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Dental Research Journal 2023Although most of the metabolism of local anesthetics (LAs) takes place in the liver, no study has investigated the effect of these anesthetics on the kidney function of...
BACKGROUND
Although most of the metabolism of local anesthetics (LAs) takes place in the liver, no study has investigated the effect of these anesthetics on the kidney function of single-kidney humans or animals. The present study was conducted to examine the effect of LAs on renal function in single-kidney rats.
MATERIALS AND METHODS
The present experimental animal study with two control groups was done in an animal laboratory. Forty-two rats were randomly assigned to seven groups of six rats, including two control groups and five experimental groups. The experimental groups underwent intraperitoneal anesthesia with 2% lidocaine, 2% lidocaine with 1:80,000 epinephrine, 4% articaine, 3% prilocaine with 0.03 IU Felypressin, and 3% mepivacaine, respectively. Unilateral nephrectomy was done. After 24 h, the rats' blood urea nitrogen (BUN), serum creatinine (Cr), and blood specific gravity (BSG) were measured. A standard dose of anesthetics was injected into the peritoneum for 4 days afterward. Then, these indices were measured again 24 h after the last injection. Data were analyzed using IBM SPSS (version 21.0). One-way analysis of variance, Tukey's honestly significant difference , and paired -tests were used for statistical analysis. < 0.05 was considered statistically significant.
RESULTS
The results indicated significant differences among groups in the rats' BUN and serum Cr 24 h after nephrectomy ( < 0.05). However, there were no significant differences in BUN, BSG, and Cr among groups after the interventions.
CONCLUSION
LAs did not affect renal function in single-kidney rats. Therefore, dentists can use the anesthetics in single-kidney people.
PubMed: 38020254
DOI: No ID Found -
Medicines (Basel, Switzerland) Nov 2023As an alternative to animal use, computer simulations are useful for predicting pharmacokinetics and cardiovascular activities. For this purpose, we constructed a...
As an alternative to animal use, computer simulations are useful for predicting pharmacokinetics and cardiovascular activities. For this purpose, we constructed a statistical model to simulate the effects of local anesthetic agents. To train the model, animal experiments were performed on 6-week-old male Hartley guinea pigs. Firstly, the guinea pigs' backs were shaved, then local anesthetic agents were subcutaneously injected, with subsequent stimulation of the anesthetized site with a needle six times at regular intervals. The number of reactions (score value) was counted. In this statistical model, the probability of reacting to needle stimulation was calculated using the elapsed time, type of local anesthetic agent, and presence or absence of adrenaline. Score values were assumed to follow a binomial distribution at the calculated probability. Parameters were estimated using the Bayesian hierarchical model and Hamiltonian Monte Carlo method. The predicted curves using the estimated parameters fitted well the observed animal values. When score values were predicted using randomly generated parameters, the median of duration was similar between animal experiments and simulations (Procaine: 55 min vs. 50 min, Lidocaine: both 60 min, and Mepivacaine: both 85 min). This approach effectively modeled the effects of local anesthetic agents. It is possible to create the simulator using the parameter values estimated in this study.
PubMed: 37999201
DOI: 10.3390/medicines10110061 -
Journal of ISAKOS : Joint Disorders &... Feb 2024To evaluate the effects of liposomal bupivacaine use for interscalene blocks on postoperative analgesia in total shoulder arthroplasty patients.
Liposomal bupivacaine interscalene blocks demonstrate a greater proportion of total shoulder arthroplasty patients with clinically tolerable pain: a retrospective quality improvement study of 491 patients.
OBJECTIVE
To evaluate the effects of liposomal bupivacaine use for interscalene blocks on postoperative analgesia in total shoulder arthroplasty patients.
METHODS
De-identified total or reverse total shoulder arthroplasty patients between 2018 and 2021 were analyzed. Patients were grouped into single shot interscalene block with liposomal bupivacaine (LB) with plain bupivacaine, other block (OB) with other local anesthetics (mepivacaine, ropivacaine, or plain bupivacaine), or no block (NB). The primary outcome was the proportion of patients with clinically tolerable pain scores (mean VAS ≤4) from 0 to 24 h in each group. Secondary outcomes included averaged visual analog pain scores (VAS) and opioid consumption measured in morphine milligram equivalents (MMEs) from 0 to 24 h. We also analyzed the proportion of patients with clinically tolerable pain, mean VAS, and opioid consumption from 0 to 72 h in those patients with at least a 3-day hospital length of stay.
RESULTS
A total of 491 de-identified total shoulder arthroplasty patients, 285 liposomal bupivacaine group (LB), 178 other block group (OB), and 28 no block group (NB), were analyzed. The primary outcome showed a statistically significant different proportion of patients with clinically tolerable pain from 0 to 24 h in the LB group (69 %) vs. OB group (39 %) vs. NB group (11 %) (<0.001). Secondary outcomes included statistically significant differences in VAS (LB median = 3.35, OB median = 4.38, NB median = 5.25 (p < 0.001, <0.001)) and total MME opioid consumption (LB median = 40, OB median = 60, NB median = 88 (p < 0.001, 0.001)) between groups from 0 to 24 h. For patients who had hospital stays of at least 3 days, a significant association was found with having achieved clinically tolerable pain 0-72 h and the LB group (51 %) vs. OB group (21 %) vs. NB group (11 %) (P = 0.006). However, there was no statistical difference in mean VAS or opioid consumption between these groups.
CONCLUSION
A greater proportion of total shoulder arthroplasty patients that received liposomal bupivacaine in interscalene block have clinically tolerable pain scores from 0 to 24 h, lower VAS, and lower MME consumption in patients following total shoulder arthroplasty.
LEVEL OF EVIDENCE
Level III - Clinical Study.
Topics: Humans; Anesthetics, Local; Arthroplasty, Replacement, Shoulder; Analgesics, Opioid; Pain, Postoperative; Retrospective Studies; Quality Improvement; Bupivacaine; Endrin
PubMed: 37866512
DOI: 10.1016/j.jisako.2023.10.007 -
BMJ Open Oct 2023Despite the wide use of articaine in paediatric dentistry owing to its proven effectiveness and safety, articaine application in children <4 years remains controversial...
INTRODUCTION
Despite the wide use of articaine in paediatric dentistry owing to its proven effectiveness and safety, articaine application in children <4 years remains controversial due to a lack of data on the use of articaine in very young children. This trial aims to examine the efficacy and safety of 4% articaine compared with 2% mepivacaine in children 3-4 years old requiring dental extractions. We aim to assess local anaesthetic efficacy and safety through a local anaesthetic infiltration technique for primary teeth requiring dental extraction in children 3 years old.
METHODS AND ANALYSIS
This prospective, double-blind, randomised clinical trial with two parallel arms aims to evaluate the safety and efficacy of 4% articaine compared with 2% mepivacaine in 3-year-old children. The trial's outcomes will be assessed by measuring the pain experienced during injection and treatment, evaluating the child's behaviour during the procedure, and monitoring postoperative pain and complications. A total of 200 children will be included in the study, with 100 children in each arm.
ETHICS AND DISSEMINATION
The Institutional Review Board (IRB) approved the study protocol and informed consent documents before initiation of the study. The IRB approval was granted by the Qassim Health Cluster under protocol number 607/43/7809. This study was also approved by the Saudi Food and Drug Authority. The study report will be disseminated through scientific forums, including peer-reviewed publications and conference presentations.
TRIAL REGISTRATION NUMBER
Saudi Clinical Trial Registry (22071802) and ClinicalTrials.gov Registry (NCT05839548).
Topics: Humans; Child, Preschool; Carticaine; Anesthetics, Local; Saudi Arabia; Mepivacaine; Prospective Studies; Double-Blind Method; Anesthesia, Dental; Randomized Controlled Trials as Topic
PubMed: 37865418
DOI: 10.1136/bmjopen-2023-077751 -
Open Veterinary Journal Aug 2023Reindeer are becoming popular animals within petting farms. Few case reports describe the sedation of domesticated reindeer, but none describe the use of ocular local...
BACKGROUND
Reindeer are becoming popular animals within petting farms. Few case reports describe the sedation of domesticated reindeer, but none describe the use of ocular local anesthetic blocks in this species.
CASE DESCRIPTION
A 9-year-old, female, Svalbard reindeer ( ) presenting for removal of a squamous cell carcinoma involving the third eyelid. Standing sedation was performed using initial boluses of medetomidine and butorphanol via intramuscular injection before catheter placement and maintenance with a variable rate infusion of medetomidine. Supraorbital, auriculopalpebral, infratrochlear blocks and local infiltration of the base of the third eyelid were performed using mepivacaine. Following the surgical removal of the third eyelid, atipamazole was administered intramuscularly to antagonize the effects of medetomidine. The patient recovered without complications.
CONCLUSION
Medetomidine-butorphanol in combination with local anesthetic blocks provided a sufficient plane of sedation and analgesia for extra ocular surgery in a domesticated reindeer.
Topics: Female; Animals; Reindeer; Anesthetics, Local; Butorphanol; Medetomidine; Nictitating Membrane; Anesthesia, Local
PubMed: 37701662
DOI: 10.5455/OVJ.2023.v13.i8.11 -
Scandinavian Journal of Urology Aug 2023During transurethral resection of the prostate (TURP), the most established surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
During transurethral resection of the prostate (TURP), the most established surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO), the prostate can bleed profusely, bringing about anaemia and compromised oxygen delivery to the entire body.
OBJECTIVE
The primary objective of this study was to assess the efficacy of mepivacaine and adrenaline (MA) injected into the prostate on bleeding. The primary endpoint was to measure blood loss per resected weight of prostate tissue.
MATERIAL AND METHODS
This randomised controlled trial evaluated 81 patients with LUTS/BPO. Patients were randomly allocated to regular TURP or TURP with intraprostatic injections of MA.
RESULTS
On univariable analyses there was a significant difference in resection weight in favour of the experimental group, not reflected by a statistically significant difference in the other studied outcome parameters. Nevertheless, in multivariable analyses, blood loss per resection weight, which was the primary outcome, showed a significant decrease in favour of the experimental group. Clavien-Dindo complication classification showed three men with a grade I complication and two men with grade II.
CONCLUSIONS
The results obtained in this study showed that it is beneficial to apply intraprostatic injections of MA in immediate conjunction with TURP, in terms of blood loss per resected gram. The study is, however, small and corroboration of our results in more extensive prospective studies may therefore be warranted before embarking upon this technique.
Topics: Male; Humans; Transurethral Resection of Prostate; Epinephrine; Prospective Studies; Prostatic Diseases; Lower Urinary Tract Symptoms; Urethral Obstruction
PubMed: 37614207
DOI: 10.2340/sju.v58.7798 -
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