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Background Complex Regional Pain Syndrome (CRPS) is a neuropathic pain condition with no universally recognised treatment. The study evaluates the efficacy of a therapeutic protocol consisting of oral citalopram and lidocaine injections in patients affected by CRPS. Methods Between January 2010 and December 2014, 150 consecutive patients with CRPS were enrolled in the study and randomly assigned into three groups: group one - lidocaine injection and oral citalopram, group two - lidocaine injection and oral placebo, group three - injective and oral placebo. The Impairment Sum Score (ISS) was used to assess the severity of CRPS before, as well as at regular intervals after treatment commenced. Statistical significance (p Results The combined treatment proved to be more effective (ISS 47.6 to 12.6) than local anesthetic alone (ISS 47.5 to 21.5) and to placebo (ISS 47.2 to 29.9). Conclusion This study indicates that CRPS may be managed with well-tolerated association of oral citalopram and lidocaine injections.

Background. The general toxic effects of local anesthe­tics on vital organs are the most severe side effects of regional blockades. The purpose was to study the effectiveness and safety of combined solutions of local anesthetics in the brachial plexus block. Materials and methods. Forty-nine patients were divided into 2 study groups. The first group (controls) consisted of 24 individuals who received a solution of 0.5% bupivacaine 36 ml (180 mg) with adrenaline 1 : 200,000 as an adjuvant to block the brachial plexus. The second group (main) consisted of 25 patients, who were treated with a mixture of 2% lidocaine 12 ml (240 mg) and 0.5% bupivacaine 12 ml (60 mg) diluted with a solution of 0.9% NaCl 12 ml and adrenaline 1 : 200,000 as an adjuvant. Results. In the first group (bupivacaine), the onset time of sensory block averaged 11.3 ± 4.3 minutes, motor block — 21.0 ± 7.8 minutes. The motor block duration was 894 ± 237 minutes. In the second group (mixture), the onset time of sensory block averaged 8.0 ± 3.6 minutes, motor block — 14.0 ± 6.2 minutes, which was significantly less than in the first group. The duration of the motor block was 539 ± 186 minutes. The longest postoperative analgesia was registered in the bupivacaine group — 984 ± 263 minutes. The duration of postoperative analgesia in the main group was slightly shorter — 612 ± 210 minu­tes. Conclusions. The proposed combination of local anesthe­tics bupivacaine and lidocaine allows reducing the bupivacaine dose by three times, which decreases the toxic complications of conduction anesthesia. The clinical use of the proposed drug combination reduces the duration of the latent period and provides long-term postoperative analgesia., Актуальність. Найважчим проявом побічних ефектів при регіонарних блокадах є загальний токсичний вплив місцевих анестетиків на життєво важливі органи. Метою дослідження є вивчення ефективності й безпечності застосування комбінованих розчинів місцевих анестетиків при блокадах плечового сплетення. Матеріали та методи. 49 хворих було розподілено у 2 групи дослідження. Першу групу (контрольну) становили 24 хворі, яким для блокування плечового сплетення застосовувався розчин бупівакаїну 0,5% 36 мл (180 мг) з додаванням як ад’юванту адреналіну 1 : 200 000. Другу групу (основну) становили 25 хворих, яким для блокування плечового сплетення застосовувалась суміш розчинів лідокаїну 2% 12 мл (240 мг) і бупівакаїну 0,5% 12 мл (60 мг) з розведенням розчином NaCl 0,9% 12 мл і додаванням як ад’юванту адреналіну 1 : 200 000. Результати. У першій групі (бупівакаїн) час до початку сенсорної блокади в середньому становив 11,3 ± 4,3 хв, моторної блокади — 21,0 ± 7,8 хв. Тривалість моторного блоку — 894 ± 237 хв. У другій групі (суміш) час до початку сенсорної блокади в середньому становив 8,0 ± 3,6 хв, моторної блокади — 14,0 ± 6,2 хв, що було вірогідно меншим, ніж у першій групі. Тривалість моторного блоку — 539 ± 186 хв. Найбільшу тривалість післяопераційної аналгезії було зареєстровано в групі бупівакаїну — 984 ± 263 хв. В основній групі тривалість післяопераційного знеболювання була дещо меншою і становила 612 ± 210 хв. Висновки. Запропонована комбінація місцевих анестетиків бупівакаїну і лідокаїну дозволяє в три рази зменшити дозу бупівакаїну, що знижує імовірність токсичних ускладнень провідникової анестезії. Клінічне застосування запропонованої комбінації препаратів скорочує тривалість латентного періоду, забезпечує тривалу післяопераційну аналгезію.

Purpose The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction. Methods A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7. Results The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus. Conclusions Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.

Aim: HTX-011 (ZYNRELEF™) is an extended-release, dual-acting local anesthetic containing bupivacaine and meloxicam. In bunionectomy and herniorrhaphy studies, HTX-011 resulted in less postoperative pain and less opioid consumption versus bupivacaine HCl. Here we evaluate HTX-011 in patients aged ≥65 years. Materials & methods: Patients received placebo, bupivacaine HCl or HTX-011 following surgery. End points included pain intensity, total opioid consumption, opioid-free patients and safety. Results: HTX-011-treated patients reported lower postoperative pain through 72 h versus bupivacaine HCl and placebo. Elderly patients administered HTX-011 used fewer opioids versus bupivacaine HCl, and a greater proportion remained opioid-free through 72 h. HTX-011 was well tolerated with a safety profile similar to bupivacaine HCl and placebo. Conclusion: HTX-011 maintained effectiveness and was well tolerated in elderly patients. Clinical Trial registration numbers: NCT03295721 and NCT03237481

Summary Background/Purpose Pediatric urology procedures are amongst the most commonly performed in children. The need for proactive treatment of pain is essential for optimal patient care. Current guidelines recommend the routine use of regional anesthesia in children as appropriate unless contraindicated. Given the commonality of urologic procedures in children, it is essential to understand the indications for and the utility of regional anesthesia. Methods The current literature was searched using PubMed as the primary platform. Search words included ‘dorsal penile nerve block,’ ‘pudendal nerve block,’ ‘ring block,’ ‘spinal anesthesia,’ and ‘caudal,’ along with ‘pediatric’, ‘circumcision,’ ‘hypospadias,’ ‘urology’, and ‘urological surgery’ as part of the keywords of the search. Results The articles resulting from the literature search were reviewed for content, clarity and study design by two co-authors, and agreement determined the incorporation into the review. Additionally, a detailed description of study design, regional anesthetic technique, local anesthetic(s) used, and outcomes of each study referenced was incorporated into the supplemental table. Conclusion Given the variance in block technique and local anesthetic choice amongst the current reported studies in the literature, it is difficult to truly compare and infer superiority of the regional anesthetic choices for ambulatory penoscrotal procedures. When choosing a regional anesthetic technique, careful consideration must be placed on block coverage, severity of expected pain and surgical duration of the procedure, type and dose of local anesthetic, as well as the patient’s past medical history and anatomy. Moreover, the regional block chosen should result from a thorough preoperative discussion between the surgeon and the anesthesiologist.

Background The management of pain resulting from anesthesia injection, tooth extraction and in the period after extraction is of great importance in pediatric dentistry. Objective The aim of this study was to compare the efficacy of the preemptive administration of ibuprofen or acetaminophen with placebo in reducing the pain during injection, extraction and postoperatively in children undergoing primary tooth extraction. Material and methods A randomized, placebo‐controlled, triple‐blinded clinical trial of cooperative children who needed primary molar extraction by local anesthesia. Sixty‐six children aged between 6 and 8 years were randomly assigned to one of three groups: (a) Acetaminophen syrup (320 mg/10 ml); (b) placebo solution; and (c) ibuprofen syrup (200 mg/10 ml). Each of the three solutions was given 30 min before administration of the local anesthetic agent. The Pain level was assessed using the Wong–Baker faces® pain rating scale after injection, extraction, and postoperatively. The Kruskal–Wallis and Mann–Whitney U test were used to evaluate the pain scores between groups at confidence level of 95%. Results The use of preemptive analgesics showed lower pain scores compared to placebo. Additionally, only ibuprofen significantly reduced pain scores compared to placebo at the points immediately after injection (p = 0.001), immediately after extraction (p = 0.0001) and 5 h after extraction (p = 0.002). Conclusion Preemptive usage of ibuprofen reduces injection pain and relieves both extraction and postoperative pain in children undergoing primary tooth extraction. What this paper or case report adds It adds the knowledge regarding pain relief of injection and extraction in children. Preemptive analgesic medications have a beneficial effect on alleviating postoperative pain following tooth extraction in children. Ibuprofen is an effective analgesic for postoperative pain relief in children undergoing primary tooth extraction. Why this paper or case report is important to pediatric dentists Pediatric dentists may consider preemptive ibuprofen in children before injection and extractions. Identifies that Ibuprofen is an effective method of reducing postoperative pain.

PURPOSE To investigate complications and outcomes of clear corneal incision cataract surgery in patients with thrombocytopenia. SETTING 1 veterans hospital and 2 academic medical centers. DESIGN Multicenter retrospective chart review. METHODS All eyes of thrombocytopenic patients that underwent clear corneal incision cataract surgery with a platelet count of 100 × 103/μL or less measured within 30 days prior to surgery were included. Subject demographics, intraoperative complications, use of pupillary expansion devices, use of local anesthetic injections, and change in corrected distance visual acuity were recorded. RESULTS 3 sites recorded 40 113 clear corneal incision cataract surgeries, of which 196 eyes (0.49%) of 150 thrombocytopenic patients were recorded. The mean platelet count in the study subjects was 73.0 ± 20.5 × 103/μL. Two cases of intraoperative iris hemorrhage that were readily and controlled occurred in conjunction with pupillary expansion. There were no bleeding complications associated with retrobulbar, peribulbar, or sub-Tenon anesthetic injections. There was a statistically significant improvement (P < .0001) in visual acuity post-operatively. CONCLUSIONS Clear corneal incision cataract surgery with pupillary expansion devices and local anesthetic injections can be safely performed in patients with thrombocytopenia.

OBJECTIVES Different anesthesia techniques are used for surgical implantation of paddle lead electrodes for neurostimulation through a laminectomy. We wanted to evaluate the use of dexmedetomidine as sedative for this procedure in a series of patients. Second, we wanted to verify whether the stimulation pattern and position of the electrode had to be changed during the procedure guided by the patient's feedback. MATERIAL AND METHODS Twenty-five consecutive patients received surgical implantation of a spinal cord stimulation electrode under conscious sedation using dexmedetomidine and local anesthesia. We evaluated the effects of the administered drug, the patient comfort, and the adequacy of the stimulation pattern. RESULTS Twenty-four patients completed the procedure with only dexmedetomidine and local anesthetic. Infusion was started on average 55 minutes (sd 29) prior to incision. The mean dose of lidocaine was 430 mg (sd 95). There were no significant hemodynamic changes. Median time to reach Modified Aldrete's score postoperative was 67 minutes (sd 38). In 46% of the patients, the position of the electrode was changed guided by the feedback of the patient. More than half of the patients remember most details of the procedure. Only four patients mentioned substantial discomfort and only three would definitely not want to undergo this procedure again. CONCLUSIONS Implantation of spinal cord stimulation electrodes through a surgical laminectomy using dexmedetomidine is a safe and feasible procedure with adequate comfort for patient and surgeon. This way of working increases the optimal position of the electrode resulting in the most convenient stimulation pattern and avoiding revisions.

Background For emergent intrapartum cesarean delivery (CD), the literature does not support the use of any particular local anesthetic solution to extend epidural analgesia to cesarean anesthesia. We hypothesized that 3% chloroprocaine (CP) would be noninferior to a mixture of 2% lidocaine, 150 µg of epinephrine, 2 mL of 8.4% bicarbonate, and 100 µg of fentanyl (LEBF) in terms of onset time to surgical anesthesia. Methods In this single-center randomized noninferiority trial, adult healthy women undergoing CD were randomly assigned to epidural anesthesia with either CP or LEBF. Sensory blockade (pinprick) to T10 was established before operating room (OR) entry for elective CD. On arrival to the OR, participants received the epidural study medications in a standardized manner to simulate the conversion of "epidural labor analgesia to surgical anesthesia." The primary outcome was the time to loss of touch sensation at the T7 level. A noninferiority margin was set at 3 minutes. The secondary outcome was the need for intraoperative analgesia supplementation. Results In total, 70 women were enrolled in the study. The mean onset time to achieve a bilateral sensory block to touch at the T7 dermatome level was 655 (standard deviation [SD] = 258) seconds for group CP and 558 (269) seconds for group LEBF, a difference in means of 97 seconds (90% confidence interval [CI], SD = -10.6 to 204; P = .10 for noninferiority). The upper limit of the 90% CI for the mean difference exceeded the prespecified 3-minute noninferiority margin. There was no meaningful difference in the requirement for intraoperative analgesia between the 2 groups. Conclusion Both anesthetic solutions have a rapid onset of anesthesia when used to extend low-dose epidural sensory block to surgical anesthesia. Data from the current study provide insufficient evidence to confirm that CP is noninferior to LEBF for rapid epidural extension anesthesia for CD, and further research is required to determine noninferiority.

Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near-infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli from changes in oxy-(HbO) and total-hemoglobin concentrations (HbT). This study aims to assess fNIRS nociceptive functional activation in the prefrontal cortex of neonates undergoing circumcision through changes in HbO and HbT, and the correlation between changes in fNIRS and Neonatal Infant Pain Scale (NIPS), a behavioral pain assessment scale.In healthy term neonates, HbO, HbT, and NIPS were recorded during sequential circumcision events 1-Prep before local anesthetic injection; 2-Local anesthetic injection; 3-Prep before incision; 4-Oral sucrose; 5-Incision; 6-Gomco (hemostatic device) attached; 7-Gomco twisted on; and 8-Gomco removed. fNIRS and NIPS changes after each event were assessed with Wilcoxon signed-rank test and summarized as median and interquartile range (IQR). Changes in fNIRS vs. NIPS were correlated with Spearman coefficient.In 31 neonates fNIRS increased (median [IQR] µmol/L) with noxious events: Local injection (HbO: 1.1 [0.5, 3.1], p .001; HbT: 2.3 [0.2, 7.6], p .001), Gomco attached (HbO: 0.7 [0.1, 1.7], p = .002; HbT: 0.7 [-0.2, 2.9], p = .02), and Gomco twisted on (HbO: 0.5 [-0.2, 1.7], p = .03; HbT: 0.8 [-0.1, 3.3], p = .02). fNIRS decreased with non-noxious event: Prep before incision (HbO: -0.6 [-1.2, -0.2] p .001; HbT: -1 [-1.8, -0.4], p .001). Local anesthetic attenuated fNIRS increases to subsequent sharp stimuli. NIPS increased with subsequent sharp stimuli despite local anesthetic. Although fNIRS and NIPS changed in the same direction, there was not a strong correlation between them.During neonatal circumcision, changes in fNIRS differed between different types of painful stimuli, which was not the case for NIPS, suggesting that fNIRS may complement NIPS to assess the quality of pain.

Coronavirus disease COVID-19 pandemic has imposed a reality that requires us to protect ourselves from infection, especially as the disease is highly infectious and has no specific treatment. Disinfectants are one of the most important ways to prevent the virus, specifically chlorine and alcohol-based hand sensitizers. This study aims to discuss the efficacy of both alcohol disinfectants and chlorine on the Coronavirus, and that discussion led us to the conclusion that both have an effective role in killing the virus in close proportion if used in the required circumstances and in the right way. Alcohol can also be used to make hand rubs, because of its short duration of action, and reduced side effects. Alcohol is superior to the time required to kill the organism, completing the task in just 30 seconds compared to chlorine, which takes 30 minutes. Chlorine can be used to disinfect many types of surfaces and facilities due to its dangerous adverse effects on humans

In the current opioid crisis, multimodal analgesic protocols should be considered to reduce or eliminate narcotic usage in the postoperative period. We assess the impact of bupivacaine liposome used along with a standard analgesia protocol following robotic inguinal hernia repair. A retrospective review of a prospectively maintained data including robotic inguinal hernia repairs (IHR) by two surgeons in the United States was performed. Within a multimodal analgesic protocol, local anesthetic was administered intraoperatively. One group received a mix of bupivacaine and bupivacaine liposome (BL), and one received standard bupivacaine (SB). Recovery room and home opiate doses were recorded. Primary outcomes included length of stay (LOS) and postoperative medication requirements. Statistical analysis was performed using Chi-square or Fisher's exact test and Mann-Whitney U test as appropriate. 122 robotic IHRs were included; 55 received BL and 67 received SB. Hospital LOS (hours) was reduced in the BL group (2.8 ± 1.1 vs 3.5 ± 1.2; p = 0.0003). There was no significant difference in recovery room parenteral MME requirements between the groups; however, BL group had less oral MME requirements (5.0 ± 6.5 MME vs. 8.1 ± 6.9 MME, p = 0.02). The BL group had a higher rate of zero opiate doses at home (44% vs 5%, p = 0.0005). Of those that did require opiates at home, there was a significant reduction in number of narcotic pills used by the BL compared to the SB group (median 1 vs 5, respectively; p

Objective To test the anesthetic effect of a bupivacaine liposome injectable suspension (BLIS), used in a multiple-dose manner for up to 5 consecutive days. Study design Prospective, randomized, experimental study. Animals A total of 30 male and female Sprague–Dawley rats (Rattus norvegicus), aged 97 (75–130) days and weighing 337.2 (219.6–465.9) g, mean (range). Methods Rats were assigned to one of five BLIS vial groups, in which drug was administered from a newly opened vial or 1, 2, 3 and 4 days after the vial was opened. The vials were refrigerated between uses. A 14 gauge needle attached to an injection plug was used to puncture each vial once and was not removed; BLIS was withdrawn from the injection plug in a multiple-dose fashion. A dose rate of 0.4 mL kg−1 was administered subcutaneously into the left pelvic limb paw. Antinociception was evaluated using a paw pressure test on both injected and uninjected paws before (time 0, baseline) and 1, 24, 48 and 72 hours after injection. Results Age of BLIS vial had no significant effect on anesthetic efficacy (p = 0.97). Across all groups, paw withdrawal latency averaged 5.23 ± 0.24 seconds at baseline (before BLIS injection), increased to 16.45 ± 0.65 seconds at 1 hour after BLIS injection, declined to 7.50 ± 0.76 seconds at 24 hours after BLIS injection, and further declined thereafter (p Conclusions and clinical relevance BLIS single-use vials retained efficacy when used up to 5 days in a multiple-dose fashion. Because anesthetic effects declined substantially after 24 hours, multimodal pain management remains important for providing analgesia care.

Ropivacaine (Rop) is one of the commonly used local nerve blocks in clinical anesthesia and postoperative analgesia and it inhibits the stimulation of peripheral nociceptive pain. However, Rop alone is not effective enough to exert a controllable anesthetic effect in patients with peripheral nociceptive pain. Therefore, there is an urgent need to improve the targeting of the local anesthetic effect of Rop and reduce its potential chronic or acute toxicity. In this study, a novel Rop nanocomposite hydrogel drug, N-isopropylacrylamide-methacrylic acid/ropivacaine magnetic nanoparticles (NIP-MAA/Rop MNPs), was constructed on magnetic iron oxide. The unique pH and temperature response of NIP-MAA can effectively retain magnetic properties, improve the stability and targeting controllability of magnetic nanoparticles, and avoid excessive drug diffusion. Therefore, the NIP-MAA/Rop MNPs is expected to open a new field of vision for the research of clinical anesthesia and postoperative analgesia.

Background The aim of the study was to evaluate the impact of addition of dexmedetomidine or magnesium sulphate to the standard local anesthetics mixture as a primary objective and to compare between both as a secondary objective utilizing the single-injection percutaneous technique for peribulbar block. In this prospective randomized double-blinded clinical trial (RCT), sixty patients, both sexes, aged 45 to 75, with an ASA of I to III, were scheduled for cataract extraction operation. They were divided into three equal groups; each received a single injection peribulbar block of a mixture of 0.5% bupivacaine (3 ml) + 2 percent lidocaine (3 ml) + 120 IU hyaluronidase + (control group (C): 0.5 ml of normal saline; group D: 50 μg of dexmedetomidine; group M: 50 mg of magnesium sulphate in 0.5 ml) with a total injected volume of 7 ml each. The duration of sensory, motor block, need for supplementary doses, hemodynamics, and satisfaction of patients and surgeons were assessed. Results For the primary outcome, both the dexmedetomidine and magnesium groups revealed statistically significant differences from the control group with shorter onsets of sensory block and lid akinesia (p value< 0.001 for both), shorter onset of globe akinesia for dexmedetomidine (p value and for magnesium sulphate (p value=0.022), prolonged duration of lid and globe akinesia and sensory block (p value), better patient satisfaction (p value=0.044) but insignificant difference regarding surgeons’ satisfaction (p value= 0.117) and a less frequent, but statistically insignificant need for supplementary injection (p value=0.075). The demographic and clinical hemodynamics and oxygen saturation parameters were comparable between the three groups. For the secondary outcome, dexmedetomidine was superior to magnesium sulphate regarding onset of globe and lid akinesia (p value= 0.047 and 0.003, respectively), and durations of globe akinesia and sensory block (p value= 0.02 and 0.016, respectively). No complications related to the drugs or procedure were recorded. Conclusions When compared to 50 mg magnesium sulphate, dexmedetomidine at a dose of 50 μg is a superior adjunct to local anesthetic combination in peribulbar block for cataract procedures in terms of start and duration of peribulbar block.

Background and aim of the study Pediatric patients are apprehensive regarding having dental treatment mainly because of painful local anesthetic (LA) injections. Various techniques like transcutaneous electrical nerve stimulation (TENS), topical anesthetic agents, and vibrator device are introduced to reduce discomfort before LA administration. Therefore, the present study aimed to compare and evaluate the effectiveness of TENS, 2% lignocaine gel, eutectic mixture of lignocaine and prilocaine (EMLA), and vibrating device before LA injections in alleviating pain in pediatric patients. Materials and methods Sixty healthy children aged 6 to 12 years who required LA injections for dental procedures were selected and divided into four groups with 15 patients in each group. Wong–Baker's facial pain rating scale (WBFPRS) and face, legs, activity, cry, and consolability scale (FLACC) are used for pain perception which are tabulated, and statistically analyzed. Results The test results demonstrated that the TENS group has shown the least mean WBFPRS and FLACC score, followed by vibrator devices, EMLA gel, and lignocaine gel. Conclusion The newly introduced TENS apparatus showed encouraging results, hence can be used as a safe and reliable technique to be used in pediatric dentistry. How to cite this article Patil SB, Popali DD, Bondarde PA, et al. Comparative Evaluation of the Effectiveness of Different Pain-alleviating Methods before Local Anesthetic Administration in Children of 6 to 12 Years of Age: A Clinical Study. Int J Clin Pediatr Dent 2021;14(4):447–453.

BACKGROUND Multimodal analgesia (MMA) during breast surgery reduces postoperative pain and opioid requirements, but the relative contribution of local anesthetic dosing as a component of MMA is not well defined among patients undergoing lumpectomy and sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS We identified consecutive patients who underwent lumpectomy and SLNB with MMA from 1/2019 to 4/2020. Univariable and multivariable linear and logistic regression were used to examine associations between local anesthetics, opioid requirements in the post-anesthesia care unit (PACU), and pain scores in the PACU and on postoperative day (POD) 1. RESULTS In total, 1603 patients [median tumor size, 14 mm (interquartile range 8-20 mm)] were included. The median PACU opioid requirement was 0 morphine milligram equivalents (interquartile range 0-5). PACU maximum pain was none or mild in 58% of patients and moderate to severe in 42%; among 420 survey respondents, 56% reported no or mild pain and 44% reported moderate to severe pain on POD 1. On multivariable analysis that adjusted for routine components of MMA, increasing doses of 0.5% bupivacaine were associated with reduced PACU opioid requirements (β -0.04, 95% confidence interval -0.07 to -0.01, p = 0.011) and lower odds of moderate to severe pain (odds ratio 0.98, 95% confidence interval 0.97-0.99, p < 0.001). Local anesthetics were not associated with pain scores on POD 1. CONCLUSIONS Higher amounts of local anesthetics reduce acute postoperative pain and opioid requirement after lumpectomy and SLNB. Maximizing dosing within weight-based limits is a low-risk, cost-effective pain control strategy that can be used in diverse practice settings.

Bupivacaine is an amide local anesthetic, available as a racemic mixture of Dextro and Levorotatory Isomers. Due to its rapid onset and longer duration of anesthesia, It is routinely preferred in various regional anesthetic techniques. However, it is associated with serious cardiovascular and neurological toxicity. Its pure S- enantiomer, Levobupivacaine having similar pharmacological profile is known to have lesser cardiovascular and CNS toxicity. Combining adjuvants like clonidine, a centrally acting partial alpha-2-adrenergic agonist to improve quality of anesthesia is common practice. Hence, the aim of our study is to compare efficacy and safety of 0.25% Levobupivacaine and 0.25% Bupivacaine when combined with clonidine in supraclavicular brachial plexus block for upper limb surgeries.Eighty patients aged between 18 to 60 years with ASA physical status I-II, scheduled for elective upper limb surgeries under were randomized into two groups. Peripheral nerve stimulator guided Supraclavicular brachial plexus block was administered. Group BC received 30ml of 0.25% Bupivacaine plus 1µg/kg Clonidine and Group LC 30ml of 0.25% Levobupivacaine plus 1µg/kg Clonidine. The time of onset of sensory and motor block, duration of sensory and motor block, perioperative hemodynamic parameters, postoperative pain for 24hours and adverse effects were studies.Group LC had faster onset of sensory block (p= 0.014) as well as faster onset of motor block (p= 0.012) compared to group BC. However, durations of sensory block and motor block were statistically not significant in both the groups (p>0.05). Perioperative hemodynamic parameters and assessment of pain during 24 hours of post operative period were comparable and statistically not significant.1mcg/kg of clonidine used as an adjuvant to 30ml of 0.25% Levobupivacaine produces faster onset of sensory and motor block compared to 0.25% Bupivacaine in supraclavicular brachial plexus block. However, similar anesthetic efficacy in terms of duration of sensory and motor block, hemodynamics and postoperative analgesia were observed.

Various additives have been employed to extend the brachial plexus block. Dexamethasone, when added to local anesthetic block prolongation with analgesic and anti-inflammatory effects has been seen. Group I (Control group) received Inj. Lignocaine 1.5% plus adrenaline (1:200000) max safe dose of 7mg/kg+ NS- 2ml while group II (Dexa group) received Inj. Lignocaine 1.5% plus adrenaline (1:200000) max safe dose of 7mg/kg + Inj. Dexamethasone - 2ml (8mg). Total volume in each group ranged between 25-32ml considering the patients individual body weight. Block characteristics, duration and quality of analgesia in the post-operative period were noted. Dexamethasone hastens the onset and prolonged the duration of motor and sensory blockade. The mean duration of postoperative analgesia was prolonged till 8th hour in the dexamethasone group while in the control group it was continued till 3hrs, the role of rescue analgesia commenced after 3rd hour. Dexamethasone provides better hemodynamic stability and profound analgesia without any untoward side effects in the perioperative period. In the supraclavicular method of brachial plexus block, the addition of dexamethasone to lignocaine adrenaline offers excellent anesthetic and analgesia.

Background. Epidural anesthesia used in percutaneous endoscopic lumber discectomy (PELD) has the risk of complete neurotactile block. Patients cannot timely respond to the operator when the nerve is touched by mistake, so the potential risk of nerve injury cannot be avoided. According to pharmacodynamics, with the decrease of local anesthetic concentration, the nerve tactile gradually recovered; however, the analgesic effect also gradually weakened. Therefore, it is necessary to explore an appropriate concentration of local anesthetics that can keep the patients’ nerve touch without pain. By comparing the advantages and disadvantages of 0.4% ropivacaine epidural anesthesia, local anesthesia and intravenous anesthesia on intraoperative circulation fluctuation, the incidence of salvage analgesia and the incidence of nerve non-touch, the feasibility of using low concentration epidural anesthesia in PELD to obtain enough analgesia and avoid the risk of nerve injury was confirmed. Methods. 153 cases of intervertebral foramen surgery from October 2017 to January 2020 were selected and divided into local anesthesia group (LA group), 0.4% ropivacaine epidural anesthesia group (EA group), and intravenous anesthesia group (IVA group) according to different anesthesia methods. The changes of blood pressure and heart rate, the incidence of rescue analgesia and nerve root non-touch were compared among the three groups. Results. The difference of map peak value among the three groups was statistically significant ( P < 0.001 ); pairwise comparison showed that the map peak value of the LA group was higher than that of the EA group ( P < 0.001 ) and IVA group ( P < 0.001 ), but there was no statistical significance between the EA group and IVA group. The difference of HR peak value among the three groups was statistically significant; pairwise comparison showed that the HR peak value of the LA group was higher than that of the EA group ( P < 0.001 ) and IVA group ( P < 0.001 ), but there was no statistical significance between the EA group and IVA group. There was significant difference in the incidence of intraoperative hypertension among the three groups ( P < 0.05 ); pairwise comparison showed that the incidence of intraoperative hypertension in the EA group was lower than that in the LA group ( P < 0.05 ), while there was no significant difference between the IVA group, EA group, and LA group. There was significant difference in the incidence of rescue analgesia among the three groups ( P < 0.01 ); pairwise comparison showed that the incidence of rescue analgesia in the EA group was lower than that in the LA group ( P < 0.05 ) and IVA group ( P < 0.05 ), but there was no significant difference between the LA group and IVA group. Due to the different analgesic mechanisms of the three anesthesia methods, local anesthesia and intravenous anesthesia do not cause the loss of nerve tactile, while the incidence of nerve tactile in 0.4% ropivacaine epidural anesthesia is only 2.4%, which is still satisfactory. Conclusion. Epidural anesthesia with 0.4% ropivacaine is a better anesthesia method for PELD. It not only has a low incidence of non-tactile nerve, but also has perfect analgesia and more stable intraoperative circulation.

Местные анестетики (МА), как и все другие медикаменты, могут вызвать нежелательные явления. В отличие от крайне редких (приблизительно 1 : 1 000 000) аллергических реакций на МА интоксикация местными анестетиками (ИМА) значительно более вероятна (инцидентность приблизительно 1 : 1000), особенно с относительно высокими дозами, применяемыми для эпидуральных или больших блокад нервов. Лечение тяжелой ИМА от современных анестетиков мощного и длительного действия (например, бупивакаины) было очень трудным и почти безнадежным до успешного «липидного спасения» довольно высокими внутривенными дозами липидной эмульсии у крыс в 1998 году, затем у пациентов в 2006 году. Этот революционный метод (20% липидная эмульсия болюсом 100 мл в течение 2–3 минут, затем инфузией 200–250 мл в течение 15–20 хвилин, если не восстановится стабильность гемодинамики — рассмотреть повторный болюс или ускорение инфузии), образно названный «серебряной пулей» против ИМА, сначала рекомендовался лишь как средство отчаяния в случае безуспешной реанимации. Однако рекомендации Американского общества региональной анестезии 2010, 2012 и 2017 годов последовательно становились все менее консервативными, и теперь «липидное спасение» рекомендуется при первых признаках серьезной ИМА, сразу после обеспечения проходимости дыхательных путей. Вывод: один литр 20% липидной эмульсии должен находиться на каждом рабочем месте, где выполняют эпидуральную анестезию или большие блокады нервов высокими дозами МА.

Ultrasound-guided intermediate cervical plexus blockade with perivascular infiltration of the carotid artery bifurcation perivacular block (PVB) is a reliable technique for regional anesthesia in carotid endarterectomy (CEA). We investigated the effect of the carotid bifurcation level (CBL) on PVB efficacy and safety in patients undergoing CEA. This prospective observational cohort study included 447 consecutive CEA patients who received PVB over a 6-y period. Vascular and neurologic puncture-related complications were recorded. The CBL was localized at the low level (C4 and C5 vertebra, low-level [LL] group) in 381 (85.2%) patients and at the high level (C2 and C3 vertebra, high-level [HL] group) in 66 (14.8%) patients. Local anesthetic supplementation by surgeons was necessary in 64 (14.3%) patients in the LL group and 38 (59.4%) patients in the HL group (p < 0.001) and was associated with a higher rate of central neurologic complications in the HL group (p = 0.031). Therefore, the efficacy of the PVB may be influenced by the CBL.

Background and Aims: Caudal epidural and ultrasound-guided ilioinguinal, iliohypogastric nerve (IL/IH) blocks are commonly used regional anesthesia techniques for postoperative analgesia in pediatric inguinal surgeries. Dexmedetomidine as an adjuvant has been proven to prolong the duration of both neuraxial and peripheral nerve blocks. We compared the duration of analgesia provided by local anesthetic (LA) and dexmedetomidine for caudal and IL/IH block for pediatric inguinal surgeries. Material and Methods: Forty-six children undergoing inguinal hernia repair were selected for this randomized double-blind study. After general anesthesia, children received either 0.75 mL.kg−1 of 0.25% bupivacaine with 1 mcg.kg−1 of dexmedetomidine in caudal epidural or 0.25 mL.kg−1 of 0.25% bupivacaine with 1 mcg.kg−1 of dexmedetomidine in IL/IH block. The pain was assessed up to 24 h postoperatively using face, legs, activity, cry, consolability (FLACC) score. For FLACC ≥4, rescue analgesia was provided using 1 μg/kg of intravenous fentanyl, up to 2 h postoperatively and 10 mg/kg of oral ibuprofen between 2 and 24 postoperative hours. The time for first rescue analgesia was taken as the duration of analgesia. Results: There were no significant differences in the pain scores or analgesic utilization between the groups. The duration of analgesia of caudal and IL/IH blocks was similar (720.3 ± 430.1 min and 808.4 ± 453.1 min, respectively). The time taken for the performance of block was significantly higher for caudal compared to IL/IH (547 ± 93 vs. 317 ± 179 s; P < 0.001). Conclusion: Both caudal epidural and USG-IL/IH block with dexmedetomidine as additive provide the comparable duration of postoperative analgesia with no significant side effects.

Background: Temporomandibular disc displacement is a widely faced clinical condition and the management options are vast with varying difficulty and success rates. This study aims to evaluate the use of Botulinum Toxin injection and dextrose prolotherapy for such cases. Methods: 20 joints were included in this study divided into 2 groups; Group 1 receiving 25% 3mL Dextrose injection (with local anesthetic and saline solution) into the retrodiscal region while group 2 received 35 U Botulinum Toxin – Type A injection in the lateral pterygoid muscle. Pain (according to the visual analogue scale), clicking and maximal interincisal opening were assessed preoperatively and at 4 months followup. Results: The results showed no statistically significant differences between the 2 groups. The click disappeared in 7/10 joints in group 1 and 9/10 in group 2. The maximal interincisal opening was regained and slightly increased in all participants of the study. All patients reported better pain scores at the end of the followup period. Conclusions: Within the limitations of this study, we conclude that both treatment options tested are considered acceptable in the management of TMJ anterior disc displacement with reduction. Moreover, the results do not allow recommending one over the other as no statistically significant differences were found.

Aim Pain control is an important aspect of ED patient management, and there are many different protocols used around the world influenced by both availability of local resources as well as staff competency and experience. This study aims to evaluate the use of topical ketamine in acute pain reduction by directly comparing it to lidocaine-prilocaine (EMLA) cream. Materials and methods In this randomized clinical trial, 300 adult patients classified as level 4 or 5 by ESI triage system were enrolled. These patients were divided randomly into three groups. The site of venipuncture was covered with 2 g of topical ketamine cream 10% in group one, 2 g of 5% EMLA cream in group two, and finally, in group 3 (control group), was covered with placebo (2 g of cold cream). The primary end point of the study was reported pain severity with secondary end points being onset of local anesthesia as well as any side effects noted. Results The data gathered showed pain score during venipuncture in both intervention groups were significantly lower when compared to the control group (P Conclusion This study showed that local cutaneous ketamine is as effective as EMLA in relieving pain during venipuncture.

Background. Spinal anesthesia methods are rele­vant and tend to spread in modern anesthetic practice. At that time, sympatholytic and toxic effects of local anesthetics, such as arterial hypotension, bradycardia, tremor and other neurological disorders, can lead to patient’s discomfort and somatic dangerous effects. The transient neurologic syndrome, which manifests itself as a local nerve root syndrome, is quite common, when using hyperbaric concentrations of local anesthetics. Post-puncture headache is a common consequence of spinal anesthesia, the pathogenesis of which, in addition to cerebrospinal fluid leak, also includes the toxicity of anesthetics. The purpose was to study of the influence of low-dose unilateral spinal anesthesia (USA) with hyperbaric bupivacaine solutions on cardiohemodynamics, respiratory function, muscle tremor, postpuncture headache, transient neurological syndrome and the need for additional sedation. Materials and methods. The study involved 68 patients, 41 women and 27 men, with the average age of 44.92 ± 6.38 years. Thirty-eight patients underwent a unilateral spinal anesthesia with 6.25–11.65 (7.50 ± 1.25) mg of 0.5% hyperbaric bupivacaine. Thirty patients were assigned to receive a standard USA, 15.0 ± 1.3 mg of isobaric bupivacaine solution was injected. On 5 perioperative stages, the number of cardiac contractions, blood pressure, the number of respiratory movements, SaO2, and the presence of shivering (yes/no) were determined. Dangerous changes on the haemodynamics were considered to be bradycardia below 55 beats per minute, or re-administration of cholinolytics, hypotension (mean blood pressure ≤ 60 mmHg), and re-administration of mesatone despite preoperative infusion preparation. Depression of respiration was considered to be present if SaO2 was ≤ 94 %, and the number of respiratory movements was ≤ 8 or above 22 per 1 minute. 24, 48 and 72 hours after the end of the operation, the presence of post-puncture headache and transient neurological syndrome (paresthesia) was evaluated by means of Numerical Rating Scale of pain — from 0 to 10 points. The Bromage scale was used to assess the effectiveness of sensorimotor block. Results. The Numeric Rating Scale did not demonstrate a significant difference on the early stages of the study. The statistically significant difference can be seen 3 hours after the surgery and on day 2 postoperatively in favour of the low-dose USA. After a day, the difference was not reliable, and in 3 days, the difference was also within the limits of statistical error. The quality of anesthesia on the Bromage scale had no significant differences in the comparison groups. Patients’ requests for additional intravenous sedation also did not have significant differences. Intraoperatively, 8 cases of minor sympatholytic muscle tremor were observed in the study group. In patients after standard USA, shivering of varying degrees, from single fasciculations to sweeping tremor, was observed in 11 cases (36.66 %, i.e., 1.5 times more often). After surgery, chills and shivering in the study group (3 cases) were observed almost 2.5 times less frequently than with the standard method (6 cases). After the introduction of a low dose of hyperbaric bupivacaine for unilateral anesthesia, cases of hypotension, bradycardia on the main stage of surgical intervention were found to be significantly less likely. With low-dosage technique, they were detected in every 9 patient (11.53 %), whereas in the standard method — in every 3–4 persons (31.25 %). After surgical treatment against nonselective spinal anesthesia, hemodynamic deviations were observed in 12.5 % of cases, with low-dose unilateral one — only in 4 %. Stable hemodynamics on the stages of surgical treatment, when using low-dose USA, was observed on average 3 times more often than with the standard USA. Cases of transient neurological syndrome were not observed in both groups. Low dose of local anesthetic 2 times decreases the number of dangerous changes in respiratory function, and by the end of the surgical intervention — 4 times. Conclusions. Low-dose spinal anesthesia showed a greater protective effect on cardiohemodynamics: a stable hemodynamics on the stages of surgical treatment with unilateral approach was observed on average 3 times more often than with a standard USA. The use of unilateral technique prevented the dangerous changes of respiratory function in the main stage 2 times, and by the end of the surgery — 4 times more often. Chills and shivering in USA on the main stage were observed 1.5 times less often, and after the end of operative treatment —2.4 times less often than with a standard USA.

BACKGROUND. Surgical treatment leads to the development of postoperative pain in 80% of cases. Therefore, prompt and effective pain management is among the key priorities for healthcare professionals. The aim of the study is to determine the CCL2 / MCP-1 level in the blood serum of patients in the postoperative period under different analgesic methods and to assess the relationship between the inflammatory response and the pain response using the Visual Analog Scale (VAS). Materials and methods. We studied 30 pediatric patients with acute surgical abdominal pathologies, aged 8 to 15 years for urgent surgical procedures requiring general anesthesia. The patients were divided into 3 groups according to selected methods of intraoperative anesthesia: the 1 group included 12 patients, who received standard general anesthesia, the 2 group involved 10 patients, who received general anesthesia and infiltration anesthesia of the wound with 0.5% bupivacaine, a local anesthetic, and the 3 group included 8 children, who received general anesthesia and wound infiltration with 0.5% bupivacaine plus adjuvant (dexamethasone – 4 mg). One hour before surgery and in the postoperative period (3 and 12 hours after surgery), the patients were asked to fill in a pain diary assessing the intensity of pain syndrome and its dynamic characteristics using a visual analogue scale (VAS). Investigation to the rate of inflammatory response was assessed by monocytechemoattractant protein-1 (MCP-1). RESULTS. We found out that the plasma CCL2 / MCP-1 level in the patients prior surgery averaged 17.25 ± 7.8 pg / ml; (p

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

This study reports the development of thermosensitive hydrogels for delivering ropivacaine (RVC), a wide clinically used local anesthetic. For this purpose, poloxamer- (PL-) based hydrogels were synthesized for evaluating the influence of polymer concentration, hydrophilic-lipophilic balances, and binary system formation on biopharmaceutical properties and pharmacological performance. Transition temperatures were shifted, and rheological analysis revealed a viscoelastic behavior with enhanced elastic/viscous modulus relationship ( G ’ / G ” = 1.8 to 22 times), according to hydrogel composition and RVC incorporation. The RVC release from PL407 and PL407/338 systems followed the Higuchi model ( R 2 = 0.923 –0.989), indicating the drug diffusion from hydrogels to the medium. RVC-PL hydrogels were potentially biocompatible evoking low cytotoxic effects (in fibroblasts and Schwann cells) and mild/moderate inflammation signs on sciatic nerve nearby histological evaluation. In vivo pharmacological assays demonstrated that PL407 and PL407/338 evoked differential analgesic effects, by prolonging the sensory blockade duration up to ~340 and 250 min., respectively. All those results highlighted PL407 and PL407/338 as promising new strategies for sustaining analgesic effects during the postoperative period.

Introduction: Pain management is an essential component of care provided by pediatric anaesthesiologists. That specially holds true due to inability of this group of patients to report their overall experience of surgical procedures like adults. Caudal analgesia is one of the most popular regional anaesthetic techniques employed in children undergoing surgery for lower abdominal, urological, and lower limb operations. Of all the major advantages that this technique has, there is one major disadvantage of short duration of anesthesia. In children it is observed that combination of ropivacaine and clonidine administered caudally has shown to prolong the effects of analgesia. The present clinical study is therefore undertaken to compare caudal ropivacaine with clonidine and ropivacaine alone with regards to hemodynamic changes, analgesic potency and side effects in children. Materials and Methods: This study included 60 children of the age group 5-10 years ASA grade I and II, of either sex, coming for various elective infra-umbilical surgical procedures who were divided into two groups each comprising of 30 subjects. Group A received plain 0.20% Ropivacaine (1ml/kg) and Group B received 0.20%Ropivacaine (1ml/kg) with clonidine 1µg/kg and the effects were analysed on various parameters. Results & Conclusion: In our study, we chose 0.20% ropivacaine which provides better quality of analgesia and clonidine 1.0?g/kg which prolongs the duration of analgesia significantly while avoiding the side effects like excessive sedation and bradycardia associated with higher doses. Other hemodynamic parameters did not differ significantly in both the groups. Keywords : Pediatric anesthesia, Caudal block, Ropivacaine, Clonidine, Anesthetic complications, Local anesthetic agents.

Background: Rectus sheath block (RSB) had been proven to reduce the pain associated with ventral abdominal surgical incisions and laparoscopic surgery. We hypothesized that the addition of hyaluronidase could increase the effectiveness of the (RSB) technique by improving the local anesthetic (LA) spread. Objective of the study: effectiveness of adding the hyaluronidase as an adjuvant to bupivacaine in ultrasound-guided rectus sheath block (RSB) in those patients planning for laparoscopic cholecystectomy (LC). Patients and methods: Eighty patients, their ages range from 20-60 years old, ASA physical statuses I to III, and planning for elective (LC): were assigned in this study and allocated randomly into two equivalent groups. Group (R) had given rectus sheath block with 19 ml of bupivacaine 0.25%+1ml of hyaluronate 1500 IU, and control group (B) received rectus sheath block 19 ml of bupivacaine 0.25%+1ml of normal saline on each side after standardized induction sequence. Results: mean intraoperative fentanyl consumption exhibit a significant decline in Group H (167.75±20.6) compared to Group B (186.25±20.57) p < 0.001. Numerical Rating Score (NRS) was significantly less in the H group than in the B group at 0 hour, 2 hours, 4 hours, 6hours, postoperatively with A significant p-value. There was a significant decrease in the total dose of analgesia in 24hrs (P

Background Anterior cruciate ligament (ACL) reconstruction is an invasive surgical procedure for the knee. Quadruple nerve blocks including continuous femoral nerve block and single-injection sciatic, obturator, and lateral femoral cutaneous nerve blocks can provide effective intraoperative anesthesia and analgesia in the early postoperative period. However, severe pain often appears after the effect of single-injection nerve blocks resolves and that is why we conducted two studies. The first study was to determine whether dexamethasone administered along with local anesthetic for sciatic nerve block could prolong the duration of analgesia in patients given quadruple nerve blocks, including continuous femoral nerve block, for ACL reconstruction using a hamstring tendon autograft. The second study was designed to evaluate any difference in effects from dexamethasone administered perineurally versus intravenously. Methods Patients undergoing unilateral arthroscopic ACL reconstruction using a hamstring tendon autograft were enrolled into two studies. The first study was prospectively conducted to see if dexamethasone 4 mg could prolong the duration of analgesia when administered perineurally to the subgluteal sciatic nerve with 0.5% ropivacaine. In the second study, we retrospectively evaluated the effects of intravenous dexamethasone 4 mg as compared with those of perineural dexamethasone to the sciatic nerve block and effects with no dexamethasone. Results In the first study, perineural dexamethasone prolonged the duration of analgesia by 9.5 h (median duration: 22.5 and 13.0 h with and without perineural dexamethasone, respectively, P = 0.011). In the second study, the duration of analgesia was similarly prolonged for intravenous and perineural dexamethasone compared with no dexamethasone. Conclusion Perineural dexamethasone administered along with local anesthetic for single sciatic nerve block prolonged the duration of analgesia of quadruple nerve blocks for ACL reconstruction, however the effects were not different from those of intravenous dexamethasone. Trial registration The protocols of both studies were approved by the Institutional Review Board of Shimane University Hospital, Japan (study number 2821 and 3390 for study 1 and study 2, respectively). Study 1 was registered in University Hospital Medical Information Network Clinical Trials Registry (UMIN000028930). Study 2, which was a retrospective study, was not registered.

Background. Many dental procedures begin with local anesthesia. Subsequent increase in blood pressure in healthy individuals commonly occurs and may be affected by several factors such as mental and physical stress, painful stimuli, and action of catecholamines present in local anesthetic solutions. The aim of the present study is to compare the effects of 4% articaine with 1 : 100000 epinephrine and 2% lidocaine with 1 : 80000 epinephrine on blood pressure after maxillary infiltration technique. Materials and Methods. In this randomized clinical trial, 102 patients were randomly assigned into two groups. One group received 4% articaine with 1 : 100000 epinephrine and the other group received 2% lidocaine with 1 : 80000 epinephrine for local maxillary infiltration. Systolic and diastolic blood pressure of both groups was determined twice: once before anesthetic injection and once 10 minutes after injection. The data were statistically analyzed using descriptive statistics, Shapiro–Wilks test, Levene test, chi-square test, independent t-test, and paired t-test. Results. The mean systolic blood pressure after anesthetic injection in the articaine and lidocaine groups was 125.00 ± 5.67 and 123.16 ± 6.417 mmHg, respectively, showing no statistically significant difference ( p = 0.127 ). The mean diastolic blood pressure after injection was 85.02 ± 7.331 in the articaine group and 81.35 ± 12.815 mmHg in the lidocaine group. These values show no statistically significant difference ( p = 0.080 ). In both groups, the mean systolic and diastolic blood pressures have increased significantly ( p < 0.001 ). Conclusion. Articaine can be regarded as a suitable alternative for lidocaine for maxillary local infiltration, as no significant difference was observed between the effects of the two anesthetic solutions on blood pressure.

Aim: Articaine, bupivacaine, lignocaine are amide type of local anesthetic agents, which are of almost equal potency. However, lidocaine is considered the gold standard and is the most widely used anesthetic agent because of its potency, safety, and efficiency. Articaine is fast acting and bupivacaine is long lasting local anaesthesia. The aim of this clinical study was to evaluate and compare the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine and 2% lignocaine in therapeutic orthodontic extractions. Materials and Methods: A 150 healthy patients, requiring Maxillary premolars extraction for orthodontic reasons were included. Patients were categorized into three groups (4% articaine and 0.5% bupivacaine, 2% lignocaine) in a crossover manner. Subjective and objective observations recorded that include age, gender, and pain score using visual analog scale. At the first appointment, both upper premolars were extracted on one or two sides of the jaws. Each patient was evaluated using a visual analogue scale. Results: The results showed that 0.5% Bupivacaine had significantly faster onset of action and lower visual analogue scores when compared with articaine and lignocaine. However, the duration of analgesia and need of first rescue analgesic medication was longer in the bupivacaine group. Conclusion: Within the limitations of study we found that Bupivacaine has the best anaesthetic effect with low pain scores followed by Articaine and followed by Lignocaine. Bupivacaine is an alternative local anaesthetic drug for performing therapeutic orthodontic extractions.

Background: Pain experienced during dental procedures evolves into negative attitude towards dentistry, which is projected as anxiety and fear of the child. Administration of local anesthesia (L.A) although an intervention to render painless procedures, in itself causes pain by its conveyance. Wand® (Milestone Scientific, Livingston, NJ, USA) is a system introduced to decrease soreness in the course of anesthetic conveyance. Owing to the sparse information comparing conventional systems with those of Wand, the present study evaluated pain related behavior in children exhibiting pre-assessed variant levels of anxiety midst administration of local anesthesia. Aim: To correlate pain related behavior amidst delivery of local anesthesia using conventional syringe and the Wand® STA system in children exhibiting variant anxiety levels. Methodology: The In vivo study embodied 32 children aged between 6 to 8 years. The volunteered participants were pre-categorized into low and high anxiety using the Modified Child Dental Anxiety Scale. They were further divided using the SNOSE technique – receiving L.A the conventional syringe (group A) and those receiving L.A using the C.C.L.A.D (group B). Pain reactions and perceptions to the two delivery methods were calculated using subjective scales and objective physiological parameters. Results: Comparing pain perception in pre-assessed anxiety categories affirmed a remarkable difference with the use of C.C.L.A.D and appeared to bestow effortless, pain-free delivery over the traditional cartridge delivery. Conclusion: C.C.L.A.D builds a refined acclivity for dispersal of the solution, ergo an utilitarian tool in pediatric dentistry.

Objective Ultrasound-guided supraclavicular brachial plexus block is a popular anesthetic technique for upper limb surgeries. Assessing the success sensory and motor block using conventional methods is time consuming and also it needs patient co-operation. In the present study, objective method like increase in perfusion index is used to predict the success of ultrasound-guided supraclavicular block. Materials and Methods This prospective trial consists of total 95 patients undergoing elective upper limb procedures. All patients received ultrasound-guided supraclavicular block using 0.5% bupivacaine 20 mL. Sensory and motor blocks were evaluated every 5 minutes followed by pinprick testing and ability to flex the elbow and the hand against gravity, respectively. The perfusion index was measured using pulse oximetry applied on the index finger and recorded at baseline and 10, 20, and 30 minutes interval after local anesthetic injection in both the blocked limb and the contralateral unblocked limb using two separate pulse oximeters. Results Perfusion index increased in blocked arm after 5 minutes compared with unblocked arm and also to its baseline value. Both perfusion index and perfusion index ratio in blocked arm were found statistically significant. Conclusion To evaluate the success of supraclavicular block, perfusion index can be considered as a useful tool.

Background: Peripheral nerve blocks have taken over as the principle technique for upper limb surgeries. A number of adjuvants have been tried individually, but very few studies have investigated the cumulative effect of two or more adjuvants given together along with local anesthetic. Aim: This study aimed to evaluate the effect of addition of sodium bicarbonate to dexamethasone and ropivacaine in supraclavicular brachial plexus block. Settings and Design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anaesthesiologist (ASA) 1 and 2 patients posted upper limb orthopedic procedures. Materials and Methods: Ninety ASA 1 and 2 patients were selected and divided into three groups of 30 each: Group R received 30 mL of 0.75% ropivacaine plus 4 mL normal saline; Group RD 30 mL of 0.75% ropivacaine, 2 mL normal saline and 2 mL of dexamethasone were given; Group RB 30 mL of 0.75% ropivacaine plus 2 mL of dexamethasone and 2 mL of sodium bicarbonate. Onset and duration of sensory and motor block and postoperative pain scores were studied in each group. Statistical Analysis: Student's independent t-test was employed for comparing the continuous variables and Chi-square test for the categorical variables. Kruskal–Wallis test was used for postoperative pain score data. Results: Addition of sodium bicarbonate to dexamethasone and ropivacaine quickens onset and prolongs duration of sensory and motor block. Conclusion: Sodium bicarbonate produces a synergistic and potentiating effect with dexamethasone as adjuvant in supraclavicular brachial plexus block.

Stellate ganglion blockade (SGB) has been used to treat electrical storm (ES) refractory to antiarrhythmic therapy or to stabilize patients before more definitive intervention. Nevertheless, its efficacy is not well understood, with only a few case reports and retrospective case series in the literature.We conducted a historical cohort study on patients with drug-refractory ES who underwent ultrasound-guided unilateral SGB from 1 January 2010 until 19 July 2019 at two hospital sites. Stellate ganglion blockade was performed with variable combinations of bupivacaine, lidocaine, ropivacaine, and dexamethasone. We collected data on demographic and procedural characteristics, the number of arrhythmias and defibrillation episodes, antiarrhythmic and anticoagulant medication, left ventricular ejection fraction (EF), and respiratory support requirement.We identified N = 13 patients; their mean (standard deviation [SD]) age was 64 (13) yr, and 10 (77%) were male. The baseline mean (SD) number of overall arrhythmia and defibrillation episodes per day were 9 (6) and 4 (3), respectively; the mean (SD) pre-SGB EF was 23 (7)%. Seven patients (54%) received dexamethasone in addition to local anesthetic for SGB. One patient experienced hypotension after SGB. Arrhythmias and defibrillation episodes significantly decreased at 24, 48, 72, and 96 hr after SGB; at 96 hr, 62% and 92% of patients had no VA and defibrillation episodes, respectively (P0.001 for all time points). Ejection fraction and the number of patients receiving antiarrhythmic medications or requiring respiratory support were unchanged.Unilateral SGB was associated with a reduction in arrhythmias and defibrillation episodes, but did not affect antiarrhythmic medication, respiratory support, or EF. Randomized controlled trials on larger cohorts are needed to confirm these findings.RéSUMé: CONTEXTE: Le bloc du ganglion stellaire (BGS) a été employé pour traiter les tempêtes électriques réfractaires à la thérapie antiarythmique ou pour stabiliser les patients avant une intervention plus définitive. Néanmoins, son efficacité n’est pas bien comprise, et il n’existe que quelques présentations de cas et séries de cas rétrospectives dans la littérature. MéTHODE: Nous avons mené une étude de cohorte historique auprès de patients souffrant de tempêtes électriques réfractaires aux médicaments qui ont subi un BGS unilatéral échoguidé entre le 1

BackgroundThis randomized trial compared ultrasound-guided pericapsular nerve group block and suprainguinal fascia iliaca block in patients undergoing primary total hip arthroplasty. We selected the postoperative incidence of quadriceps motor block (defined as paresis or paralysis of knee extension) at 6 hours as the primary outcome. We hypothesized that, compared with suprainguinal fascia iliaca block, pericapsular nerve group block would decrease its occurrence from 70% to 20%.MethodsForty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=20) using 20 mL of adrenalized levobupivacaine 0.50%, or a suprainguinal fascia iliaca block (n=20) using 40 mL of adrenalized levobupivacaine 0.25%. After the performance of the block, a blinded observer recorded pain scores at 3, 6, 12, 18, 24, 36, and 48 hours; cumulative breakthrough morphine consumption at 24 and 48 hours; opioid-related side effects; ability to perform physiotherapy at 24 and 48 hours; as well as length of stay. Furthermore, the blinded observer also carried out sensory assessment (of the anterior, lateral, and medial aspects of the mid-thigh) and motor assessment (knee extension and hip adduction) at 3, 6, and 24 hours.ResultsCompared with suprainguinal fascia iliaca block, pericapsular nerve group block resulted in a lower incidence of quadriceps motor block at 3 hours (45% vs 90%; pConclusionFor primary total hip arthroplasty, pericapsular nerve group block results in better preservation of motor function than suprainguinal fascia iliaca block. Additional investigation is required to elucidate the optimal local anesthetic volume for motor-sparing pericapsular nerve group block and to compare the latter with alternate motor-sparing strategies such as periarticular local anesthetic infiltration.Trial registration numberNCT04402450.

Blocking the suprascapular nerve under the inferior belly of the omohyoid muscle is a novel regional anesthesia technique that has been proposed for shoulder analgesia. We describe the use of and our experience with bilateral indwelling suprascapular catheters for pain management via continuous infusions in a patient undergoing bilateral shoulder surgery. Bilateral subomohyoid suprascapular catheters were inserted prior to surgery for postoperative analgesia in a patient undergoing bilateral rotator cuff tear repair. The catheters were placed 0.5–1 cm beyond the needle tip, and low local anesthetic infusion rates (ropivacaine 0.2% at 5 mL·hr−1 on each side) were used. Judicious use of preoperatively placed bilateral suprascapular catheters added to a comprehensive multimodal analgesic regimen provided excellent analgesia without respiratory compromise throughout the perioperative course.

The CNS effects occurred earlier than cardiotoxic symptoms during an intravenous infusion of local anesthetic (10 mg/min of ropivacaine or bupivacaine) in human volunteers and the infusion was stopped at this point. Significant changes in cardiac function involving the contractility, conduction time QRS width occurred and the increase in a QRS width was found to be significantly smaller with ropivacaine than with bupivacaine. Informed and written consent was taken from selected patients. Following approval of institutional ethics committee, 60 patients aged 20-60 years, weighing more than 50 kgs were taken up for the study. All the patients were evaluated thoroughly on the previous day of the surgery. A detailed history, complete physical examination and routine investigations were done for all patients were explained about procedure. Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) between two groups are comparable and statistically not significant. There were no variations in blood pressure between two group. Both the groups had good hemodynamic control throughout the study and did not show a significant difference at any time interval.

Background The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity. This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. Methods Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20-60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. Results The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. Conclusion Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

HTX-011 is an extended-release, dual-acting local anesthetic consisting of bupivacaine (sodium-channel blocker) and low-dose meloxicam (non-steroidal anti-inflammatory drug [NSAID]) applied needle-free during surgery. Introducing low-dose meloxicam addresses the limited efficacy of liposomal bupivacaine in acidic inflamed tissues and allows enhanced analgesic effects over three days. It has great promise to be an extremely effective postoperative pain regimen and produce an opioid-free surgical recovery, as it has consistently significantly reduced pain scores and opioid consumption through 72 h. This manuscript provides an updated, concise narrative review of the pharmacology, clinical efficacy, safety and tolerability of this drug and its applications to prevent postoperative pain.Lay abstract HTX-011 is a local anesthetic (a drug to induce temporary loss of sensation or awareness, usually during a medical procedure), which is made up of a combination of two drugs and applied needle-free during surgery. It has great promise to provide effective treatment for postoperative pain (pain after an operation), allowing patients to have an opioid-free option for their pain relief. This paper reviews how this drug works and the clinical trials that have taken place so far to investigate its safety and effectiveness in reducing pain after an operation.

Methemoglobinemia is a blood disorder in which an abnormal amount of methemoglobin is produced, and prilocaine is one of the drugs that can cause this disorder. The maximum recommended dose of prilocaine is 8 mg/kg. We report a case of methemoglobinemia caused by the administration of 4.2 mg/kg of prilocaine without other methemoglobinemia-inducing drugs during general anesthesia. A 17-year-old girl with hyperthyroidism and anemia was scheduled to undergo maxillary sinus floor elevation and tooth extraction. The patient's peripheral oxygen saturation (SpO2) decreased from 100% at arrival to 95% after receiving prilocaine with felypressin following induction of general anesthesia. However, the fraction of inspired oxygen was 0.6. Blood gas analysis showed that the methemoglobin level was 3.8% (normal level, 1%-2%), fractional oxygen saturation was 93.9%, partial pressure of oxygen was 327 mmHg, and arterial oxygen saturation was 97.6%. After administration of 1 mg/kg of methylene blue, her SpO2 improved gradually to 99%, and the methemoglobin value decreased to 1.2%. When using prilocaine as a local anesthetic, it is important to be aware that methemoglobinemia may occur even at doses much lower than the maximum recommended dose.

Background The objective of this study is to determine if the addition of dexmedetomidine to dexamethasone in transversus abdominis plane (TAP) blocks lowers postoperative opioid use following colorectal surgery. Methods Retrospective review of patients undergoing minimally invasive colorectal surgery and perioperative TAP block with either 1) local anesthetic and dexamethasone or 2) local anesthetic, dexamethasone, and dexmedetomidine. Post-operative opioid use was converted to morphine milligram equivalents (MME). Results 55 patients were identified: 38 (69%) receiving dexamethasone only and 17 (31%) receiving dexamethasone and dexmedetomidine. The dexamethasone and dexmedetomidine group had significantly lower median MME use at 12-h (2 vs. 13 mg), 24-h (4 vs. 28 mg), 36-h (8 vs. 38 mg), and 48-h (17 vs. 53 mg) (all p Conclusion Perioperative TAP blocks with dexamethasone and dexmedetomidine following colorectal surgery results in significantly less postoperative opioid use up to 48 h after surgery.

Cautery hot-iron disbudding is a painful routine husbandry practice performed on many dairy farms and calf rearing facilities. Refinements to eliminate or reduce the pain associated with disbudding are desired. Carbon dioxide (CO2) laser scalpels cut and ablate tissue using high-power light energy. The objective of this study was to test the utility of a CO2 laser scalpel in bovine disbudding and to compare healing and pain measures with those of cautery hot-iron disbudding. Twelve Holstein bull calves (6–39 d of age) were enrolled in the study. Calves were randomly assigned into groups that were disbudded with a CO2 laser scalpel (n = 6) or cautery hot iron (n = 6). Calves were sedated with xylazine for the procedure and were given oral meloxicam and a local anesthetic block for analgesia. Outcome measures were maximum surface temperature by infrared thermography, mechanical nociception threshold (MNT) tests, and digital images for wound healing. The infrared thermography and MNT measures were collected before disbudding and out to 72 h postprocedure. Images for wound healing were collected before disbudding and at 6, 24, and 72 h and 7, 14, 28, and 42 d postdisbudding. Overall maximum surface temperatures were not different between groups (35.3 ± 0.3°C vs. 36.0 ± 0.3°C for laser and hot iron, respectively). No differences in overall MNT measures were noted between the laser calves (2.28 ± 0.19) and the hot-iron calves (2.42 ± 0.19 kg of force). All 6 calves in the laser group were completely healed by d 42, whereas only 4 out of 6 hot-iron calves were fully healed. These results suggest that disbudding calves using a CO2 laser scalpel may be painful based on the outcomes measured. Further research that focuses on pain associated with time points beyond those used in this study and that performs the procedure in unsedated calves is needed to fully evaluate its utility.

Background: A perfectly conducted regional anesthetic guided by ultrasound offers much to anesthesiologists. Objective: This study was aimed to compare supraclavicular block with infraclavicular brachial plexus block for anesthesia in the forearm, hand surgery using two different methods: ultrasound alone or ultrasound together with a nerve stimulator. Patients and Methods: This prospective randomized study was performed on 80 adult patients, aged from 20 to 60 years, with ASA (American Society of Anesthesiology) physical status I and II. Patients were randomized in one of four groups: Supraclavicular block used Ultrasound (n =20), Supraclavicular block used ultrasound with nerve stimulator (n =20), Infraclavicular block used Ultrasound (n =20), Infraclavicular block used ultrasound with nerve stimulator (n =20). The local anesthetic solution used consisted of a 1:1 volume of 0.5 % bupivacaine and 2% lidocaine with 1:200.000 adrenaline. This solution was injected in a dose of 0.5 ml/kg to maximal 40 ml. The Measured parameters were: Demographic values, the scanning time, the block performance time, the onset time, the degree of pain during block performance, evaluation of sensory and motor block, and complications. Result: There were no significant differences between groups as regards all measured parameters. Conclusion: It could be concluded that the supraclavicular nerve block showed no significant difference from infraclavicular ultrasound-guided with or without nerve stimulator. It remains controversial whether the adding of the nerve stimulation to the ultrasound is more beneficial in ensuring rapid onset, longer duration of action, and avoiding complications.

Introduction: Dexmedetomidine is a selective alpha-2 adrenoceptor agonist. It is conventionally used as a sedative in the intensive care unit. However, recently, the application of dexmedetomidine as an adjuvant to a local anesthetic agent has been studied. The present study intends to evaluate the effectiveness of dexmedetomidine as an adjuvant to 2% plain lignocaine for surgical removal of impacted mandibular third molar and to compare the efficacy of dexmedetomidine with 2% plain lignocaine with 2% lignocaine and 1:200000 adrenaline. Materials and Methods: A total of 80 patients who required surgical removal of impacted mandibular third molar extraction were included in the study. Patients were randomly divided into two groups using a computer-generated table. Patients in the study group received 2% plain lignocaine with 1 mcg/ml dexmedetomidine. Patients in the control group received 2% lignocaine with 1:200000 adrenaline. The parameters evaluated were onset and duration of action, pulse rate, blood pressure, oxygen saturation, and blood loss. Results: Onset of action was faster and the duration of action was longer when dexmedetomidine was used with lignocaine as a local anesthetic agent. The vital parameters in both the groups were stable. Bleeding at the surgical site was less in the dexmedetomidine group. Conclusion: The study concluded that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine when injected for nerve blocks.

Qi Chen,1 Changyu Liang,2 Jingqiu Liang,2 Jiapeng Qiu,3 Bin Yang3 1Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China; 2Chongqing Cancer Multi-Omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, People’s Republic of China; 3Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of ChinaCorrespondence: Bin YangDepartment of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, People’s Republic of ChinaEmail yangbin4332@outlook.comBackground: Despite the popularity of the ultrasound-guided transversus abdominis plane (TAP) block and the diversity of advancing approaches, the extent of injectate spread limits its clinical benefits. This study used three-dimensional computed tomography (3D-CT) imaging and a cold stimulus to evaluate the spread of a local anesthetic injected through the subcostal exterior semilunaris to transversus abdominis plane (SE-TAP) block in healthy volunteers.Methods: Eight healthy volunteers received a right-side ultrasound-guided SE-TAP block with 25 mL of 0.3% ropivacaine. The sensory block was assessed by a cold stimulus at 30 min, 2 h, 4 h, and 8 h following the SE-TAP block according to the 18-zone division method. A CT scan and 3D imaging were performed after the first sensory assessment.Results: The injectate spread into the transversus abdominis space in all eight volunteers. 3D imaging confirmed that the injectate spread extensively along the costal margin in the plane of the transverse abdominis muscle and that it surpassed the semilunaris. Regarding the assessment using cold stimulus, five of six anterior zones and three of six lateral zones obtained successful rates of cutaneous sensory block higher than 75% 30 min after SE-TAP. Sensory block was achieved in the ventral dermatomes of all volunteers.Conclusion: Our study showed that the SE-TAP injectate, which was administered using simple anatomical landmarks to provide reliable analgesia for abdominal surgery, consistently spread along the costal margin and extensively blocked cutaneous sensitivity in the anterior and lateral abdominal walls.Keywords: subcostal exterior semilunaris, transversus abdominis plane block, three-dimensional computed tomography

Este artículo se encuentra disponible en la siguiente URL: https://www.sciencedirect.com/science/article/abs/pii/S1467298721000611?via%3Dihub En este artículo de investigación también participan: Lisa Tarragona y Diego A. Portela. Este es el pre-print del siguiente artículo: Verdier, N., Martinez-Taboada, F., Otero, P. E., Redondo García, J. I., Zaccagnini, A. S., Costoya, A. A., Tarragona, L. & Portela, D. A. (2021). Evaluation of electrical nerve stimulation to confirm sacrococcygeal epidural needle placement in dogs. Veterinary Anaesthesia and Analgesia, vol. 48, i. 4 (jul.), pp. 612?616, que se ha publicado de forma definitiva en https://doi.org/10.1016/j.vaa.2020.12.008. This is the pre-peer reviewed version of the following article: Verdier, N., Martinez-Taboada, F., Otero, P. E., Redondo García, J. I., Zaccagnini, A. S., Costoya, A. A., Tarragona, L. & Portela, D. A. (2021). Evaluation of electrical nerve stimulation to confirm sacrococcygeal epidural needle placement in dogs. Veterinary Anaesthesia and Analgesia, vol. 48, i. 4 (jul.), pp. 612?616, which has been published in final form at https://doi.org/10.1016/j.vaa.2020.12.008. Objectives: To evaluate the use of 0.7 mA as a fixed electrical current to indicate epidural needle placement and to confirm that 0.7 mA is greater than the upper limit of the minimal electrical threshold (MET) for sacrococcygeal epidural needle placement in dogs. Study design: Prospective clinical study. Animals: A group of 20 client-owned dogs. Methods: During general anaesthesia and with standard monitoring, the presence of the 3patellar reflex was confirmed in all dogs. An insulated needle was inserted through the sacrococcygeal intervertebral junction and absence of tail movement was confirmed when a fixed electrical current of 0.7 mA was applied. Then, the needle was further advanced towards the epidural space until the expected motor response was obtained – the 'nerve stimulation test' (NST). The NST was considered positive when a motor response of the muscles of the tail was elicited but not the perineal muscles, whereas it was considered negative when no movement of the tail was evoked. The electrical current was turned to 0 mA and then increased by 0.01 mA increments until tail movement was evoked, this was recorded as the MET. In the positive NST cases, 0.05 mL cm-1 occipitococcygeal length of 2% lidocaine or 0.25-0.5% bupivacaine was administered. Epidural blockade was confirmed by the loss of patellar reflex. Descriptive statistics were used to present data. Results: Sacrococcygeal epidural needle placement, corroborated by loss of the patellar reflex, was correctly predicted in 89.5% (95% confidence interval: 68.6%-97.1%) of the cases. The MET was 0.22 mA (0.11-0.36). Conclusions and clinical relevance: A current of 0.7 mA is approximately twice the upper limit of the MET for epidural placement. Therefore, this study demonstrates, with a success rate of 89.5%, the adequacy of using 0.7 mA as the fixed electrical current to detect sacrococcygeal epidural needle placement in dogs. Preprint