Local Anesthetic Agents Research Articles

Spinal, Epidural, and General Anesthesia for Knee Joint Arthroscopy: Diversity, Equity, and Inclusion - Comparison Study.

Knee arthroscopic surgery is a commonly performed procedure for diagnosing and treating knee joint problems. This procedure can be achieved under various types of anesthesia, general; or by applying regional anesthesia or even local. Epidural anesthesia and peripheral nerve blockage have been utilized in short procedures and provided a shorter length of hospital stay than general anesthesia in many former articles; however, spinal anesthesia including bupivacaine infusion has also offered a shorter length of hospital stay compared to general anesthesia. While the literature has not compared optimal techniques for these valid options. This review was conducted to challenge the hypothesis: What would be of choice for local anesthesia agents (either epidural or spinal anesthesia) that would be comparable to short-acting general anesthesia agents in terms of patient satisfaction and discharge times?! The review was conducted as a prospective, randomized study. Patients were randomized using a sealed envelope method to be selected to one anesthesia technique (general, epidural, or spinal anesthesia). During the period between January 2019 and December 2020, 198 patients underwent unilateral knee joint arthroscopy. Seventy-seven patients refused anesthesia randomization and opted for one option directly. One hundred and twenty-one patients were qualified for the final recruitment stage of this analysis to contribute to the anesthesia randomization and they were assigned into three groups. Demographical analysis showed no significant differences between cohorts. No major surgical or anesthetic adverse effects were reported. Anesthesia reported satisfactory for incision among three groups. For regional anesthesia cohorts, sphincteric control (voiding) considered a mandatory parameter for discharge, was shorter in the epidural group compared to the spinal anesthesia cohort (154 ± 28 vs. 189 ± 47 min, P < 0.0013). Time to discharge for the three cohorts was also significantly shorter for general anesthesia and epidural cohorts as compared to spinal cohort (general, 106 ± 29 min; epidural, 90 ± 18 min; spinal, 151 ± 48 min, P < 0.003). A total of 114 patients stated that they would select the same anesthetic method over again. This review revealed that regional epidural anesthesia using 2-chloroprocaine and general anesthesia using short-acting agents were similarly successful in terms of perioperative conditions and duration of hospital stay in our center. Whereas spinal anesthesia using 10 mg of bupivacaine combined with fentanyl in the same setting lacked behind in terms of extended discharge time and showed a higher prevalence of adverse effects.

Impact of Ultrasound-Guided Deep Serratus Anterior Plane Block Combined With Dexmedetomidine as an Adjuvant to Ropivacaine Inpatient Quality of Recovery Scores Undergoing Modified Radical Mastectomy: A Randomized Controlled Trial.

BackgroundBreast cancer has overtaken lung cancer as the most commonly diagnosed malignancy and is the leading cause of cancer-related death in women. Surgery is the only possible cure for breast cancer, and the incidence of acute postoperative pain (APP) is high in breast surgery. Previous reports suggested that ultrasound-guided deep serratus anterior plane block (dSAPB) provided effective blockade to relieve pain after modified radical mastectomy for breast cancer. In fact, despite the long-acting local anesthetic agents used, the patient’s pain cannot completely be eliminated due to the short duration of anesthesia. Dexmedetomidine as an adjunct to local anesthetics can prolong peripheral nerve block duration. However, no study has investigated the role of dSAPB with dexmedetomidine in the quality of recovery scores undergoing modified radical mastectomy. Thus, this study was conducted aiming at this aspect.Material and MethodsThis single-center, double-blind, randomized clinical trial was conducted at Bethune International Peace Hospital. A total of 88 participants of elective modified radical mastectomy were enrolled from May and November 2021. Ultrasound-guided dSAPB combined with 30 ml of 0.375% ropivacaine or 30 ml of 0.375% ropivacaine with dexmedetomidine (1 μg/kg) was administrated before anesthesia at the fourth to fifth ribs of the axillary midline. The primary outcome was quality of recovery, measured 24 h postoperatively using the QoR-15. Secondary outcomes were the Visual Analogue Scale (VAS) scores at rest and movement at 1, 6, 12, 24, and 48 h after surgery, 48 h sufentanil consumption postoperatively, the incidence of postoperative nausea and vomiting (PONV), length of post-anesthesia care unit (PACU) stay, dizziness, delirium, SAPB-related adverse events, and patient’s satisfaction with pain management.ResultsAmong the 88 participants, 8 did not meet the inclusion criteria; the other 80 were randomized to receive dSAPB combined with ropivacaine (Group R, N=40) and dSAPB combined with ropivacaine plus DEX (Group RD, N=40), of which a total of 7 (4 in Group R and 3 in Group RD) were excluded due to protocol deviation. Eventually,73 participants (36 in Group R and 37 in Group RD) were included for final analysis, with age (SD, years, 54.08[6.28] vs. 54.62[7.44], p=0.740), body mass index (BMI) (SD, 27.96[1.67] vs. 27.57[2.38], p=0.428), and median preoperative global QoR-15 score (interquartile range (IQR), 127[123.25–131] vs. 126[121–130], p=0.662). The median postoperative global QoR-15 score (IQR, 107[103–112] vs. 109.5[107–114], p=0.016), VAS score at rest at 12th hour (IQR, 1[1–2] vs. 1[1–2], p=0.033), VAS score in movement at 12th hour (IQR, 2[1–3] vs. 2[1–3], p=0.014) and at 24th hour (IQR, 3[2–3] vs. 3[2–3], p=0.040), and median sufentanil rescues consumption (IQR, 14[12–17 vs. 14[12–15], p=0.022] of Group RD were significantly lower than those of the Group R. Patient satisfaction score (SD, 8.28[0.70] vs. 8.62[0.59], p=0.024) of Group RD were significantly higher than those of the Group R.ConclusionThe ultrasound-guided dSAPB combined with dexmedetomidine plus ropivacaine may improve the QoR-15 in patients undergoing modified radical mastectomy and indicates that it may be a useful intervention to aid recovery following breast cancer surgery. Furthermore, participants in the ropivacaine with DEX group met the superior pain relief in the early postoperative period, reduced postoperative cumulative opioid consumption, increased patient satisfaction, and no increase in the incidence of complications.

Local Infiltrative Analgesia of Murine Femur Fractures In Vivo Does Not Inhibit Fracture Healing.

The opioid epidemic in the United States has forced care providers to seek out alternatives to narcotic analgesics. Physicians involved in trauma care, including orthopaedic trauma surgeons, often have patients requiring significant amounts of these medications, especially in the perioperative period, given the acuity and severity of their injuries. Modalities such as local infiltration of fractures with anesthetic agents during operative treatment may provide some benefit to this population by decreasing postoperative pain and narcotic usage. However, prior data suggest that these agents are chondrotoxic, which may impede secondary fracture healing. The purpose of this study was to investigate the hypothesis that local anesthetics decrease secondary bone healing and callus formation in stabilized murine femur fractures through chondrocyte apoptosis. Male C57BL/6 mice underwent intramedullary stabilization and fracture of bilateral femurs followed by immediate infiltration of the fracture site with local anesthetic agents. Femurs were dissected at 10- and 20-days post-fracture and evaluated by muCT and histological analysis. No significant differences were seen in callus size or mineralization between controls and fractures treated with a local anesthetic. When the callus was analyzed histologically, local anesthetic agents appeared to increase cartilage density. Therefore, infiltration of local anesthetics during operative treatment of fracture as part of a multimodal approach to pain control does not appear to significantly affect callus formation in a preclinical model, although subclinical molecular effects may be present. Local infiltrative analgesia with local anesthetics may be used as an adjunct for perioperative pain control during femur fracture surgery without a significant effect on secondary bone healing.

A review of the efficacy of intraarticular hip injection for patients with hip osteoarthritis: To inject or not to inject in hip osteoarthritis?

Hip injection (HI) for osteoarthritis (OA) are in vogue nowadays. Corticosteroids (CSs) and hyaluronic acid (HA) gel are the two most common agents injected into the hip. Off late, platelet-rich plasma (PRP), mesenchymal stem cell (MSC), bone marrow aspirate concentrate (BMAC), local anesthetic (LA) agents, non-steroidal anti-inflammatory drugs (NSAIDs) and their different combinations have also been injected in hips to provide desired pain relief. However, there is a group of clinicians who vary of these injections. A search of the literature was performed on PubMed, Cochrane Library, and DOAJ using the keywords “hip osteoarthritis injection”. Data were analyzed and compiled. Intraarticular CSs are effective in providing the desired pain relief in OA hip, but repeated injections should be avoided and the interval between HI and hip arthroplasty must be kept for more than three months. Methylprednisolone or triamcinolone are combined with 1% lidocaine or 0.5% bupivacaine. Chondrotoxic effects of LA is a concern. Although national guidelines do not favor the use of HA for hip OA, numerous publications have favored its usage for a moderate grade of OA. The PRP, MSC, and BMAC are treatment options with great potential; however, currently, the evidence is conflicting on their role in hip OA. There is always a risk of septic arthritis, particularly when aseptic precautions are not followed, and clinicians must vary of this complication.

Pain Control in Lower Abdominal Surgeries in Post-Operative Period; Comparison of Transversus Abdominis Plane Block Vs Infiltration of Wound with Bupivacaine

Introduction: Post-operative pain is very common problem for both patients and medical professionals. Different medicines and procedures are used to treat it. Aim: To compare the efficacy of transversus abdominis plane block (TAP) with local anaesthetic infiltration in surgical wound regarding post-operative pain management. Study Design: Randomized control trial. Material &amp; Methods: 60 patients (30 in each group) undergoing for lower abdominal surgery were included and divided into two group A and B by using lottery method. In group A bilateral TAP block was applied with 20 ml of 0.25 % bupivacaine on each side. In the triangle of petit with 16 gage Tuohy’s needle. In group B 40 ml of 0.25 % bupivacaine was given in the margins of surgical incision with full aseptic technique at the end of procedures. . Result: The mean age of patient was 36.70 ± 8.55 year while mean age in group A was 36.50 ± 9.48 year and in group B it was 36.90 ± 7.67 year. The mean pain in group A was 2.77 ± 2.21 and in group B it was 6.72 ± 1.00 The mean pain was statistically less in group A as compared to group B and P value was ≤ 0.05. Conclusion: Post-operative pain control was batter with TAP block as compare to incisional wound infiltration of local anaesthetic agent. Keywords: TAP Block, Wound infiltration, Surgery, pain.

Outpatient transperineal prostate biopsy under local anaesthesia is safe, well tolerated and feasible.

BackgroundTransperineal biopsy (TPB) of the prostate has been increasingly utilized as it has reduced infection risks. Traditionally however, it is performed under general anaesthesia, thus it carries a differing set of risks. Recently, new studies have performed TPB under local anaesthesia with success. In the present study, we explored our experience of performing TPB under local anaesthesia in an Australian cohort.MethodsIn this prospective study based at a metropolitan outpatient clinic, patients were provided with TPB under local anaesthesia. We assessed prostate cancer detection rates, complication rates and patient tolerability. Pain tolerability was assess using patient reported pain score on the visual analogue scale. Follow up data was collected at days 7 and 30 post‐biopsy via telephone interview.ResultsA total of 48 patients were enrolled in this study between June 2020 and March 2021. Median age was 65.5 years and median PSA was 6.95 ng/mL. Clinically significant prostate cancer was detected in 58% of patients. During the procedure, pain scores were rated the highest during infiltration of local anaesthetic agent with a median score of 5. By the conclusion of the procedure, median pain score was 1. Vast majority of patients (85.4%) would opt for a repeat TPB under local anaesthesia should the need for prostate biopsy arise again. Two of our patients experienced infectious complications, and one experienced urinary retention.ConclusionOur data is in line with currently available data and confirms that TPB under local anaesthesia can be achieved in a safe and tolerable manner.

Evaluating the Efficacy of Pre-incisional Infiltration and Intraperitoneal Instillation of a Local Anesthetic Agent on Postoperative Analgesia and Hemodynamics in Patients Undergoing Laparoscopic Cholecystectomy Under General Anesthesia.

AimThe study aimed to compare the effects of 0.5% bupivacaine injection at pre-incisional port sites and intraperitoneal application on postoperative pain in laparoscopic cholecystectomy cases.MethodsAfter taking ethical clearance, a total of 60 patients of the American Society of Anaesthesia (ASA) grades 1 and 2 scheduled to undergo laparoscopic cholecystectomy were enrolled in the study and were randomized into two groups. Group 1 (n=30) received 20 ml of 0.5% bupivacaine infiltration subcutaneously over the port sites before being given incision. Group 2 (n=30) received 20 ml of 0.5% bupivacaine applied in the intraperitoneal subdiaphragmatic space and in the gall bladder fossa after removal of the gall bladder. The efficacy in terms of abdominal pain, hemodynamics, complications, and total analgesic requirements were assessed at regular intervals throughout the postoperative period for 24 hours.ResultsNo significant difference in terms of demographic variables in the groups. The mean visual analog score (VAS) score for abdominal pain was found to be significantly lower in group 1 from the first postoperative hour till the twenty-fourth hour. Also, no significant difference was seen between the groups regarding hemodynamic parameters. No significant difference between the groups was seen regarding postoperative nausea and vomiting (PONV). The supplemental analgesic requirement was significantly higher in group 2 than in group 1.ConclusionIt was observed from this study that pre-incisional infiltration of a local anesthetic agent produces effective postoperative analgesia in the immediate postoperative hours and reduces additional analgesic requirements without causing any adverse reactions.

Comparison of EMLA Cream versus Mucosal Vibration or Pre-cooling Systems as Topical Anesthetic Agents in Children

Comparison of EMLA Cream versus Mucosal Vibration or Pre-cooling Systems as Topical Anesthetic Agents in Children

Effect of Local Injection of Lidocaine and Articaine plus Epinephrine on Methemoglobin Level during General Anesthesia.

Statement of the Problem: Methemoglobinemia is a potentially life-threatening rare medical condition, which refers to an increase in the level of oxidized form of hemoglobin (methemoglobin). Excessive replacement of hemoglobin with methemoglobin leads to functional hypoxia and even fatal conditions.Purpose: The aim of this study was to evaluate the effect of two common local anesthetic agents namely lidocaine and articaine administered for hemostasis during surgery on methemoglobin level.Materials and Method: This prospective cohort study was conducted from January 2017 to December 2019. Demographic data including age, gender, and weight of patients were collected. Sixty patients were randomly divided into three groups (n=20) regarding the local anesthetic agent administered for hemostasis during surgery as lidocaine group (group 1), articaine group (group 2), and control group (no local anesthetic; group 3). The patients were candidates for orthognathic surgery, reconstruction of the maxillary and mandibular atrophic ridges with autogenous grafts, and reconstruction of maxillofacial fractures. The methemoglobin level was measured before surgery and six hours after the initiation of surgery.Results: The mean age and weight of patients were not significantly different among the three groups (p= 0.891 and p= 0.416, respectively). No significant differences were observed among the three groups regarding the gender distribution (p= 0.343) or type of surgery (p= 0.990). Statistical analysis did not show any significant difference in the mean baseline methemoglobin level among the three groups (p= 0.109). Although the mean methemoglobin values increased in the three groups, paired sample t-test did not show any significant change in the values at six hours after the initiation of surgery compared with baseline in any of the three groups (p= 0.083 for group 1, p= 0.096 for group 2, and p= 0.104 for group 3).Conclusion: The results demonstrated that administration of lidocaine and articaine plus epinephrine for hemostasis during general anesthesia are equally safe.

When Regional Anesthesia Met Pharmacokinetics.

Pharmacokinetics of Local Anaesthetic Agents. By Tucker GT, Mather LE. Br J Anaesth 1975; 47(suppl 1):213-24 Information derived from measurements of blood concentrations of local anaesthetics can be extended by the application of pharmacokinetic analysis. A better understanding of quantitative aspects of the disposition and absorption of these drugs should assist the anaesthetist in deciding the optimal agent and dosage for regional block techniques.

A Comparative Study of Intrathecal Magnesium Sulphate with or without Intrathecal Fentanyl to 0.5% Hyperbaric Bupivacaine in Parturients Undergoing Elective Lower Segment Caesarean Section

Background: Prolongation of analgesia in Neuraxial anaesthesia is achieved by adding various adjuvants intrathecally along with local anaesthetic agent. Using two adjuvants together in lower doses will prolong the duration of analgesia without causing much side effects. Aims: To compare the efficacy and safety of Intrathecal Magnesium v/s Fentanyl with Magnesium sulphate as an adjuvant to 0.5% Bupivacaine in terms of onset and duration of Sensory and Motor Blockade and Duration of Postoperative analgesia. Material and Methods: Prospective randomized double blinded study was conducted on 70 ASA 1 &amp; 2 patients undergoing elective caesarean section. They were randomly divided into two groups (35 each). All patients received spinal anaesthesia. Group M received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml of normal saline intrathecally. Group FM received 1.7 ml of 0.5% bupivacaine, 0.1 ml (50 mg) magnesium sulphate and 0.2 ml (10microgram) of fentanyl intrathecally. Results: Onset of sensory block was similar in Group M and Group FM. Duration of sensory block was prolonged in group FM (191±45.60) compared to Group M (178.12±38.06). Duration of analgesia was significantly prolonged. Conclusion: We conclude that, the addition of both intrathecal magnesium sulphate and fentanyl to bupivacaine for spinal anesthesia, in parturients undergoing elective LSCS results in prolonged duration of analgesia.

Evaluation of postoperative analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound guided adductor canal block in patients undergoing unilateral Total Knee Replacement

The aim of anaesthesia in Total knee replacement (TKR) is to provide adequate analgesia and early ambulation. The recent success of adductor canal block in providing post-operative analgesia and achieving early ambulation has evoked interest in studying the effects of local anaesthetic agents and various adjuvants.This study was a randomized three arm parallel group comparative study conducted in a tertiary care center in India on 135 patients undergoing unilateral total knee replacement under spinal anaesthesia. After completion of the surgery, the adductor canal block was performed with ultrasound guidance at mid-thigh level in all three groups. In group A, 20 ml 0.375% ropivacaine was only used but in group B and C Dexmedetomidine was added to ropivacaine (total volume of 20 ml; 0.375%) at a dose of 0.25 µg/kg and 0.50 µg/kg respectively. The primary outcome of the study was to compare duration of analgesia after the adductor canal block. Duration to rescue analgesia (in hours) was significantly longer [Group A: 15.71±4.87; Group B: 16.44±6.21; Group C: 19.78±5.57 (p=0.014)] and total opioid (24 hours tramadol needed in mg) consumption [Group A: 60.00±13.94; Group B: 52.22±18.80; Group C: 33.33±13.95 (p=0.033)] was significantly lower in Group C. NRS scores both at movement and rest were significantly lesser in Group C at 18 and 24 hours timepoints. Patient satisfaction was significantly higher in Group C with 46.67% patient reporting better than expected peri-operative experience (p=0.022).The addition of dexmedetomidine, 0.5 µg/kg to 0.375% ropivacaine in adductor canal block results in longer duration of analgesia, less 24 hours opioid consumption, better motor strength and better patient satisfaction without any adverse effect after unilateral total knee replacement surgery.

Updates on Topical and Local Anesthesia Agents.

Use of topical and local anesthesia (LA) is the workhorse of all aspects of dentistry. There was a time in the past when dentistry was performed without any local pain control. Owing to this there are patients with dental anxiety and fear of a dental office. The media portraying dentistry as being painful, or showing a dentist with needles, enlists fear and distrust of dentists. In contrast, pain is what brings the patient to the dental office and with local pain control measures a dentist is able to alleviate the patient's cause of pain.

EVALUATION OF ANALGESIC EFFICACY OF DEXAMETHASONE AS AN ADJUVANT TO CAUDAL BUPIVACAINE IN PAEDIATRIC PATIENTS UNDERGOING INFRAUMBLICAL SURGERY

Background: caudal epidural block is one of the common regional techniques in paediatric anaesthesia for patients scheduled for infraumblical surgeries. Major disadvantage of this technique is its limited duration of action. Various adjuvants have been added to local anaesthetic agents for prolongation of analgesic effect of caudal block. The purpose of this study was to evaluate the analgesic efcacy of dexamethasone as an adjuvant to caudal bupivacaine in paediatric patients undergoing infraumblical surgeries. Material and method: 100 paediatric patients aged 1 to 6 years (&lt; 20kg weight) of ASA class 1 or 2 scheduled for infraumblical surgery were enrolled in the study and randomly allocated in to two groups. Group B (n=50) received caudal block with 1ml/kg of 0.25% bupivacaine while Group D (n=50) received caudal block with 1ml/kg of 0.25% bupivacaine with 0.1 mg/kg dexamethasome. After completion of surgery, postoperative pain was assessed with FLACC (face, legs, activity, cry, consolability) scale at hourly interval till the score &gt;3 (duration of analgesia). Both the groups were compared for the duration of analgesia and total analgesic requirement in the rst 24 hours postoperatively. Result: Group D showed signicantly longer duration of analgesia in comparison to Group B. Total analgesic requirement and mean FLACC score was also lower in Group D as compared to group B. Conclusion: Addition of dexamethasone (0.1mg/kg) to caudal bupivacaine increases the duration of postoperative analgesia and decreases the analgesic requirement during postoperative period

Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review.

Neuraxial anaesthesia is widely utilised for elective caesarean section, but the prevalence of inadequate intra-operative anaesthesia is unclear. We aimed to determine the prevalence of inadequate neuraxial anaesthesia for elective caesarean section; prevalence of conversion from neuraxial anaesthesia to general anaesthesia following inadequate neuraxial anaesthesia; and the effect of mode of anaesthesia. We searched studies reporting inadequate neuraxial anaesthesia that used ≥ ED95 doses (effective dose in 95% of the population) of neuraxial local anaesthetic agents. Our primary outcome was the prevalence of inadequate neuraxial anaesthesia, defined as the need to convert to general anaesthesia; the need to repeat or abandon a planned primary neuraxial technique following incision; unplanned administration of intra-operative analgesia (excluding sedatives); or unplanned epidural drug supplementation. Fifty-four randomised controlled trials were included (3497 patients). The overall prevalence of requirement for supplemental analgesia or anaesthesia was 14.6% (95%CI 13.3-15.9%); 510 out of 3497 patients. The prevalence of general anaesthesia conversion was 2 out of 3497 patients (0.06% (95%CI 0.0-0.2%)). Spinal/combined spinal-epidural anaesthesia was associated with a lower overall prevalence of inadequate neuraxial anaesthesia than epidural anaesthesia (10.2% (95%CI 9.0-11.4%), 278 out of 2732 patients vs. 30.3% (95%CI 26.5-34.5%), 232 out of 765 patients). Further studies are needed to identify risk factors, optimise detection and management strategies and to determine long-term effects of inadequate neuraxial anaesthesia.

Safety considerations in laparoscopic surgery: A narrative review.

Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.

Systematic literature review of topical local anaesthesia or analgesia to donor site wounds.

BackgroundTopical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use.MethodsSystematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented.ResultsThere were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels.ConclusionsTopical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.

Effectiveness of local and topical anesthesia during gingival retraction

Objective: To compare the effectiveness of local and topical anesthesia during gingival retraction in preparedabutment teeth. Material and Methods: 72 patients desiring full mouth rehabilitation or bilateral fixed partialdenture in the same arch were selected based on the inclusion criteria framed and were randomly allocated intoGroups A and B of 36 each. Patients in Group A received gingival retraction with topical anesthesia and GroupB received gingival retraction with infiltration anesthesia. All the patients were tested for pain, discomfort andbleeding during gingival retraction. Results: There was no significant difference in pain, discomfort and gingivalbleeding (P &gt;.05) during gingival retraction using topical and local anesthetic agents. Conclusion: Topicalanesthesia was equally effective as infiltration anesthesia in managing the pain, discomfort and bleeding duringgingival retraction by cord packing in prepared abutment teeth. KEYWORDSGingival retraction techniques; Topical administration; Infiltration; Pain.

An unusual complication after subarachnoid block in a cesarean section patient: Lidocaine allergic contact dermatitis

Type I hypersensitivity reactions to lidocaine are infrequent, whilst type IV- delayed hypersensitivity reactions are even rarer, with only a few reported cases in the literature. A proper diagnosis is essential to differentiate between the two, for appropriate management of the same. As local anesthetic agents are routinely used for various invasive procedures, it is imperative to be familiar with the presentation and management of the such allergic reactions. We present a case of morbidly obese obstetric patient who developed allergic contact dermatitis (ACD) after receiving subcutaneous lidocaine before subarachnoid block. Patch test was positive for lidocaine, and the diagnosis was further confirmed by a positive intradermal challenge test.

Comparison between Plain Ropivacaine, Ropivacaine with Buprenorphine and Ropivacaine with Clonidine for Intrathecal use in Lower Limb Orthopaedic Surgeries: A Randomised Controlled Trial

Introduction: Ropivacaine is an amide local anaesthetic agent. The lower limb surgeries involves the great somatic pain. By using these adjuvants such as buprenorphine and clonidine with local anaesthetic agent to know the effective intraoperative and postoperative analgesia. Aim: To compare the anaesthetic characteristics in terms of quality of blockade when intrathecal ropivacaine with buprenorphine and ropivacaine with clonidine as adjuvant. Materials and Methods: The present study was a doubleblinded randomised control trial in which a total of 75 subjects were divided into three groups, with 25 per group-group R (Inj. Ropivacaine 0.75%-3 mL with 0.2 mL sterile water), group RB (0.2 mL Buprenorphine with Inj. Ropivacaine 0.75% 3 mL), and group RC (0.2 mL Clonidine with Inj. Ropivacaine 0.75% 3 mL). Onset and duration of blocks were observed. Haemodynamic parameters, and pain score were monitored intraoperatively and postoperatively. Data was entered in MS excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) software version 16.0. The p-value &lt;0.05 were considered as statistically significant. Results: The onset time of sensory and motor blockade for group RC was significantly more in comparison to R and RB groups (sensory block-5 minutes 50 seconds vs 3 minutes 39 seconds vs 3 minutes 50 seconds); and (motor block-6 minutes 52 seconds vs 4 minutes 39 seconds vs 4 minutes 74 seconds). Group RC had significantly longer duration of sensory block than R and RB groups (327 minutes 88 seconds vs 166 minutes 60 seconds (167 minutes) vs 222 minutes 44 seconds). Conclusion: Ropivacaine with clonidine showed significantly more duration of sensory block, motor block and time for first rescue analgesia with haemodynamic stability than ropivacaine and ropivacaine with buprenorphine.