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Journal of Anesthesia, Analgesia and... Jan 2022Local anesthesia is the most used anesthetic technique for inguinal hernia repair, despite its unpredictability. Selective spinal anesthesia with a short-term local...
Selective spinal anesthesia with hyperbaric prilocaine provides better perioperative pain control than local anesthesia for ambulatory inguinal hernia repair without affecting discharging time: a randomized controlled trial.
PURPOSE
Local anesthesia is the most used anesthetic technique for inguinal hernia repair, despite its unpredictability. Selective spinal anesthesia with a short-term local anesthetic guarantees rapid recovery, predictable duration and low incidence of side effects. We tried to assess the efficacy of this neuraxial technique in ambulatory setting.
METHODS
One hundred thirty-two ASA I-III, aged > 18 patients scheduled for inguinal hernia repair have been randomized into two groups receiving unilateral spinal anesthesia with 40 mg of hyperbaric prilocaine (group A) or local anesthesia with mepivacaine (group B).
PRIMARY ENDPOINT
intraoperative and post-operative NRS. Other outcomes: sensory block onset, need for opiates and deep sedation, surgery duration, and time to discharge.
RESULTS
Group A: intraoperative NRS was 0 in 100% of patients; post-operative maximum NRS was > 3 in 12.12% of patients. Group B: mean intraoperative NRS was 4; mean post-operative NRS was 2.5. Spinal anesthesia resulted superior in controlling both intraoperative and post-operative pain (p < 0.00001; p = 0.008). Mean time of the motor block resolution in group A was 98 ± 2 min. Mean time to discharge was not significantly different between groups. Surgical time was significantly different between the two groups (mean time of 37 ± 3.2 min group A; 54 ± 6 min group B-p < 0.00001).
CONCLUSION
Spinal anesthesia group patients had significantly less pain than local anesthesia group, both intraoperatively and post-operatively, without differences in time to discharge, incidence of complications and with improvement of surgical time. More randomized controlled trials are needed to confirm this hypothesis.
TRIAL REGISTRATION
NCT05136534 . Registered November 29, 2021-Retrospectively registered.
PubMed: 37386519
DOI: 10.1186/s44158-022-00034-x -
The Canadian Veterinary Journal = La... Jan 2022The objective of this study was to compare effects of butorphanol (BUT) or buprenorphine (BUP), in combination with detomidine and diazepam, on the sedation quality,...
The objective of this study was to compare effects of butorphanol (BUT) or buprenorphine (BUP), in combination with detomidine and diazepam, on the sedation quality, surgical conditions, and postoperative pain control after cheek tooth extraction in horses, randomly allocated to 2 treatment groups (BUT: = 20; BUP: = 20). A bolus of detomidine (15 μg/kg, IV) was followed by either BUP (7.5 μg/kg, IV) or BUT (0.05 mg/kg, IV). After 20 min, diazepam (0.01 mg/kg, IV) was administered and sedation was maintained with a detomidine IV infusion (20 μg/kg/h), with rate adjusted based on scores to 5 variables. All horses received a nerve block (maxillary or mandibular), and gingival infiltration with mepivacaine. Sedation quality was assessed by the surgeon from 1 (excellent) to 10 (surgery not feasible). A pain scoring system (EQUUS-FAP) was used to assess postoperative pain. Serum cortisol concentrations and locomotor activity (pedometers) were measured. Horses in BUP and BUT required a median detomidine infusion rate of 30.2 μg/kg/h (20 to 74.4 μg/kg/h) and 32.2 μg/kg/h (20 to 48.1 μg/kg/h), respectively ( = 0.22). Horses in the BUP group had better sedation quality ( < 0.05) during surgery and higher step counts ( < 0.001) postoperatively. Buprenorphine combined with detomidine provided a more reliable sedation than butorphanol. However, the EQUUS-FAP pain scale became unreliable because of BUP-induced excitement behavior.
Topics: Animals; Buprenorphine; Butorphanol; Cheek; Diazepam; Horse Diseases; Horses; Hypnotics and Sedatives; Imidazoles; Pain, Postoperative; Tooth Extraction
PubMed: 34975166
DOI: No ID Found -
American Journal of Veterinary Research Nov 2021To determine whether palmar digital nerve (PDN) blockade in horses with a combination of dexmedetomidine and mepivacaine would block the response to mechanical force...
OBJECTIVE
To determine whether palmar digital nerve (PDN) blockade in horses with a combination of dexmedetomidine and mepivacaine would block the response to mechanical force applied to the digit longer than would anesthetizing these nerves with mepivacaine alone or dexmedetomidine alone.
ANIMALS
8 mares with no signs of lameness.
PROCEDURES
In a randomized, crossover, blinded, experimental study, both PDNs of the same forelimb of each horse were anesthetized by perineural injection with either 30 mg mepivacaine alone, 250 µg of dexmedetomidine alone, or 30 mg mepivacaine combined with 250 µg of dexmedetomidine. Each horse received each treatment, and treatments were administered ≥ 2 weeks apart. The mechanical nociceptive threshold was measured at a region between the heel bulbs with the use of a digital force gauge before (baseline) and at 15-minute intervals after treatment.
RESULTS
The mean duration of sensory blockade of the digit was 2-fold longer when a combination of mepivacaine and dexmedetomidine was administered (371 minutes), compared with when mepivacaine alone was administered (186 minutes). Treatment with dexmedetomidine alone did not change the mechanical nociceptive threshold substantially from baseline and resulted in no clinical signs of sedation.
CLINICAL RELEVANCE
Results indicated that relief from digital pain provided by perineural treatment with mepivacaine for PDN blockade can be extended by adding dexmedetomidine to the injectate.
Topics: Anesthetics, Local; Animals; Dexmedetomidine; Female; Forelimb; Horses; Mepivacaine; Nerve Block
PubMed: 34851852
DOI: 10.2460/ajvr.20.10.0188 -
Severe Anaphylaxis in Pregnancy: A Systematic Review of Clinical Presentation to Determine Outcomes.Journal of Personalized Medicine Oct 2021Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are... (Review)
Review
Anaphylactic reactions during pregnancy can range from subjective cutaneous symptoms to anaphylaxis and lethal anaphylactic shock. The fetal and maternal outcomes are unpredictable. This study is the first systematic review of the clinical presentation of severe anaphylaxis in pregnancy as defined by the World Allergy Organization to determine maternal and fetal outcomes. We searched PubMed, the Web of Science, and Scopus databases for articles published between 1 January 1985 and 15 April 2021 using the following terms (((anaphylactic shock) AND (pregnancy)) OR ((anaphylaxis) AND (pregnancy))). In 42 studies involving 47 patients, 36.17% of patients were 31-35 years old, and 74.47% of cases occurred peripartum, mostly during cesarean section. Accurate diagnosis with valid and reliable outcome measures was reported for 71.74% of cases. Twenty-two allergens were identified: antibiotics (penicillins and cephalosporins), anesthetic drugs (suxamethonium, mepivacaine), latex, oxytocin, sodium and sucrose iron, laminaria, misoprostol, rubber from Foley catheter, oral phytomenadione, ranitidine, chamomile, and ant sting. Two cases of maternal death related to latex and intravenous iron sucrose, and six infants with neurological disease were reported, mostly related to antibiotics. This review of the currently available literature shows that favorable outcomes are attainable with a high degree of observation, multidisciplinary cooperation, and rapid treatment.
PubMed: 34834412
DOI: 10.3390/jpm11111060 -
Journal of Oral Science Jan 2022Stellate ganglion block (SGB) is effective in treating head and neck pain and neuropathic diseases by increasing tissue blood flow through its sympatholytic effect. This... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Stellate ganglion block (SGB) is effective in treating head and neck pain and neuropathic diseases by increasing tissue blood flow through its sympatholytic effect. This study aimed to investigate the relationship between duration of cervical sympathetic nerve block by SGB and its therapeutic efficacy against trigeminal neuropathy after orthognathic surgery.
METHODS
Twenty-eight patients with trigeminal neuropathy were randomly assigned to two groups (mepivacaine and levobupivacaine) according to the drug used for SGB. Increased blood flow, which is a symptom of sympathetic blockade, was recorded for 180 min after SGB. Current perception threshold, warm or cool detection threshold, and tactile detection threshold were measured preoperatively, postoperatively, on day 10 after initiation of SGB, and 3 months postoperatively to compare therapeutic efficacy between the groups.
RESULTS
The levobupivacaine group had a significantly longer duration of increased blood flow compared with the mepivacaine group. Values of current perception threshold, warm and cool detection threshold, and tactile detection threshold significantly improved in the levobupivacaine group on day 10 after initiation of SGB and 3 months postoperatively.
CONCLUSION
A prolonged increase in blood flow due to long-term sympatholytic effects accelerates the therapeutic efficacy of SGB in trigeminal neuropathy.
Topics: Autonomic Nerve Block; Humans; Mepivacaine; Stellate Ganglion; Trigeminal Nerve Diseases
PubMed: 34789618
DOI: 10.2334/josnusd.21-0245 -
BMC Anesthesiology Nov 2021Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control.
METHODS
Patients (n = 90) with ASA physical status 1-3 were prospectively randomised to receive; SCB with mepivacine 1%, 25-30 ml (n = 30), SCB with ropivacaine 0.5%, 25-30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups.
RESULTS
The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3-3.3) and 2.7 (IQR 1.3-4.2) (p = 0.017) and OEC 30 mg (IQR 10-80) and 85 mg (IQR 45-125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%).
CONCLUSIONS
The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution.
TRIAL REGISTRATION
NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).
Topics: Adult; Aged; Aged, 80 and over; Analgesics, Opioid; Anesthesia, General; Anesthetics, Local; Brachial Plexus Block; Female; Humans; Male; Mepivacaine; Middle Aged; Pain Measurement; Pain, Postoperative; Prospective Studies; Radius Fractures; Ropivacaine; Time Factors; Young Adult
PubMed: 34753423
DOI: 10.1186/s12871-021-01499-z -
Equine Veterinary Journal Sep 2022A 10-year-old 466 kg mustang gelding presented to an equine referral hospital for surgical repair of nasal, frontal and lacrimal bone fractures from an unknown trauma.... (Review)
Review
A 10-year-old 466 kg mustang gelding presented to an equine referral hospital for surgical repair of nasal, frontal and lacrimal bone fractures from an unknown trauma. Surgical repair was performed under general anaesthesia, including a right-sided maxillary regional anaesthetic block with mepivacaine hydrochloride. Progressive hyperkalaemia was documented perianaesthetically (T-3 mins; 134 mins after induction; potassium 6.4 mmol/L (ref 3.5-5.1 mmol/L). Perianaesthetic bradycardia was attributed to alpha -2 agonist infusion administration, and other characteristic ECG changes (flattened P waves, narrow T waves of increased amplitude, prolonged QRS complex) were not documented. Asystole occurred 137 min after induction of anaesthesia; however, a review of the available literature suggests the degree of hyperkalaemia documented was unlikely to be the primary cause of asystole but may have been a contributing factor. It is hypothesised that a trigeminocardiac reflex was the primary contributory factor to asystole in the described case, and may represent a maxillomandibulocardiac reflex that has not been previously described in the horse.
Topics: Animals; Arrhythmias, Cardiac; Blood Pressure; Heart Arrest; Horse Diseases; Horses; Hyperkalemia; Male; Reflex
PubMed: 34738246
DOI: 10.1111/evj.13535 -
PloS One 2021The main objective of this study is to test the feasibility of the local anesthetic (LA) Mepivacaine 1% and sedation with Remifentanil as the primary anesthetic...
STUDY OBJECTIVE
The main objective of this study is to test the feasibility of the local anesthetic (LA) Mepivacaine 1% and sedation with Remifentanil as the primary anesthetic technique for the insertion of a peritoneal dialysis (PD) catheter, without the need to convert to general anesthesia.
METHODS
We analyzed 27 consecutive end-stage renal disease (ESRD) patients who underwent the placement of a peritoneal catheter at our center between March 2015 and January 2019. The procedures were all performed by a general or vascular surgeon, and the postoperative care and follow-up were all conducted by the same peritoneal dialysis team.
RESULTS
All of the 27 subjects successfully underwent the procedure without the need of conversion to general anesthesia. The catheter was deemed prone to usage in all patients and was found to be leak-proof in 100% of the patients.
CONCLUSION
This study describes a safe and successful approach for insertion of a PD catheter by combined infiltration of the local anesthetic Mepivacaine 1% and sedation with Remifentanil. Hereby, ESRD patients can be treated without general anesthesia, while ensuring functionality of the PD catheter.
Topics: Adult; Aged; Aged, 80 and over; Catheterization; Feasibility Studies; Female; Humans; Kidney Failure, Chronic; Male; Mepivacaine; Middle Aged; Peritoneal Dialysis; Prospective Studies; Remifentanil; Treatment Outcome
PubMed: 34735524
DOI: 10.1371/journal.pone.0259351 -
International Journal of Pharmaceutics Sep 2021Liquid forms of active pharmaceutical ingredients, ionic liquids (ILs) and deep eutectic mixtures (DEMs), offer several potential benefits in respect to advancing...
Liquid forms of active pharmaceutical ingredients, ionic liquids (ILs) and deep eutectic mixtures (DEMs), offer several potential benefits in respect to advancing pharmaceutical formulations. The aim of this study was to develop and characterise ILs/DEMs composed of two active molecules: ketoprofen (KET), as the acidic component, and a local anaesthetics (LA), lidocaine (LID), mepivacaine (MEP) or bupivacaine (BUP), which constituted the basic component. A mechanosynthetic approach was successfully applied to obtain LA-KET low melting systems. Composition/temperature phase diagrams were determined by differential scanning calorimetry. The amide LA-KET mixtures showed a eutectic behaviour during heating and formed viscous liquids upon quench cooling. Considering the quench cooled LA-KET mixtures, LA crystallisation was observed only in the LA-rich mixtures. LID, MEP and BUP formed disordered complexes with KET at an approximate 1:2 stoichiometry. Infrared spectroscopy studies revealed that the mixtures were composed mainly of hydrogen bonded acid and base molecules, but small amounts of carboxylate anions were detected. The formation of LA-KET complex not only suppressed the high crystallisation tendency of the LA molecules in the dry state, but also eliminated the crystallisation of KET and LA molecules induced by moisture, as revealed by dynamic vapour sorption studies.
Topics: Amides; Anesthetics, Local; Calorimetry, Differential Scanning; Ionic Liquids; Ketoprofen
PubMed: 34358543
DOI: 10.1016/j.ijpharm.2021.120969 -
Bioengineered Dec 2021With the gradual recognition of the side effects of local anesthetics, the nerve injury caused by local anesthetics has received growing attention. This research...
With the gradual recognition of the side effects of local anesthetics, the nerve injury caused by local anesthetics has received growing attention. This research intended to delve into miR-183-5p changes in mepivacaine-mediated SH-SY5Y cell injury, as well as its modulatory mechanism on cell apoptosis. RT-qPCR was adopted for assaying miR-183-5p and PDCD4 mRNA expression. Our team respectively transfected miR-183-5p mimic and inhibitor to enhance or inhibit miR-183-5p function. We employed Western blot for detecting PDCD4 protein levels, as well as flow cytometry and Hoechst 33342/PI double staining for determining cell apoptosis rate. Additionally, our crew applied an ELISA kit for measuring TNF-α, IL-1β, IL-6, and IL-8 contents. The level of reactive oxygen species (ROS) production was examined by the Image-iT LIVE Green ROS detection Kit. As well as dual-luciferase reporter experiment for verifying the targeting link of miR-183-5p with PDCD4. In mepivacaine-induced cell apoptosis in SH-SY5Y cells, miR-183-5p expression was down-regulated. TNF-α, IL-1β, IL-6, and IL-8 contents were elevated. The rate of apoptosis increased visibly, cleaved caspase-3 and Bax levels waxed, whereas Bcl-2 level waned. MiR-183-5p could alleviate the damaging impact of mepivacaine. Dual-luciferase reporter experiments demonstrated that miR-183-5p directly targeted PDCD4. Collectively, we concluded that a high concentration of mepivacaine can cause SH-SY5Y cell damage, miR-183-5p functions crucially in mepivacaine-mediated cell damage. This study provides a theoretical basis for elucidating the mechanism of mepivacaine-induced nerve cell damage, and overexpressed miR-183-5p likely become a novel strategy to combat mepivacaine-induced nerve damage.Abbreviations:miRNA: Micro RNA; PDCD4: Programmed Cell Death 4; MDA: Malondialdehyde; SOD: Superoxide Dismutase; ROS: Reactive Oxygen Species; WT: Wild Type; Mut: Mutant; UTR: Untranslated Region; IL-6: Interleukin-6; IL-1β: Interleukin-1β; TNF-α: Tumor Necrosis Factor-α; IL-8: Interleukin-8; COX-2: Cyclooxygenase-2; iNOS: inducible NOS; MEP: Mepivacaine.
Topics: Apoptosis; Apoptosis Regulatory Proteins; Cell Line, Tumor; Cytokines; Humans; Mepivacaine; MicroRNAs; Protective Agents; RNA-Binding Proteins
PubMed: 34180760
DOI: 10.1080/21655979.2021.1946358