Pinprick Method Research Articles

Correction: Do We Need Cephalic Spread of Spinal Anaesthesia for Caesarean Section? A Different Approach to CSE-EVE for Reducing Hypotension.

Spinal anaesthesia is the most preferred anaesthetic technique for elective as well as for unplanned Caesarean sections. Spinal-induced hypotension remains the most important side effect with a reported incidence between 20% and 100%. It can cause -maternal discomfort (nausea and vomiting) and impaired utero-placental perfusion. The present study was designed to examine the influence of epidural volume effect on the spread and duration of low-dose hyperbaric levobupivacaine. The aim of this study was to evaluate the influence of epidural restriction (injection of saline) on the distribution of anaesthesia as well as the incidence of hypotension during the spinal anaesthesia.After the approval by the ethics committee, 60 full-term parturient women (ASA I or II) with uncomplicated pregnancies were prospectively randomized into 2 groups: the SA group (single shot spinal anaesthesia) included 37 patients and the CSE-EVR group (combined spinal-epidural anaesthesia) included 39 patients in whom we induced the restriction of the spinal space by epidural volume compression. The blocks were performed at the L2/3 or L3/4 level in a sitting position, in the CSE-EVR group using the needle-through-needle technique. The initial dose for CSE-EVR was exactly half of the SA dose (0.5 mg per 10 cm height of hyperbaric levobupivacaine and 20 microg fentanyl). After spinal injection, an epidural catheter was located in the CSE-EVR and a volume of 20 mL saline solution injected. After injection, the women were turned supine with a left uterine displacement. Surgery was allowed when a sensory block at or above the T8 dermatome was established. We evaluated the height of the block by the pinprick method and the motor block by the Bromage scale, 10 min after spinal injection, during the operation time and at the end of surgery. Haemodynamic monitoring (NIBP, HR) was assessed every 2 min until the childbirth, then every 5 min during operative time. Anaesthetic efficacy was evaluated for breakthrough pain by visual analogue pain score (VAPS), Apgar score at birth, umbilical artery pH, and epinephrine consumption.The level of anaesthesia 10 min after the induction was significantly higher in the spinal group (SA) than in the CSE-EVR T5 (T4-T7) vs. T7 (T6-T8) group.The SA group experienced complete motor block during the time of anaesthesia, while the CSE-EVR group demonstrated significantly faster motor recovery. The incidence of hypotension and ephedrine supplementation was significantly lower in the CSE-EVR group (19 vs. 35 patients) than in the SA group (p<0.05).The neonatal outcome and umbilical artery pH were higher in the CSE-EVR group. Both groups were comparable in demographic data, VAS scores, preloading and infusion volume, atropine or ephedrine use, and adverse effects such as nausea or skin pruritus.We demonstrated a possible restriction of the spread of spinal anaesthesia by using epidural volume restriction with 20 mL saline as part of a combined spinal epidural technique. The study shows that CSE with EVR using only 50% of the levobupivacaine dose provided adequate anaesthesia for elective Caesarean delivery, as well as better maternal haemodynamic stability.

Can repeated scorpion bite lead to development of resistance to the effect of local anesthetics? Maybe it does!

An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.

Effect of previous scorpion bite(s) on the action of intrathecal bupivacaine: A case control study

Background:During the routine practice in the institution, it was observed that there were persistent incidents of inadequate/failed spinal anaesthesia in patients with a history of single or multiple scorpion bite/s. To test any possible correlation between scorpion bite and the altered response to spinal anaesthesia, a case control study was conducted involving patients with a history of scorpion bite/s and without such a history.Methods:Randomly selected 70 (n=70) patients of either sex and age range of 18-80 years, were divided into two equal groups, giving past history of one or multiple scorpion bites and giving no such a history. The anaesthetic management was identical inclusive of subarachnoid block with 3.5 ml. 0.5% bupivacaine heavy. The onsets of sensory, motor and peaks of sensory and motor blocks were observed with the pin-prick method and Bromage scale. After waiting for 20 min, if the block was inadequate, then balanced general anaesthesia was administered. The analysis of the data and application of various statistical tests was carried out using Chi-square test, percentages, independent sample t-test and paired t-test.Results:Demographically both groups were comparable. In scorpion bite group, the time of onsets of both sensory and motor blocks and time for the peak of sensory and motor blocks were significantly prolonged, 4 patients had failed/inadequate sensory block and 5 patients had failed/inadequate motor block while all the patients in non-bite group had adequate intra-operative block.Conclusion:We conclude that there appears to be a direct correlation between the histories of old, single or multiple scorpion bites and development of resistance to effect of local anaesthetics administered intra-thecally.

Standardizing resistance screening to Pseudomonas fuscovaginae and evaluation of rice germplasm at seedling and adult plant growth stages

Sheath lesions, grain sterility and grain discolouration of rice caused by Pseudomonas fuscovaginae can cause yield losses of up to 100 %. The most sustainable method of managing this disease is the use of host plant resistance. To identify sources of resistance an inoculation method that is practical, rapid and reliable is needed. We compare three different inoculation methods. Results showed that the pin-prick method is appropriate for identifying sources of resistance to P. fuscovaginae, while the spray method could be useful for mass screening of rice genotypes. The seed-soaking method was also evaluated and has showed potential in detection of early disease resistance. A total of 16 Multiparent Advanced Generation Inter-Crosses and 20 OryzaSNP set varieties from the International Rice Research Institute were evaluated using the pin-prick and seed-soaking methods. All growth stages were susceptible to the pathogen and the 107 cfu mL−1 inoculum concentration was optimal for discriminating between resistant and susceptible genotypes. For the pin-prick method, a single point assessment of disease severity at 14 days post-inoculation could be used instead of the AUDPC values to classify genotypes. An index of reduction in seedling height 10 days after seed soaking was established for the classification of the genotypes reaction to the disease. Resistant varieties identified using both the pin-prick and seed-soaking methods could be verified for use in disease resistance breeding programs. Of the 36 genotypes evaluated 22 were found to be resistant at the late booting or early panicle exsertion stage by pin-prick method, while 25 were resistant at the seed to germination stage. No correlation was found between the resistance classification of varieties between the two inoculation methods, indicating that there could be different mechanisms of resistance to P. fuscovaginae in rice.

First Report on Association of Colletotrichum coccodes with Chili Anthracnose in India.

Chili (Capsicum annuum L.) is an important condiment and cash crop grown throughout India, including Andhra Pradesh, Karnataka, Maharashtra, Punjab, Tamilnadu, and Himachal Pradesh. In Himachal Pradesh (HP), a northwestern Himalayan state of India, chilies including sweet pepper occupy an area of 2,447 ha with total production of approximately 31,810 t and productivity of 13.00 t per hectare. In 2007 and 2008, chili- and sweet pepper-growing areas of HP were surveyed for the prevalence of fruit rot/anthracnose disease caused by a complex of Colletotrichum species. Fields infested with disease were randomly sampled and four samples from each location were collected. Disease incidence ranged from 12.5 to 45.0% based on total plants assessed in the field. Symptoms of disease in the field included light brown, sunken lesions containing salmon-colored masses of conidia and microsclerotia on the fruit. Microscopic examination of the diseased samples revealed a variation in morphology of spores from two isolates (Cc 70 and Cc 74) collected from two locations in HP, the Kotkhai area of district Shimla and Shamsher (Ani) locality of district Kullu. Five fruits and ten leaves from five plants of a susceptible local variety were inoculated with a suspension of 5 × 105 conidia/ml of isolates Cc70 and Cc74 using a pin prick method as described by Montri et al. (2). The inoculated fruits and leaves were kept in humid chambers at 25 ± 1°C with 12 h of light. After 48 h, the fruits and leaves were observed daily for the appearance of disease symptoms. Disease symptoms were similar to those of natural infections but with darker lesions. The fungus was recovered from infected fruit on Mathur's medium (glucose 2.80 g, peptone 2.00 g, magnesium sulfate hydrated 1.72 g, potassium dihydrogen orthophosphate 1.23 g, and agar 1.50 g/liter) and initially produced white-to-gray mycelia that became dark brown with age. Setae were present along with production of microsclerotia by the tenth day of culturing. A daily average growth of 8.1 mm was recorded on potato dextrose agar at 25 ± 1°C. Conidia were hyaline, unicellular, aseptate, and fusiform abruptly tapering to each end, and 15.5 to 19.6 μm long and 4.2 to 5.3 μm wide. The fungus was identified as Colletotrichum coccodes based on morphological and cultural traits as per the descriptions of Junior et al. (1). The identity of the isolates was confirmed by amplifying the internal transcribed spacer (ITS) region using primer pair ITS1 and ITS4 (3). The sequences (550 bp) were subjected to a BLAST search with the isolates showing the highest identity to GenBank Accession Nos. GU935878 and EF017205. The sequences have been submitted to GenBank (Accession Nos. HQ264175 and HQ264176). Very few reports exist about the natural occurrence of C. coccodes on Capsicum spp. around the world. To our knowledge, this current report constitutes the first record of this pathogen on Capsicum spp. from the Indian subcontinent.

Bier′s block using lignocaine and butorphanol

Background:Opioids are most commonly used as adjuncts in intravenous regional anesthesia (IVRA) to improve the quality of intraoperative and postoperative analgesia. There is paucity of literature on the use of butorphanol in IVRA.Aims:The aim of this study was to evaluate the likely benefits of addition of butorphanol to lignocaine in Bier's block in terms of onset and duration of sensory block and also for analgesic requirement in postoperative period.Settings and Design:A randomized double blind study was conducted at Tertiary Care Educational Institute.Patients and Methods:A total of 40 adult ASA I or II patients scheduled to undergo upper limb surgery were randomized in two groups (n=20). Group I received 3 mg/kg of lignocaine alone and group II received 1 mg butorphanol in addition to 3 mg/kg lignocaine. Sensory block onset time and time to recovery from sensory block after tourniquet deflation were noted using the pin prick method. Duration of postoperative analgesia was noted using a visual analogue scale. All the patients were compared for the time to first rescue analgesic consumption and total analgesic consumption in first 24 hours postoperatively.Statistical Analysis Used:The statistical analysis was done using unpaired Student's t-test.Results:Our study showed significant prolongation of postoperative analgesia in group II as noted by the time to first analgesic requirement. Total analgesic consumption in first 24 hours postoperatively was less in group II. Sensory block onset time and time to recovery from sensory block after tourniquet deflation, did not show any significant difference between the two groups.Conclusions:Addition of butorphanol to lignocaine in IVRA significantly prolongs the duration of postoperative analgesia and 24 hours analgesic consumption is less in patients receiving butorphanol along with lignocaine in IVRA. However, there is no effect on sensory block onset time and time to recovery from sensory block.

Anti-hyperalgesic effect of Mangifera indica L. extract on the sciatic chronic constriction injury model in rats

Context: The aqueous extract of Mangifera indica L. stem bark (MSBE) shows antioxidant, anti-inflammatory and analgesic properties. Aims: To test the MSBE in chronic constriction injury (CCI) of the sciatic nerve in rats, a classical model of neuropathic pain. Methods: Given the possibility that some clinical effect of MSBE can appear only after its chronic administration, we designed a long term medication protocol with 500 mg/kg, p.o. or distilled water daily during 8 days from 9 days post-CCI. Pregabalin (10 mg/kg, p.o.) was used as reference drug. Sham CCI animals received vehicle. Behavioral tests were carried out before CCI, at 9 and 16 days after injury. A section of sciatic nerve, 5 mm distal to the ligature site was dissected for histopathological studies. A single oral similar dose or vehicle was administered to mononeuropathic rats, 14 days after surgery. Mechano-hyperalgesia and thermal hyperalgesia of the ipsilateral paw were determined using a modification of pin prick method and the unilateral hot plate, respectively before CCI, 0, 30, 60, 120 and 180 min post-administration. Results: Repeated oral MSBE doses reduced nociceptive score, increased paw withdrawal latency and attenuated CCI-induced Wallerian degeneration-related changes involved in the hyperalgesic state of CCI rats. Likewise, MSBE shows significant mechanical and thermal anti-hyperalgesic effect from 1h after its single administration. Conclusions: The study of MSBE should be focused in neuropathic pain models since this natural product could have a clinical relevance in the treatment of neuropathic pain syndromes.

Femorosciatic nerve block for lower limb orthopedic surgeries

Abstract Femorosciatic block is an important peripheral nerve block that can be used in surgeries of lower limb. The present study was conducted to evaluate the efficacy of femorosciatic nerve block via posterior approach for lower limb orthopedic surgeries. A total of 40 ASA grade I or II patients were taken for this prospective double-blind study. Various orthopedic surgeries were selected and femoro-sciatic blocks were made. Adequate amount of drug was injected, and effect was evaluated via pin-prick method. The extent of sensory blockade of both nerves, success rate, and intensity of pain were measured. The success of block was observed in 90% patients, and only 4 patients required supplementation of analgesia or general anesthesia. Femorosciatic blockade is an effective and safe technique for lower limbs orthopedic surgeries.

A clinical study comparing epinephrine 200μg or clonidine 90μg as adjuvants to local anaesthetic agent in brachial plexus block via supraclavicular approach

A double blind randomized prospective study was undertaken to determine the effect of adjuncts like epinephrine 200μg or clonidine 90μg in combination of bupivacaine and lignocaine into the brachial plexus sheath to study the sensory and motor onset, duration of analgesia, hemodynamic changes and adverse effects. PATIENTS #ENTITYSTARTX00026; 60 patients aged 18-65 years, with ASA grade I and II were randomly divided into group I and group II to receive 10 ml of lignocaine2% and 20 ml of bupivacaine0.5% with 1ml of 200μg epinephrine or 90μg clonidine respectively. Onset of sensory blockade was determined by pinprick method by a three point score and motor blockade by three point scale. Duration of postoperative analgesia, the hemodynamic changes, sedation scores and any adverse effects were observed. Statistical analysis was done by student's "t" test and p<0.05 was considered significant. It was found that there was faster onset of sensory and motor blockade, the postoperative analgesia was prolonged and the amount of sedation was profound in group II as compared to group I. All the above findings were statistically significant. We thereby conclude that clonidine 90μg is a better option as an additive than epinephrine 200μg for hastening the onset of sensory and motor block with prolonged postoperative analgesia and sedation as the only adverse effect.

The influence of epidural volume extension on spinal block with hyperbaric or plain bupivacaine for Caesarean delivery

Epidural volume extension via a combined spinal-epidural is the enhancement of a small-dose intrathecal block by an epidural injection of physiological saline solution. We evaluated the effect of epidural volume extension on the combined spinal-epidural technique of providing spinal anaesthesia for Caesarean section with hyperbaric or plain 0.5% bupivacaine. Patients (n = 240) with height >163 cm received 9 mg and patients <163 cm received 8 mg of bupivacaine. Each study drug was combined with 20 mug fentanyl. Using the combined spinal-epidural technique, Group A (n = 60) received hyperbaric bupivacaine, and Group B (n = 60) received hyperbaric bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. Group C (n = 60) received plain bupivacaine and Group D (n = 60) received plain bupivacaine and 10 mL saline epidurally 5 min after subarachnoid injection. An anaesthetist blinded to the anaesthetic solution injected examined the level of analgesia by the pinprick method and motor block with the modified Bromage scale for 30 min after subarachnoid injection, during the intraoperative period and subsequently every 15 min for 135 min during the recovery period. Time to reach a sensory block at T4 was significantly shorter in Groups C and D than in Groups A (P = 0.003 and 0.017) and B (P = 0.006 and 0.048), respectively. During the intraoperative period, sensory block levels were significantly higher in Group C than in Group A. Recovery was similar in all groups; only onset was faster in Groups C and D. There was no effect of epidural volume extension on the profile of spinal anaesthesia with the combined spinal-epidural technique for Caesarean section using hyperbaric or plain bupivacaine.

A Comparison of Stimulation Patterns in Axillary Block: Part 2

Radial plus musculocutaneous nerve stimulation may have a predominant role in the success of an axillary block, producing more extensive anesthesia of the upper limb than median plus musculocutaneous nerve stimulation. However, no comparison has been made with ulnar plus musculocutaneous nerve stimulation. We compared the extent of both sensory and motor block after ulnar plus musculocutaneous nerve stimulation or radial plus musculocutaneous nerve stimulation. Sixty patients were randomly assigned to receive an axillary block using either radial plus musculocutaneous or ulnar plus musculocutaneous nerve stimulation with 40 mL plain 1.5% mepivacaine. Patients were assessed for sensory block by the pinprick method at 5 and 20 minutes. No statistically significant differences were found in the rates of anesthesia at 20 minutes in the cutaneous nerve distributions of the upper limb between radial plus musculocutaneous and ulnar plus musculocutaneous nerve stimulation except for the following nerves: radial (90% and 63.3%, respectively), medial cutaneous of the forearm (83.3% and 100%, respectively), and medial cutaneous of the arm (73.3% and 93.3%, respectively). Global sensory score (minimum: 0; maximum: 12 points) at 20 minutes was significantly higher after radial plus musculocutaneous than after ulnar plus musculocutaneous nerve stimulation: 12 (11-13) and 11 (10-12), respectively. The rates of median nerve blockade were 50% and 53%, respectively. Radial plus musculocutaneous nerve stimulation produced more extensive anesthesia of the upper limb than did ulnar plus musculocutaneous nerve stimulation. However, there is not an optimal combination of 2 responses in axillary brachial plexus block.

First report of Rhizoctonia solani causing blight on yam bean (Pachyrrhizus erosus) in India

Yam bean (Pachyrrhizus erosus) is a native of Mexico and Central America and is widely cultivated throughout the tropics, in both hemispheres. In India, it is popularly grown in parts of West Bengal, Bihar, Orissa and Assam. The plant has many uses: the young tubers are edible and rich in ascorbic acid, while mature tubers yield high-quality starch and the seeds can be used as insecticides (CSIR, 1966). Central Tuber Crops Research Institute, Kerala, maintains 63 germplasm accessions collected from different parts of India. From 2002 onwards, 80% of the yam bean accessions were found to be infected with severe blight spots on leaves, stems and pods. The symptoms first appeared as small, water-soaked lesions with a dark margin and grey centre on leaves. As the disease progressed, spots would expand and coalesce, resulting in severe leaf blight and wilt. Spots could also be seen on both pods and seeds. The pathogen was isolated from infected seeds onto potato dextrose agar medium. After 3 days’ incubation at room temperature(28 ± 2°C), abundant pale brown mycelium with small white sclerotia were evident. The hyphae became dark brown to black with age. Hyphae were superficial, short-celled and abundantly branched, measuring 6–9 µm in diameter. Lateral branches were constricted at their point of origin with a septum in the branch near its junction. Brown-to-black sclerotia were uniform in texture and highly variable in shape and size. Based on the morphological and cultural characters, the pathogen was identified as Rhizoctonia solani. Pathogenicity of the fungus was proved by inoculating healthy leaves with both fungal mycelium and sclerotia using a pin-prick method. Inoculated leaves were covered with a small piece of moist cotton. Moist cotton without inoculum served as a negative control. The fungus was successfully reisolated from leaves showing symptoms after 7 days at room temperature (28 ± 2°C), but not from the negative controls. A culture was deposited in Indian Type Culture Collection of the Indian Agricultural Research Institute (ITCC.5790.04). Although R. solani has been reported previously on various crops from India (Bilgrami & Jamaluddin Rizwi, 1991; Butler, 1997), and R. solani has been found affecting P. erosus in Hawaii (Raabe et al., 1981), this is the first report of R. solani on P. erosus in India. The authors would like to thank Dr Prameeladevi and Ms Nita Mathur, ITCC, Indian Agricultural Research Institute, New Delhi, India for their help in identification.

透析患者のシャント穿刺の痛みに対する局所麻酔法としてのリドカインのｉｏｎｔｏｐｈｏｒｅｓｉｓ投与の有用性の検討

We investigated the usefulness and effectiveness of iontophoresis (IP) for the delivery of lidocaine in local anesthesia during shunt puncture for patients undergoing dialysis since IP has not previously been used for this purpose. Initially, we determined the optimal dosing time and concentration of lidocaine in 14 healthy adults by the pin prick method, finding that the administration of a 1% lidocaine solution by IP for 15 min induced significant local anesthesia and the anesthetic effect was comparable to that achieved by Lidocaine tape (Penles®) for 120 min. These two methods of administering local anesthesia were also similar as regards adverse reactions. We then investigated the usefulness of IP for delivering the 1% lidocaine solution for 15 min in obtaining local anesthesia for shunt puncture in 14 patients undergoing dialysis. Again there was no marked difference in the local anesthesic effect between IP and Penles®. The incidence of adverse reactions, however, was significantly lower with IP than with Penles®, though there was no difference in the degree of patient satisfaction. These findings suggest that the administration of lidocaine via IP is superior to Penles® as a method of delivering lidocaine, and would be useful for patients undergoing dialysis who have forgotten to apply Penles® before dialysis sessions at a hospital and patients in whom the puncture site has to be changed due to dermal disorders.

A Comparison of Four Stimulation Patterns in Axillary Block

Insufficient spread of the local anesthetic toward the retroarterial region of the neurovascular space may be responsible for inconsistent anesthesia of the upper limb after single-injection axillary block. We hypothesized that injection of the local anesthetic on a single radial-nerve stimulation would produce the same extent of anesthesia as either a single median-nerve stimulation, a double-stimulation technique (radial and musculocutaneous nerves), or a triple-stimulation technique (radial, musculocutaneous, and median nerves). One hundred twenty patients were randomly assigned to receive an axillary block by either median-nerve, radial-nerve, radial-nerve plus musculocutaneous-nerve, or triple-nerve stimulation with 40 mL of plain 1.5% mepivacaine. Patients were assessed for sensory block by the pinprick method at 5 and 20 minutes. Radial-nerve stimulation produced more extensive anesthesia than did median-nerve stimulation. The rate of anesthesia at 20 minutes in the median-nerve cutaneous distribution was similar after median-nerve stimulation or radial-nerve stimulation. The ulnar nerve was more frequently blocked at 20 minutes after radial-nerve stimulation than after median-nerve stimulation. Extent of anesthesia at 20 minutes after radial-nerve plus musculocutaneous-nerve stimulation was similar to that produced by triple-nerve stimulation, except for lower rates of anesthesia that corresponded to the median nerve. All of the differences were statistically significant. Musculocutaneous-nerve stimulation and radial-nerve stimulation play predominant roles in the success of axillary brachial plexus block, although a triple-nerve stimulation technique is still required to produce complete anesthesia of the upper limb.

Comparison of 0.5%, 0.75% Ropivacaine and 0.5% Bupivacaine for Caudal Anesthesia

Background: Ropivacaine is a long acting, amide-type local anesthetic with a chemical structure similar to that of bupivacaine. In this study we investigated the efficacies of 18 ml of 0.5% bupivacaine, and of 0.5% and 0.75% ropivacaine to provide caudal anesthesia. Methods: Sixty ASA physical status 1 or 2 patients undergoing hemorrhoidectomy were randomly allocated to 3 parallel treatment groups to receive either 18 ml of 0.5% bupivacaine, or 0.5% or 0.75% ropivacaine. Caudal anesthesia was performed using the loss of resistance method via sacral hiatus. Soft touch testing around the anal sphincter muscle, the pin prick method at the S3 dermatome, onset time of loss of anal sphincter reflex, and sensory block were checked following local anesthetic injection. Duration of sensory block was assessed at 30 minute intervals through out block duration. Quality of muscle relaxation was assessed by the surgeon at the end of each operation. Blood pressures were measured and the incidences of nausea, vomiting and dizziness were recorded. Results: Significant differences were observed between the 0.5% ropivacaine and 0.75% ropivacaine groups (P

The Effects of an Epinephrine-containing Epidural Test Dose during Epidural Anesthesia on Ropivacaine

Background: Epinephrine-containing epidural test dose is used for obstetric epidural anesthesia to identify the unintentional cannulation of an epidural vessel. This study evaluated the effects of an epinephrine test dose during epidural anesthesia with 0.5% ropivacaine in ceasrean section. Methods: Seventy healthy pregnant women, scheduled for elective cesarean section were randomly assigned to one of two groups. A lumbar epidural catheter was placed and aspirated. If aspiration was positive for blood or cerebrospinal fluid, the catheter was replaced. All patients received an 3 ml test dose of either 1.5% lidocaine with epinephrine 5/ml (group E) or lidocaine only (group C). After test dose, 50 fentanyl and 20 ml of 0.5% ropivacaine were given to the all patients. Applying the pin prick method and a modified Bromage scoring system, senseory block level and motot block intensity were checked at 5 min intervals for the first hour following ropivacaine injection. After then, they were checked at 15 min intervals for the rest of the test period. Heart rate (HR) and blood pressure (BP) were measured as well. Results: No significant difference between the two groups was detected in HR, BP, the profile of sensory block, motor scores and the onset of motor block. However, group C showed significantly shorter span of motor block (102 31 min.) than group E (134 32 min.) (P

Epidural Morphine Delays the Onset of Tourniquet Pain During Epidural Lidocaine Anesthesia

We conducted a randomized, double-blinded study to examine the onset time of tourniquet pain during epidural lidocaine anesthesia either with or without morphine in the epidural solution. Forty-five patients undergoing knee surgery with a thigh tourniquet were randomly allocated into 3 groups of 15 patients each: epidural morphine (EM; epidural administration of 17 mL of 2% lidocaine plus 2 mg of morphine, followed by IV injection of 0.2 mL of normal saline), IV morphine (IVM; 17 mL of 2% lidocaine plus 0.2 mL of normal saline, followed by IVM 2 mg IV), and control (17 mL of 2% lidocaine plus 0.2 mL of normal saline, followed by 0.2 mL of normal saline IV). The onset time of tourniquet pain was recorded. The level of sensory block was determined by the pinprick method at the occurrence of tourniquet pain. Hemodynamic changes and side effects of EM were also recorded. The onset time of tourniquet pain from both the epidural injection and the tourniquet inflation were significantly longer in the EM group (103 ± 15 min and 80 ± 15 min, respectively) compared with the IVM group (74 ± 12 min and 50 ± 12 min, respectively;P < 0.05) and the Control group (67 ± 9 min and 45 ± 9 min, respectively;P < 0.05). The level of sensory block at the onset of tourniquet pain and hemodynamic changes were not different among the three groups. Only two and three patients in the EM group complained of nausea/vomiting and pruritus, respectively. Respiratory depression was not observed in any patient. We conclude that epidural injection of the mixture of 2 mg of morphine and 2% lidocaine solution delayed the onset of tourniquet pain during epidural lidocaine anesthesia without significant morphine-related side effects.

Levels of Stewart's Wilt Resistance Necessary to Prevent Reductions in Yield of Sweet Corn Hybrids.

Stewart's wilt reactions and yield of a total of 69 sweet corn hybrids were evaluated in trials in 1999 and 2000 in order to determine the level of Stewart's wilt resistance necessary to prevent reduction in yield of sweet corn hybrids. Plants at the 2- to 3-leaf stage were inoculated with Erwinia stewartii using the pinprick method. Stewart's wilt symptoms were rated from 1 to 9, and incidence of systemic infection was determined as a percentage for each experimental unit. Primary ears were harvested about 21 days after midsilk, and yield was measured as ear weight and number of marketable ears. Percent yield was calculated for each hybrid by dividing yield from inoculated treatments by yield from noninoculated treatments and multiplying by 100. Hybrid means for Stewart's wilt ratings in inoculated treatments ranged from 2.0 to 7.3. The relationships between percent yield and Stewart's wilt severity ratings were described best by curvilinear regressions, whereas percent yield decreased linearly with the incidence of systemic infection in 2000. Ear weights of hybrids with ratings below 3 or 3.5 were estimated from the regression equations to be within 95 or 92%, respectively, of those from noninoculated treatments of the same hybrid. The number of marketable ears from hybrids with ratings of 3 or below was estimated from the regression equations to be within 90% of those from noninoculated treatments of the same hybrid. A level of resistance that resulted in Stewart's wilt ratings below 3 or 3.5 corresponded to nonsystemic infection of most plants (i.e., incidence of systemic infection below 5 or 10%, respectively). The adverse effects of Stewart's wilt on ear weight and marketability appeared to be minor for sweet corn hybrids with levels of resistance that prevented or minimized systemic infection.

Epidural fentanyl speeds the onset of sensory block during epidural lidocaine anesthesia

Background and Objectives: Shortening the onset time of sensory block is a practical goal to improve the quality of epidural anesthesia. The addition of fentanyl to a local anesthetic solution is widely used during epidural anesthesia. This randomized double-blind study examined the onset time of sensory block during epidural lidocaine anesthesia with and without added fentanyl to the epidural solution. Methods: Thirty-six young male patients undergoing knee arthroscopy were randomly allocated into 3 groups of 12 patients each: epidural fentanyl (EF, epidural administration of 17 mL of 2% lidocaine plus 100 [mu ]g fentanyl and followed by intravenous (IV) injection of 2 mL of normal saline); IV fentanyl (IF, epidural administration of 17 mL of 2% lidocaine plus 2 mL of normal saline and followed by IV injection of 100 [mu ]g of fentanyl); and control (C, epidural administration of 17 mL of 2% lidocaine plus 2 mL of normal saline and followed by IV injection of 2 mL of normal saline). The sensory block was assessed by pinprick method. The hemodynamic changes, postepidural shivering, and side effects of epidural fentanyl were also recorded. Results: There was no difference in the distribution of age, weight, and height among the 3 groups. The onset time of sensory block up to T10 dermatome was significantly more rapid in the EF group (8.3 [plusmn] 3.7 minutes) than that of the IF group (13.1 [plusmn] 4.2 minutes, P [lt ] .05) or C group (14.2 [plusmn] 5.4 minutes, P [lt ] .05). The upper level of sensory block was also significantly higher in the EF group. Although the incidence of shivering was lower in the EF group, this did not reach statistical significance. Postepidural arterial blood pressures and heart rates were no different among the 3 groups. No nausea, vomiting, pruritus, respiratory depression, urinary retention, or hypotension were observed in any patients. Conclusion: Epidural injection of the mixture of 100 [mu ]g fentanyl and 2% lidocaine solution accelerated the onset of sensory block during epidural lidocaine anesthesia without increased side effects. Reg Anesth Pain Med 2001;26:523-526.

In vitro permeation profile of a local anaesthetic compound from topical formulations with different rheological behaviour — verified by in vivo efficacy data

The object of this study was to develop a topical cream of suitable consistency, i.e. with a high apparent yield stress, without affecting the in vitro permeation profile and the subsequent in vivo efficacy of the formulation. Different formulations of a model compound were manufactured, an oil-in-water (o/w) emulsion, a cream consisting of the o/w emulsion thickened with various concentrations of neutralised Carbopol934P gel, and a semisolid water-in-oil (w/o) emulsion. Rheological measurements were performed giving the apparent yield stress of the formulations. The in vitro permeation rate of the compound was measured, using static diffusion cells with both guinea pig and human skin as membrane. The o/w emulsion without polymer was used as reference. The in vivo efficacy of the formulations was investigated on guinea pigs by the pinprick method. The apparent yield stress of the w/o emulsion was in the same range as that of the most viscous o/w cream while the o/w emulsion behaved as a Newtonian liquid. Furthermore, the yielding property of the w/o emulsion was not as temperature-sensitive as that of the o/w cream. The permeation rate of the compound from the two emulsions, o/w and w/o, was similar at 6% (w/w), while the o/w cream resulted in a significantly lower permeation rate at the same concentration. The two emulsions produced sufficient and comparable in vivo efficacy, while the o/w cream was less efficient. In conclusion, a reversed-phase emulsion may be used to produce the appropriate apparent yield stress, without affecting the in vivo efficacy of the formulation. The viscosity of a w/o emulsion depends on the amount of the aqueous phase and the degree of dispersity. Thus, the transport of the active compound is not prevented by the excipients present in the formulation, as is the case for the o/w cream.