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Anesthesia Progress Dec 2022Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical...
OBJECTIVE
Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers.
METHODS
Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals.
RESULTS
A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia.
CONCLUSION
No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.
Topics: Adult; Male; Female; Humans; Anesthetics, Local; Anesthesia, Local; Pilot Projects; Cannabis; Vasoconstrictor Agents; Lidocaine; Epinephrine; Anesthesia, Dental; Dental Pulp Test; Dental Pulp
PubMed: 36534774
DOI: 10.2344/anpr-69-02-08 -
Translational Vision Science &... Jan 2022Prolonged local anesthesia (PLA) of the cornea is currently assumed to cause neurotrophic keratitis and is strongly discouraged. We investigate whether PLA of the cornea...
PURPOSE
Prolonged local anesthesia (PLA) of the cornea is currently assumed to cause neurotrophic keratitis and is strongly discouraged. We investigate whether PLA of the cornea per se causes neurotrophic keratitis.
METHODS
PLA of the cornea was induced in 12 female albino BALB/c mice by retrobulbar injection of a polymeric prodrug (PGS-TTX) where the site 1 sodium channel blocker tetrodotoxin (TTX) was slowly released from the polymer polyglycerol sebacate. The duration and depth of corneal anesthesia was monitored by the Cochet-Bonnet esthesiometer. Corneal injury from PLA was assessed by slit lamp examination with 2% sodium fluorescein dye, histology, corneal nerve density by immunohistochemistry with anti-β III tubulin antibody and confocal microscopy, and corneal neurotrophin levels (substance P and neurokinin A) by an enzyme-linked immunosorbent assay. PLA was also induced by topical amitriptyline (80 mM), used as a positive control for local anesthetic-induced corneal injury. Frequent ocular lubrication was provided.
RESULTS
Retrobulbar PGS-TTX resulted in complete corneal anesthesia lasting 50.1 ± 3.6 hours and mean time to complete resolution of block of 55.1 ± 3.6 hours with no keratopathy provided lubrication was provided. Topical 80 mM amitriptyline induced complete corneal anesthesia for 24 hours and developed keratopathy. There was no difference in the histology, levels of corneal neurotrophins, and corneal nerve density between the retrobulbar PGS-TTX group and normal cornea.
CONCLUSIONS
In the absence of topical toxicity or corneal exposure, PLA of the cornea per se does not cause keratitis.
TRANSLATIONAL RELEVANCE
PLA of the cornea could be highly beneficial in acute and chronic painful corneal conditions.
Topics: Anesthesia, Local; Anesthetics, Local; Animals; Cornea; Corneal Dystrophies, Hereditary; Female; Keratitis; Mice
PubMed: 35072700
DOI: 10.1167/tvst.11.1.33 -
Anesthesia Progress 2012An earlier paper by Becker and Reed provided an in-depth review of the pharmacology of local anesthetics. This continuing education article will discuss the importance... (Review)
Review
An earlier paper by Becker and Reed provided an in-depth review of the pharmacology of local anesthetics. This continuing education article will discuss the importance to the safe and effective delivery of these drugs, including needle gauge, traditional and alternative injection techniques, and methods to make injections more comfortable to patients.
Topics: Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Equipment Design; Humans; Nerve Block
PubMed: 23050753
DOI: 10.2344/0003-3006-59.3.127 -
Indian Journal of Ophthalmology Jul 2023Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million... (Review)
Review
Cataract surgery ranks among the commonest procedures performed worldwide. Approximately 51% of blindness worldwide is related to cataracts, affecting about 65.2 million people worldwide and more so in developing countries. Over the years, there has been a significant evolution in the surgical techniques of cataract extraction. The advancement in phacoemulsification machines, phaco-tips, and the availability of ophthalmic viscoelastic devices have played a substantial role in cataract surgery such that they are faster and more controlled than before. Similarly, anesthetic techniques in cataract surgery have advanced significantly from retrobulbar, peribulbar, and sub-Tenon's blocks to topical anesthesia. Though topical anesthesia eliminates the possible complications of injectable anesthesia, it is not suitable for use in uncooperative, anxious patients, pediatric age groups, and patients with cognitive disabilities. Hyaluronidase is an enzyme that breaks down hyaluronic acid in the retrobulbar tissue, facilitating uniform diffusion of the anesthetic drug and hastening the onset of anesthesia and akinesia. Hyaluronidase has been used in the last 80 years successfully as an adjuvant in retrobulbar, peribulbar, and sub-Tenon's blocks. Initially, the hyaluronidase enzyme was animal-derived and of bovine and ovine sources. Recombinant human-derived hyaluronidase, which has lesser allergic reactions, impurities, and toxicity, is now available. There is conflicting evidence regarding the efficacy of hyaluronidase as an adjuvant in retrobulbar and peribulbar blocks. This article summarizes a brief review of the literature on the role of hyaluronidase as an adjuvant in local anesthetic blocks in ophthalmic surgeries.
Topics: Humans; Animals; Cattle; Sheep; Child; Anesthesia, Local; Hyaluronoglucosaminidase; Anesthetics, Local; Cataract Extraction; Cataract; Lidocaine
PubMed: 37417102
DOI: 10.4103/IJO.IJO_2515_22 -
Orthopaedics & Traumatology, Surgery &... May 2023The anaesthetic modality "wide-awake" or "WALANT" (wide awake local anaesthesia not tourniquet) is based on the combination of a local anaesthetic with a vasoconstrictor... (Review)
Review
INTRODUCTION
The anaesthetic modality "wide-awake" or "WALANT" (wide awake local anaesthesia not tourniquet) is based on the combination of a local anaesthetic with a vasoconstrictor to reduce bleeding during surgery and to avoid the use of a pneumatic tourniquet. The combination of 1% lidocaine together with 1:100,000 epinephrine is the most commonly used formula. The objective of this work is to carry out a review of the literature about this anaesthetic modality in the field of orthopaedic surgery and traumatology.
METHODS
PubMed and Embase databases were consulted with clearly defined operators. Two independent searches were conducted by two investigators, which were combined. Experimental, observational comparative studies, descriptive studies with n> 5 cases and cost studies were included. The individual results of the included studies are described.
RESULTS
A total of 8794 entries were collected of which a total of 36 studies were included in the review. A large number of these studies have been published since 2010 and refer almost entirely to hand surgery, with multiple indications applied. There is heterogeneity regarding the type of study design and variables studied, among others. In addition, there is a disparity when defining the methodology of the WALANT technique between the different studies.
CONCLUSIONS
This is the first comprehensive and reproducible review of the current state of the WALANT modality. There is great heterogeneity in terms of the study populations, the different comparators, variables studied between the different studies and a lack of precise details regarding the WALANT technique.
LEVEL OF EVIDENCE
III, Therapeutic study.
Topics: Humans; Orthopedics; Wakefulness; Brain Neoplasms; Anesthesia, Local; Anesthetics, Local; Epinephrine; Orthopedic Procedures
PubMed: 36191901
DOI: 10.1016/j.otsr.2022.103427 -
Hernia : the Journal of Hernias and... Aug 2022In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to...
PURPOSE
In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to evaluate how the use of local anesthesia for this procedure changed over time following the publication of the trials' level 1 evidence.
METHODS
We used the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database to identify adults who underwent open, unilateral inguinal hernia repair under local or general anesthesia. Our primary outcome was the percentage of cases performed under local anesthesia. We used a time-series design to examine the trend and rate of change of the use of local anesthesia.
RESULTS
We included 97,437 veterans, of which 22,333 (22.9%) had hernia surgery under local anesthesia. The median age of veterans receiving local anesthesia remained stable at 64-67 years over time. The use of local anesthesia decreased steadily, from 38.2% at the beginning year to 15.1% in the final year (P < 0.0001). The publication of results from randomized trials (in 2003) did not appear to increase the overall use or change the rate of decline in the use of local anesthesia. Overall, we found that the use of local anesthesia decreased by about 1.5% per year.
CONCLUSION
The utilization of local anesthesia for inguinal hernia repair in the VA has steadily declined over the last 20 + years, despite data showing equivalence or superiority to general anesthesia. Future studies should explore barriers to the use of local anesthesia for hernia repair.
Topics: Adult; Aged; Anesthesia, General; Anesthesia, Local; Hernia, Inguinal; Herniorrhaphy; Humans; Middle Aged; Time Factors
PubMed: 34743254
DOI: 10.1007/s10029-021-02532-3 -
The Journal of Medical Investigation :... 2019Full-endoscopic spinal surgery was first developed for the lumbar herniated nucleus pulposus. Mainly, there are two types in the full-endoscopic lumbar... (Review)
Review
A novel surgical concept of transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) for central canal stenosis of the lumbar spine with local anesthesia : A case report and literature review.
Full-endoscopic spinal surgery was first developed for the lumbar herniated nucleus pulposus. Mainly, there are two types in the full-endoscopic lumbar surgery : i.e., transforaminal (TF) and interlaminar approach. The surgery can be done under the local anesthesia for the TF approach ; therefore, we need to further develop the TF approach to variety of the spinal disorders. Recently, the TF full-endoscopic surgery has been applied for the spinal canal stenosis. First, transforaminal full-endoscopic lumbar foraminoplasty for the foraminal stenosis ; then, transforaminal lumbar lateral recess decompression for the lateral recess stenosis has been developed. Finally, we have developed the surgical technique to decompress the central stenosis via TF approach under the local anesthesia. Prior to initiate the clinical case, we have attempted the lumbar undercutting laminectomy using a fresh cadaveric spine. After we technically confirmed that the transforaminal full-endoscopic lumbar undercutting laminectomy (TE-LUL) is possible, we applied the technique to the patient whose lung capacity did not allow general anesthesia. The 72 years old female patient with central canal stenosis could be improved her left leg pain and muscle weakness after TE-LUL under the local anesthesia. In this paper, we introduce the surgical technique of the TE-LUL and discuss of the efficacy of the TE-LUL. J. Med. Invest. 66 : 224-229, August, 2019.
Topics: Aged; Anesthesia, Local; Endoscopy; Female; Humans; Laminectomy; Lumbar Vertebrae; Spinal Stenosis
PubMed: 31656278
DOI: 10.2152/jmi.66.224 -
Medicina Oral, Patologia Oral Y Cirugia... Aug 2011To determine the frequency of appearance and the factors most commonly associated with ocular complications following dental local anesthesia, also establishing the... (Review)
Review
OBJECTIVE
To determine the frequency of appearance and the factors most commonly associated with ocular complications following dental local anesthesia, also establishing the location and type of anesthesia used.
STUDY DESIGN
An indexed search in the Pubmed and Compludoc databases was carried out with the keywords "oral anesthesia", "ocular", "ophthalmologic", "damage", "complications", "injection". We established a limitation that the literature had to have been published after the year 1970. A total of 19 articles were obtained, forming a total sample of 37 patients. The patient's sex, age, nerve anesthetized, type of anesthetic used, ophthalmological complication present, recovery time, treatment and side effects were analyzed.
RESULTS
There is a higher involvement of females (77%). The average age was 34.2 years. There was no preference for an anesthetic technique. Diplopia was the most common complication (65%), which coincides with the data from other authors. Almost all of the complications were of a temporary nature, with an average recovery time of 68 minutes.
CONCLUSIONS
This is one of the few studies of its kind in dental literature, it thus being difficult to make precise conclusions. Ophthalmological complications are seldom a problem, diplopia being the most common among them. The authors appear to indicate an intravascular injection of the anesthetic as the cause of the problem, and therefore, it should be avoided in order to prevent accidents at the ocular level.
Topics: Adult; Anesthesia, Dental; Anesthesia, Local; Eye Diseases; Female; Humans; Male
PubMed: 20711104
DOI: 10.4317/medoral.17078 -
Anaesthesia Apr 2010The introduction of local anaesthesia some years after the first public demonstration of general anaesthesia not surprisingly created less excitement and interest... (Review)
Review
The introduction of local anaesthesia some years after the first public demonstration of general anaesthesia not surprisingly created less excitement and interest amongst both the public and the medical profession. However, in its own way, a new revolution was happening. Local anaesthesia produced an increase in the choice of anaesthetic techniques available to practitioners and patients. In common with general anaesthesia, the choice of agents remained very limited for the first six decades, and interest in the practice of local, regional or central neuraxial blockade and the development of new techniques and drugs were hampered by perceived safety issues even as late as the second half of the 20th century. It is only in the last few years that, with an apparent renaissance in the use of local anaesthesia, the pace of development has picked up. As the use and range of techniques has increased, so has interest in solving some of the longstanding problems with the available drugs.
Topics: Adjuvants, Anesthesia; Anesthesia, Local; Anesthetics, Local; Drug Delivery Systems; Humans
PubMed: 20377544
DOI: 10.1111/j.1365-2044.2009.06201.x -
Obstetrics and Gynecology Sep 2012To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures. (Review)
Review
OBJECTIVE
To assess the effectiveness of intrauterine local anesthesia in reducing pain associated with outpatient gynecologic procedures.
DATA SOURCES
We searched online databases PubMed or MEDLINE, Embase, Google Scholar, and Clinicaltrials.gov and hand-searched reference lists from reviews evaluating pain-control methods for gynecologic office procedures. We identified randomized controlled trials using intrauterine local anesthetic in gynecologic procedures.
METHODS
Titles and abstracts were screened for 1,236 articles. We identified 45 potential articles for inclusion. We excluded 22 of these studies because: 1) they were not randomized controlled trials; 2) they did not describe a quantifiable dose of medication used in the study; 3) they did not investigate an intrauterine anesthetic; 4) they did not study a potentially awake, outpatient procedure; and 5) they did not clearly report results or represented duplicate publication. Twenty-three articles were ultimately included for review.
TABULATION, INTEGRATION, AND RESULTS
Two authors independently reviewed full search results and assessed eligibility for inclusion and independently abstracted data from all articles that met criteria for inclusion. Disagreements regarding eligibility or abstraction data were adjudicated by a third independent person. Our primary end point was the reported effect of intrauterine local anesthesia on patient-reported pain scores. As a result of heterogeneity in study methods, outcome measures, and reporting of outcomes, results could not be combined in a meta-analysis. Good evidence supports use of intrauterine anesthesia in endometrial biopsy and curettage, because five good-quality studies reported reduced pain scores, whereas only one good-quality study reported negative results. We found moderate evidence to support intrauterine anesthesia in hysteroscopy, because one good-quality study and two fair or poor quality studies reported reduced pain scores, whereas two good-quality studies had negative results. Good evidence suggests that intrauterine anesthesia is not effective in hysterosalpingography; three good-quality studies reported that pain scores were not reduced, and no good quality studies showed a beneficial effect in that procedure. Evidence was insufficient concerning first-trimester abortion, saline-infusion ultrasonogram, tubal sterilization, and intrauterine device insertion.
CONCLUSION
Intrauterine local anesthesia can reduce pain in several gynecologic procedures including endometrial biopsy, curettage, and hysteroscopy and may be effective in other procedures as well.
Topics: Ambulatory Surgical Procedures; Anesthesia, Local; Anesthesia, Obstetrical; Anesthetics, Local; Female; Gynecologic Surgical Procedures; Humans; Pain Measurement; Uterus
PubMed: 22914480
DOI: 10.1097/AOG.0b013e3182639ab5