Local Anesthetic Research Articles

Recent Progress in Isolating and Purifying Amide Alkaloids from their Natural Habitats: A Review

: Alkaloids are nitrogen-containing chemical compounds found in nature. Many alkaloids are heterocyclic in nature. They are nitrogen-based organic compounds with the nitrogen atoms enclosed in a heterocyclic ring. The chemical "pro alkaloid" is derived from the alkyl amines in it. Many ancient people, long before the advent of organic chemistry, recognized that many of these substances have measurable effects on the body's physiological functions. Alkaloids are a type of natural substances that are classified as secondary metabolites. Many different types of organisms create alkaloids, which are a class of natural products. Alkaloids showed antifungal, local anesthetic, anti-inflammatory, anticancer, analgesic, neuropharmacologic, antimicrobial, and many other activities. Amines, as opposed to alkaloids, are the more common classification for naturally occurring compounds that contain nitrogen in the exocyclic position (such as mescaline, serotonin, and dopamine). An amide molecule has a nitrogen atom that is chemically bound to a carbon atom in the carbonyl group. The -oic acid ending of the corresponding carboxylic acid is converted to -amide to form the correct nomenclature for an amide. This article offers an overview of numerous techniques for extracting, separating, and purifying alkaloids for use in natural medicine.

In Patients With Painful Hip Osteoarthritis, Is It More Beneficial to Offer Them an Ultrasound-Guided or a Fluoroscopic-Guided Intra-Articular Corticosteroid Injection to Relieve Their Symptoms? A Systematic Review and Network Meta-Analysis.

Hip osteoarthritis (OA) is a common disabling musculoskeletal condition. Clinical guidelines recommend intra-articular corticosteroid injections (IACSI) as a pharmacological adjunct to help manage pain. IACSI are typically image-guided either by ultrasound guidance (USG) or fluoroscopic guidance (FG) with no clear evidence towards the more efficacious guidance technique. This study aims to systematically review the scientific literature to determine the clinical effectiveness of USG compared with FG-IACSIs for people with pain-related hip OA. A systematic review of major bibliographic databases from inception to 24 August 2023 was conducted. Randomised controlled trials of USG- and FG-IACSIs for patients with hip OA were included. The primary outcome measure was pain. Hedges' g calculated effect size and meta-analysis using the random-effects model-estimated pooled effect sizes. τ2, I2 and Cochran's Q calculated heterogeneity. Network meta-analysis was completed to indirectly compare effect sizes. Quality was assessed using the Cochrane risk-of-bias tool (RoB2). A total of 1464 citations were identified; eight studies were included in the review. No studies directly compared imaging modalities. Two network meta-analyses indirectly comparing USG- to FG-IACSI via an image-guided comparator hip injection ([any comparator], [local anaesthetic or saline]) established effect sizes (g) of 2.61 and 2.46, respectively, both in favour of FG-IACSI. Heterogeneity was low in the USG studies and high in the FG studies. Evidence suggests that both USG and FG-IACSI are effective at reducing pain at 1 month in patients with painful hip OA. Although network meta-analyses favoured FG-IACSI, further high-quality trials are needed to determine the preferred guidance technique.

The potential suboptimal diffusion pattern of the local anesthetic following modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): An anatomical examination using a soft-embalmed Thiel cadaver

The potential suboptimal diffusion pattern of the local anesthetic following modified thoracoabdominal nerve block through perichondrial approach (M-TAPA): An anatomical examination using a soft-embalmed Thiel cadaver

How does corticosteroid (CS) and local anesthetic (LA) injection compare with LA injection alone for adults with Morton's neuroma?

How does corticosteroid (CS) and local anesthetic (LA) injection compare with LA injection alone for adults with Morton's neuroma?

Caudal versus regional block with the use of ultrasound in pediatric analgesia: a systematic review of the main clinical results

Introduction: Regional anesthesia has been gaining prominence in recent decades. A variety of peripheral and central nerve blocks have been developed to ensure that perioperative pain can be effectively controlled. Caudal block is one of the most widely administered techniques of regional anesthesia, and the use of ultrasound has enabled the optimization and precision of the techniques. Objective: This study aimed to analyze the main clinical considerations and outcomes of ultrasound-guided caudal and regional block for pediatric analgesia. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from May to July 2024 in the Web of Science, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 120 articles were found. 75 articles were evaluated and 27 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with a high risk of bias and 21 studies that did not meet GRADE. Most studies showed homogeneity in their results, with I2 = 18.7% < 50%. All these techniques protect children from perioperative pain and, combined with periprocedural sedation, allow surgical interventions with spontaneous breathing in groups of patients with maximum risk of difficult airways. We consider this specific point the main advantage of regional anesthesia in pediatric patients. Ultrasound-guided caudal epidural, performed under sedation with a non-instrumented airway, is an effective technique in daily clinical routine; however, higher body weight and surgical procedures in the mid-abdomen are risk factors for pain-related block failure. Patients who, regardless of chronological age, were born as extremely premature infants have a higher risk of respiratory events. For bilateral inguinal hernia surgeries, ultrasound-guided caudal epidural block and transversus abdominis plane block showed similar analgesic efficacy in the first six hours postoperatively. Furthermore, ultrasound-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and longer-lasting analgesia compared with ultrasound-guided caudal block for pediatric lower limb surgeries. Ultrasound-guided erector spinae block was safe and effective in pediatric patients undergoing unilateral lower abdominal surgery, as it provided longer-lasting analgesia and fewer analgesic requirements than caudal block and fewer side effects. In children undergoing regional anesthesia, the incidence of infection, hematoma, and local anesthetic toxicity is low.

Buffered 4% Articaine Reduces Pain and Enhances Anesthesia in Maxillary Third Molar Extractions: A Randomized, Double-Blind Split-Mouth Study

Background/Objectives: Buffered local anesthetics are suggested to enhance patient comfort and anesthetic efficacy during dental procedures. However, their advantages over non-buffered solutions in maxillary third molar extractions remain under-investigated. This prospective, randomized, double-blind, split-mouth study aimed to compare the efficacy of buffered versus non-buffered 4% articaine in terms of pain, anesthetic onset, and the duration of anesthesia during maxillary third molar extractions. Methods: Each participant randomly received two buccal infiltrations on two single appointments to extract maxillary third molars: one with 4% articaine buffered with sodium bicarbonate and the other with non-buffered 4% articaine. Pain during injection, post-extraction pain, onset time, and the duration of anesthesia were assessed using a visual analog scale (VAS; 0–10). Results: Fifty adult participants (23 males and 27 females) with a mean age of 21.6 years were included in the study. Buffered 4% articaine significantly reduced injection pain (mean VAS: 3.12 ± 1.36 vs. 4.2 ± 0.3, p = 0.0001) and post-extraction pain (mean VAS: 4.4 ± 1.75 vs. 5.76 ± 1.78, p = 0.0002) compared to non-buffered articaine. Additionally, buffered articaine demonstrated a faster onset of anesthesia (mean time (seconds): 85.92 ± 27.37 vs. 126.86 ± 33.15, p < 0.0001) and a longer duration of anesthesia (mean duration (minutes): 70.4 ± 13.64 vs. 51.4 ± 7.2, p < 0.0001). Regarding gender’s factor, the comparisons revealed no statistically significant differences (p < 0.05) in pain perception between males and females for either injection pain or post-extraction pain. Conclusions: Buffered 4% articaine provides superior anesthetic efficacy compared to non-buffered 4% articaine, enhancing patient comfort by reducing pain, accelerating onset, and prolonging the duration of anesthesia during maxillary third molar extractions.

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: report 19, a comparative study of the cost and carbon footprint of local anaesthesia techniques for cataract surgery.

Understanding the financial and environmental impact of clinical pathways is important for designing sustainable services. This study aimed to compare the cost and carbon footprint of sub-Tenon's and topical anaesthesia for cataract surgery, benchmark minimum topical anaesthesia utilisation rates, and quantify the benefits of increased topical anaesthesia usage in the United Kingdom National Health Service (NHS). The cost and carbon footprint of products and staffing for topical and sub-Tenon's anaesthesia for cataract surgery were calculated and applied to National Ophthalmology Database audit data. A mainly process-based approach was used to estimate the carbon dioxide equivalent (CO2e) of product production, usage, and waste disposal. The typical CO2e per case was 0.71 kg for topical anaesthesia and 1.19 kg for sub-Tenon's anaesthesia. Around a third of CO2e was generated by usage of unneccesary equiptment and wasteful practices. The typical cost per case was £14.60-£17.14 for topical anaesthesia, £27.74 for sub-Tenon's anaesthesia performed by an operating department practitioner and £56.15 for sub-Tenon's anaesthesia performed by a consultant anaesthetist. It is estimated that around 25,000 NHS cataract cases could annually be converted from sub-Tenon's to topical anaesthesia, which would reduce the CO2e emissions of services by 12,000 kg while saving £265,000 on product usage and between £63,500 and £773,750 on staffing. Topical anaesthesia is a cheaper and more environmentally sustainable alternative to sub-Tenon's anaesthesia for cataract surgery. Increased topical anaesthesia usage in cataract services could contribute towards the NHS aspiration of becoming "net zero" by 2040.

Tranexamic Acid in Rhytidectomy: A Split-Face Multi-Institutional Study.

Background: Tranexamic acid (TXA) has the ability to reduce intraoperative bleeding and facilitate hemostasis in addition to its anti-inflammatory properties that can potentially aid in recovery among patients who underwent rhytidectomy. Objective: To compare postoperative ecchymosis in patients who underwent rhytidectomy with TXA added to the tumescent anesthetic. Methods: A multi-institutional, single-blind study was performed on patients who underwent rhytidectomy. The sidedness of the face was randomized to receive either local anesthetic with TXA or without, prior to incision for rhytidectomy. The primary outcome was postoperative ecchymosis that was graded by the surgeons at the 1 week postoperative time frame in standard photograph review. Results: A total of 70 patients, mean age 62.1, were enrolled in the study. The surface area of postoperative ecchymosis at 1 week was shown to be significantly less on the side of the face that received local anesthetic infiltration prior to incision with TXA than the side that had local anesthetic without TXA (p < 0.001). These results were consistent with subjective measurements of postoperative ecchymosis graded at 1 week with two blinded investigators to the sidedness of the face that received TXA (p < 0.001). Conclusions: TXA may potentially facilitate a reduction in postoperative ecchymosis in patients undergoing rhytidectomy.

Hypotension after unilateral versus bilateral spinal anaesthesia: A Systematic review with meta-analysis.

Spinal anaesthesia is frequently used in surgical procedures involving the lower abdomen and extremities, however, the occurrence of hypotension remains a common and clinically important adverse effect. Unilateral spinal anaesthesia seems to be a promising approach to minimise this complication but the effectiveness of this remains controversial. A meta-analysis was undertaken to evaluate the superiority of unilateral spinal anaesthesia over bilateral spinal anaesthesia with regard to the incidence of hypotension and other complications. Systematic reviews and meta-analysis of randomised controlled trials (RCTs). PUBMED, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched from their inception to 5 March 2024. Randomised controlled trials (RCTs) comparing unilateral spinal anaesthesia with bilateral spinal anaesthesia were eligible for inclusion. Observational studies, case reports, case series, and studies not conducted in humans were excluded. The incidence of hypotension, vasopressor requirement, and other complications were compared. Heterogeneity was assessed by subgroup analyses and sensitivity analysis. Twenty-one trials involving 1358 patients undergoing unilateral lower extremity surgery or lower abdominal surgery were included in the meta-analysis. Hyperbaric solutions were used in most trials. The Mantel-Haenszel random-effect model was used for the analysis of binary endpoints, reported as relative risk (RR) with a 95% confidence interval (CI). The incidence of hypotension was significantly lower in the unilateral spinal anaesthesia group compared with the bilateral spinal anaesthesia (RR 0.38, 95% CI 0.27 to 0.55; P < 0.001; I2 = 38%). Subgroup analysis shows that the occurrence of hypotension was significantly lower in the unilateral subgroup, regardless of dosage, surgical site, adjuvants to the local anaesthetics, and different definitions of hypotension. Unilateral spinal anaesthesia is associated with a significant reduction in the occurrence of hypotension, despite variations in the definition of hypotension, adjuvants, and site of surgery. These results favour the use of lateral spinal anaesthesia in patients undergoing unilateral lower abdominal or lower limb surgery. However, the GRADE assessment of the quality of evidence was 'low' due to the high risk of bias and heterogeneity. All the results should be treated with caution.

Influence of Different Volumes and Frequency of Programmed Intermittent Epidural Bolus in Labor on Maternal and Neonatal Outcomes: A Systematic Review and Network Meta-Analysis

(J Clin Anesth. 2024;93:111364. https://doi.org/10.1016/j.jclinane.2023.111364) Potentially causing physiological and long-term emotional effects, labor is one of the most painful experiences for women. Epidural analgesia, involving the insertion of a catheter and administration of local anesthetics like levobupivacaine and opioids such as fentanyl, is the gold standard for pain relief. Local anesthetics and opioids can be administered through the epidural catheter either by continuous epidural infusion (CEI) or programmed intermittent epidural bolus (PIEB).

Assessment of In-Office Tympanostomy Tube Insertion Tolerability in Children Under 2 Years.

Objective: In-office tympanostomy tube insertion (TTI) is becoming more available in the practice of pediatric otolaryngology. This study evaluated the tolerability of this procedure in young children. Method: Four methods were used to assess tolerability. (1) Standardized video recordings were collected from 30 patients under 24 months who underwent in-office TTI with a single-pass insertion device with topical anesthesia alone. The videos were then reviewed by 3 independent experts in pediatric care and rated at 5 procedural time points using a defined response scale developed with the U.S. Food and Drug Administration. (2) Separately, overall tolerability was subjectively assessed by the same experts. (3) Patient recovery was assessed by the participating otolaryngologist and support staff. (4) Patient caregivers were surveyed for their impressions of the procedure, including whether they would recommend it to other caregivers. Results: In a total of 90 reviews, 100% of children were successfully treated and were rated as having acceptably tolerated the in-office tympanostomy tube procedure. All patients returned to an acceptable baseline without inappropriate crying and were assessed as fully recovered immediately following the procedure or by the time the child was leaving clinic. For caregivers, 93% agreed or strongly agreed that they would recommend the use of in-office TTI to other caregivers. Conclusions: In-office TTI in young children was determined to be universally well tolerated in young children and is a procedure that patient caregivers would recommend to other caregivers for their children. These results should help reassure otolaryngology specialists and caregivers alike that in-office ear tube placement is a viable option for young children with middle ear disease.

Efficacy and Safety of Ketamine as an Adjuvant to Regional Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

(J Clin Anesth. 2024;94:111415. https://doi.org/10.1016/j.jclinane.2024.111415) Effective management of perioperative pain is crucial for patients and surgeons due to the potential adverse effects of the body’s physiological response to surgical pain. Proper perioperative analgesia not only improves patient recovery but also decreases the incidence of chronic postoperative pain. Regional anesthesia is vital for perioperative pain control, reducing opioid use, and enhancing pain management. However, the limited duration of single-shot nerve blocks is a significant drawback. To address this, anesthesiologists have been exploring ways to extend the benefits of single-shot regional anesthesia, such as adding perineural adjuncts to local anesthetics (LA).

Radical surgical excision of extensive perianal melanomas on standing horses: Twenty cases.

To report a radical surgical technique for perianal melanomas involving the anal margin in standing horses. Observational retrospective study. Twenty client-owned horses presented for surgical excision of extensive (≥4 cm) perianal melanomas. Demographic data, surgical technique, intraoperative, immediate- and late-postoperative complications were reviewed. All horses (median age 15, Q1-Q3 12 to 17.3 years) were operated under standing sedation and epidural anesthesia. Median hospitalization period was 6.5 days (Q1-Q3 5 to 8.3 days). The anal margin was fully resected in 14 cases. A deep perirectal dissection was performed in 16 cases. Eight cases required additional local anesthetics. One case bled profusely during and after the procedure. One case became recumbent during the procedure, showed intense postoperative pain, and was eventually euthanized 6 weeks later because of ataxia. During hospitalization, one horse displayed colic signs and 10 others required manual evacuation of the rectum because of decreased fecal output. Complications after hospital discharge included mild colic signs (n = 4), partial wound dehiscence (n = 1) and hypergranulation of the wound (n = 2). All other cases healed without complications in 6 to 12 weeks. Median follow-up period was 11.8 months (Q1-Q3 6.3 to 27.2 months). Six horses developed new melanomas with only one in the perianal region. This technique of surgical excision of extensive perianal melanomas was efficiently performed on standing horses with minimal local recurrence. This procedure led to high client satisfaction. Early postoperative pain was commonly encountered. Owners should be warned of the potentially large surgical wound that will be created. This technique allowed for removal of large perianal melanomas with limited recurrence during the long term follow up and may improve the quality of life of affected horses.

Magnesium sulphate and sodium bicarbonate as additives for periarticular local infiltration analgesia improve pain management after unicompartmental knee arthroplasty: a prospective, double-blind, randomized controlled trial

BackgroundPeriarticular local infiltration analgesia (LIA) has become a widely used method for postoperative pain management after unicompartmental knee arthroplasty (UKA). However, the efficacy of using magnesium sulphate or sodium bicarbonate in LIA cocktails during UKA is not yet clear. The present study aimed to evaluate whether the modified LIA has advantages in pain control and joint function recovery after UKA surgery.MethodsSixty-one patients who underwent UKA were enrolled and randomly assigned to receive periarticular infiltration of a modified cocktail (comprising ropivacaine, epinephrine, dexamethasone, magnesium sulphate, and sodium bicarbonate) or a conventional cocktail (comprising ropivacaine, epinephrine, dexamethasone, ketorolac, and morphine). The outcomes included the consumption of patient-controlled intravenous analgesia (PCIA) medication used for postoperative analgesia, pain score, early joint functional recovery, discharge time, and complication rates.ResultsIn the first 12 h after surgery, the conventional cocktail was not superior to the modified cocktail in terms of visual analogue scale (VAS) scores. However, beginning on the second postoperative day, the analgesic effect was significantly prolonged in the modified group, leading to lower VAS scores and better knee functional recovery. Additionally, patients in the modified group required less pain medication via PCIA, both within the first 24 h and cumulatively up to 48 h after surgery. Both groups had similar rates of complications.ConclusionsThe present modification of a conventional cocktail significantly prolonged the analgesic effect and reduced pain medication consumption after UKA surgery, which was associated with better functional recovery in the early postoperative days.Trial registrationChinese Clinical Trial Registry, ChiCTR2200060500. 21 March 2023.

Dextromethorphan Role on Cough Suppression and Patient Procedure Tolerance in Flexible Bronchoscopy

Objective: To determine the role of Dextromethorphan on cough suppression and patient procedure tolerance in flexible bronchoscopy. Study Design: Quasi-experimental study. Place and Duration of Study: Pulmonology Department, District Head Quarters Hospital, Faisalabad Pakistan, from Oct 2019 to Mar 2020. Methodology: Patients were divided into Group-1 and Group-2. Group-1 was given syrup Dextromethorphan 20miligram one hour before bronchoscopy and Group- 2 was given a placebo one hour before procedure. During procedure, oxygen saturation and blood pressure were recorded continuously by monitor. 10cm Visual analogue scale was used to chart their cough perception where 0 taken as no cough and 10 as incessant cough. Patients recorded their tolerability of procedure after 2 hours on 10cm visual analogue scale. Results: Mean age of whole study population, Group-A and Group-B was 48.80+11.24, 46.63+11.70 and 47.72+11.43 respectively. Females were 25(41.7%) and males were 35(58.3%). Both groups have same mean SpO2 with supplemental oxygen. Four patients had an oxygen saturation below 90% during flexible bronchoscopy in both groups (p-value 0.647). Similar doses of Midazolam were used in the Dextromethorphan and placebo groups (p-value 0.879). The perception of cough by the patient, assistant staff and bronchoscopist in Dextromethorphan group 1 was significantly low (p-value 0.041, 0.0001, 0.037 respectively). Duration of procedure was also significantly lower in Dextromethorphan group p-value 0.0001. Conclusion: Dextromethorphan use in addition to Midazolam and local anesthetic during flexible bronchoscopy results in

Nationwide Trends in Anesthetic and Analgesic Protocols for Spay-Neuter Clinics: A Survey of Practices and Preferences in the United States

Introduction: The advancement of spay-neuter procedures has been vital to the reduction of euthanized dogs and cats. Even though many spay-neuter clinics and shelters have adopted anesthesia protocols that align with best practices, there is currently little published data reporting trends among these clinics in the United States. The aim of this study was to document the most commonly used spay-neuter anesthetic/analgesic protocols. Methods: In 2017, a voluntary, anonymous web-based survey was distributed to shelters/clinics through the high quality, high volume spay-neuter (HQHVSN) veterinarians’ listserv and the ASV listserv. Results: One hundred and six facilities participated in the survey spanning 36 states in the United States. The most commonly used canine anesthesia premedication was acepromazine paired with an opioid, with acepromazine/hydromorphone and acepromazine/butorphanol representing 26% (24/91), and 23% (23/91) of the responses, respectively. Ketamine/midazolam was the most commonly used canine induction anesthetic representing 39% (35/91) of the responses. The most commonly used feline protocol was a total intramuscular anesthetic combination such as dexmedetomidine/ketamine/butorphanol (DKT) or Telazol/butorphanol/dexmedetomidine (TTDex) accounting for 39% (35/91) and 33% (30/91) of the responses, respectively. The majority of respondents administered an injectable non-steroidal anti-inflammatory drug (NSAID) to their canine and feline patients at 63% (67/106) and 59% (63/106)), respectively. Only 26% (25/98) of respondents used to-go-home (TGH) medications and only 40% (41/102) of respondents used local anesthetics. Overall protocol satisfaction was 86% (59/66). Conclusion: This survey identified that across a wide range of spay-neuter clinics there exists significant trends with regards to anesthetic and analgesic protocols.

Intrathecal Pethidine Plus Dexamethasone Versus Intrathecal Bupivacaine in Lower Extremity Orthopedic Surgeries: A Randomized Clinical Trial

Background: Spinal anesthesia remains the preferred technique for lower abdominal and orthopedic procedures. Objectives: This study compares the effects of an intrathecal injection of pethidine combined with dexamethasone versus intrathecal bupivacaine alone in patients undergoing lower extremity orthopedic surgeries. Methods: In this prospective, randomized, controlled, double-blinded study, 46 participants scheduled for elective lower extremity orthopedic surgeries were randomly allocated into two groups. Group PD (n = 23) received an intrathecal injection of 1 mg/kg preservative-free pethidine combined with 4 mg dexamethasone, diluted with 0.9% sodium chloride saline to a total volume of 3 mL. Group B (n = 23) received an intrathecal injection of 3 mL (15 mg) of 0.5% hyperbaric bupivacaine alone. The primary outcome measured was the time to the first need for rescue analgesia. Secondary outcomes included spinal anesthesia characteristics, intraoperative hemodynamic stability, and incidence of perioperative adverse events. Results: The time to first need for rescue analgesia was significantly longer in Group PD (7.76 ± 0.79 hours) compared to Group B (4.48 ± 0.63 hours). Differences in the onset of sensory and motor blocks between Group PD (6.39 ± 1.12 and 10.09 ± 2.23 minutes, respectively) and Group B (6.43 ± 1.99 and 9.96 ± 2.33 minutes, respectively) were statistically non-significant. However, the regression time for sensory and motor blocks was significantly shorter in Group PD compared to Group B (146.74 ± 15.35 and 119.56 ± 14.13 minutes vs. 188.44 ± 6.84 and 168.04 ± 5.25 minutes, respectively). Incidence of hypotension and shivering was also less frequent in Group PD than in Group B. Conclusions: Intrathecal administration of 1 mg/kg pethidine plus 4 mg dexamethasone provided improved spinal anesthesia, with extended postoperative analgesia, minimal intraoperative hemodynamic disturbances, and reduced incidence of shivering compared to bupivacaine alone in patients undergoing lower extremity orthopedic surgeries. This approach may be particularly beneficial for patients with hypersensitivity to ester or amide local anesthetics, offering a cost-effective alternative to standard local anesthetics.

Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated...

James (Carrick) Moore (1763-1860): Another (Scottish) Local Anaesthetic Hero.

Modern technology has provided the author with access to a previously unobtainable publication, John Moore's 1784 work, 'A Method of Preventing or diminishing Pain in Several Operations of Surgery'. Not only did this allow direct consideration of his technique of nerve compression (which has been described briefly by many others since), but also showed that Moore had very advanced humane views on the need to try and produce pain relief for surgery. It also became possible to obtain far more information on the author, notably that although he worked in London he was born and educated in Glasgow, and did his initial medical training in Edinburgh. He thus is one of a group, all of whom were Scots, who did preliminary work on local anaesthesia before the recognition of the local action of cocaine. His technique was tried, apparently successfully, for a below-knee amputation by John Hunter, and while both the technique and his humane approach were noted by others, the method does not seem to have found wider favour. He continued working as a surgeon in London until he inherited an estate in south-west Scotland, this allowing him to give up clinical practice and focus on writing and campaigning. He wrote the definitive biography of his brother (Sir John Moore of Corunna fame) and was a leading advocate of vaccination, leading the organisation after Jenner's death. These activities meant that he was well known in his lifetime, but he deserves to be better known today as being the first person to promote the need for pain relief during surgery.

INTRAOPERATIVE LOCAL BUPIVACAINE WOUND INFILTRATION VERSUS TRADITIONAL SYSTEMATIC ANALGESIA: A COMPARISON IN TERM OF POST-OPERATIVE PAIN

Effective management of post-operative pain is essential for patient recovery and satisfaction, especially in procedures like appendectomies where pain management can influence overall outcomes. Traditional systemic analgesia, while effective, often comes with side effects and limitations. Local infiltration of anesthetics like bupivacaine may provide a targeted approach to pain control with fewer systemic effects. Objective: To compare the effectiveness of intraoperative local bupivacaine wound infiltration versus traditional systemic analgesia in managing post-operative pain in patients undergoing appendectomies. Methods: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, following approval from the hospital's Ethical Committee. A total of 60 patients, who consented and met eligibility criteria, were enrolled. All patients underwent appendectomy under general anesthesia, followed by random allocation into two groups. Group A received 0.5% bupivacaine for local wound infiltration, while Group B did not. Both groups were administered intravenous tramadol on demand, with a maximum dose of 400 mg per 24 hours. Post-operative pain was assessed using a Visual Analog Scale (VAS) at 4, 12, and 24 hours post-surgery. Stratified analysis by age and gender was also performed. Results: The study population (mean age: 41.13 ± 7.96 years) included 34 males (56.7%) and 26 females (43.3%). Group A (bupivacaine group) had a significantly lower mean post-operative pain score (3.33 ± 0.66) compared to Group B (systemic analgesia group) with a score of 5.30 ± 0.95 (p=0.00). Age-based stratification revealed significant differences: among 22-30-year-olds, Group A scored 3.00 versus 6.00 in Group B (p=0.00); for 31-50-year-olds, Group A scored 3.36 compared to 5.33 in Group B (p=0.00); and for those over 50, scores were 3.33 in Group A and 4.50 in Group B (p=0.04). Both male and female patients in Group A experienced significantly lower pain scores compared to Group B (p=0.00 for both). Conclusion: Intraoperative bupivacaine wound infiltration significantly reduces post-operative pain in appendectomy patients compared to traditional systemic analgesia. These findings support its use as an effective pain control method. Further research is recommended to optimize dosing and assess the combined use with other analgesics to enhance pain management across various surgical procedures.