Local Anesthetic Agents Research Articles

A randomized controlled trial to study the efficacy of 1% vs. 2% lignocaine in topical airway anesthesia in routine bronchoscopy procedures

BackgroundBronchoscopists worldwide still prefer to use 2% lignocaine as the preferred topical airway anesthetic. The minimum concentration of lignocaine used during flexible bronchoscopy to prevent uncontrolled coughing is still unclear. This double-blinded, randomized controlled trial compared the efficacy of 1% and 2% lignocaine solutions for topical anesthesia during routine flexible bronchoscopy procedures.Five hundred patients were randomized to receive either 1% or 2% lignocaine. For topical airway anaesthesia, lignocaine was administered in aliquots of 2 ml each in a spray-as-you-go technique. The study’s primary outcome was the assessment of cough objectively by the consultant proceduralist, respiratory nurse, and assisting respiratory therapist. The subjective cough evaluation was taken from the patient using the cough visual analog score (VAS). The key secondary outcomes investigated were the total lignocaine dose, complications due to lignocaine administration, overall procedure satisfaction assessed by bronchoscopist (VAS), and patient (VAS) pain score.ResultsThe cough VAS scores, as assessed by patients in both groups (2% vs. 1%), were similar (28.4 vs. 28.0 [p − 0.997]). The cough VAS scores evaluated by the bronchoscopist (31.4 vs. 34.5 [p − 0.116]), respiratory nurse (31.3 vs. 34.3 [p − 0.182]), and therapist (31.7 vs. 34.3 [p − 0.209]) were slightly higher in the 1% arm. The pain ratings by the patient were similar between the two groups (0.82 vs. 0.92 [p − 0.135]). The overall satisfaction of bronchoscopists was slightly higher in the 1% arm (35.01) vs. 2% arm (32.18) [p − 0.167]. The cumulative dose in the 1% lignocaine arm was 253 mg compared to 490 mg in the 2% lignocaine arm. There was no adverse event related to lignocaine overdose in either arm.ConclusionsOne percent of lignocaine was found to be as effective as 2% lignocaine for topical anesthesia during routine flexible bronchoscopy procedures, and it was achieved at a significantly lower dose of lignocaine in the 1% arm. So, in flexible bronchoscopy, we suggest 1% lignocaine as the preferred topical airway anesthetic agent over 2% lignocaine.

DIGITAL BLOCK APPLICATIONS; A DETAILED SURVEY BETWEEN SURGICAL BRANCH SPECIALIST AND SPECIALIST STUDENTS

Purpose: The purpose of this study was to investigate the digital block application methods of specialists and assistants working in the Departments of Orthopedics and Traumatology, Emergency Medicine, Anesthesia and Reanimation, and Plastic and Reconstructive Surgery in Turkey and the accuracy of the information on which these methods are based, through a survey, and to interpret the survey results.Study plan: In the survey consisting of a total of eighteen questions, the personal information of the physicians, their preferred digital block application methods, local anesthetic agent selection and application doses, and the source of the information on which these preferences are based were questioned in a digital environment. The responses were interpreted and analyzed.Findings: A total of 110 physicians, 16 specialists and 94 assistants, participated in our survey. In the responses given to the multiple-choice question asked to the participants about the cases you encounter most frequently in your clinic, we saw that the most common ones were fractures at the finger and toe level, skin and subcutaneous lacerations at the finger level, and tendon injuries. In the responses we received to the question of the most preferred type of anesthesia in such injuries, we saw that 51.9% preferred digital block and 42.6% preferred regional anesthesia. In the responses we received to other questions regarding the application method, dosage and different usage patterns in our survey, it was seen that traditional and personal experiences were effective in digital block applications.Conclusion: It was determined that the digital nerve block applications preferred by specialists and specialist students were not compatible with the literature. The results of the study are warning signs for the revision of digital block applications. Experience-based applications and personal teachings should be replaced by evidence-based applications in digital block applications.

The effect of local anaesthetic agents on opioid use and recovery in patients undergoing open heart surgery: a randomized controlled study.

After open heart surgery, patients experience high levels of pain at the sternotomy incision site and around the chest tube(s), affecting their recovery. This study was conducted to determine the effects of local anesthetic application around the sternotomy incision site and chest tube(s) on the amount of opioids used and recovery after surgery in patients undergoing open heart surgery. This randomized controlled experimental study was conducted with a total of 60 patients, with 30 patients in the experimental group and 30 patients in the control group. In the experimental group, LIDOFAST 40mg/2ml + 0.025mg/2ml, a local anesthetic agent, was applied to the postoperative sternotomy incision site and around the chest tube(s) in addition to routine treatment. Patients in the control group received only routine treatment. Data were collected using the "Descriptive Characteristics Form" and the "Postoperative Recovery Index". It was observed that postoperative pain started later, opioid consumption decreased, and postoperative recovery was faster in the experimental group. As the number of chest tubes increased, recovery was delayed in all groups, and as the number of opioids used increased, postoperative recovery was negatively affected in the control group. In this study, local anesthetic application to the sternotomy incision site and around the chest tubes after open heart surgery was found to reduce postoperative opioid consumption and positively affect recovery. Current Controlled Trials NCT06642077 (Retrospectively registered).

Intrathecal Clonidine versus Dexmedetomidine as Adjuvants to Hyperbaric Ropivacaine in Lower Limb Orthopaedic Surgeries: A Randomised Clinical Study

Introduction: Subarachnoid block is the most chosen mode for orthopaedic surgeries in lower limb. Adjuvants such as opioids and α2 agonists are often added intrathecally to improve or prolong the anaesthetic and analgesic effects. Ropivacaine, a novel local anaesthetic agent, is widely accepted as it has better safety profile as compared to bupivacaine and lignocaine. Aim: To compare clonidine and dexmedetomidine as adjuvants to hyperbaric ropivacaine given intrathecally in lower limb orthopaedic surgeries, focusing on haemodynamic changes, sedation, duration of analgesia, and sensory and motor blockades. Materials and Methods: This randomised clinical study was conducted in a teritary care facility at the Operation Theatre (OT) complex in the Department of Anaesthesiology at Dhiraj Hospital, Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (SBKS and MIRC), Piparia, Waghodia, Vadodara, Gujarat, India. The study duration was 18 months, with a total sample size of 60 patients, comprising of 30 patients in each group. Group RC30 (Ropivacaine+Clonidine) was given 3.5 mL of 0.75% hyperbaric ropivacaine with 30 μg of clonidine, while Group RD5 (Ropivacaine + Dexmedetomidine) was given 3.5 mL of 0.75% hyperbaric ropivacaine along with 5 μg of dexmedetomidine, intrathecally. Results were assessed by comparing the onset and duration of sensory and motor blockade. The absolute and effective analgesia durations were also compared and side-effects and complications along with haemodynamic changes were analysed. Data was analysed using Statistical Package of Social Sciences (SPSS) Software version 26.0. Mean and Standard Deviation (SD) were derived for continuous variables and t-test or Analysis of Variance (ANOVA) was used to evaluate relationship between them, proportions for categorical variables and the Chi-square test was used for categorical variables. Results: The mean for age in Group RD5 was 39.43±10.6 years and Group RC30 was 41.43±13.65 years. The time to S2 regression was longer in Group RD5 (136.10±8.10 min) compared to Group RC30 (102.67±7.69 min) (p<0.0001). Longer duration of sensory and motor blockade was seen in Group RD5 (312.53±23.22 min, 381.40±30.01 min) as compared to Group RC30 (279.90±29.64 min, 321.63±38.82 min) (p<0.0001, respectively). Group RD5 also required fewer analgesic interventions in the first 24 hours. Absolute and effective analgesia was found longer in Group RD5 as compared to Group RC30 (p=0.0006, p=0.0022, respectively). Conclusion: Dexmedetomidine offers superior postoperative analgesia compared to clonidine but is associated with a higher incidence of bradycardia and hypotension, both of which are manageable with standard interventions.

Comparison of Hyperbaric 0.5% Levobupivacaine and Hyperbaric 0.75% Ropivacaine for Intrathecal Use in Infraumbilical Surgeries: A Randomised Clinical Study

Introduction: Ropivacaine is a long-acting amide local anaesthetic agent and the pure S (-) enantiomer of propivacaine. It has been readily available as an isobaric solution for a long time. Recently, a hyperbaric solution has become available in the Indian market. Levobupivacaine is the pure S-enantiomer of bupivacaine, which is safer than racemic bupivacaine in regional anaesthesia. It has less affinity and strength of depressant effects on myocardial and Central Nervous System (CNS) vital centers in pharmacodynamic studies, along with a superior pharmacokinetic profile. Aim: To compare the sensory and motor blockade, time of twosegment regression, time for rescue analgesia, haemodynamic effects and sedative effects between hyperbaric 0.5% levobupivacaine and hyperbaric 0.75% ropivacaine. Materials and Methods: This prospective, double-blinded and randomised clinical study was conducted in the Department of Anaesthesiology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre (a tertiary care institute), Sumandeep Vidyapeeth Deemed to be University, Piparia, Vadodara, Gujarat, India, from September 2023 to July 2024, with a sample size of 40 patients. Patients with American Society of Anaesthesiologists (ASA) I/II status were randomly allocated into two equal groups of 20 each. Group-R received 0.75% hyperbaric ropivacaine 3.5 mL+0.1 mL normal saline (total 3.6 mL) and Group-L received 0.5% hyperbaric levobupivacaine 3.5 mL+0.1 mL normal saline (total 3.6 mL). Data were recorded using MS Excel and analysed using Statistical Package for Social Sciences (SPSS version 22.0) software. The Student’s t-test was used for data comparison regarding the onset and duration of sensory and motor blockade, time of two-segment regression, time for rescue analgesia, haemodynamic stability and sedative effects between the study groups. Results: The mean age for Group-R was 45.00±7.1 years and Group-L 51.95±8.03 years. onset of sensory blockade at the T10 level and the onset of motor blockade in Group-R were slower than in Group-L (p-value <0.05). The time to two-segment regression was significantly faster in Group-R than in Group-L (p-value <0.05). The duration of sensory and motor blockade, as well as the time for rescue analgesia, was significantly prolonged in Group-L compared to Group-R (p-value <0.05). The sedative effects, arterial oxygen saturation (SpO2 ) and respiratory rate were comparable in both groups. Intraoperatively, haemodynamics were more stable in Group-R compared to Group-L. Conclusion: The present study implies that in haemodynamically unstable patients, 0.75% hyperbaric ropivacaine can provide a less complicated neuraxial blockade. In contrast, levobupivacaine offers a superior effect in terms of the duration of blockade and analgesia. This makes levobupivacaine useful for longer-duration surgeries, while ropivacaine is more suitable for shorter-duration procedures.

α-Adrenoreceptor blocker phentolamine inhibits voltage-gated sodium channels via the local anaesthetic binding site.

Phentolamine is a non-selective α-adrenoreceptor antagonist used to reverse local anaesthesia, for example, during dental procedures when a vasoconstrictor is co-applied. Phentolamine-mediated vasodilation leads to faster clearance of injected drugs. Previous electrophysiological studies hypothesized that phentolamine acts as a modulator of voltage-gated sodium channels, which could conflict with its indication as local anaesthetic reversal agent. We performed manual and high throughput patch-clamp recordings on HEK and CHO cells expressing NaV1.7 and NaV1.5. We investigated the effects of phentolamine on sodium channel biophysics and the additive impact of phentolamine on cells preconditioned with the local anaesthetic mexiletine. We used site-directed mutagenesis, homology modelling and drug docking to identify phentolamine's binding site. We compared the effect on sodium channels with other clinically established α-adrenoreceptor antagonists. Phentolamine inhibits NaV1.7 in HEK and CHO cells with an IC50 value of 72 and 57 μM and NaV1.5 in CHO cells with an IC50 of 27 μM. Phentolamine enhances the tonic block induced by the local anaesthetic mexiletine. Phentolamine binds to sodium channels at the local anaesthetic receptor site. The α-adrenoreceptor antagonists alfuzosin, urapidil and phenoxybenzamine show lower potency on NaV1.5 and NaV1.7 in patch-clamp recordings. Phentolamine blocks voltage-gated sodium channels via the local anaesthetic receptor site. This may conflict with its current indication as an antidote for local anaesthetics. We propose alternative α-adrenoreceptor antagonists as possible candidates for local anaesthetic reversal because these are less potent inhibitors of both cardiac and neuronal voltage-gated sodium channels.

Review of the Simulators Used in Pharmacology Education and Statistical Models When Creating the Simulators

Animal experiments have long been used as an educational tool in pharmacological education; however, from the perspective of animal welfare, it is necessary to decrease the number of animals used. ingAlthough using of simulators is effective, the development of these simulators is necessary when there is no existing simulator for animal experiments. In this review, we describe free, downloadable, and commercial simulators that are currently used in pharmacological education. Furthermore, we introduce two strategies to create simulators of animal experiments: (1) bioassay, and (2) experiments that measure the reaction time. We also describe five sigmoid curves (logistic curve, cumulative distribution function [CDF] of normal distribution, Gompertz curve, von Bertalanffy curve, and CDF of Weibull curve) to fit the results and their inverse functions. Using this strategy, it is possible to create a simulator that calculates the reaction time following drug administration. Moreover, we introduce a statistical model for local anesthetic agents using hierarchical Bayesian modeling. Considering the correlation among estimated parameters, we suggest it is possible to create simulators that give results more similar to those of animal experiments. The pharmacological education will be possible by these simulators at educational institutions where animal experiments are difficult due to various restrictions. It is expected that the number of simulator-based education programs will increase in the future.

Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method.

Comparative Evaluation of 4% Articaine and 2% Lignocaine Anesthetic Agents in Children: A Split-mouth Randomized Control Trial.

The objective of the present study is to assess and compare the effectiveness of two different anesthetic agents, namely, 4% articaine and 2% lignocaine, in the extraction of primary molar teeth in children. The study included 25 children requiring bilateral extractions of primary molar, with extraction performed on one side with 4% articaine and the contralateral side extraction with 2% lignocaine at two separate appointments. The anesthetic efficacy was evaluated objectively by assessing pain and the child's behavior at baseline, during injection and during extraction using the sound, eye, and motor (SEM) scale objectively, and subjectively using the faces pain rating scale (FPS). The data were then compiled and subjected to statistical analysis. On statistical analysis, there was no statistically significant difference found between the two anesthetic agents during extraction of primary molar teeth, whereas a statistically significant difference was present between articaine and lignocaine during local anesthesia administration on the FPS scale. Also, there was no statistically significant difference found on SEM scale during the procedure between the two anesthetic agents. Articaine can effectively be used as an alternative to lignocaine and inferior alveolar nerve block (IANB) where a long-term procedure is required. In pediatric dentistry, articaine and lignocaine play a very important roles as local anesthetic agents, offering clinicians effective tools to manage pain and discomfort during dental procedures for children. How to cite this article: Grover J, Grover R, Gupta S, et al. Comparative Evaluation of 4% Articaine and 2% Lignocaine Anesthetic Agents in Children: A Split-mouth Randomized Control Trial. J Contemp Dent Pract 2024;25(10):950-954.

An In Vivo Comparative Analysis of Pain Perception in Children Following Lidocaine Gel, Clove Oil, and Precooling for Intraoral Injections: A Pilot Study.

Dental anxiety about injections are common challenge in pediatric dentistry, often leading to delayed dental treatment. The aim of the study was to evaluate the anesthetic effectiveness of three different topical agents in pediatric dental procedures. The study was a cross-sectional in vivo study carried out in the department of pediatric and preventive dentistry. Ninety children were chosen using convenience sampling and divided into three groups based on the topical anesthetic agent administered. The procedure included anxiety assessment using the Modified Venham Picture Scale (MVPS) before and after the procedure, and pain perception was measured with the visual analog scale (VAS) and sound, eye, and motor scale (SEMS). Group A received 2% lidocaine gel, group B experienced precooling of the injection site with an ice cone, and group C was treated with clove oil, followed by a 0.9 mL infiltration injection of 2% lidocaine with 1:1,00,000 epinephrine using a 30-gauge needle for all groups. Variations in scores of the MVPS, VAS, and SEMS within and between the three groups were examined with the Kruskal-Wallis test. Spearman's correlation was employed to assess the relationships between the three scales with statistical significance set at p < 0.05. Clove oil demonstrated the best anesthetic properties and exhibited the least pain perception among all groups. Natural options like clove oil and precooling with ice cones may serve as cost-effective alternatives to lidocaine gel in reducing pain and anxiety during pediatric dental procedures. Sudha PM, Mathew BM, Rajasudhakar H, et al. An In Vivo Comparative Analysis of Pain Perception in Children Following Lidocaine Gel, Clove Oil, and Precooling for Intraoral Injections: A Pilot Study. Int J Clin Pediatr Dent 2024;17(12):1394-1398.

Local Administration of (-)-Epigallocatechin-3-Gallate as a Local Anesthetic Agent Inhibits the Excitability of Rat Nociceptive Primary Sensory Neurons.

While the impact of (-)-epigallocatechin-3-gallate (EGCG) on modulating nociceptive secondary neuron activity has been documented, it is still unknown how EGCG affects the excitability of nociceptive primary neurons in vivo. The objective of the current study was to investigate whether administering EGCG locally in rats reduces the excitability of nociceptive primary trigeminal ganglion (TG) neurons in response to mechanical stimulation in vivo. In anesthetized rats, TG neuronal extracellular single unit recordings were made in response to both non-noxious and noxious mechanical stimuli. Following the administration of EGCG, the mean firing rate of TG neurons to both non-noxious and noxious mechanical stimuli significantly decreased in a dose-dependent manner (1-10 mM), and both the non-noxious and nociceptive mechanical stimuli experienced the maximum suppression of discharge frequency within 5 min. These inhibitory effects lasted for approximately 20 min. These findings suggest that the local injection of EGCG into the peripheral receptive field suppresses the responsiveness of nociceptive primary sensory neurons in the TG, almost equal to that of the local anesthetic, 1% lidocaine. As a result, the local application of EGCG as a local anesthetic could alleviate nociceptive trigeminal pain that does not result in side effects, thereby playing a significant role in pain management.

Does Liposomal Bupivacaine Reduce Postoperative Pain Following Third Molar Extractions? A Double-Blinded Randomized Controlled Trial.

Liposomal bupivacaine (LB) is a long-lasting local anesthetic providing analgesia for several days. The current literature examining the efficacy of LB in pain management following third molar extractions remains unclear. The purpose of this study was to compare postoperative pain management between LB and standard bupivacaine (SB) in mandibular third molar extractions. A double-blinded randomized controlled trial of subjects undergoing bilateral mandibular third molar extractions at our institution from 2022 to 2024 was conducted using a split-mouth study design. Subjects were excluded if they received additional mandibular teeth extractions, were unable to complete the questionnaire, or had medical contraindications. The predictor variable was postsurgical local anesthetic agent, and the sides of mouth were randomly assigned to LB or SB. Primary outcome was postoperative pain on a 10-point numerical rating scale (NRS), and the mean cumulative pain rating via area under the curve (AUC) analysis. Secondary outcomes were adverse events and ibuprofen or acetaminophen consumption. Demographics, procedure time, preoperative and perioperative local anesthetics used, and procedural difficulty coded as nonsurgical or surgical were collected. We used mixed-effects models to compare the NRS scores during each time period and paired t-tests to compare AUC values. Statistical tests included 95% CIs with alpha=0.05. The study sample included 72 subjects (mean age 25.8, SD: 9). Pain was lower in the LB versus SB group on surgery day (NRS difference -0.75; P=.002) until the morning of postoperative day 2 (-0.68, P=.003). When limiting the analysis to bilateral surgical extractions, it was statistically significant until the morning of postoperative day 3 (-0.61, P=.02). AUC analysis showed cumulative pain reduction for the LB group in comparison to the SB group through all 4 postoperative days for the overall cohort (average AUC0-96 difference 93.5, P=.005), with a similar effect for bilateral surgical extractions (101.88, P=.006). LB modestly reduces pain following third molar extractions, with this difference more pronounced following surgical extractions. This suggests that LB may be more beneficial in complex extractions and greater pain-inducing surgeries.

Efficacy of Articaine versus Lignocaine as Local Anesthetic Agents Using Buccal Infiltration Technique for Extraction of Mandibular Premolars

ABSTRACT Introduction: Lignocaine, commonly used for local anesthesia, often results in discomfort during mandibular premolar extractions due to limited tissue diffusion with the buccal infiltration technique. Articaine, with better lipid solubility, promises improved diffusion and patient comfort. This study compares the efficacy of 2% Lignocaine and 4% Articaine in reducing pain during mandibular premolar extractions. Methodology: A split-mouth, randomized, controlled trial included 40 patients, aged between 18 and 40 years, undergoing bilateral mandibular premolar extractions. Each patient received 4% Articaine with adrenaline and 2% Lignocaine with adrenaline on opposite sides at separate appointments. Pain was assessed using the Visual Analog Scale (VAS) and Faces Pain Scale (FPS). Results: Patients in the Articaine group reported significantly lower pain levels (mean FPS: 0.2) compared to the Lignocaine group (mean FPS: 3.6) (P &lt; 0.001). In the Articaine group, 34 out of 40 patients experienced no pain, whereas all patients in the Lignocaine group reported mild to severe pain. Mild pain was reported by 23 patients in the Lignocaine group, and moderate pain by 12 (P &lt; 0.05). No severe pain was recorded in the Articaine group. Conclusion: Articaine demonstrated superior pain control, making it a more effective choice over Lignocaine for mandibular premolar extractions using the buccal infiltration technique.

A Comparative Study of Nalbuphine, Clonidine, and Dexmedetomidine as Adjuvants to Ropivacaine in Epidural Anesthesia for Lower Limb Surgery.

In epidural anaesthesia, the addition of an adjuvant to local anaesthetics enhances the efficacy, thereby providing increased duration and intensity of blockade in lower limb surgeries. The aim was to compare the efficacy, onset, and duration of sensory and motor blockade; haemodynamic changes; and sedative and analgesic effects of nalbuphine, clonidine, and dexmedetomidine as an adjuvant to ropivacaine in epidural anaesthesia. A prospective, randomised, double-blind study among 90 patients after taking consent was divided into three groups (30 patients each; Group D received 15 ml of 0.75% ropivacaine + injection (inj.) dexmedetomidine 1.5 μg/kg + normal saline to make it a total volume of 18 ml; Group N received 15 ml of 0.75% ropivacaine + inj. nalbuphine 0.2 mg/kg + normal saline to make it a total volume of 18 ml; Group C received 15 ml of 0.75% ropivacaine + inj. clonidine 1.5 μg/kg + normal saline to make it a volume of 18 ml, given epidurally). Data were analysed using IBM SPSS Statistics software version 23.0 (IBM Corp., Armonk, NY), and appropriate statistical tests were applied. The onset of sensory and motor block in Group D was 8.0±1.1 minutes and 10.5±1.7 minutes, respectively; in Group C, 10.3±1.4 minutes and 14.7±1.1 minutes, respectively; and in Group N, 11.3±1.5 minutes and 14.8±1.4 minutes, respectively, found to be very highly statistically significant (p<0.001). The total duration of sensory, motor block and analgesia was longest in Group D (495.5±16.1 minutes, 405.7±16 minutes, and 525.5±16.1 minutes, respectively), followed by Group N (356.8±17.7 minutes, 257±13.4 minutes, and 386.8±17.6 minutes, respectively), and shortest in Group C (309.9±13.4 minutes, 255.7±11 minutes, and 340.0±13.4 minutes, respectively), found to be very highly statistically significant. (p < 0.001). Out of 30 patients, 12 patients in Group D, six in Group C, and eight patients in Group N had sedation (Ramsay's Sedation Score (RSS) > 3). The clonidine group showed significant bradycardia, hypotension, nausea, and vomiting as compared to the others. We concluded that the use of dexmedetomidine as an adjuvant to the local anaesthetic agent during epidural block hastens the onset of sensory and motor blockade, provides a longer duration of sensory and motor block, provides longer duration of analgesia, and decreases the total analgesic requirement without causing clinically significant and unmanageable side effects as compared to nalbuphine followed by clonidine.

A prospective comparative study of levobupivacaine hydrochloride 0.5% with ropivacaine hydrochloride 0.75% for peri-operative epidural anesthesia in infra- umbilical surgeries

Background: Epidural anesthesia is a neuraxial regional anesthesia used to provide surgical anesthesia, to supplement general anesthesia, and to provide intra and post-operative analgesia. Levobupivacaine and ropivacaine are local anesthetic agents used in an epidural. Aims and Objectives: The aim of this study is to evaluate the onset and duration of sensory and motor block, duration of analgesia, hemodynamics, and adverse effects of levobupivacaine and ropivacaine given epidurally for infra-umbilical surgeries. Materials and Methods: This prospective randomized study was conducted in a total of 142 patients undergoing an infra-umbilical surgery, divided into two groups of 71 patients each. Group L received 15 mL of 0.5% levobupivacaine and Group R received 15 mL of 0.75% of ropivacaine. The onset and duration of sensory and motor blockade, duration of analgesia, hemodynamics, and side effects were assessed. Results: The mean time of onset of sensory and motor block is faster with ropivacaine (P&lt;0.05). The duration of sensory and motor block and analgesia was longer with ropivacaine (P&lt;0.05), whereas the incidence of side effects such as hypotension was more with ropivacaine. Conclusion: Our study concluded that ropivacaine produced a superior quality of epidural block but levobupivacaine had a more stable hemodynamic profile.

To compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in the subarachnoid block for infraumbilical surgeries

Background: Spinal anesthesia is the neuraxial regional anesthesia technique used in infraumbilical surgeries such as inguinal hernia, hydrocele, hysterectomy, and lower limb surgeries. Levobupivacaine and bupivacaine are local anesthetic agents used for spinal anesthesia. Aims and Objectives: The aim of the study was to compare the efficacy of hyperbaric levobupivacaine (0.5%) versus hyperbaric bupivacaine (0.5%) in subarachnoid blocks for infraumbilical surgeries. Materials and Methods: A total of 112 patients with American Society of Anesthesiologists grades 1 and 2 scheduled for infraumbilical surgeries were randomly divided into two groups. Group L received 3 mL of hyperbaric levobupivacaine, and group B received 3 mL of hyperbaric bupivacaine intrathecally. The onset of sensory block, onset, and duration of motor block, duration of analgesia and time of first rescue analgesia, hemodynamic parameters, and post-operative side effects, if any, were recorded. Results: The time of onset of sensory block at T10 for group L was 03.16±00.29 min and for group B was 02.16±00.27 min and the time of onset of motor block was higher in group L (03.29±00.32 min) compared to group B (02.45±00.32 min). Duration of motor block was significantly shorter in group L (209.80±6.44 min) compared to group B (252.41±11.49 min). All these findings were statistically significant. Conclusion: Levobupivacaine had a delayed onset of sensory and motor block as compared to bupivacaine, but due to its short duration of motor block and better hemodynamic profile, it seems to be a better alternative to bupivacaine.

Prospective multicentric randomised clinical trial among early stage tongue cancer patients- evaluating effect of peritumoural infiltration of local anaesthetic agent prior to surgery on local control

Prospective multicentric randomised clinical trial among early stage tongue cancer patients- evaluating effect of peritumoural infiltration of local anaesthetic agent prior to surgery on local control

Endoscopic polidocanol foam sclerobanding for treatment of internal hemorrhoids: A novel outpatient procedure.

In the study, we comment on the article by Qu et al. Internal hemorrhoids are the most common anorectal disorders worldwide with bleeding, prolapse, and difficulty in defecation. Endoscopic rubber band ligation (ERBL) is a safe, convenient, quick, and economical outpatient procedure. The main goal of ERBL is to alleviate prolapse, but the high incidence of recurrence and post-procedural pain are of clinical concern. Polidocanol foam as a local hemostatic and anesthetic agent could reduce the rates of post-procedural pain and bleeding. Endoscopic polidocanol foam sclerobanding (EFSB) is a novel approach that could lift the mucosa for easy ligation and promote increased scarring in the submucosal tissue which translates into long-term relief from prolapse recurrence and reduced 24-h post-procedural pain. The study by Qu et al is a novel multi-center prospective randomized study to compare ERBL and EFSB in patients with grades II and III internal hemorrhoids with one-year follow-up. Results showed that EFSB is a novel therapy for internal hemorrhoids, but future studies with a larger sample, multiple treatment sessions, and long-term follow-up are required to confirm these findings.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

PBM for dental analgesia and reversal from injected local anesthetic agents: a systematic review

PBM for dental analgesia and reversal from injected local anesthetic agents: a systematic review