Local Anesthetic Solution Research Articles

Pilot epinephrine dose-finding study to counter epidural-related blood pressure reduction

ObjectiveAn unwanted side effect associated with epidural analgesia is the reduction in blood pressure (BP) due to the sympathetic blockade. This study evaluated the hemodynamic effects of adding different epinephrine...

Ultra-Sound Guided Quadratus Lamborum Block Using Dexamethasone and Bupivacaine versus Dexmedetomidine and Bupivacaine for Post-Operative Analgesia after Labaroscopic Cholecystectomy

Abstract Background The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using regional anethesia. Transversus abdominis plane (TAP) block has been increasedly used for postoperative pain relief after lower abdominal surgeries. The main advantage of quadratus lumborum block (QLB) compared to TAP block is the extension of local anesthetic agent beyond the transversus abdominis plane to the thoracic paravertebral space. The wider spread of the local anesthetic agents may produce extensive analgesia and prolonged action of the injected local anesthetic solution. Objective To assess the analgesic effect of addition dexamethasone or Dexmedetomidine with bupivacaine in ultrasound-guided QLB to prolong it’s duration in patients undergoing laparscopic abdominal surgeries in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods After approval of anesthesiology department scientific and ethical committees in Ain Shams University Hospitals, patients undergoing laparscopic abdominal surgeries were included in the study, and were divided into two groups (n = 10; each); group A and B . Where in group A patients(n = 10) received 20 ml bupivacaine 0.5% plus 100 μg Dexmedetomidine diluted in 5ml 0.9% NaCl (the total volume injected in all patients is 25 ml), and group B patients (n = 10) received 20 ml bupivacaine 0.25% plus 8 mg dexamethasone (2 ml) plus 3 ml 0.9% NaCl . Results The thesis proved that the addition of either Dexmedetomidine or dexamethasone to bupivacaine 0.25% in ultrasound guided QLB for laparscopic abdominal (cholecystectomy) surgeries hastened the onset, prolonged the duration of sensory block, increased post-operative analgesia and decreased rescue analgesia needed without increasing the risk of adverse effects, with Dexmedetomidine showing better results. Conclusion The addition of either 100 μg Dexmedetomidine diluted in 5 ml 0.9% NaCl or 8 mg dexamethasone to 20 ml bupivacaine 0.25% in ultrasound guided quadratus lumborum block for laparscopic abdominal surgery prolonged the duration of analgesia significantly and decreased the postoperative analgesic requirement. Hence, our study suggests that either Dexmedetomidine or dexamethasone may be a useful alternative as an adjuvant to long-acting local anesthetics for quadratus lumborum nerve block with Dexmedetomidine showing better results.

Programmed Intermittent Epidural Boluses of 0.1% Ropivacaine Versus 0.2% Ropivacaine for the Maintenance of Epidural Analgesia in Labor.

Objective The gold standard for pain management during labor is epidural analgesia, which can be administered in two different ways to the parturients, either bybolus doses or continuous infusions of local anesthetic solutions with opioids. Recently, programmed intermittent epidural boluses (PIEBs) via a pump are gaining popularity as a very effective method with minimal side effects. The aim of this study was to evaluate the optimum ropivacaine concentration between two different regimens (0.1% or 0.2% both with fentanyl 2 μg/ml) that can provide satisfactory analgesia with the minimum degree of motor blockade, using PIEBs. Methods A prospective randomized controlled study was performed from March 2020 to March 2022. Two different concentrations of ropivacaine 0.1% and 0.2% via PIEBs were equally allocated to two groups of parturients with an additional patient control epidural rescue bolus if needed. Our primary endpoint was motor blockade, as assessed by the modified Bromage scale (MBS). We also recorded visual analog scale (VAS) scores, heart rate, blood pressure, total local anesthetic consumption, labor duration and method of delivery, and APGAR score of the newborns. Results All patients presented Bromage scores equal to 6, and the total consumption of the anesthetic solution was comparable between the two groups. Women in the 0.2% group showed higher pain relief and satisfaction compared to the 0.1% group. Concerning the 0,2% group, diastolic blood pressure and APGAR scores were lower alongside with a lower satisfactory extrusion stage observed bythe obstetrician. Conclusion Both ropivacaine regimens provide satisfactory labor epidural analgesia for the expectant mother without any motor blockade.

Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial.

Patients undergoing laparoscopic sleeve gastrectomy (LSG) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LSG in a high-volume bariatric center, applying an enhanced recovery after bariatric surgery (ERABS) pathway. One hundred ten patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU) and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting (PONV), analgesic requirement, time to walking, time to flatus, length of hospital stay (LOS), and surgical complications. No significant differences were observed between LG-TAP and placebo groups in postoperative analgesia, with a median (IQR) NRS of 2 (4.75-0) vs. 2 (5.25-0) in PACU, 5.5 (7-3) vs. 6 (7-4) at 6 h, 2 (6-0) vs. 3 (5.25-1.75) at 12 h, and 2 (3.75-0) vs. 1 (2-0) at 24 h; all p > 0.05. A significant difference was found in PONV in PACU (LG-TAP, 46%; placebo, 25%, p-value, 0.019) and at 6 h postoperatively (LG-TAP, 69%, placebo, 41%, p-value, 0.003). No differences were observed as regards other secondary outcomes. Our results suggest that LG-TAP block is not related to more effective postoperative analgesia compared to placebo when LA-PSI is performed.

The efficacy of lumbar epidural steroid injections in “failed back surgery syndrome” and lumbar radiculopathy

Aims: Lumbago is one of the common conditions in our present community. Definite periods of human’s life people encountered in the form of usually regressing attacks that %10-%15 of this important condition requires surgical therapy. Cause of wrong diagnosis and treatment Spinal surgery may not always give favourable result. Patients undergone one or more back surgery exist back and/or leg pain which does not improve, is called failed back surgery syndrome. Epidural steroid administration is one of the most invasive method which is used in back pain. Effects and application results are controversial. In this study we aimed to compare the effects of steroid and local anesthetic solutions which administered by epidural way on pain controlling between the patients that have chronic back pain because of lomber radiculopathy, undergone surgery and not surgery. Methods: It was evaluated retrospectively pain controlling effect of administered steroid and local anesthetics by interlaminal epidural way to ASA 1-2-3, between 18-80 aged 40 patient which undergone piror one or plural back surgery and have no surgery between May 2009-December 2009 apply with back pain complaint to İstanbul Education and Research Hospital Algology Department. Patient’s visuel analog scala (VAS) and severity of back pains, before procedure, second week after procedure, fourth week after procedure, sixth week after procedure in either two groups out of ten points was estimated. Results: Totally of 7 ml solution which contains 1 ml triamsinolon asetonid 40 mg/ml (Sinakort-A ampul, İ.E. Ulugay), 3 ml levobupivacaine 5mg/ml ( Chirocaine ampul, Abbott) and 3 ml serum phsiyologic ( % 0,9 NaCl ) administered by epidural way into either two group patients. There were no significant difference between two groups by mean of age, weight, height, BMI and back pain durations. Evaluating the groups into themselves, opioid requirements and VAS scores before injection was markedly higher than 2,4 and 6. week scores in either two groups (p<0.05). There was no statistically significant difference when we compare into groups of 2,4 and 6. week opioid requirements and VAS scores in either two groups. All patient manifested their pleasure and there was no complication occured. Conclusion: Consequently; it was thought that epidural administration of steroid (triamsinolon) ,local anesthetics (levobupivacaine) and serum physiologic solution was effective especially on early back pain treatment, also safe method and beneficial to patient satisfaction in the patients who has failed back surgery and chronic back pain.

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (>65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

The Impact of 4% Articaine on ECG: Insights from a Randomised Control Trial

Aim and Background of The Study: Articaine can be used as alternative drug of choice for lignocaine because it has rapid onset and longer duration of action so these qualities of articaine can be beneficial for patient travelling from long distance in which patient can be free from pain. The aim of this study is to Compare the efficacy and safety such as blood pressure and pulse rate, ECG of the both of 4% Articaine with 1:100,000 epinephrine and 2% Lignocaine with 1:100,000 epinephrine in patients operated for mandibular third molar impaction. Method: This is a randomized controlled clinical trial a total 30 subjects were participated in the study with age ranging from 22-45 years and parameters such as Drug volume(ml), Duration of surgical procedure, Intra operative pain evaluation, Onset of anesthesia, Duration of anesthesia, Duration of postoperative analgesia, ECG,blood pressure,pulse,spo2,temperature were assessed. Results: It was evident that 4% articaine has longer duration of action and great postoperative analgesia in terms of 2% lignocaine and there was no significant difference in ECG, blood pressure, pulse, spo2, temperature. Conclusion: It was established that 4% articaine is more effective than 2% lignocaine. Hence might be thought of as a lignocaine substitute in clinical settings.A local anaesthetic solution that is efficient enough to produce sufficient anaesthesia while causing minimal problems is essential for minor oral surgical procedures.

Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years.

Local anesthetics are used to alleviate pain, but the prick of the injection delivering anesthesia is known to cause anxiety and pain that affect dental treatment. The most difficult aspect of pediatric dentistry is minimizing discomfort while the intraoral local anesthetic is administered. This pain has been treated using physical, psychological, pharmacological, and combinations of these approaches. Recently, the idea of vibration, which is based on the gates control theory, has gained popularity as a way to reduce discomfort while local anesthesia (LA) is being administered. The aim of this trial was to evaluate the efficacy of mucosal vibrators in children aged 6-10 years to alleviate pain associated with LA administration. A total of 60 patients aged 6-10 years requiring inferior alveolar nerve block were enrolled for this randomized, single-blind clinical trial. In group I, before and during LA administration, the customized mucosal vibrator was placed at the injection site. In group II, the topical local anesthetic gel was applied to the injection site prior to the administration of LA. Then, the local anesthetic solution was deposited using a disposable syringe needle on both groups. The pain was evaluated using the physiological scale (pulse rate and oxygen saturation), the subjective scale (Wong-Baker scale), and the objective scale [Face, Legs, Activity, Cry, Consolability (FLACC) scale] by an experienced assistant who was unaware of the procedure. A customized mucosal vibrator along with local anesthetic injections resulted in significantly less pain (p = 0.001*) when compared with the injections with topical anesthetic gel. The results show that the customized mucosal vibrator is an effective and inexpensive means to reduce pain during LA administration. Tatiya N, Singh C, Surana P, et al. Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years. Int J Clin Pediatr Dent 2024;17(4):404-409.

A comparative evaluation of the efficiency of warm local anesthetic solution delivered on precooled injection sites with the conventional local anesthetic technique in 7-9-year-old children: A randomized split-mouth cross-over trial.

Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7-9-year-old children. A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.

Retrospective comparison between low-volume high-concentration and high-volume low-concentration levobupivacaine for bilateral erector spinae plane block in dogs undergoing hemilaminectomy

ObjectiveTo compare the analgesic effect of a bilateral ultrasound-guided erector spinae plane block (ESPB) in dogs undergoing hemilaminectomy using either a low-volume high-concentration (LV-HC) or a high-volume low-concentration (HV-LC) local anaesthetic solution. Study designRetrospective observational equivalence trial. AnimalsA total of 391 client-owned dogs undergoing hemilaminectomy. MethodsDogs were assigned to group LV-HC or HV-LC depending on whether 0.2–0.25% levobupivacaine (0.4–0.5 mL kg–1) or 0.125–0.15% levobupivacaine (0.8–1 mL kg–1) was used to perform the ESPB, respectively. The number of dogs in which intraoperative rescue fentanyl boluses were administered, the total dose of fentanyl administered, the overall methadone consumption during the first 24 hours postoperatively and anaesthetic complications were recorded. Univariate and multivariate statistical analyses were performed considering p < 0.05 significant. ResultsA total of 248 and 143 dogs were assigned to groups LV-HC and HV-LC, respectively. In group HV-LC, the number of dogs requiring fentanyl intraoperatively (64.3%) was higher (p = 0.0001) than that in group LV-HC (43.5%). The overall intraoperative fentanyl consumption was higher in group HV-LC between the first skin incision and the end of the lamina drilling (p = 0.028). According to the regression analysis, the group allocation was the best variable to predict the intraoperative fentanyl consumption (p < 0.001).Antimuscarinic drugs were administered more frequently in group LV-HC (p < 0.02). However, the prevalence of hypotension and other pharmacological cardiovascular interventions did not differ between groups. No differences in methadone consumption during the first 24 hours postoperatively were found between the groups. Conclusionsand clinical relevanceWhen performing a bilateral ESPB in dogs undergoing hemilaminectomy, compared with HV-LC, the use of LV-HC local anaesthetic solution reduces the intraoperative fentanyl consumption without affecting the postoperative methadone requirement.

Validating the Modified Small Double Opposing Z-Plasty for Palatal Lengthening in Primary Palatoplasty.

To appraise the degree of intraoperative palatal lengthening with the modified Furlow small double-opposing Z-plasty (sDOZ). Retrospective single-surgeon (R.D.) study. Nonsyndromic children (n = 167) with Veau types I to IV cleft palates who underwent primary sDOZ palatoplasty. Intraoperative measurements of palatal lengths and widths were collected using calipers, paper rulers, and metal rulers before the administration of local anesthetic solution and before the removal of the mouth gag (initial and final palatal dimensions, respectively). Assessment of the intraoperative percentage change (difference between final and initial values) in surface palatal length, straight palatal length, and soft palatal length. Bivariate and multivariate analyses were performed to identify independent predictors (sex, age at surgery, Veau, Kernahan/ Stark, and Randall classifications, widest cleft width, presence of lateral relaxing incision, type of coverage with buccal fat flap, and postoperative complications) of soft palatal lengthening. Surface palatal, straight palatal, and soft palatal lengths had an intraoperative increase of 8%, 14.7%, and 27.7%, respectively. The degree of intraoperative soft palatal lengthening significantly varied among Veau cleft types (I = II < III = IV). Veau type III and cleft lip/palate were independent positive predictors (P < .001) of soft palatal lengthening, while other tested variables were not correlated (P > .05) with this outcome. Overall intraoperative palatal lengthening occurs with the modified sDOZ palatoplasty, with differences within the spectrum of cleft palate deformity.

Pharmacokinetics of Local Anesthetics in Dentistry: The Example of Articaine-Containing and Mepivacaine- Containing Anesthetics

Aim. To analyze current data on the pharmacokinetics of drugs used for local anesthesia in dental practice, with particular emphasis on articaine-containing and mepivacaine-containing anesthetics. Materials and Methods. The study of up-to-date information from the Cyberleninka, Elibrary, Google Scholar and PubMed electronic databases was carried out during a systematic review of the literature. Selected and included articles, the content of which concerns the pharmacokinetics of local anesthetics articaine and mepivacaine. Results. 55 publications were reviewed. After analyzing the literature for inclusion criteria, the total number of publications has become 42. Conclusions. According to the analyzed data, the choice of local anaesthetic solution should be made individually for each patient and be based on the pharmacokinetics of the drug.

A literature review on various diagnostic modalities and treatment options for the treatment of the osteomyelitis of the jaw

Osteomyelitis of the jaw is found to be the most common disease affecting the maxillofacial region. Osteomyelitis is found to be true bacterial infection affecting the jaw bone. Different types of osteomyelitis which are distinguishable are acute osteomyelitis, primary chronic osteomyelitis and secondary chronic osteomyelitis of the jaw. The main characteristic features of the osteomyelitis of the jaw are, formation of the fistula, suppuration, and sequestration of the jaw bone. Different treatment modalities of the osteomyelitis of the jaw include surgery, debridement of the lesion superficially and curettage and in non surgical approach it includes usage of proper antibiotics, usage of topical agents, usage of hyperbaric oxygen, local anesthetic solution.

Comparison of levobupivacaine with dexamethasone versus levobupivacaine for ultrasound-guided transversus abdominis plane block in lower abdominal surgeries in a tertiary care hospital in Chengalpattu district – A randomized control trial

Introduction: Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. Ultrasound guidance is now considered the gold standard in TAP blocks. It involves the injection of a local anesthetic solution into a plane between the internal oblique muscle and transversus abdominis muscle. Since the thoracolumbar nerves originating from the T6 to L1 spinal roots run into this plane and supply sensory nerves to the anterolateral abdominal wall, the local anesthetic spread in this plane can block the neural afferents and provide analgesia to the anterolateral abdominal wall. Levobupivacaine is a local anesthetic from the amino amide class of medications. Adjuvants are drugs when added along with local anesthetics have a synergistic action to improve the duration and quality of analgesia. Objectives: The objective of this study was to study the effectiveness of ultrasound-guided transversus abdominis plane block using levobupivacaine with dexamethasone in terms of hemodynamic stability and duration of postoperative analgesia and pain scores (visual analog scale [VAS]), time of requirement of rescue analgesics among patients who have undergone lower abdominal surgeries. Methods: This is a double-blinded randomized control trial. This study was conducted among 60 patients who have undergone lower abdominal surgeries in a tertiary care hospital. Postsurgery, intraoperatively prior shifting out the patient, two groups received transversus abdominis plane block, one received 28 ml of 0.25% levobupivacaine with 2 ml of normal saline and another group received 28 ml of 0.25% levobupivacaine with 2 ml (8 mg) dexamethasone. Duration of postoperative analgesia and the efficacy between the two groups were compared with hemodynamic parameters and VAS score. Results: The study groups were not significantly different in terms of demographic data or the American Society of Anesthesiologists Grading. The mean onset of breakthrough pain was significantly higher in the L group. The time of requirement of rescue analgesics was also significantly shorter in the L group compared to the LD group. The VAS pain score was significantly lower in the Group LD as compared to the L group. Conclusion: Hence, it was noticed that dexamethasone when added to levobupivacaine had better hemodynamic stability in terms of blood pressure, heart rate, saturation, respiratory rate, and mean arterial pressure. The requirement of rescue analgesics was also reduced in this group and the time of breakthrough pain was also prolonged. This group had significantly lower pain scores.

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

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

Survey investigation of articaine use in the United States

BackgroundLocal anesthesia is an essential component of dentistry, but there is limited quantifiable understanding of what techniques and local anesthetic solutions are used by practicing dentists. Use of the local anesthetic articaine has been highly debated in dentistry regarding its efficacy and risks for paresthesia. The aims of this study were to expand the knowledge of local anesthesia practices of dentists in the United States through a large-scale survey and associate potential influencing factors regarding articaine use specifically. MethodsThe 23-item survey was sent to 10,340 practicing dentists in the United States, gathering demographic data and local anesthesia approaches and concerns. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression analyses. ResultsA total of 1,128 dentists completed the survey. Previous experience with articaine was reported by 97.6% of respondents, with 3.3% no longer using articaine. Sixty percent of respondents indicated using articaine for most local anesthetic injections administered. Multivariable regression analysis found those reporting to use articaine for all local anesthetic injections involving vasoconstrictors were more likely to be male (odds ratio, 1.59; P = .002) or general dentists (odds ratio, 1.63; P < .001). ConclusionsArticaine has a perceived benefit to practitioners as most respondents reported using articaine as their primary local anesthetic. A practitioner’s sex and type were found to affect the profile of use of articaine. Practical ImplicationsAssembling evidence-based local anesthesia practices would be beneficial to ensure US practitioners are more standardized in administering local anesthetics, particularly articaine, in the safest and most efficacious way.

Expect the Unexpected!! – Transient Cranial Nerve Palsies after Radiofrequency Ablation of Gasserian Ganglion for Trigeminal Neuralgia

Trigeminal neuralgia is the most common type of craniofacial neuralgia, characterized by paroxysmal lancinating electric shock-like pain confined to the somatosensory distribution of the trigeminal nerve. Fluoroscopy-guided Radiofrequency Ablation of Gasserian Ganglion (RFA-GG) is the commonly performed minimally invasive pain intervention in these patients. Various complications such as masseter weakness, corneal anesthesia, dysesthesia, anesthesia dolorosa, keratitis, and cranial nerve deficits have been reported during the procedure. We present the case of a 58-year-old male diagnosed with left-sided trigeminal neuralgia involving mandibular division of trigeminal nerve (V3 division) with a Numerical Rating Scale of 9/10 at the time of presentation. As the patient was unresponsive to medical management, RFA of the V3 division of GG was performed with acceptable sensory and motor stimulation. Postablation, 1 ml of 1.0% Lidocaine injection with 2 mg injection dexamethasone was given. After the procedure, the patient complained of dizziness, left-sided hearing loss, and double vision on looking toward the left side. On examination, deviation of the angle of the mouth toward the right side, reduced blink reflex on the left side, and incomplete closure of the left eyelid were observed. Vitals were stable and there was no respiratory discomfort. The patient was reassured and monitored in the recovery room. Signs and symptoms were transient and the patient recovered completely after 45 min. Clinical findings were suggestive of the involvement of three cranial nerves: the abducens nerve, the facial nerve, and the vestibulocochlear nerve. Spillage of local anesthetic solution into adjacent cranial nerves surrounding the GG might be the causative mechanism for transient cranial nerve palsies in this case.

Differential blockade, comparative study of different ropivacaine concentrations (0.75%; 0.2%; 0.12%) for ultrasound guided sciatic and femoral nerve blocks in calves: Prospective cross-over study

Pharmacodynamic understanding of the different local anesthetic concentrations allows adapting their use to diverse clinical/surgical procedures, such as intraoperative and/or postoperative analgesia. A crossover study was performed, where 6 calves (5 male and 1 female), weighing 120 ± 28 Kg, were subjected to combined sciatic and femoral nerve block using three ropivacaine concentrations. The treatments were: R0.75, using 0.75% ropivacaine; R0.2, 0.2% ropivacaine; and R0.12%, 0.12% ropivacaine. All treatments were performed with ultrasound and neurostimulation assistance, and a volume of 0.1 mL/kg of the respective local anesthetic solution was administered in each block point. The sites of mechanical nociceptive threshold (MNT) evaluation were based on the calf pelvic limb dermatomes. The proportion between desensitized areas, MNT elevation time and level of ataxia were registered. Elevation of MNT occurred in 100% of the tested areas in the R0.75 and R0.2 treatments, and in 82% of the R0.12 treatment. Mean MNT elevation times were 9.5 ± 0.7 h for R0.75, 6 ± 0.8 for R.02, and 2.4 ± 2.3 for R0.12, differing significantly between all treatments. No difference was observed between MNT elevation time and ataxia duration time, in each treatment. It is concluded that the duration of sensory-motor effects is dose-dependent, but there was not possible to detect block selectivity as the concentrations was reduced. More desensitized areas and extension were obtained with the use of higher concentrations.

Spinal anesthesia, puncture position and local anesthetic solutions. Better understanding for better indication

Two schools teach spinal anesthesia, one prefers the lateral decubitus position and the other the sitting position. The vast majority of anesthesiologists worldwide use routinely the hyperbaric solution of bupivacaine for almost all types of surgery, mainly performed in a sitting position. There is renewed interest in understanding spinal anesthesia about puncture position, the various solutions used, and the position of the operating table during the surgical procedure. Understanding the vertebral column, of the anterior and posterior roots, allows the different puncture positions, and the hyperbaric, isobaric, and hypobaric solutions to offer better quality of these techniques and will be shown in this article. The application of the three solutions in different puncture positions, and the position of the surgical table during the procedure, will be shown in seven items in 14 tables, and 6 figures, for the complete understanding of spinal anesthesia. The possibility of performing hemi-spinal anesthesia (unilateral and posterior), and the possibility of performing completely sensory spinal anesthesia without any degree of motor block are discussed. The explanations in this article with the different puncture positions and the three local anesthetic solutions are applied both in the lumbar region and in the thoracic region.

The Effects of Dexamethasone versus Potassium Chloride as Additives to Local Anesthetic in Supraclavicular Brachial Plexus Block

Abstract Background Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Regional anesthesia of the trunk and the extremities an alternative to general anesthesia in many situations. It avoids the unwanted effects of the anesthetic drugs used during general anesthesia and the stress of laryngoscopy and tracheal intubation. Aim of the Work To compare the clinical efficacy of addition of dexamethasone or potassium chloride to local anesthetic solution of bupivacaine and lignocaine on the onset, duration, quality of analgesia, and quality of sensory and motor blockade in supraclavicular brachial plexus block in patients undergoing upper extremity surgeries. Patients and Methods This study is a prospective double – blinded, randomized trial After obtaining approval from the Research Ethical Committee of faculty of medicine Ain shams University, this study was conducted in the operating theaters of Ain shams University Hospital. Results In the current study, it was obvious that: addition of Dexamethasone to bupivacaine in supraclavicular nerve block shortened the onset times of both sensory and motor blocks than add. Addition of Dexamethasone to bupivacaine significantly prolongs both sensory and motor block durations than injecting dexamethasone intravenously. Addition of Dexamesthasone to bupivacaine prolongs the analgesia of brachial plexus block with subsequent consumption of less amount of analgesics than adding Potassium Chloride. Conclusion The use of ultrasonography in performing the supraclavicular nerve block, decreased significantly the incidence of complications such as pneumothorax or intravascular injection and hence, lowered the incidence of systemic toxicity of local anesthetics.