in group A was 43.82 ± 15.76 years and in group B was 44.76 ± 16.92 years. The mean visual analogue pain score at 4th week in the group A patients was 1.14 ± 0.32 and in group B was 1.90 ± 0.97. Statistically significant difference was found in group A (local Bupivacaine) with visual analogue score (VAS) at 4th week (pvalue=0.002).&#x0D; Conclusion: The local Bupivacaine injection showed significant reduction in mean pain score than local Methylcobalamin injection in patients with acute herpetic neuralgia.

Effect of Local Injection of Bupivacaine for Pain Management After Tonsillectomy: A Randomized Clinical Trial

Background: Pain is one of the main side effects of tonsillectomy, especially in the pediatric population. Objectives: This study aimed to examine the effects of a local injection of bupivacaine on pain and postoperative nausea and vomiting after tonsillectomy. Methods: In this double-blind clinical trial, we enrolled 96 patients who were referred for elective tonsillectomy to the ear, nose, and throat (ENT) Clinic of Imam Khomeini Hospital in Ahvaz, Iran, from December 2016 to January 2018. The patients were selected by the simple random sampling method on a 1:1 ratio. To analyze the data, Student's t‐test or chi‐squared test were used. Results: Visual analog score measured in the recovery period at 0, 1, 2, 4, 8, 12, and 24 h after surgery was significantly lower in the bupivacaine group than in the placebo group (P &lt; 0.001). Nausea was significantly different between the groups at all time, but for vomiting, significant differences between the groups were noted at 0, 1, 2, 4, and 8 h but not at 12 and 24 h after surgery. Conclusions: Preoperative local injection of 0.5% bupivacaine for tonsillectomy was effective in reducing postoperative pain, and it significantly reduces postoperative nausea and vomiting in children.

A Comparison of the Effect local Injection of Bupivacaine on the Post Tonsillectomy Pain in Children

A Comparison of the Effect local Injection of Bupivacaine on the Post Tonsillectomy Pain in Children

Perioperative interdisciplinary approach for reduction of opioid use in pediatric tonsillectomy: Protocol using dexmedetomidine and bupivicaine as adjunct agents.

Pediatric tonsillectomy is a common procedure now being performed most often for patients with obstructive sleep apnea, which has been associated with increased sensitivity to the respiratory side effects of opioid medications. This study investigates a strategy to decrease the use of opiate medications in a particularly vulnerable population. Describe an interdisciplinary approach between Otolaryngologists and Anesthesiologists to decrease opiate use in tonsillectomy patients. Demonstrate safety of this protocol. Evaluate the effect of the protocol on intraoperative need for opiate medications and inhaled anesthetic use. Perform cost analysis of the protocol. Retrospective case-control study with cost analysis. Tertiary Care Hospital. Pediatric patients undergoing tonsillectomy at a tertiary care hospital. Preoperative and intraoperative dexmedetomidine with local bupivacaine injection into the tonsillar fossa. Intraoperative need for sevoflurane, opiate, and propofol. Post-operative pain scores, and utilization of post-operative opiate, acetaminophen, and ibuprofen pain medications. Post-operative adverse events. Cost analysis of protocol. This protocol led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum post-operative pain score without any increase in adverse events. The protocol added a small increase in medication cost of $4.07 to each procedure. The use of dexmedetomidine and local anesthetic in pediatric tonsillectomy is a safe and effective protocol that allows for the reduction of opiate use and improved post-operative pain control. Question: Can the combination of dexmedetomidine and infiltration of local anesthetic reduce overall opioid use for peediatric patients undergoing tonsillectomy? In this case-control study, use of dexmedetomidine and local anesthetic injected into the tonsillar fossa led to a decrease in intraoperative opiate use by 49.6%, a decrease in intraoperative sevofluorane use by 18%, and a lower reported maximum pain score without an increase in adverse events. Meaning: Use of dexmedetomidine and local anesthetic as anesthetic adjuncts may help reduce need for intraoperative opiates and decrease the use of volatile anesthetic agents in pediatric tonsillectomy patients, which are undesirable medications in the pediatric population for their respective respiratory depression and potentially neurotoxic side effects.

Abstract: A Randomized Placebo-Controlled Double Blind Study of Intercostal Nerve Block Versus Incisional Infiltration with Bupivacaine for Postoperative Pain Control after Subpectoral Breast Augmentation

INTRODUCTION: Breast augmentation is among the most popular surgery procedures performed in the Asian countries. Adequate pain control can have a substantial impact on morbidity and patient satisfaction. To date, no standard of care exists and management is based on surgeon preferences. The purpose of our study is to examine the role of intercostal nerve block and local bupivacaine injection in pain management following subpectoral breast augmentation. METHODS: This study was a prospective, randomized, placebo controlled double blind clinical trial with ethical approval. Thirty-two consecutive women undergoing subpectoral breast augmentation were enrolled. Patient received general anesthesia and were allocated randomly to two study groups. Patient in group 1 received intercostal nerve block using 10 ml of 0.25% bupivacaine with epinephrine in one side of the breast and normal saline in another side prior to implant placement. Patient in group2 received locally administered of 20 ml of 0.25% bupivacaine with epinephrine at the surgical site in one side of breast and placebo infiltration of normal saline in the contralateral breast. Both the patient and evaluator were blinded to the side given anesthesia and method of anesthesia used. Primary outcome was pain measured with the visual analogue scale recorded at 2, 6, 12, 24 and 48 hours at rest and after movement. Pain score was compared between breasts (anesthesia vs placebo) and between types of anesthesia. By comparing analgesic outcomes in the same patients, we could control for the subjectivity of pain assessments. A p-value of < 0.05 was considered statistically significant. RESULTS: Postoperative pain gradually decreased with time in all patients. No difference in pain scores was found over time at rest or on movement when comparing Intercostal nerve block to placebo or local infiltration to placebo. There was also no statistically significant difference in pain between intercostal nerve block and local infiltration of bupivacaine. All patients can return to normal activities within 48 hours after surgery. CONCLUSION: Our study did not demonstrate any statistically significant difference in postoperative pain when comparing those receiving intercostal nerve block versus placebo and those receiving local administered bupivacaine versus placebo. No beneficial effect of reducing postoperative pain demonstrated regardless of the type of local anesthetic used.

Effectiveness of Bupivacaine after Rubber Band Ligation of Hemorrhoids for Post Procedure Pain

Introduction: Pain is the most common complication of rubber band ligation (RBL) of hemorrhoids when compared to other non-operative techniques to treat hemorrhoids. Local anesthetic injection has been used in a few studies to reduce pain after RBL but its routine use is still not established. We evaluated the effectiveness of local injection of bupivacaine after RBL of hemorrhoids to reduce pain after the procedure.Objective: To compare the mean pain scores by visual analogue scale with and without local injection of bupivacaine after RBL of 1st and 2nd degree hemorrhoids. Design: Randomized controlled trial. Material and Methods: Study was conducted in Surgical unit 1, Civil Hospital, Karachi, for a period of 2 months, from Aug 17, 2016 to Oct 17, 2016. 60 patients having first and second degree hemorrhoids were included in the study from OPD by non-probability consecutive sampling. They were randomized to either to receive local injection of bupivacaine or no injection after RBL of hemorrhoids by closed envelop method. Pain score at 2 hours after the procedure was the main outcome measured.Results: Our study showed that there was a significant reduction in the pain at 2 hours after RBL of hemorrhoids with the use of local bupivacaine injection, mean pain scores 3.30 ± 1.055 when compared to 3.93 ± 0.944 in patients without administration of bupivacaine with p-value = 0.017.Conclusion: Our study concluded that local bupivacaine injection may be used routinely after RBL of hemorrhoids to reduce pain after the procedure.

Local Injection of Bupivacaine Hydrochloride to Reduce Postoperative Pain in Obstetrical and Gynaecological Surgical Incision

Background and objectives: The post-operative pain experienced by patients after abdominal surgery is significant and this has necessitated studying the efficacy of local injection of Bupivacaine to decrease severity of this pain. Patients and methods: A prospective, randomized, comparative clinical trial was conducted on 800 women admitted to Maternity Hospital, Erbil, Iraq, for either Caesarean section or any gynaecological abdominal surgery. All were classified as American Society of Anesthesiologists (ASA) physical status I-II. The sample was divided in two groups by systematic random sampling (400 each). Group A was designed to receive 25 mg of Bupivacaine hydrochloride as infiltration at the site of the incision after skin closure and Group B was treated with standard of care. The degree of pain was assessed after 6, 12, 24, 48,72 and 96 h from the operation by using defense and veterans pain rating scale (0-10). The amount and type of systemic painkiller medicine used during the operation day and the first three post-operative days were recorded. Patient satisfaction, time of first mobilization, h of confinement to bed per day and complication rates were compared in both groups. Chi-square (χ2) test and Fisher’s exact test Student’s t-test was used in data analyses. p value of ≤ 0.05 was considered statistically significant and p value of ≤ 0.01 was considered highly significant. Results: The group treated with post-operative wound infiltration with bupivacaine hydrochloride had lower pain score (p>0.001), earlier mobilization (p<0.001), fewer h of confinement to bed (p<0.001), better patient satisfaction (p<0.001), lower consumption of painkiller medicine (p<0.05, but no significant difference in complication rates (p=0.158). Conclusion: Instillation of Bupivacaine hydrochloride into the surgical incision is a safe, well-tolerated treatment and it is superior to traditional systemic pain medication in both self-reported and clinical outcomes.

Port site infiltration of local anesthetic after laparoendoscopic single site surgery for benign adnexal disease.

ObjectiveTo determine whether local bupivacaine injection into the incision site after gynecologic laparoendoscopic single site surgery (LESS) improves postoperative pain.MethodsThis prospective cohort study included consecutive 158 patients who had LESS for benign adnexal disease from March 2013 to December 2015. Chronologically, 82 patients (March 2013 to August 2014) received no bupivacaine (group 1) and 76 (August 2014 to December 2015) received a bupivacaine block (group 2). For group 2, 10 mL 0.25% bupivacaine was injected into the 20 mm-incision site through all preperitoneal layers after LESS completion. Primary outcome is postoperative pain score using the visual analog scale (VAS).ResultsThere was no difference in clinicopathological characteristics between the groups. Operating time (expressed as median [range], 92 [55–222] vs. 100 [50–185] minutes, P=0.137) and estimated blood loss (50 [30–1,500] vs. 125 [30–1,000] mL, P=0.482) were similar between the groups. Post-surgical VAS pain scores after 3 hours (3.5 [2–6] vs. 3.5 [2–5], P=0.478), 6 to 8 hours (3.5 [2–6] vs. 3 [1–8], P=0.478), and 16 to 24 hours (3 [2–4] vs. 3 [1–7], P=0.664) did not differ between groups.ConclusionBupivacaine injection into the trocar site did not improve postoperative pain after LESS. Randomized trials are needed to evaluate the benefits of local bupivacaine anesthetic for postoperative pain reduction.

The role of local injection of Bupivacaine in the management of pain after tonsillectomy surgery

Pain relief after tonsillectomy is an important part of post-operative management. There are some common drugs and local anesthetics such as bupivacaine used to treat postoperative pain. This research was aimed to assess the role of local injection of bupivacaine in the management of pain after tonsilectomy surgery 96patients aged 5–12 were included in a double-blind clinical trial prospective study. Patients in treatment group received an injection 3cc of 0.5% bupivacaine solution in side and upper peritonsillar areas, and patients in group B were injected 3cc of normal saline in the same area. Patients were asked to Visual Analog Score, After tracheal extubation, 1st, 2th, 4th, 8th,12th, and 24th hours after operation. The first request for analgesic and the total amount of analgesic consumption was also recorded. Regarding to Visual Analog Score over a 24-h period, there was a significant difference between two groups (p&lt;0.05). Also demand for analgesic in 24 hours after surgery was significantly less in treatment group than in placebo (p&lt;0.001). preoperative local 0.5% bupivacaine injection in tonsillectomy patients was effective relieves the post-tonsillectomy pain and significantly reduces opioid consumption in kids.

Pain control of thoracoscopic major pulmonary resection: is pre-emptive local bupivacaine injection able to replace the intravenous patient controlled analgesia?

The aim of this open-label, non-inferiority trial was to evaluate whether pre-emptive local bupivacaine injection (PLBI) can replace intravenous patient controlled analgesia (IV PCA) in video-assisted thoracic surgery (VATS) major pulmonary resection. A total of 86 patients scheduled for VATS segmentectomy/lobectomy were randomly assigned into two groups. The PLBI group (n=42) received 0.5% bupivacaine wound infiltration before skin incision, and the IV PCA group (n=44) received a continuous infusion of fentanyl with a basal rate of 10 µg/mL/h. Visual analogue scale (VAS; range, 0-10) was measured as the primary endpoint. The secondary endpoint was an additional use of analgesics and drug induced side effects. Both groups showed no difference in terms of age, sex, disease entity, operation time, chest tube indwelling time, and hospital stay. Serial pain scores between the PLBI and IV PCA groups demonstrated no statistical differences (non-inferiority margin; ΔVAS =1.0) (Recovery room: 8.3±2.1 vs. 8.5±1.7; Day 0: 5.1±1.6 vs. 5.2±1.4; Day 1: 3.5±1.6 vs. 3.3±1.2; Day 2: 2.7±1.3 vs. 2.5±1.2; Day 3: 2.3±1.3 vs. 2.1±1.5; 1 week after discharge: 3.0±1.7 vs. 2.8±1.5; 1 month: 1.9±1.2 vs. 2.3±1.4 and 2 months: 1.5±1.2 vs. 1.3±1.2; 95% confidential interval (CI) of ΔVAS <1.0; P>0.05). The mean one-additional usage of IV analgesics was needed in the PLBI group (3.3±2.1 vs. 2.3±1.3; P=0.03). The occurrence of nausea/vomiting was higher in the IV PCA group (12.5% vs. 38.9%; P=0.026) and 41.7% of IV PCA patients experienced drug side effects that required IV PCA removal within postoperative day (POD) 1. PLBI is a simple, safe, effective, and economical method, which is not inferior to IV PCA in VATS major pulmonary resection.

Effects of Oral Gabapentin, Local Bupivacaine and Intravenous Pethidine on Post Tonsillectomy Pain.

Tonsillectomy is one of the most common surgeries performed worldwide. Post-operative pain arising from tonsillectomy is one of the earliest complications that can postpone oral nutrition and increase the hospitalization period. Administration of opioids via injection is usually preferred to relieve pain in these patients. However, the side effects of this approach prompted us to seek alternative treatments. In this study, the effectiveness of oral gabapentin is compared with an intravenous (IV) injection of pethidine and a local injection of bupivacaine in the control of pain after tonsillectomy. This clinical trial was performed on 7-15 year-old patients who were candidates for tonsillectomy at Shahrekord Kashani hospital from 2012-2013. The patients were divided into three groups at random. Group 1 was give 20 mg/kg oral gabapentin 1 hour before anesthesia. In Group 2, 2.5 ml bupivacaine 0.25% was injected into each tonsil bed by a surgeon. In Group 3,1 mg/kg pethidine was injected intravenously after intubation. To assess post-operative pain, the Oucher scale was used in recovery as well as 3,6,12, and 24 hours after surgery. The pain score was lowest in the gabapentin group and highest in the bupivacaine group during the study. The pain score in the gabapentin group was significantly lower than that in the bupivacaine group (P<0.05). No statistically significant difference was found between the pain score of the Pethidine group and that of the Bupivacaine group (P>0.05). Gabapentin, with its antihyperalgesic properties and other unknown properties, is a convenient drug for controlling pain following tonsillectomy.

Does bupivacaine in laparoscopic ports reduce postsurgery pain in tubal ligation by electrocoagulation? A randomized controlled trial

BackgroundTubal ligation (TL) is the most popular method of permanent contraception. In order to reduce postoperative pain, different analgesic techniques have been proposed. The objective of this study was to compare the level of postoperative pain in patients submitted to TL with electrocoagulation, under general anesthesia, using bupivacaine infiltration vs. placebo in trocar ports. Study DesignConsecutive patients scheduled for laparoscopic TL were randomized by sequenced coded envelopes to receive bupivacaine 0.5% (n=29) or placebo (n=24). Pain was blindly assessed at 15 min, 30 min, 120 min and 14 h postoperatively, by verbal analogue scale (VAS). Standard pain medications (morphine, dipyrone and sodium diclofenac) were prescribed for the subjects and compared between groups. ResultsNo difference in pain assessment was found between bupivacaine and placebo groups at all times [median (25–75 quartiles)] (all p>.05): 15 min: 3 (1–6.3) vs. 4 (0–7); 30 min: 1.5 (0–4.3) vs. 2 (0–5); 2 h: 0 (0–0.5) vs. 0 (0–1); 14 h: 1 (0–4) vs. 0 (0–4); and for use of analgesics: dipyrone (g): 1 (0–1) vs. 1 (0–1); morphine (mg): 3 (0–3) vs. 3 (0–3.5); sodium diclofenac (mg): 0 (0–50) vs. 0 (0–50). ConclusionThe use of local injection of bupivacaine 0.5% in the trocar ports was not superior to placebo to reduce pain after laparoscopic TL with electrocoagulation under general anesthesia.

Reduced Blood Loss After Total Knee Arthroplasty with Local Injection of Bupivacaine and Epinephrine

Our goal was to determine by direct measurement of drain output whether intraoperative injection of bupivacaine with epinephrine significantly reduces postoperative blood loss in total knee arthroplasty (TKA). The study and control groups were primary TKAs performed by 1 surgeon using a single-cemented TKA design and a consistent postoperative protocol. The study group comprised 37 sequential TKAs injected intraoperatively with bupivacaine and epinephrine (one-third pericapsular, two-thirds peri-incisional). The control group included 71 sequential TKAs. The study group had 32% (95% confidence interval, 11%-48%), or 195 mL, less drain output (P = .006). There were no statistically significant differences in the transfusion rate or bleeding indices. Control and study groups were comparable regarding tourniquet times, intraoperative soft-tissue releases, preoperative anticoagulant use, and overall postoperative complications. Our study demonstrated a statistically significant decrease in TKA postoperative drain output with intraoperative injection of bupivacaine with epinephrine.

Femoral Nerve Blockade as a Preemptive Anesthetic in Patients Undergoing Anterior Cruciate Ligament Reconstruction

Background Femoral nerve blockade has been purported to be an effective regional anesthetic in patients undergoing various procedures to lower extremities. Hypothesis Femoral nerve blockade will provide improved postoperative pain control over a local anesthetic in the knee joint alone in patients undergoing endoscopic patellar tendon anterior cruciate ligament reconstruction. Study Design Randomized, controlled trial; Level of evidence, 1. Methods Fifty-six adult patients undergoing an endoscopic patellar tendon anterior cruciate ligament reconstruction under general anesthesia were prospectively randomized to receive either a bupivacaine femoral nerve blockade (block) or a saline placebo injection (control). Both groups received local bupivacaine injection and intravenous ketorolac at wound closure. Outcomes included postoperative pain measured on a validated visual analog scale at postoperative intervals for 72 hours, intraoperative and postoperative narcotic consumption, admission rates, hospital charges, patient satisfaction, and complications related to the femoral nerve block. Results There were 31 block patients and 25 control patients. No significant differences between groups for postoperative pain scores, intraoperative or postoperative narcotic consumption, readiness for discharge, duration of hospitalization, admission rates, hospital charges, or patient satisfaction were observed. There were no complications related to the femoral nerve block. Conclusion A preemptive femoral nerve blockade, although safe, does not provide significant clinical benefit in this patient population to justify its routine use.

Effect of Bupivacaine application on cholinesterase activities, total protein- and albumin concentration in serum and cerebrospinal fluid

The rationale of this study was to determine whether Bupivacaine used for spinal anesthesia alters the specific secretory activity of nerve cells and/or the function of the blood/cerebrospinal fluid barrier. Four groups were assessed: (1) patients undergoing spinal anesthesia using Bupivacaine for lower limb surgery, (2) spinal Bupivacaine anesthesia without subsequent surgery, (3) local facet joint infiltration using Bupivacaine, and (4) general anesthesia for lower limb surgery without Bupivacaine application. Cholinesterase activities, total protein- and albumin concentrations in serum as well as in cerebrospinal fluid were significantly decreased after surgical intervention under spinal Bupivacaine anesthesia but remained unchanged following spinal Bupivacaine application without surgery. No significant correlation was found between Bupivacaine dosage and parameter alteration. There was no influence of intrathecal Bupivacaine application on the albumin ratio cerebrospinal fluid/serum, nor was there any significant alteration of total protein- or albumin concentrations and butyrylcholinesterase activity in the serum as a result of local injection of Bupivacaine to facet joints. These serum parameters were reduced after surgery under general anesthesia. Alterations of serum- and cerebrospinal fluid parameters investigated after surgery are not related to Bupivacaine application but to effects linked to operative treatment, i.e. suppressed secretory cell activity or protein depletion owing to blood loss. We conclude that the secretory function of cholinesterase-releasing nerve cells is not affected by spinal application of Bupivacaine. The blood/cerebrospinal fluid barrier remains intact.

Time course of the regenerative response in bupivacaine injured orbicularis oculi muscle.

Local anesthetics, particularly bupivacaine, are known to be myotoxic to skeletal muscle. Injury is followed by satellite cell mediated regeneration. The eyelid is a common site for the injection of local anesthetics. Due to the complex anatomy of this region and the unique properties of facial musculature compared to limb skeletal muscle, the response of the orbicularis oculi to local injection of bupivacaine was examined to determine the time course of maximum satellite cell activation and division. The lower eyelids of rabbits were injected with two doses of a combination of bupivacaine and hyaluronidase, spaced 18 h apart. To assess the time course of satellite cell division, bromodeoxyuridine (BrdU) was injected immediately or, 1, 2, 3, 6 or 13 days after the second bupivacaine injury. The rabbits were sacrificed 24 h later. The eyelids were prepared for immunohistological examination and morphometric analysis of the presence of CD11-positive monocytes, neutrophils and macrophages, MyoD expression in satellite cells and/or myoblasts, and co-expression of BrdU and the developmental myosin heavy chain isoform. One day after bupivacaine injury of the orbicularis oculi, there was a large influx of CD11-positive cells which gradually decreased over time. Maximum activation of satellite cells, as defined by MyoD expression, occurred 2 and 3 days after the injury. Using double labeling techniques, the peak of BrdU incorporation occurred on day 3 and was identified in developmental myosin co-labeled cells 4 days after injury. The peak of satellite cell activation and division occurred 3 days after bupivacaine induced injury, as demonstrated by both MyoD expression and after pulse labeling with BrdU as identified in double labeled cells positive for BrdU and the developmental myosin heavy chain isoform. The process of regeneration in this muscle extended beyond the duration of this study. Muscle fibers remained small in cross-sectional area and positive for developmental myosin 2 weeks after injury, at a time when the fiber number had reached control, uninjured levels.

Shoulder complaints in patients with reflex sympathetic dystrophy of the upper extremity

Five hundred forty-one patients with reflex sympathetic dystrophy (RSD) of the upper extremity were prospectively studied. One hundred fifteen patients complained of pain and/or limited range of motion in the shoulder. Shoulder complaints more often occurred in women ( p = .01); age and etiology were not different from patients with RSD without shoulder complaints. Physical examination showed a tendinitis of one or both tendons of the biceps muscle in 109 patients. Seventy one patients were treated with local injection of bupivacaine followed by methylprednisolone. This resulted in permanent relief of complaints in 34 patients, temporary or moderate relief in 31, no difference in 3, increase of complaints in 1 patient, and in 2 patients results were not documented. We conclude that shoulder complaints in RSD occur in a minority of patients and more often in female patients. There are no predisposing factors. The pathophysiologic mechanism for developing shoulder complaints remains unknown. In most cases complaints can be attributed to a bicipital tendinitis for which local injection of bupivacaine followed by prednisolone are both diagnostic and therapeutic.