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Animals : An Open Access Journal From... Feb 2023Surgical castration of piglets is generally recognized as a painful procedure, but there is currently no gold standard for the assessment of pain behavior in piglets....
Surgical castration of piglets is generally recognized as a painful procedure, but there is currently no gold standard for the assessment of pain behavior in piglets. However, pain assessment is essential for evaluating the effectiveness of local anesthetics. In this study, we investigated the efficacy of four local anesthetics in terms of pain relief during and after surgical castration in three sequential study parts. To do so, we filmed 178 piglets before the applied procedures, after injection of the local anesthetic, and up to 24 h after castration (five observation times in total) in an observation arena and compared their behavior before and after castration and between treatments and control groups. The results showed significant differences in the behavior of the piglets before and after castration and between the sham-castrated control group and the control group castrated without anesthesia. The different local anesthesia treatment groups showed diverging differences to the control groups. The most frequently shown pain-associated behaviors of the piglets were changes in tail position and hunched back posture. We observed a reduction but no complete elimination of the expressed pain-associated behaviors after local anesthesia. Several behavioral changes-such as changes in tail position, hunched back posture or tail wagging-persisted until the day after castration. Owing to the limited duration of the effects of the local anesthetics, local anesthesia did not influence long-term pain.
PubMed: 36766418
DOI: 10.3390/ani13030529 -
Cureus Dec 2022Many dentists use articaine as their choice of local anesthetic agent. However, the use of articaine is limited to inferior alveolar nerve blocks (IANBs),...
Many dentists use articaine as their choice of local anesthetic agent. However, the use of articaine is limited to inferior alveolar nerve blocks (IANBs), and literature data are scarce concerning its perception and choice among various dental practitioners. The aim of the present study was to assess the extent of articaine use as a local anesthetic in dentistry, its perception basis, and the consistency of evidence of the efficacy and safety of articaine in recent practice. The present study utilized a survey tool that was given to all the participating dental practitioners, and the participants were given five minutes to fill out the survey questionnaire. The questionnaire was in English and had 14 questions to be answered. The data gathered were statistically assessed to formulate the results. The results of this cross-sectional survey reported that articaine is used as a choice of local anesthetic by more than half of the participating dental practitioners. Sixty percent (n = 480) participants used articaine in their practice, followed by lidocaine, which was used by 33% (n = 264) dental practitioners, mepivacaine by 2% (n = 16) participants, prilocaine by 1% (n = 8) dental practitioners, and other local anesthetics by 4% (n = 32) participants, respectively. Concerning the safety and efficacy of articaine use, 43% used it for all procedures except for IANBs, whereas 20% used it for all procedures, including IANBs. Despite the reported efficacy and safety of articaine as a local anesthetic for all dental procedures, many dental practitioners refrain from using it, especially for IANBs. These data depict a difference between current research evidence and reported clinical practice.
PubMed: 36654547
DOI: 10.7759/cureus.32510 -
Journal of the American Dental... Jan 2023Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction... (Review)
Review
BACKGROUND
Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction and in patients with symptomatic irreversible pulpitis.
TYPES OF STUDIES REVIEWED
The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the US Clinical Trials registry through November 21, 2020. The authors included randomized controlled trials (RCTs) comparing long- vs short-acting injectable anesthetics to reduce pain after tooth extraction (systematic review 1) and evaluated the effect of topical anesthetics in patients with symptomatic pulpitis (systematic review 2). Pairs of reviewers screened articles, abstracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. The authors assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Fourteen RCTs comparing long- vs short-acting local anesthetics suggest that bupivacaine may decrease the use of rescue analgesia and may not result in additional adverse effects (low certainty evidence). Bupivacaine probably reduces the amount of analgesic consumption compared with lidocaine with epinephrine (mean difference, -1.91 doses; 95% CI, -3.35 to -0.46; moderate certainty) and mepivacaine (mean difference, -1.58 doses; 95% CI, -2.21 to -0.95; moderate certainty). Five RCTs suggest that both benzocaine 10% and 20% may increase the number of people experiencing pain reduction compared with placebo when managing acute irreversible pulpitis (low certainty).
PRACTICAL IMPLICATIONS
Bupivacaine may be superior to lidocaine with epinephrine and mepivacaine with regard to time to and amount of analgesic consumption. Benzocaine may be superior to placebo in reducing pain for 20 through 30 minutes after application.
Topics: Humans; Acute Pain; Anesthesia, Local; Anesthetics, Local; Benzocaine; Bupivacaine; Epinephrine; Lidocaine; Mepivacaine; Pulpitis
PubMed: 36608963
DOI: 10.1016/j.adaj.2022.10.014 -
Journal of Conservative Dentistry : JCD 2022The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a...
Efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: An study.
AIM
The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block (IANB) with lidocaine in patients with irreversible pulpitis.
MATERIALS AND METHODS
A total of 120 patients were included in the study. Patients were given IANB with 2 ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Patients who showed subjective symptoms of IANB but did not secure pulpal anesthesia were randomly allocated to one of the following four groups by random sampling for supplementary local anesthesia - Group 1: buccal infiltration (BI) with 4% articaine with 1:100,000 epinephrine, Group 2: four-site intraligamentary (IL) injection with 4% articaine with 1:100,000 epinephrine, Group 3: BI with 2% mepivacaine with 1:100,000 epinephrine, and Group 4: four-site IL injection with 2% mepivacaine with 1:100,000 epinephrine.
RESULTS
Group 1 - BI with articaine provided anesthesia success in 27 cases (90%, = 30). Group 2 - IL injection with articaine provided anesthesia success in 20 cases (66.67%, = 30). Group 3 - BI with mepivacaine provided anesthesia success in 21 cases (70%, = 30). Group 4 - IL injection with mepivacaine provided anesthesia success in 15 cases (50%, = 30). A significant difference between the four groups was found.
CONCLUSION
In patients with a mandibular first molar exhibiting symptomatic irreversible pulpitis, block injection with lidocaine along with supplemental BI with articaine allowed more pain-free treatments. Articaine showed better results when compared with mepivacaine.
PubMed: 36591593
DOI: 10.4103/jcd.jcd_299_22 -
Veterinary Surgery : VS Apr 2023To determine the effect of concurrent versus delayed treatment with corticosteroid on equine articular tissues also treated with local anesthetic in vitro in the...
OBJECTIVE
To determine the effect of concurrent versus delayed treatment with corticosteroid on equine articular tissues also treated with local anesthetic in vitro in the presence of inflammatory mediators.
STUDY DESIGN
Controlled laboratory study.
ANIMALS
Five geldings, one mare (aged 3-18 years).
METHODS
From each horse, 24 synovial and 12 osteochondral explants were cultured in a 12-well plate (2 wells/group, 2 synovial and 1 osteochondral explant/well, total 216 explants in the study). Explants were stimulated in culture medium with 10 μg/ml recombinant equine interleukin-1β and 10 μg/ml tumor necrosis factor-α for 48 hours, then randomly assigned to six treatments: unstimulated control, stimulated control, triamcinolone acetonide (TA, 10 M), mepivacaine hydrochloride (MH, 4.4 mg/ml), MH + TA (concurrent) and MH + TA (delayed). The delayed group was treated with MH and, 6 days later, treated with TA. Every 3 days for 9 days total, medium levels of lactate dehydrogenase (LDH), prostaglandin E (PGE ), matrix metalloproteinase 13 (MMP-13) and glycosaminoglycan (GAG) were quantified via ELISA. Data were analyzed with mixed-effects models with Tukey's multiple comparisons.
RESULTS
Stimulation increased medium PGE and MMP-13 and had no effect on LDH or GAG. Treatment with MH increased LDH and decreased PGE and MMP-13. Treatment with TA decreased PGE and MMP-13.
CONCLUSION
There were no differences in cytotoxicity, inflammation or matrix degradation for delayed or concurrent MH and TA treatment groups up to 9 days in culture.
CLINICAL SIGNIFICANCE
The lack of an effect of concurrent versus delayed treatment might indicate that concurrent therapy is acceptable.
Topics: Horses; Animals; Male; Female; Anesthetics, Local; Matrix Metalloproteinase 13; Cartilage, Articular; Adrenal Cortex Hormones; Triamcinolone Acetonide; Glycosaminoglycans
PubMed: 36571324
DOI: 10.1111/vsu.13924 -
Skeletal Radiology Nov 2023The purpose of this systematic review is to evaluate the current literature on the use of image-guided corticosteroid injections in the treatment of patients with knee...
PURPOSE
The purpose of this systematic review is to evaluate the current literature on the use of image-guided corticosteroid injections in the treatment of patients with knee and hip OA.
EVIDENCE ACQUISITION
We conducted a comprehensive literature search through June 30, 2022. Publication type, study design, imaging guidance modality, osteoarthritis severity, number of injections, steroid type and dose, anesthetic type and dose, the total number of patients, follow-up intervals, and measured outcomes were extracted from the included studies.
EVIDENCE SYNTHESIS
There were 23 included studies (10 hips, 12 knees, 1 both hip and knee). Hip injections were found to be effective in treating short- and long-term pain and more effective than hyaluronic acid, Mepivacaine, NSAIDs, and normal saline in terms of improvement in pain and/or function. There was less impact on QoL. Knee injections were found either to have little or no impact or were similar or inferior to comparison injections (intra-articular hyaluronic acid, PRP, NSAIDs, normal saline, adductor canal blocks). Study data could not be aggregated because the corticosteroid types and doses, methods of outcome assessment, and follow-up time points varied widely.
CONCLUSION
Our systematic review found generally positive outcomes for the hip, but overall negative outcomes for the knee, although hip injections may carry a risk of serious adverse outcomes. A larger trial with uniform methodology is warranted. Specific studies on the adverse effects of corticosteroid injections are also warranted.
Topics: Humans; Osteoarthritis, Knee; Hyaluronic Acid; Osteoarthritis, Hip; Saline Solution; Quality of Life; Treatment Outcome; Adrenal Cortex Hormones; Pain; Anti-Inflammatory Agents, Non-Steroidal; Injections, Intra-Articular
PubMed: 36517614
DOI: 10.1007/s00256-022-04257-5 -
Frontiers in Veterinary Science 2022To determine the synovial fluid (SF) concentrations of lidocaine and mepivacaine after intra-articular injection with clinically relevant doses to the distal...
OBJECTIVE
To determine the synovial fluid (SF) concentrations of lidocaine and mepivacaine after intra-articular injection with clinically relevant doses to the distal interphalangeal (DIP), metacarpophalangeal (MCP), middle carpal (MC), and tarsocrural (TC) joint at two different time points after injection in order to be able to compare concentrations with previously established concentrations associated with cytotoxicity and antimicrobial activity.
PROCEDURES
In the first of two experiments, 20 joints (5 MC, 5 MCP, 10 DIP joints) of five horses under general anesthesia were injected with clinically referenced doses of 2% lidocaine. Simultaneously, the horses had 19 joints (5 MC, 5 MCP, 9 DIP joints) injected with clinically referenced doses of 2% mepivacaine. Synovial fluid samples were collected ~7 min after injection. In experiment 2, 23 joints of seven horses under standing sedation were injected with clinically referenced doses of 2% lidocaine. Similarly, the horses had 21 joints injected with 2% mepivacaine. Synovial fluid samples were collected ~23 min after injection. The concentration of mepivacaine and lidocaine in the obtained SF samples was assessed using high-performance-liquid-chromatography with mass spectrometry detection (HPLC MS).
RESULTS
Synovial fluid was obtained 6.8 ± 1.5 (experiment 1) and 23 ± 4.3 (experiment 2) min following intra-articular injection of mepivacaine and lidocaine. Synovial fluid concentrations of experiment 1 for lidocaine and mepivaciane were 6.46-19.62 mg/mL (mean 11.96 ± SD 3.89 mg/mL) and 5.01-13.38 mg/mL (mean 8.18 ± SD 1.76 mg/mL), respectively. In experiment 2, concentrations were 2.94-10.40 mg/mL (mean 6.31± SD 2.23 mg/mL) for lidocaine and 2.10-8.70 mg/mL (mean 4.97 ± SD 1.77 mg/mL) for mepivacaine.
CONCLUSIONS AND CLINICAL RELEVANCE
Intra-articular LA injections in horses resulted in SF concentrations above those previously associated with cytotoxic effects but also above those associated with beneficial antimicrobial activities. Local anesthetic concentration was 33-60% lower after 23 min (experiment 2) than after 7 min (experiment 1).
PubMed: 36439347
DOI: 10.3389/fvets.2022.1007399 -
Combinatorial Chemistry & High... 2023Mepivacaine, an amide-type local anesthetic drug widely used in regional anesthesia, was studied by some aspects such as electrochemical behavior, mechanism...
Mepivacaine, an amide-type local anesthetic drug widely used in regional anesthesia, was studied by some aspects such as electrochemical behavior, mechanism illumination, and analytical applications by cyclic voltammetry (CV) and different pulse voltammetry (DPV) methods. In this study, a novel, fast, simple, portable, and the inexpensive electrochemical sensor was developed for the determination of mepivacaine. This study was carried out by mepivacaine anodic direction detection for the first time. The modified sensor was fabricated with silver nanoparticles (AgNP) and multiwalled carbon nanotubes paste electrode (MWCNTPE) by using the drop-dry method. Different experimental parameters, such as pulse amplitude, step potential, and scanning rate in the DPV application module, were optimized. Under optimal operation conditions, the limit of detection (LOD) as low as 31 μg L was found over the dynamic range (0.1-8.0 mg L). In contrast to its high response towards mepivacaine, the DPV exhibits negligible responses on modified AgNP/MWCNTPE when exposed to interfering species such as dopamine, uric acid, glucose, ascorbic acid, and some heavy metals. Exceptionally, the proposed DPV method on modified AgNP/MWCNTPE was successfully applied to pharmaceutical dosage form and synthetic human serum with a low relative standard deviation (RSD) of 1.35% and 2.02%, respectively.
Topics: Humans; Nanotubes, Carbon; Silver; Mepivacaine; Metal Nanoparticles; Electrochemical Techniques; Electrodes
PubMed: 36424789
DOI: 10.2174/1386207326666221124103102 -
Cureus Oct 2022Pelizaeus-Merzbacher disease (PMD) is a genetic leukodystrophy, which is a progressive and degenerative central nervous system abnormality caused by dysmyelination....
Pelizaeus-Merzbacher disease (PMD) is a genetic leukodystrophy, which is a progressive and degenerative central nervous system abnormality caused by dysmyelination. Because the incidence of PMD is extremely low, only a few case reports have been published regarding its anesthetic management. In particular, epidural anesthesia has only been reported in one case of general anesthesia combined with caudal anesthesia. We performed general anesthesia combined with epidural anesthesia for the soft-tissue release surgery for bilateral hip subluxation in a six-year-old male patient diagnosed with PMD. General anesthesia was induced with sevoflurane in nitrous oxide and oxygen. Rocuronium was administered to facilitate tracheal intubation. After intubation, general anesthesia was maintained with sevoflurane in the air and oxygen. An epidural catheter was placed from L3/4. For epidural anesthesia and analgesia, 1% mepivacaine was used as needed, and 2 ml/h of 0.2% ropivacaine was started one hour before the end of surgery. During surgery, only epidural analgesia was provided as postoperative analgesia, and the patient did not complain of pain after extubation. Anesthesia lasted three hours and 55 minutes. No significant hemodynamic or respiratory changes occurred. Postoperatively, the patient received continuous epidural analgesia and regular oral acetaminophen, and pain control was good. The epidural catheter was removed on the second postoperative day. The postoperative course was good, and the patient was transferred to a pediatric rehabilitation hospital on the fifth postoperative day. No adverse events occurred and no neurological deficits were observed during hospitalization. In conclusion, anesthesiologists should pay attention to the possibility of perioperative aspiration, spasticity, and seizure, even with mild PMD. Proper preoperative evaluations, intraoperative monitoring, and anesthetic techniques will ensure safe anesthesia for PMD patients. Although regional anesthesia in patients with pre-existing neurologic deficits is controversial, we were able to safely perform epidural anesthesia and postoperative continuous epidural analgesia in a pediatric patient with PMD.
PubMed: 36381865
DOI: 10.7759/cureus.29983 -
Animals : An Open Access Journal From... Oct 2022To evaluate pain responses to intratesticular and subscrotal injection of three local anaesthetics and their efficacy during castration a randomized controlled study was...
To evaluate pain responses to intratesticular and subscrotal injection of three local anaesthetics and their efficacy during castration a randomized controlled study was conducted. In groups of 20 piglets, procaine (2%), lidocaine (2%), or mepivacaine (2%) were administered subscrotal and intratesticularly in two different dosages: 0.5 mL of the original substances or the maximum recommended dosage according to body weight diluted with isotonic saline to a volume of 0.3 mL per each injection site. Two placebo groups received the equivalent volume of isotonic saline. A control group was injected intramuscularly with 0.5 mL isotonic saline for injection pain comparison. Electroencephalographic changes, respiratory rate, heart rate and its variability, blood pressure, and nocifensive movements were assessed in superficial isoflurane anaesthesia. While EEG-changes and linear measures of heart rate variability did not appear conclusive, the low frequency/high frequency (LF/HF) ratio corresponded best with the other pain indicators recorded. The injection of 0.3 mL diluted local anaesthetic per injection site elicited significant fewer signs of pain compared to intramuscular injection of saline. However, pain reduction, but not complete pain elimination, during castration could only be achieved with 0.5 mL of the 2% local anaesthetics per injection site, whereby lidocaine and mepivacaine were the most effective.
PubMed: 36290223
DOI: 10.3390/ani12202833