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Journal of Ultrasound Mar 2024Ultrasound guidance is particularly useful for percutaneous injections in the diagnosis and management of painful conditions of the ankle and foot. The injectates used...
Ultrasound guidance is particularly useful for percutaneous injections in the diagnosis and management of painful conditions of the ankle and foot. The injectates used include steroids and local anesthetics, such as lidocaine, mepivacaine, bupivacaine, ropivacaine, and platelet-rich plasma. Osteoarthritis is the main indication for joint injections. Joints amenable to being injected include the tibiotalar, subtalar, midtarsal, and metatarsophalangeal joints. Tendon injections mainly involve the Achilles, peroneus, extensors, and tibialis tendons, while plantar fascia injections are useful for treating plantar fasciitis and plantar fibromatosis. Forefoot injections include joint arthritis, intermetatarsal bursitis, and Morton neuroma. The standardized approaches and doses reviewed in this paper are based on the authors' experience and can lead to high success in symptomatic relief for various conditions. These injections can be curative or serve as a guide to identify the source of pain when surgery or other therapeutic options are planned.
Topics: Humans; Ankle; Lower Extremity; Ankle Joint; Achilles Tendon; Pain; Ultrasonography, Interventional
PubMed: 37518823
DOI: 10.1007/s40477-023-00808-1 -
Veterinary Surgery : VS Jan 2024To determine if targeted blocking of frontal and infratrochlear nerves provided anesthesia for the approach to a frontonasal sinusotomy.
OBJECTIVE
To determine if targeted blocking of frontal and infratrochlear nerves provided anesthesia for the approach to a frontonasal sinusotomy.
STUDY DESIGN
Two part study: Part 1 randomized crossover design; Part 2 proof of concept.
ANIMALS
N = 12; six each in Parts 1 and 2.
METHODS
Part 1: Each horse had either frontal and infratrochlear nerve blocks or a line block performed with 2% mepivacaine hydrochloride. Mechanical nociceptive thresholds (MNT) were obtained at five sites along a proposed frontonasal sinusotomy prior to injection, and at 10, 60, and 120 min after blocking. After a 4 day washout period, the opposite procedure was performed. Order of procedure and side of face were randomized. MNTs were analyzed using mixed-model ANOVA with p < .05. Part 2: Frontal and infratrochlear nerve blocks were performed followed by creation of a skin/periosteal incision, which was closed at 2 h. Ability to create and suture the incision, and the size of the incision were recorded.
RESULTS
For part 1, both line and targeted blocks resulted in at least two times an increase in median MNT values at each of the five sites, as compared to baseline MNT values (p < .0025). In Part 2, incisions could be completed in five of six horses, with median incision size of 6.5 × 5 cm.
CONCLUSION
Following frontal and infratrochlear nerve blocks, MNTs were increased along a proposed frontonasal sinusotomy, and skin incisions could be created in the majority of horses.
CLINICAL SIGNIFICANCE
Frontal and infratrochlear nerve blocks provide an alternative technique to create a frontonasal sinusotomy.
Topics: Horses; Animals; Anesthetics, Local; Mepivacaine; Nerve Block
PubMed: 37483085
DOI: 10.1111/vsu.13997 -
The Thoracic and Cardiovascular Surgeon Jun 2024Surgically implanted Impella 5.5. delivers full cardiac support and left ventricular unloading for patients with heart failure. So far, the Impella device is...
BACKGROUND
Surgically implanted Impella 5.5. delivers full cardiac support and left ventricular unloading for patients with heart failure. So far, the Impella device is implanted under general anesthesia (GA).
MATERIAL AND METHODS
A total of = 3 critically ill patients presented with acute heart failure in need of cardiac support. All patients suffered cardiogenic shock of varying etiology. Due to hemodynamically unstable conditions, GA was avoided. All implantations were performed solely under local anesthesia (LAS) without any regional anesthesia.
RESULTS
All implantations were performed successfully under LAS with 60 mL of mepivacaine of 2% solution and ropivacaine of 1% solution (50:50 ratio). All devices were placed from the right axillary artery. One patient needed hematoma evacuation several days after surgery. No other Impella-related complication was observed.
CONCLUSION
A surgical implantation of the Impella 5.5 device under LAS is feasible and safe. Despite the small number of cases, no disadvantage can be described at the present moment. Our series should encourage physicians to perform the procedure under LAS.
Topics: Humans; Heart-Assist Devices; Anesthesia, Local; Treatment Outcome; Male; Shock, Cardiogenic; Middle Aged; Aged; Prosthesis Implantation; Prosthesis Design; Female; Ventricular Function, Left; Anesthetics, Local; Ropivacaine; Mepivacaine; Heart Failure; Axillary Artery; Hemodynamics
PubMed: 37463601
DOI: 10.1055/a-2132-4694 -
Regional Anesthesia and Pain Medicine Apr 2024Same-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an...
INTRODUCTION
Same-day discharge total knee and hip arthroplasty is becoming more common. Anesthetic approaches that optimize readiness for discharge are important. Based on an institutional change from low-dose bupivacaine to mepivacaine, we aimed to assess the impact on postanesthesia care unit (PACU) recovery in a quaternary care, academic medical center.
METHODS
In this quality improvement retrospective study, a single surgeon performed 96 combined total knee and hip arthroplasties booked as same-day discharge from September 20, 2021 to December 20, 2021. Starting on November 15, 2021 the subarachnoid block was performed with isobaric mepivacaine 37.5-45 mg instead of hyperbaric bupivacaine 9-10.5 mg. We compare these cohorts for time to discharge from PACU, perioperative oral morphine milligram equivalent (OMME) administration, PACU pain scores, conversion to general anesthesia (GA), and overnight admission.
RESULTS
We found the use of isobaric mepivacaine as compared with hyperbaric bupivacaine for intrathecal block in same-day discharge total joint arthroplasty was associated with decreased length of PACU stay at our academic center (median 4.03 vs 5.33 hours; p=0.008), increased perioperative OMME (mean 22.5 vs 11.4 mg; p<0.001), increased PACU pain scores (mean 6.29 vs 3.41; p<0.01) and no difference in conversion to GA or overnight admission.
CONCLUSIONS
Intrathecal mepivacaine was associated with increased perioperative OMME consumption and PACU pain scores, but still realized a decreased PACU length of stay.
Topics: Humans; Bupivacaine; Mepivacaine; Anesthetics, Local; Arthroplasty, Replacement, Hip; Patient Discharge; Retrospective Studies; Quality Improvement; Arthroplasty, Replacement, Knee; Pain; Pain, Postoperative; Analgesics, Opioid
PubMed: 37433742
DOI: 10.1136/rapm-2023-104378 -
Osteoarthritis and Cartilage Open Sep 2023This study aimed to test a novel treatment combination (TC) (equivalent to sildenafil, mepivacaine, and glucose) with disease-modifying properties compared to...
OBJECTIVE
This study aimed to test a novel treatment combination (TC) (equivalent to sildenafil, mepivacaine, and glucose) with disease-modifying properties compared to Celestone® bifas® (CB) in a randomized triple-blinded phase III clinical study in horses with mild osteoarthritis (OA). Joint biomarkers (reflecting the articular cartilage and subchondral bone remodelling) and clinical lameness were used as readouts to evaluate the treatment efficacy.
METHODS
Twenty horses with OA-associated lameness in the carpal joint were included in the study and received either TC ( 10) or CB ( 10) drug intra-articularly-twice in the middle carpal joint with an interval of 2 weeks (visit 1 & 2). Clinical lameness was assessed both objectively (Lameness locator) and subjectively (visually). Synovial fluid and serum were sampled for quantification of the extracellular matrix (ECM) neo-epitope joint biomarkers represented by biglycan (BGN) and cartilage oligomeric matrix protein (COMP). Another two weeks later clinical lameness was recorded, and serum was collected for biomarkers analysis. The overall health status was compared pre and post-intervention by interviewing the trainer.
RESULTS
Post-intervention, SF BGN levels significantly declined in TC () and COMP levels significantly increased in CB (). The flexion test scores improved in the TC compared to CB () and also had an improved trotting gait quality (). No adverse events were reported.
CONCLUSION
This is the first clinical study presenting companion diagnostics assisting in identifying OA phenotype and evaluating the efficacy and safety of a novel disease-modifying osteoarthritic drug.
PubMed: 37416846
DOI: 10.1016/j.ocarto.2023.100381 -
Journal of Anesthesia, Analgesia and... Dec 2022Dexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few...
BACKGROUND
Dexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few side effects. We report our experience with dexmedetomidine use during orthopaedic surgery under locoregional anaesthesia to ensure adequate sedation and optimal postoperative pain control.
METHODS
In this retrospective analysis, we included 128 patients who underwent orthopaedic surgery between January 2019 and December 2021. All patients received the same local anaesthetic dose of 20 ml of ropivacaine 0.375% + mepivacaine 0.5% for axillary and supraclavicular block and 35 ml of ropivacaine 0.375% + mepivacaine 0.5% for triple nerve block (femoral, obturator and sciatic nerve). The cohort was divided into two groups based on sedation drugs used during surgery (dexmedetomidine, or group D, vs midazolam, or group M). All patients received postoperative 24-h analgesia consisting of 60 mg of ketorolac, 200 mg of tramadol and 4 mg of ondansetron. The primary outcome measured how many patients in the two groups required an analgesic rescue dose of pethidine and the time to first pethidine administration. To reduce confounding, we included patients in two groups with non-statistically different demo-anamnestic parameters and who received the same dose of intraoperative local anaesthetic and postoperative analgesia.
RESULTS
The number of patients in group D who did not require a rescue dose of analgesia was significantly greater than in group M (49 vs 11, p < 0.001). Time-to-first postoperative opioid administration did not show a fundamental difference between the two groups under examination (523.75 ± 131.55 min vs 564 ± 117.84 min). Total opioid consumption was higher in the M group than in the D group (3529.8 ± 30.36 μg vs 1864.8 ± 31.59 μg, p 0.075), with a mean opioid consumption significantly higher in the M group than in the D group (26.26 ± 42.8 μg vs 69.21 ± 46.1 μg, p < 0.001): D group received 62.06% less opioid than M group.
CONCLUSIONS
The continuous infusion of dexmedetomidine during orthopaedic surgery performed under locoregional anaesthesia has been shown to increase the analgesic effect of local anaesthetics and reduce the consumption of major opioids in the postoperative period. Dexmedetomidine offers a unique ability to supply sedation and analgesia without respiratory depression, having a wide safety margin and an excellent sedative capacity. It does not increase the rate of postoperative complications.
PubMed: 37386676
DOI: 10.1186/s44158-022-00076-1 -
Veterinary Surgery : VS Oct 2023To evaluate corneal sensitivity and adverse events following subconjunctival administration of three local anesthetics in horses.
OBJECTIVE
To evaluate corneal sensitivity and adverse events following subconjunctival administration of three local anesthetics in horses.
STUDY DESIGN
Randomized, masked, crossover study.
ANIMALS
Twelve healthy adult mares.
METHODS
The subconjunctival space of the treated eye was injected with 0.2 mL of liposomal bupivacaine (1.3%), ropivacaine (0.5%), or mepivacaine (2%). All horses received each medication once and the contralateral eye received saline (control). Corneal touch threshold (CTT) was measured using a Cochet-Bonnet esthesiometer before sedation, after sedation, and at specified intervals until it returned to baseline. Ocular examinations were performed at 24-, 72, and 168 h post-injection to monitor for adverse effects.
RESULTS
The mean total time of anesthesia (TTA) was 168.3 min for ropivacaine, 169.2 min for liposomal bupivacaine, 103.3 min for mepivacaine and 30.7 min for the control. TTA for liposomal bupivacaine (p < .001) and ropivacaine (p = .001) was longer than the control. TTA for mepivacaine was not different from the control (p = .138), liposomal bupivacaine (p = .075) or ropivacaine (p = .150). Injection site hemorrhage reduced TTA regardless of treatments (p = .047). No adverse effects attributed to injections were noted.
CONCLUSION
All three medications were well tolerated. Subconjunctival administration of ropivacaine and liposomal bupivacaine resulted in longer TTAs compared to the control; however, their TTAs were not different from that of mepivacaine.
CLINICAL SIGNIFICANCE
Subconjunctivally administered liposomal bupivacaine and ropivacaine are viable options to provide prolonged corneal analgesia in horses. Future studies are needed to assess the efficacy in diseased eyes.
Topics: Animals; Female; Anesthesia, Local; Anesthetics, Local; Bupivacaine; Cross-Over Studies; Horses; Mepivacaine; Ropivacaine
PubMed: 37332132
DOI: 10.1111/vsu.13980 -
Journal of Dental Anesthesia and Pain... Jun 2023Local anesthetics are an essential part of pain control during dental treatment. Despite its effectiveness and safety, patients should constantly be aware of potential...
Local anesthetics are an essential part of pain control during dental treatment. Despite its effectiveness and safety, patients should constantly be aware of potential adverse effects, including allergic reactions. Allergic reactions to amide-type local anesthetics (LAs), such as lidocaine and mepivacaine, are rare compared to those to ester-type LAs. Herein, we report the case of a patient with a history of allergy to lidocaine and mepivacaine, with symptoms of itching, diffuse erythema of the wrists and hands, dizziness, and pectoralgia. This case report emphasizes the importance of collecting medical and dental histories of patients is necessary, and how an allergy test in the allergy and clinical immunology department helps select safe LAs for patients.
PubMed: 37313269
DOI: 10.17245/jdapm.2023.23.3.173 -
Current Pharmaceutical Design May 2023Local anesthetic (LA) compounds decrease the permeability of the ion channels to sodium, which in turn, diminishes the rate of depolarization. These agents (a.k.a....
Local anesthetic (LA) compounds decrease the permeability of the ion channels to sodium, which in turn, diminishes the rate of depolarization. These agents (a.k.a. -caines) are also used to depress mucosal sensations, e.g., gag reflex in the form of topical anesthetics. Overdose of LA can lead to local anesthetic systemic toxicity (LAST), which is the precursor of potentially lethal consequences on clinical grounds. There is a wide array of possible presentations of LAST, from mild findings, such as temporary hypertensive events, to serious conditions, including refractory cardiac dysfunction, dysrhythmias and prearrest situations. Lidocaine, prilocaine, mepivacaine, ropivacaine, and bupivacaine are among the most commonly used members of the family. The agents' dosages should be adjusted in children, elderly and fragile individuals and those with organ failures, as the metabolism of the compounds will be impaired. The ideal body weight, along with hepatic and renal functional reserves, will have an impact on elimination kinetics. Systemic absorption is an untoward consequence of LA administration which deserves every means of prevention. Intravenous lipid emulsion is an important life-saving treatment in severe, life-threatening cases. This narrative review article is designed to cover the clinical uses of LA in children, recognition, and management of untoward effects of the agents, with special emphasis on the LAST.
PubMed: 37231720
DOI: 10.2174/1381612829666230525122040 -
Dental Research Journal 2023This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two...
Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine: A randomized controlled clinical trial.
BACKGROUND
This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine.
MATERIALS AND METHODS
The current randomized controlled clinical trial was conducted on 100 patients in two groups ( = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and < 0.05 was set as statistically significant.
RESULTS
The patients' pain severities during the three stages were significantly different ( = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine.
CONCLUSION
The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.
PubMed: 37180689
DOI: No ID Found