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Voltage-gated sodium (NaV) channels are critical molecular determinants of action potential generation and propagation in excitable cells. Normal NaV channel function disruption can affect physiological neuronal signaling and lead to increased sensitivity to pain, congenital indifference to pain, uncoordinated movement, seizures, or paralysis. Human genetic studies have identified human NaV1.7 (hNaV1.7), hNaV1.8, and hNaV1.9 channel subtypes as crucial players in pain signaling. The premise that subtype selective NaV inhibitors can reduce pain has been reinforced through intensive target validation and therapeutic development efforts. However, an ideal therapeutic has yet to emerge. This review is focused on recent progress, current challenges, and future opportunities to develop NaV channel targeting small molecules and peptides as non-addictive therapeutics to treat pain.

This study aimed to formulate semisolid niosomal encapsulated lidocaine and prilocaine using the patented palm oil base Hamin-C® for further characterization and in vivo pain assessment. Seven formulations were initially studied with various chemical compositions. A thin-layer film hydration method was used to produce niosome using a mixture of surfactant (Span® 40 or Span® 60) and cholesterol (CHOL) at a 1:1 ratio, with/without a charge-inducing agent (diacetyl phosphate) (DCP) and with/without labrasol®. Niosome F1 formulation had been identified as the highest %EE achieved, at 53.74 and 55.63% for prilocaine and lidocaine, respectively. Furthermore, NIO-HAMIN F1 emulgel indicated the best formulation with higher permeability of prilocaine and lidocaine compared to the rest of the formulations. The reformulation of optimization of NIO-HAMIN F1 emulgel using a cold process to NIO-HAMIN F1-C emulgel to improve the viscosity resulted in higher diffusion of prilocaine and lidocaine by 5.71 and 33.38%, respectively. In vivo pain perception studies by verbal rating score (VRS) and visual analogue score (VAS) on healthy subjects show a comparable local anesthetic effect between NIO-HAMIN F1-C emulgel and EMLA® cream.

Abstract Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.

Background and Aim: Eye surgeries often evoke strong negative emotions in patients, including fear and anxiety. Patient education material plays a crucial role in informing and empowering individuals. Traditional sources of medical information may not effectively address individual patient concerns or cater to varying levels of understanding. This study aims to conduct a comparative analysis of the accuracy, completeness, readability, tone, and understandability of patient education material generated by AI chatbots versus traditional Patient Information Leaflets (PILs), focusing on local anesthesia in eye surgery., Methods: Expert reviewers evaluated responses generated by AI chatbots (ChatGPT and Google Gemini) and a traditional PIL (Royal College of Anaesthetists' PIL) based on accuracy, completeness, readability, sentiment, and understandability. Statistical analyses, including ANOVA and Tukey HSD tests, were conducted to compare the performance of the sources., Results: Readability analysis showed variations in complexity among the sources, with AI chatbots offering simplified language and PILs maintaining better overall readability and accessibility. Sentiment analysis revealed differences in emotional tone, with Google Gemini exhibiting the most positive sentiment. AI chatbots demonstrated superior understandability and actionability, while PILs excelled in completeness. Overall, ChatGPT showed slightly higher accuracy (scores expressed as mean ± standard deviation) (4.71 ± 0.5 vs 4.61 ± 0.62) and completeness (4.55 ± 0.58 vs 4.47 ± 0.58) compared to Google Gemini, but PILs performed best (4.84 ± 0.37 vs 4.88 ± 0.33) in terms of both accuracy and completeness (p-value for completeness <0.05)., Conclusion: AI chatbots show promise as innovative tools for patient education, complementing traditional PILs. By leveraging the strengths of both AI-driven technologies and human expertise, healthcare providers can enhance patient education and empower individuals to make informed decisions about their health and medical care., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Nanostructured lipid carriers (NLC) have emerged as innovative drug delivery systems, offering distinct advantages over other lipid-based carriers, such as liposomes and solid lipid nanoparticles. Benzocaine (BZC), the oldest topical local anesthetic in use, undergoes metabolism by pseudocholinesterase, leading to the formation of p -aminobenzoic acid, a causative agent for allergic reactions associated with prolonged BZC usage. In order to mitigate adverse effects and enhance bioavailability, BZC was encapsulated within NLC. Utilizing a 2 3 factorial design, formulations comprising cetyl palmitate (solid lipid), propylene glycol monocaprylate (liquid lipid), and Pluronic F68 as surfactants were systematically prepared, with variations in the solid/liquid lipid mass ratios (60:40-80:20%), total lipid contents (15-25%), and BZC concentrations (1-3%). The optimized formulation underwent characterization by dynamic light scattering, differential scanning calorimetry, Raman imaging, X-ray diffraction, small-angle neutron scattering, nanotracking analysis, and transmission electron microscopy (TEM)/cryo-TEM, providing insights into the nanoparticle structure and the incorporation of BZC into its lipid matrix. NLC BZC exhibited a noteworthy encapsulation efficiency (%EE = 96%) and a 1 year stability when stored at 25 °C. In vitro kinetic studies and in vivo antinociceptive tests conducted in mice revealed that NLC BZC effectively sustained drug release for over 20 h and prolonged the anesthetic effect of BZC for up to 18 h. We therefore propose the use of NLC BZC to diminish the effective anesthetic concentration of benzocaine (from 20 to 3% or less), thus minimizing allergic reactions that follow the topical administration of this anesthetic and, potentially, paving the way for new routes of BZC administration in pain management.

Background: The retro superior costotransverse ligament space (RSS) block, reported as a novel target in paraspinal block, involves the spreading of local anesthetics into the thoracic paravertebral space through slits around the superior costotransverse ligament . This blocks not only the dorsal rami but also the ventral rami, achieving a reliable complete sensory blockade., Case: We performed an RSS block at the T5, T7, and T9 levels on both sides for postoperative analgesia in two patients who underwent laparoscopic gastrectomy. Both patients showed complete sensory blockade from T4 to L1 on the anterior, lateral, and posterior chest walls in the recovery room. The resting and dynamic pain scores were 0 at 30 min and 6 h postoperatively. The pain score consistently remained below 3 throughout postoperative period., Conclusions: The RSS block provided effective postoperative analgesia in laparoscopic gastrectomy through definitive complete sensory blockade.

Modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) is a novel strategy for peripheral nerve block in the abdomen. Its usefulness has been highlighted in adults, but no literature is currently available regarding its efficacy in infants. This report describes the cases of a one-day-old neonate in open abdominal surgery and a one-month-old infant in laparoscopic surgery who received M-TAPA. The postoperative condition of the infants was assessed through a neonate pain scale and the Face, Legs, Activity, Cry, and Consolability behavioral scale, respectively; both scales remained at 0 until discharge. Despite the need for special attention, M-TAPA may provide effective analgesia in neonatal and infant abdominal surgery in addition to adult cases, and its indications should be considered., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nakahari et al.)

Lidocaine is a commonly used anesthetic. High doses or intravenous administration of lidocaine, as well as other local anesthetics, may result in systemic effects involving the cardiovascular and neurologic systems. Typically, effects are dependent on the serum concentrations of the offending agent. This is a case where a patient presented with symptoms of systemic lidocaine toxicity despite therapeutic dosage and an undetectable serum lidocaine concentration. A 47-year-old Caucasian male received a lumbar medial branch injection of lidocaine and presented with symptoms of perioral numbness, seizure-like activity, and confusion. The patient had a workup, including a CT head without acute findings and an undetectable serum lidocaine level. Due to symptoms consistent with systemic local anesthetic toxicity, intravenous lipid emulsion (ILE) was administered with resolution and without recurrence of symptoms. There should be a low threshold of suspicion for local anesthetic systemic toxicity when patients have neurologic or cardiovascular symptoms following exposure. Toxicity may be present despite therapeutic dosages and low serum concentrations. ILE may be beneficial and should be considered., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Charleston Area Medical Center issued approval not applicable. Charleston Area Medical Center's IRB does not require approval for case reports. Review has been waived. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Martin et al.)

Objective: To observe the perioperative analgesic effect and the changes of T lymphocyte subsets of ultrasound- guided lumbar quadratus block with different concentrations of ropivacaine before anesthesia induction in patients undergoing laparoscopic surgery for colorectal cancer. Methods Sixty patients with colorectal cancer undergoing laparoscopic surgery were randomly divided into group H, group M and group L, with 20 patients in each group. All patients in the three groups underwent ultrasound-guided lumbar quadratus block with ropivacaine. The concentrations of ropivacaine were 0. 5%, 0. 375%, and 0. 25%, respectively. After completing lumbar quadratus block, they were treated with general anesthesia, laparoscopic surgery and follow-up. The VAS scores at 2, 6, 12, 24 and 48 h after operation at rest and at exercise each, the first pressing time of postoperative analgesic pump, the dosage of sufentanil and the score of analgesic satisfaction were observed. The intraoperative dosage (propofol dosage, remifentanil dosage), the first exhaust time, the first time to the ground, the total hospital stay and other related indexes were observed. The hemodynamic indexes, mean arterial pressure (MAP)and heart rate (HR)were observed at the time points of entering the room (T0), starting skin incision (T1), tumor resection (T2)and tracheal catheter extraction (T3). The proportions of CD3+, CD4+, CD8+ and CD4+/CD8+ in T lymphocyte subsets were observed at 6, 12, 24 and 48 h after operation. Nausea and vomiting, lower limb movement block, pruritus, urinary retention and sensory deterioration were observed. Results The VAS scores at 6, 12, 24 and 48 h after operation at rest and at exercise each in the three groups were significantly higher than those at 2 h after operation (all P<0. 05), the VAS scores at rest and exercise at 6, 12 and 24 h after operation in the group M and group H were significantly lower than those in the group L (all P<0. 05), and the VAS scores at 48 h after operation at exercise in the group M and group H were significantly lower than those in the group L (all P<0. 05). The dosage of remifentanil, propofol and sufentanil in the group M and group H were significantly lower than those in the group L (all P<0. 05), the first pressing time of analgesic pump and the score of analgesic satisfaction were significantly higher than those in the group L (all P< 0. 05). MAP and HR at T1 and T2 were significantly higher than those at T0 (all P<0. 05), MAP and HR in the group M and group H were significantly lower than those in the group L at T1 and T2 (all P<0. 05). The proportions of CD3+, CD4+, CD8+ and CD4+/CD8+ in T lymphocyte subsets at 12 h, 24 h and 48 h after operation were significantly higher than those at 6 h after operation (all P<0. 05), the proportions of CD3+, CD4+, CD8+ and CD4+/CD8+ in T lymphocyte subsets of group M and group H at 12 h after operation were significantly higher than those of group L (all P<0. 05), and the proportions of CD4+ and CD4+/CD8+ in T lymphocyte subsets of group M and group H at 24 h after operation were significantly higher than those of group L (all P<0. 05). The total incidence of postoperative adverse reactions in the group H was significantly higher than those of group M and group L (all P<0. 05). Conclusion Ultrasound-guided lumbar quadratus block with 0. 375% ropivacaine has a good effect on perioperative analgesia in patients with colorectal cancer undergoing laparoscopic surgery, the total incidence of adverse reactions is low, and it is conducive to the recovery of T cell immune function after operation. [ABSTRACT FROM AUTHOR]

To test the anesthetic effect of a bupivacaine liposome injectable suspension (BLIS), used in a multiple-dose manner for up to 5 consecutive days. Prospective, randomized, experimental study. 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). 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. 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 < 0.001). There was no significant change in paw withdrawal latency in the uninjected paw over time. 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. [ABSTRACT FROM AUTHOR]

Local anesthetic systemic toxicity (LAST) is a life-threatening event caused by elevated local anesthetic plasma concentration. It is often unrecognized or misdiagnosed. Peripartum women are at increased risk for toxicity due to pregnancy-related physiological changes. Rising serum drug levels can cause cellular level impairment of mitochondria and voltage-gated ion channels leading to a cascade of symptoms that can end in cardiac arrest. Local anesthetic systemic toxicity can mimic other maternal pathologies but may be considered if local anesthetics have been used. Published treatment guidelines for this event include lipid emulsion which is approved for use in pregnant women. We review LAST in the maternity care setting, published treatment protocols, management of maternity patients with toxicity, and recommendations to increase awareness among maternity care clinicians for this medical emergency. Local anesthetic systemic toxicity during labor, birth, and postpartum is a medical emergency requiring prompt identification and immediate resposne. A review of the pathophysiology, clinical presentation, and recommended management is provided. [ABSTRACT FROM AUTHOR]

QXOH‐LB, a fixed‐dose combination (35 mM QXOH and 10 mM levobupivacaine) has been shown to induce a long duration of local anesthesia in animal efficacy testing, which indicates potential for postoperative pain management. In this study, we evaluated the potential toxicity of QXOH‐LB in NIH mice under the Guidance on the repeated‐dose toxicity published by the China Food and Drug Administration. Mice (n = 30 per sex per group) were subcutaneously injected 5, 10, 20 mg/kg QXOH‐LB, 5, 10, 20 mg/kg QXOH, and 5 mg/kg levobupivacaine (LB) once a day for 14 days with sacrifice of main study animals; remaining mice (n = 10 per sex per group) were monitored for an additional 4‐week recovery period. Mice in the 10 and 20 mg/kg QXOH, and 20 mg/kg QXOH‐LB died, which was considered due to excessive respiratory inhibition. The doses of 10 mg/kg QXOH‐LB and 5 mg/kg QXOH were well tolerated without any clinical signs of toxicity. Therefore, the no‐observed‐adverse‐effect level (NOAEL) of QXOH‐LB and QXOH was considered to be 10 and 5 mg/kg/day, respectively. In the dose range from 5 to 20 mg/kg, the exposure of QXOH and LB in QXOH‐LB was equal to each agent used alone at the same dose in NIH mice. There was no gender difference on exposure and no evidence of accumulation. In 14‐day repeated dosing study, mice in the 10 and 20 mg/kg QXOH, and 20 mg/kg QXOH‐LB died, which was considered due to excessive respiratory inhibition. The NOAEL of QXOH‐LB and QXOH was 10 and 5 mg/kg/day, respectively. The exposure of QXOH and LB in QXOH‐LB was equal to each agent used alone at the same dose in NIH mice, and there was no gender difference on exposure and no evidence of accumulation. [ABSTRACT FROM AUTHOR]

Background: The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. Methods: A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. Results: The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine—n = 4, 20%; 0.5% levobupivacaine—n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). Conclusion: A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

General guidelines for the maximum amounts of locally injected lidocaine exist; however, there is a paucity of data in the Mohs micrographic surgery (MMS) literature. This study aimed to determine the safety and adverse effects seen in patients that receive larger amounts of locally injected lidocaine. A retrospective chart review of 563 patients from 1992 to 2016 who received over 30 mL of locally injected lidocaine was conducted. Patient records were reviewed within seven postoperative days for complications. The average amount of anesthesia received was 40 mL, and the average patient weight was 86.69 kg. 1.4% of patients had a complication on the day of surgery, and 4.4% of patients had a complication within 7 days of the surgery. The most common complications were excessive bleeding/hematoma formation and wound infection. Only two complications could be attributable to local anesthetics. Gender, heart disease, hypertension, diabetes, and smoking were not significant risk factors for the development of complications. MMS is a safe outpatient procedure for patients that require over 30 mL of locally injected anesthesia. The safety of high volumes of lidocaine extends to patients with risk factors such as heart disease, hypertension, diabetes, and smoking. [ABSTRACT FROM AUTHOR]

Background and Purpose: Many pain‐triggering nociceptor neurons express TRPV1 or TRPA1, cation‐selective channels with large pores that enable permeation of QX‐314, a cationic analogue of lidocaine. Co‐application of QX‐314 with TRPV1 or TRPA1 activators can silence nociceptors. In this study, we describe BW‐031, a novel more potent cationic sodium channel inhibitor, and test whether its application alone can inhibit pain associated with tissue inflammation and whether this strategy can also inhibit cough. Experimental Approach We tested the ability of BW‐031 to inhibit pain in three models of tissue inflammation:‐ inflammation in rat paws produced by complete Freund's adjuvant or by surgical incision and a mouse ultraviolet (UV) burn model. We tested the ability of BW‐031 to inhibit cough induced by inhalation of dilute citric acid in guinea pigs. Key Results: BW‐031 inhibited Nav1.7 and Nav1.1 channels with approximately sixfold greater potency than QX‐314 when introduced inside cells. BW‐031 inhibited inflammatory pain in all three models tested, producing more effective and longer‐lasting inhibition of pain than QX‐314 in the mouse UV burn model. BW‐031 was effective in reducing cough counts by 78%–90% when applied intratracheally under isoflurane anaesthesia or by aerosol inhalation in guinea pigs with airway inflammation produced by ovalbumin sensitization. Conclusion and Implications: BW‐031 is a novel cationic sodium channel inhibitor that can be applied locally as a single agent to inhibit inflammatory pain. BW‐031 can also effectively inhibit cough in a guinea pig model of citric acid‐induced cough, suggesting a new clinical approach to treating cough. [ABSTRACT FROM AUTHOR]

Background: Neurotoxicity caused by a local anesthetic after regional anesthesia is a rare but serious problem for anesthesiologists. It is difficult to diagnose neurotoxicity from anesthetics because of the large number of possible diagnoses. In this case report, careful monitoring by neurological examinations helped to diagnose local neurotoxicity caused after epidural anesthesia. Case description: A 41-year-old pregnant woman who underwent emergency cesarean delivery under combined spinal-epidural anesthesia suffered left leg paralysis after surgery. Multiple neurological examinations (e.g., electromyography, nerve conduction study) revealed that the paralysis was induced by the neurotoxicity of ropivacaine. The neurological examinations were also useful to monitor the recovery process. Conclusions: This is the first clinical case report that describes the diagnosis of and recovery from local anesthesia-induced neurotoxicity monitored by electromyography and nerve conduction study. Neurological disorders caused by regional anesthetics should be carefully examined and diagnosed using these neurological examinations. [ABSTRACT FROM AUTHOR]

Local anesthetics are drugs used for their anesthetic and analgesic effects in different sites of the human body by blocking sodium channels and inhibiting excitation of nerve ends and conduction of peripheral nerves. Despite their main function, there are numerous studies aimed to clarify their role as antimicrobial agents. A lot of them prove that local anesthetics observe bacteriostatic, bactericidal, fungistatic and fungicidal effects against a wide range of microorganisms. The aim of the present work is to summarize data from different sources that demonstrates the antimicrobial effects of some drugs used as local anesthetics. Local anesthetics may be used successfully not only as pain control agents, but also as an additional therapy in various infectious diseases. That’s why their antimicrobial potential has to be taken into account when different microbiological test are done. [ABSTRACT FROM AUTHOR]

Single intra-articular (IA) injection of long-acting local anesthetics such as bupivacaine is commonly used clinically for postoperative analgesia, in particular, after arthroscopic surgery. Despite their widespread use, the side effects of IA bupivacaine on joint cartilage as well as hepatotoxic and nephrotoxic effects remain to be elucidated. The aim of this study is to assess the in vitro effect of bupivacaine 5% on donkey chondrocytes at different time points, in addition to the in vivo effects of a single IA bupivacaine injection on the middle carpal joint in a group of 10 clinically healthy adult male donkeys. In phase I, the effect of in vitro treatment with bupivacaine 5% or saline 0.9% on freshly isolated donkey chondrocytes for 30, 60 min, 24, 48, and 96 h was investigated using MTT and LIVE/DEAD assay. In phase II, in vivo effects of single injection of bupivacaine on the middle carpal joint of the donkey were evaluated compared with saline 0.9%. Biochemical analysis of collected serum and synovia was performed. Additionally, articular cartilage damage was evaluated using radiography, computed tomography (CT), catabolic marker expression via quantitative polymerase chain reaction (qPCR), and histopathological examination 96 h after injection. Our results showed that after a 30-min exposure to bupivacaine 5%, the viability of donkey chondrocytes was 97.3 ± 4.4% and was not significantly affected at the indicated time points (n = 8, p < 0.05). No significant changes in biochemical analytes of serum and synovial fluid following IA bupivacaine injection were observed, compared with saline injection (n = 5 for each group, p < 0.05). Furthermore, in vivo IA injection of bupivacaine revealed no significant differences in radiography, CT scan, gene expression of cartilage catabolic biomarkers, and histopathological examination. These results provide an evidence for the safety of bupivacaine on the donkey cartilage.

This study aimed to evaluate changes in blood pressure of rats treated or not with amitriptyline after infiltration in the buccal sulcus and intravenous injection of epinephrine, felypressin and phenylephrine in equivalent doses (ED) to the amounts present in 2, 8 and 32 local anesthetic tubes. 42 male Wistar rats, with 45-day-old, treated for seven days with amitriptyline hydrochloride (0.3 mg/kg). On the eighth day, the animal was submitted to general anesthesia and surgery for direct blood pressure rate. The significance level was 5%. The treatment with amitriptyline caused a significant decrease in blood pressure of the treated group compared to the control group (101.80 ± 2.52 and 110.12 ± 2.91 mmHg, respectively, * p < 0.05), and slightly potentiates the hypertensive response after infiltration of epinephrine (4.11 ± 0.54; 7.15 ± 0.55; 9.03 ± 0.87 mmHg, respectively, 2, 8 and 32 tubes, p > 0.05). Felypressin promotes lower blood pressure changes and phenylephrine proved to be the most potent vasoconstrictor of the three studied, producing important changes in blood pressure and, even though infiltration, in doses greater than 8 tubes (15.43 ± 1.15; 70.62 ± 3.70 mmHg, respectively, 8 and 32 tubes, * p < 0.05). The infiltration of the three vasoconstrictors in doses equal to or less than 8 tubes does not cause significant changes in blood pressure, both in the control and amitriptyline treated groups.

A trigger point injection (TPI) with local anesthetic in myofascial pain syndrome (MPS) often has the immediate effect of a decrease in pain. It is unknown whether the immediate effect of a decrease in pain affects the subsequent course of pain. It is also unknown whether expectations of a decrease in pain mediate such effects. We aimed to clarify how the effect of a decrease in pain immediately after TPI with local anesthetic affected the subsequent course of pain, and whether it increased expectations of a decrease in pain. This was a prospective, single-center, observational clinical trial. Patients with incurable cancer who visited the palliative care department and received TPI with local anesthetic for MPS were prospectively examined. We evaluated whether the immediate effect of a TPI with local anesthetic affects the subsequent course of pain in MPS by setting expectations as a mediator, using path analysis. From 2018 to 2020, 205 patients with incurable cancer received TPI for MPS. Of these, 58.1% of patients reported an immediate effect of decreased pain. Compared with the non-immediate effect group, the immediate effect group had higher expectations of a decrease in pain, and the higher expectation was maintained at 7 days (p < 0.001). The percentage of patients with pain reduction at 7 days after TPI was 88.2% in the immediate effect group and 39.5% in the non-immediate effect group (p < 0.001). The immediate effect of decreased pain had the greatest influence on pain reduction at 7 days, both directly (β = 0.194) and indirectly through increased expectations (β = 0.293), as revealed by path analysis. The effect of a decrease in pain immediately after TPI with local anesthetic affected the subsequent course of MPS pain in patients with incurable cancer by setting expectations as a mediator. There were limitations to the discussion of these findings because this was an observational study.

A trigger point injection (TPI) with local anesthetic in myofascial pain syndrome (MPS) often has the immediate effect of a decrease in pain. It is unknown whether the immediate effect of a decrease in pain affects the subsequent course of pain. It is also unknown whether expectations of a decrease in pain mediate such effects. We aimed to clarify how the effect of a decrease in pain immediately after TPI with local anesthetic affected the subsequent course of pain, and whether it increased expectations of a decrease in pain. This was a prospective, single-center, observational clinical trial. Patients with incurable cancer who visited the palliative care department and received TPI with local anesthetic for MPS were prospectively examined. We evaluated whether the immediate effect of a TPI with local anesthetic affects the subsequent course of pain in MPS by setting expectations as a mediator, using path analysis. From 2018 to 2020, 205 patients with incurable cancer received TPI for MPS. Of these, 58.1% of patients reported an immediate effect of decreased pain. Compared with the non-immediate effect group, the immediate effect group had higher expectations of a decrease in pain, and the higher expectation was maintained at 7 days (p < 0.001). The percentage of patients with pain reduction at 7 days after TPI was 88.2% in the immediate effect group and 39.5% in the non-immediate effect group (p < 0.001). The immediate effect of decreased pain had the greatest influence on pain reduction at 7 days, both directly (β = 0.194) and indirectly through increased expectations (β = 0.293), as revealed by path analysis. The effect of a decrease in pain immediately after TPI with local anesthetic affected the subsequent course of MPS pain in patients with incurable cancer by setting expectations as a mediator. There were limitations to the discussion of these findings because this was an observational study. [ABSTRACT FROM AUTHOR]

QXOH‐Levobupivacaine (LB) is a fixed‐dose combination of 35‐mM QXOH and 10‐mM LB. It was developed for perioperative analgesia because of its long‐acting analgesic effect. The purpose of this study was to evaluate the potential toxicity of QXOH‐LB in beagle dogs in accordance with the Guidance on the repeated‐dose toxicity published by the China Food and Drug Administration. Groups of five male and five female beagle dogs received normal saline, QXOH‐LB (2, 4, and 8 mg/kg, calculated as QXOH), QXOH (2, 4, and 8 mg/kg), or LB (2 mg/kg, equals the concentration of LB in 8‐mg/kg QXOH‐LB group) at the volume of 1 mL/kg once per day for 14 days through subcutaneous injection. No mortality was observed. Dogs in the control group as well as animals treated with 2‐mg/kg QXOH or QXOH‐LB exhibited normal behaviors. Clinical signs of toxicity in dogs treated with 4 and 8 mg/kg of QXOH or QXOH‐LB included decreased activity, unsteady gait, jerks, tremors, vocalization, emesis, ataxia, lateral/sternal recumbency, deep/rapid respiration, and gasping. Additionally, neurological function was found to be affected by QXOH and QXOH‐LB at the doses of 4 and 8 mg/kg. All clinical signs were recovered within 24 h. The no‐observed‐adverse‐effect level of QXOH and QXOH‐LB was considered to be 2 mg/kg. Toxicokinetic data showed that exposure to QXOH and LB increased as QXOH‐LB doses were increased from 4 to 8 mg/kg. There was no evidence of drug accumulation or any effect of gender. In our 14‐day repeated‐dose study, no dog mortality was observed. Toxicity‐related clinical signs and neurological function interference were observed in beagle dogs treated with 4 and 8 mg/kg of QXOH or QXOH‐LB. The no‐observed‐adverse‐effect level for QXOH and QXOH‐LB was considered to be 2 mg/kg. Toxicokinetic data showed that exposure to QXOH and LB increased as QXOH‐LB doses were increased from 4 to 8 mg/kg. There was no evidence of drug accumulation or any effect of gender. [ABSTRACT FROM AUTHOR]

Background and Aims: Use of high dose opioids following laparoscopic surgery delays discharge from the hospital. Unlike intraperitoneal instillation, nebulization has been reported to provide a homogeneous spread of local anesthetics and provide better analgesia. In our study, we aimed to assess the efficacy of intraperitoneal nebulization of local anesthetic in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy. Material and Methods: This randomized control double-blinded study was conducted after obtaining approval from the hospital ethics committee and informed consent from patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients recruited were divided into two equal groups of 20 each. Group B received intraperitoneal nebulization with 4 ml of 0.75% ropivacaine and Group C received intraperitoneal nebulization with 4ml of saline before surgical dissection. Postoperative pain score using a numeric rating scale was monitored until 24 h, the need for rescue analgesics and associated complications were noted. Chi-square test, Student's test, and Mann–Whitney U test were used for statistical analysis. Results: The pain score was significantly less in Group B during rest and deep breathing up to 24 h with a P value <0.05. The pain score on movement was also less in Group B and this difference was statistically significant at 6 and 24 h (P = 0.004 and 0.005, respectively). Tramadol consumption was less in Group B and was statistically significant at 24 h with P value of 0.044. No adverse events were noted. Conclusion: Intraperitoneal nebulization of ropivacaine is effective and safe in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

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. Prospective clinical study. A group of 20 client-owned dogs. During general anesthesia and with standard monitoring, the presence of the patellar 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 toward 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. 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). 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. [ABSTRACT FROM AUTHOR]

Background: Despite being the most frequently used pediatric nerve block, certain aspects of the initial intraspinal spread of local anesthetics when performing a caudal block need further elucidation. The fact that injected volumes of 0.7–1.3 mL kg−1 initially only reach the thoraco‐lumbar junction, with only a few vertebral segments difference despite the huge difference in injected volume, still has no apparent explanation. We hypothesize that the narrowing of the epidural space caused by the lumbar spinal enlargement may provide an anatomical barrier causing this restriction of initial spread, alone or in combination with increased intrathecal pressure caused by the "cerebrospinal fluid rebound mechanism." The aim of this observational study was to find support for or refute this hypothesis. Methods: Twenty nine MRI scans of the vertebral column, performed in children 0–6 years of age, was identified from the radiographic imaging computer system and analyzed for the vertebral level of the maximum of the lumbar spinal enlargement (Associated anatomical data related to the spinal canal, the dura mater, and the spinal cord were also recorded. Results: The maximum of the lumbar spinal enlargement was found at a median vertebral level of Th 11 (IQR 11–11). Conclusion: The maximum of the lumbar spinal enlargement is located at the Th 11 vertebral level. Although not entirely conclusive, the findings of the present study do support the notion that the lumbar spinal enlargement, in combination with the CSF rebound mechanism, may be the factors limiting the initial spread of a caudal block to the thoraco‐lumbar junction. [ABSTRACT FROM AUTHOR]

Objectives: This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. Methods: Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. Results: There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). Conclusion: The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. Clinical relevance: The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative pain management is an essential module for perioperative care, especially for enhanced recovery after surgery programs. Continuous wound infiltration (CWI) with local anesthetic may be a promising postoperative analgesic strategy. However, its analgesic efficacy and safety remain debatable. Methods: Embase and PubMed databases were systematically searched for relevant randomized controlled trials (RCTs). RCTs assessing the analgesic efficacy and safety of CWI with local anesthetic for postoperative analgesia were selected. The outcomes contained pain scores during rest and mobilization, total opioid consumption, time to the first request of rescue analgesia, length of hospital stay, satisfaction with analgesia, time to return of bowel function, postoperative nausea and vomiting, total complication, wound infection, hypotension, and pruritus. The weighted mean difference and risk ratio were used to pool continuous and dichotomous variables, respectively. Results: A total of 121 RCTs were included. CWI with local anesthetic reduced postoperative pain during rest and mobilization at different time points, increased satisfaction with analgesia, shortened recovery of bowel function, and reduced postoperative nausea and vomiting compared with the placebo group, especially for laparotomy surgery. There were no significant differences in these clinical outcomes compared to epidural and intravenous analgesia. CWI with local anesthetic reduced the total opioid consumption and hypotension risk and did not increase total complications, wound infection, or pruritus. CWI with local anesthetic had a better analgesic efficacy without increased side effects for sternotomy surgery. However, CWI with local anesthetic did not translate into favorable analgesic benefits in laparoscopic surgery. Conclusion: CWI with local anesthetic is an effective postoperative analgesic strategy with good safety profiles in laparotomy and sternotomy surgery, and thus CWI with local anesthetic may be a promising analgesic option enhancing recovery after surgery programs for these surgeries. Plain Language Summary: Continuous wound infiltration (CWI) with local anesthetic may be a promising postoperative analgesic strategy, but its effect remains debatable. We performed this meta-analysis based on 121 high-quality articles (RCTs) to evaluate the analgesic efficacy and safety of CWI with local anesthetic. We found that CWI with local anesthetic could reduce postoperative pain, increase satisfaction with analgesia, shorten recovery of bowel function, and reduce postoperative nausea and vomiting, especially for laparotomy surgery. However, CWI with local anesthetic did not show favorable analgesic benefits in laparoscopic surgery. [ABSTRACT FROM AUTHOR]

The important characteristic of a local anesthetic solution is the value of the hydrogen index. The aim of the study was to determine the relationship between the value of the hydrogen index of a local anesthetic and the objective efficacy of local anesthesia. It is objectively shown that solutions of local anesthetics, whose pH level is weakly alkaline or greater than 4.9, take precedence in evaluating the effectiveness of local anesthesia. Subjectively, patients note the absence of pain during injection, as well as discomfort when opening the mouth in the case of conductive methods of anesthesia.

Abstract Background This study compared a needle-free anesthesia method with traditional local anesthesia for insertion and removal of Nexplanon® long-acting removable contraceptive device. In our clinic, patients often avoid this highly effective form of contraception due to fear of needles. We sought to determine if patients perceived a difference in pain with the injection, anxiety level or pain with the procedure when local anesthesia was given with a needle v/s a needle-free jet injector device. Methods Patients were randomly assigned to one of two groups: jet injector or needle lidocaine delivery. Outcomes were ease of use, patient anxiety level, painfulness, and efficacy of anesthesia method. Results Patient pain perception with administration of jet injector lidocaine was statistically lower than traditional needle with no difference in anxiety or ease of use, or efficacy of the anesthesia. Conclusion The jet injector device is a reasonable alternative to needle injection delivery of anesthesia prior to insertion/removal of Nexplanon® device. Further studies may determine whether this needle-free alternative for administration of local anesthetic would result in more women choosing Nexplanon® as a contraceptive method.

Background: Injectable anaesthetic agents, topical creams and aqueous solutions have previously been used to anaesthetise the tympanic membrane for minor ear procedures. Topical creams take 20–30 minutes to work and injectable anaesthetics can cause canal swelling. The effectiveness of lidocaine spray has not previously been investigated in patients undergoing minor ear procedures. Methods: Eighteen participants attending for out-patient grommet insertion or intratympanic steroid injection were prospectively recruited for this study over six months. Post-operatively, they were asked about their perceived level of pain and overall experience. Results: The median level of pain measured on an 11-point visual analogue scale was 2 out of 10. Forty-four per cent reported the overall experience as pleasant, with the remainder selecting slightly unpleasant (66 per cent). All participants stated they would undergo the procedure again. Conclusion: Xylocaine spray is simple to administer, rapid-acting and well tolerated by patients for anaesthesia of the tympanic membrane during minor ear procedures in the out-patient setting. [ABSTRACT FROM AUTHOR]

Keywords: Maxillofacial surgery; Ultrasound-guided inferior alveolar nerve blocks; Ultrasound-guided maxillary nerve blocks; Local anesthetic; Complication EN Maxillofacial surgery Ultrasound-guided inferior alveolar nerve blocks Ultrasound-guided maxillary nerve blocks Local anesthetic Complication 1 3 3 06/20/22 20220616 NES 220616 To the Editor, Recent studies have reported that ultrasound-guided trigeminal nerve blocks are effective as a postoperative analgesic method in maxillofacial surgery [[1]-[4]]. In addition, IANBs and MNBs are peripheral nerve blocks that are categorized as compartment nerve blocks. These mainly include ultrasound-guided inferior alveolar nerve blocks (IANBs), also called mandibular nerve blocks, and ultrasound-guided maxillary nerve blocks (MNBs) [[5]]. [Extracted from the article]

Abstract Background The ultrasound guided intermediate cervical plexus block with perivascular infiltration of the internal carotid artery (PVB) is a new technique for regional anesthesia in carotid endarterectomy (CEA). We conducted a pilot study investigating the effects of deep cervical block (DCB), intermediate cervical block alone (ICB) and PVB on perioperative complications in patients undergoing elective CEA. We hypothesized, that the ropivacaine plasma concentration is higher in patients receiving DCB compared to PVB and ICB. Methods In a randomized controlled pilot study thirty patients scheduled for elective CEA were randomly assigned into three groups: DCB receiving 20 mL ropivacaine 0.5% (n = 10), ICB receiving 20 mL ropivacaine 0.5% (n = 10) and PVB receiving 20 mL ropivacaine 0.5% and 10 mL ropivacaine 0,3% (n = 10). As primary outcome, plasma levels of ropivacaine were measured with high performance liquid chromatography before, 5, 10, 20, 60, and 180 min after the injection of ropivacaine. Secondary outcomes were vascular and neurological complications as well as patients’ and surgeons’ satisfaction. All analyses were performed on an intention-to-treat basis. Statistical significance was accepted at p

When penetrating into the cell, local anesthetics affect some structures and processes, in addition to blocking sodium channels, leading to the development of cell damage. The aim of the article was to study the damaging effect of bupivacaine on the sciatic nerve and biceps femoris in rats. The study is double-blind and placebo-controlled. We used 0.9% sodium chloride as the placebo. The studied concentrations of bupivacaine were 0.2%, 0.5%, 0.75%, and 1%. We performed perineural introduction of 0.2 ml into the sciatic nerve and administered 0.2 ml into the biceps femoris muscle under the ultrasound guidance. The samples were taken twice: 1 hour after administration, and over 14 days. Cell necrosis or apoptosis were not found in the muscle and nerve after the 0.9% sodium chloride administration; occasional inflammatory cells were detected. Introduction of all concentrations of bupivacaine induced damage and inflammatory infiltration of muscle tissue and neural structures compared with 0.9% sodium chloride solution. Dystrophic changes and neutrophilic infiltration were detected in nerve fibers. Perimuscular edema, apoptosis, polychromasia, necrosis, disappearance of cross-striation of muscles, clusters of inflammatory cells were found in the biceps femoris. Signs of damage and inflammatory infiltration decreased, but continued to persist over 14 days. The study showed the presence of neurotoxicity and myotoxicity of all concentrations of bupivacaine compared to a 0.9% sodium chloride solution. It was revealed that signs of damage and inflammatory infiltration persisted 14 days after the administration of bupivacaine.

Abstract Introduction The aim of this study was to evaluate the efficacy and safety of a new hard-boiled lozenge formulation containing ambroxol 20 mg versus placebo for the relief of sore throat in patients with acute pharyngitis. Methods This was a phase 3, randomized, double-blind, placebo-controlled, parallel-group multicenter trial conducted between June and September 2018 in South Africa. Patients with a diagnosis of acute pharyngitis, onset ≤ 72 h, and sore throat pain of at least moderate intensity were randomized to receive either ambroxol 20 mg or placebo hard-boiled lozenges. The primary efficacy endpoint was the normalized time-weighted sum of pain intensity differences (SPID) from baseline over 3 h following administration of the first lozenge (SPIDnorm,0–3h). Secondary efficacy endpoints included SPID 24 h after the first lozenge intake (SPIDnorm,0–24h) and patient assessment of efficacy at 3 and 24 h after the first lozenge. Results Of 422 patients from 11 centers, 390 were randomized to one of the two treatment groups (n = 196, ambroxol; n = 194, placebo) and 388 were analyzed (modified intention-to-treat). The mean ± standard deviation SPIDnorm,0–3h values were −0.386 (0.259) and −0.366 (0.243) in the ambroxol and placebo groups, respectively, and the adjusted mean ± standard error SPIDnorm0–3h difference between ambroxol and placebo was −0.020 (0.025) (p = 0.443). Comparable results between treatment groups were also found for SPIDnorm,0–24h and patient assessment of efficacy at 3 and 24 h after the first lozenge. The incidence of treatment-emergent adverse events (TEAEs) was similar between treatment groups (11.7% for ambroxol versus 9.3% for placebo). Conclusion Although marked pain relief was observed over the first 3 h of treatment, superiority of ambroxol 20 mg hard-boiled lozenges versus placebo was not demonstrated in this study. Trial Registration NCT03583658. Funding Sanofi-Aventis Group.

Objective:Percutaneous nephrolithotomy is not pain-free due to the procedure itself and presence of post-operative diversion. Our purpose was to evaluate the efficacy of local anesthetic infiltration in postoperative analgesia in children who undergo percutaneous nephrolithotomy.Materials and Methods:Forty-two renal units were included to our study. Local anesthesia group received prilocaine and bupivacaine injection through the percutaneous access line where patients received no local anesthetic constituted the control group. All patients received the same anesthesia protocol and 15 mg/kg paracetamol infusion postoperatively four times a day. Post-operative pain scores of patients were evaluated by using FLACC-FPS scales. Patients with pain scores ≥4 received meperidine 1 mg/kg as rescue analgesic.Results:Between the two groups there was no significant difference in pain scores except 24th hour, where the local anesthesia group found to be favorable. The need (p=0.040) and total number (p=0.018) of rescue analgesic was significantly less in local anesthesia group. According to need for repetitive analgesic dose, the local anesthesia group was founded to be more advantageous (p=0.017). The postoperative analgesic satisfaction of parents’ was favorable in local anesthesia group (p=0.002).Conclusion:In pediatric percutaneous nephrolithotomy, preemptive local anesthetic infiltration reduces postoperative pain, the need for analgesics, the number of analgesics used and also improves patient comfort and analgesic satisfaction.

The purpose of the study was to examine the damaging activity of Lidocaine and Ropivacaine on the sciatic nerve and biceps muscle of rats. A double blind randomized study was conducted. The control group received injectiona of 0.9% NaCl. The following concentrations of Lidocaine were examined – 0.5, 1, 1.5, and 2. For Ropivacaine, these concentrations were 0.25, 0.5, 0.75, and 1. Under the US control, 0.2 ml were injected along the perineural sciatic nerve and 0.2 ml into the two-headed muscle. The drugs were taken out in 1 hour after their injection. When injecting 0.9% NaCl no cell necrosis or apoptosis in the muscle and nerve were found, only single cells of inflammatory type were found. The administration of all concentrations of local anesthetics caused inflammatory filtration and damage to muscle tissue and nerve stems compared to 0.9% NaCl. Increased expression of damage and inflammatory infiltration depended on the concentration of the local anesthetic. The higher the concentration of Lidocaine or Ropivacaine was, the greater were the damage and inflammatory changes. The study demonstrated neurotoxic and miotoxic activity of all concentrations of Lidocaine and Ropivacaine compared to 0.9% NaCl. The dependence of damage strengthening and the growth of inflammatory filtration in the muscle and peripheral nerve on the increased concentration of the local anesthetic was revealed.

Background: Nasal packing is commonly done after septal surgeries. Nonabsorbable nasal pack is used to minimize bleeding from surgery site, support the mucoperichondrial flaps, and minimize the risk of formation of septal hematomas and adhesions. However, these materials cause pain and discomfort in-situ as well as during removal. This study was done to evaluate the effect of 2% lignocaine rehydration of nasal pack on pain during pack removal. Methods: This prospective study was conducted on 60 patients who had undergone septoplasty. The patients were divided into 2 groups: Lignocaine and Normal saline group, with 30 patients each. In the Lignocaine group, 2.5 ml of 2% of lignocaine was diluted with 2.5 ml of distilled water and was injected into the nasal pack; and in Normal saline group, 5 ml of normal saline was injected into the nasal pack. Nothing was injected to the left nostril, which acted as a control, in both groups. All patients were asked severity of pain during removal of nasal packing by VAS. Results: In lignocaine group, mean pain score was 3.73 ± 1.63 on lignocaine side and 6.23 ± 1.69 on control side (U=109.5, p

Abstract Background This randomized, double-blind study was designed to compare single injection pectoral nerve block (Pecs I and Pecs II) versus local anesthetic infiltration for ambulatory breast augmentation under monitored anesthesia care (MAC). Methods In this randomized, double-blind, prospective study, 80 patients scheduled for breast augmentation under MAC using dexmedetomidine were divided into two groups. Pecs group: Ultrasound-guided pectoral nerve block was performed on both sides of the chest. Local anesthetic (LA) group: Local anesthetic infiltration was performed in the desired plane and skin incision site of each breast. The number of patients converted to general anesthesia was calculated. Postoperative pain intensity was measured using visual analog scale (VAS), and morphine consumption in the first 24 h and patient satisfaction were measured. Results The success rate of the ultrasound-guided block versus local infiltration to complete surgery without conversion to general anesthesia was statistically non-significant. VAS, time of the first analgesia, and total morphine consumption were statistically significantly different between the two studied groups with significantly higher values in the LA group than Pecs group. Patient satisfaction was significantly higher in the Pecs group than in the LA group. Conclusion The combination of Pecs blocks with MAC is helpful in patients undergoing breast augmentation.

Castration of male ruminants is a common livestock management practice, but induces pain. However, little is known about the effectiveness of multimodal analgesia compared to local anesthesia (LA) alone in reducing pain associated with burdizzo castration in sheep. This study aimed to monitor the pain response induced by castration in sheep and to assess the efficacy of analgesia strategies. Twenty-four 12-month-old male Texel sheep were burdizzo-castrated after administration of physiological serum (Burd), local anesthetic (Burd+LA) or LA plus non-steroidal anti-inflammatory drug (Burd+LA+NSAID). Sheep responses were monitored using behavioral and physiological indices of pain. Sampling occurred from 24 h pre-castration to 78 h post-castration, split into four periods based on the duration of analgesia: P0 (T-24 to T-1 h), P1 (T0 to T+2 h), P2 (T+3 to T+32 h) and P3 (T+36 to T+78 h). Behavioral indices were attention and head position, ear position, position of the eyelid, other facial expression, standing/lying postures, postures of the legs, clinical signs and abnormal activities. Physiological indices consisted in indicators of inflammation (haptoglobin, serum amyloid A (SAA), body temperature), hypothalamo–pituitary–adrenal axis (cortisol, non-esterified fatty acids, glucose), autonomous nervous system (heart rate variability (HRV)) and oxidative stress. The variables contributing most to discrimination of the period×treatment groups were analyzed by factorial discrimination analysis. Pre-castration (P0), there was no significant difference between treatments for all indicators (P > 0.05). Post-castration, eight indicators varied significantly according to period and treatment: cortisol, clinical signs, ratio of low frequency/high frequency (LF/HF) bands of the HRV, attention and head position, SAA, haptoglobin, body temperature and glucose. The treatment×periods groups were well discriminated by the 23 indicators. Burd in P0, Burd+LA in P0 and Burd+LA+NSAID in P0, P1 and P2 had low values for all indicators, likely reflecting absence of pain and discomfort. Burd in P1 and P2 and Burd+LA in P2 showed clinical signs and reduced attention, high LF/HF and high cortisol levels, reflecting acute pain. Burd and Burd+LA in P3 had high temperature, high haptoglobin, high glucose and high SAA, but no response from other pathways. These results suggest that (i) behavioral signs of pain were apparent up to 32 h post-castration, (ii) LA was partially effective, but only during its time of action (2 h) and (iii). multimodal analgesia (LA and NSAID) was effective for up to 3 days post-castration. These findings, and especially those related to sheep behavior, can help veterinarians and farmers better detect pain and refine their pain alleviation methods.

A large number of surgical interventions are performed ambulatory under local infiltrative anesthesia. Local anesthetic wound infiltration provides anesthesia for minor surgical procedures and perioperatively improves analgesia after surgery in general anesthesia as part of a multimodal analgesic approach. The effect of a single block wound infiltration at the end of a surgical procedure in general or regional anesthesia provides additional analgesia for several hours. Infiltrative local anesthesia performed in a continuous modality reduces the use of analgesics, prolongs duration of analgesia and enhances the patient's mobilization. Benefits of local infiltrative anesthesia are described in inguinal hernioplasty, breast surgery, sternotomy, orthopedic, and gynecological surgery. However, in abdominal surgery, continuous infiltrative local anesthesia is combined with other analgesic modalities respecting complex innervation of the abdominal wall and intra-abdominal organs,. Wound infiltration is a safe technique without the risk of surgical wound infection. There is a lack of data about cost-benefit ratio when wound infiltration is used. In order for local infiltrative anesthesia to fully meet the expectations it is necessary to have mastery of the relatively simple technique, and the knowledge of when it is suitable to appply.