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Background Objective Design Data Sources Eligibility Criteria Results Conclusion Intravenous lignocaine has been used as an analgesic adjunct in pediatric surgical patients, although its efficacy is still unclear.We aimed to clarify the efficacy of perioperative intravenous lignocaine (bolus followed by an infusion) on pediatric postoperative pain outcomes.A systematic review and meta‐analysis.PubMed, EMBASE, Web of Science, Google Scholar (inception to June 2024).Studies involving pediatric patients (≤18 years) undergoing surgery under general anesthesia with one group receiving perioperative intravenous lignocaine (bolus followed by infusion) and the other group receiving placebo. The primary outcome was 24‐h postoperative opioid consumption. Postoperative pain scores and the need for rescue analgesia were the secondary outcomes.Seven studies (n = 415) were included in the final meta‐analysis. The use of intravenous lignocaine significantly reduced the morphine consumption in the first 24 h after surgery, compared to placebo (SMD ‐1.31, 95% CI ‐2.18 to −0.43, p = 0.003). A meta‐analysis could not be performed for the secondary outcomes.There is low quality evidence to suggest that perioperative intravenous lignocaine bolus followed by an infusion significantly reduced the opioid consumption on the first postoperative day in pediatric surgical patients. The effects of perioperative lignocaine on postoperative pain scores and the need for rescue analgesia are uncertain. [ABSTRACT FROM AUTHOR]

Objective: This study functional endoscopic sinus surgery (FESS) is a surgical procedure requiring minimal bleeding to optimize the surgical field. This study aimed to evaluate the effectiveness of magnesium sulfate, lignocaine, and propofol in attenuating hemodynamic response. The primary objective of this study was to compare the efficacy of these agents in reducing hemodynamic response. The secondary objectives included assessing the quality of the surgical field, recovery time, and total neuromuscular dose. Methods: We randomly allocated 105 patients scheduled for FESS into three groups: lignocaine, propofol, and magnesium sulfate. Heart rate and mean arterial pressure were recorded every 5 min for the first 30 min, followed by measurements every 10 min at the end of the procedure. Moreover, recovery time, total neuromuscular blocking dose, and surgical field score were noted upon completion of the procedure. Statistical analysis was conducted using the number cruncher statistical systems version 9.0.8 software. Results: All three groups showed comparable hemodynamic response and surgical field scores. The recovery time was notably longer in the magnesium sulfate group [10.94 min (2.45)] than in the lignocaine [4.37 min (1.03)] [95% confidence interval (CI) -7.32, -5.83; P=0.000] and propofol groups [4.60 min (0.60)] (95% CI 5.60, 7.095; P=0.000). Moreover, the total neuromuscular blocking agent used was significantly lower in the magnesium sulfate group [5.89 mg (0.47)] than in the lignocaine [6.26 mg (0.56)] (95% CI 0.66, 0.03; P=0.035). Conclusion: Propofol, magnesium sulfate, and lignocaine exerted equal efficacy in attenuating hemodynamic responses during surgery and ensuring a satisfactory surgical field. However, magnesium sulfate led to significantly longer recovery times compared with propofol and lignocaine. In addition, magnesium sulfate required a significantly lower total dose of neuromuscular blocking agents than lignocaine. [ABSTRACT FROM AUTHOR]

Background: Dermatosurgery is one of the fastest expanding subspecialty of dermatology. Local anesthetic agents play an important role in these procedures. Materials and Methods: This was a prospective, interventional study that included eighty patients with forty patients in each group (groups A and B). Group A: Topical 2.5% lignocaine and 2.5% prilocaine cream. Group B: Infiltration of 2% lignocaine Injection. Patients satisfying the inclusion criteria were recruited for the study. The patients were asked to rate pain perception at the time of drug administration and, then, during and after the surgical procedure using a visual, analogue scale separately. Results: In our study, the most common age group at presentation was 21-40 years. Males constituted 57.8%, whereas females constituted 42.2%. The common procedures performed in our study were electrocautery 33.3%, intralesional steroid 18.9%, and intralesional PRP 15.7%. In the topical EMLA cream group, the VAS score during drug administration was 0. In the lignocaine infiltration group, 70% were found to have VAS a score of 4-6, and 30% had a VAS score of 1-3, preprocedurally. The mean VAS score during the procedure was 3.36 for the topical EMLA cream group and 1.33 for the lignocaine infiltration group. The post-procedural VAS score showed similar results as the procedural VAS score. Conclusion: The results of our study showed that topical EMLA cream is a better choice of anesthesia in superficial aesthetic and dermatosurgical procedures in providing adequate analgesia. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the anesthetic efficacy of 1% chloroprocaine in comparison to 2% lignocaine hydrochloride and adrenaline (1:80,000) in third molar surgery. Materials and Methods: A randomized single-blind trial comprising of 30 healthy patients requiring bilateral extraction of impacted lower third molars with similar difficulty index was undertaken. A test dose was administered to all patients with subdermal infiltration of 1% chloroprocaine with 0.5 ml. A classic inferior alveolar and long buccal nerve block was given using 1% chloroprocaine 2 ml on one side and 2% lignocaine hydrochloride 2 ml with adrenaline on the other side. The time to onset and duration of action were noted. Pain during the surgical intervention, need for additional local anesthetic solution during the surgical intervention and the hemodynamic changes associated with the administration of the drugs were monitored. Results: Chloroprocaine had an early onset of action with a mean of 1.17 ± 0.55 min as compared to lignocaine 4.2 ± 0.48 min. Patients administered with lignocaine experienced less postoperative pain compared with chloroprocaine since the duration of action of chloroprocaine was lesser than that of lignocaine. Additional amount of LA was required when chloroprocaine was administered as compared to lignocaine. Chloroprocaine alone did not cause any appreciable changes in the hemodynamics, but lignocaine with adrenaline caused a transient increase in arterial pressure and heart rate 2 min following the administration. It was also observed that more blood was lost following chloroprocaine administration than with lignocaine. Conclusion: Chloroprocaine has a rapid onset of action and short duration of action with minimal effects on the hemodynamic changes than lignocaine. Considering the fact that it is a safe drug with no effects of the cardiovascular system it can be advocated that Chloroprocaine can be used as an effective local anesthetic agent for performing oral and maxillofacial surgical interventions of short duration. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusion Nasal anaesthetic‐decongestant sprays are commonly used prior to nasal instrumentation, such as flexible and rigid nasal endoscopy. Co‐phenylcaine (lignocaine 5%, phenylephrine 0.5%, ENT Technologies Pty Ltd., Melbourne, VIC, Australia) is a combination spray commonly used for this purpose. However, lignocaine is less potent than other local anaesthetics, and both active constituents of Co‐phenylcaine have a bitter taste. It was hypothesised that a combination spray containing tetracaine and oxymetazoline would both offer more potent topical anaesthesia and have a better taste.Four anaesthetic‐decongestant nasal sprays were tested in 10 healthy participants (Co‐phenylcaine, and tetracaine 0.5%, 1% and 2% with oxymetazoline 0.05%). Sensory thresholds were sequentially measured at the head of the inferior turbinate using Semmes‐Weinstein monofilaments over the following hour. Participants also rated taste on a Likert‐style scale, and reported whether they experienced subjective numbness of the maxillary teeth.A median peak sensory threshold of 60 g (the maximum tested) was observed with Co‐phenylcaine, but this threshold was exceeded by all the tetracaine‐based sprays. Tetracaine 2% with oxymetazoline 0.05% had a significantly more rapid onset than Co‐phenylcaine (4 min vs. 6 min, p < 0.05) and a longer duration of action. Eight participants reported dental numbness after administration of tetracaine 2% with oxymetazoline 0.05%, but only one participant after Co‐phenylcaine. Tetracaine‐based sprays were generally perceived to taste less unpleasant than Co‐phenylcaine.Tetracaine 2% with oxymetazoline 0.05% is a more potent and rapidly acting anaesthetic‐decongestant spray than Co‐phenylcaine, with a longer duration of action. [ABSTRACT FROM AUTHOR]

BACKGROUND This study aims to document the characteristics of caudal epidural block with lignocaine in adults undergoing anorectal surgeries, to assess the effect of adding ketamine as an adjuvant to lignocaine in caudal epidural block, in adults undergoing anorectal surgeries. We also wanted to compare the characteristics of caudal epidural block in lignocaine group and lignocaine with Ketamine group, along with the side effects of lignocaine group and lignocaine with ketamine group. MATERIALS & METHODS This was a Randomized control study conducted in the Department of Anesthesiology, Sri Venkateshwara Ramnarayan Ruia (SVRRGGH), Tirupati for 1 year from the date of approval from IEC and scientific committee. Total of 50 patients were selected and divided into two groups and were classified as Group L (n=25) (30 mL of 1.5% lignocaine caudal) and Group LK (n=25) (30ml of 1.5% lignocaine +ketamine 0.5 mg/kg). Patients of age between 20-60 years who were undergoing anorectal surgeries are included and classified as Grade 1 and 2. People who were hemodynamically and neurologically unstable, morbid obese patients, and who did not agree to give written informed consent are excluded. RESULTS The mean time to onset of anesthesia was 6.04 and 5.16 in Group C & Group T respectively. Both the groups were compared and found statistically significant (P value < 0.05). Group C had 2.56 and Group T had 3.08 as mean sedation score. Both the groups were compared and found statistically significant (P value < 0.05). CONCLUSION The caudal epidural block (CEB) using 30ml of lignocaine was demonstrated to be safe, reliable, and simple technique for anorectal surgeries in this study involving 50 adult patients. When administered as an adjuvant in sub- anesthetic doses, ketamine significantly enhances both quality and duration of the caudal block, as well as improves patient comfort. [ABSTRACT FROM AUTHOR]

Objective: This study functional endoscopic sinus surgery (FESS) is a surgical procedure requiring minimal bleeding to optimize the surgical field. This study aimed to evaluate the effectiveness of magnesium sulfate, lignocaine, and propofol in attenuating hemodynamic response. The primary objective of this study was to compare the efficacy of these agents in reducing hemodynamic response. The secondary objectives included assessing the quality of the surgical field, recovery time, and total neuromuscular dose. Methods: We randomly allocated 105 patients scheduled for FESS into three groups: lignocaine, propofol, and magnesium sulfate. Heart rate and mean arterial pressure were recorded every 5 min for the first 30 min, followed by measurements every 10 min at the end of the procedure. Moreover, recovery time, total neuromuscular blocking dose, and surgical field score were noted upon completion of the procedure. Statistical analysis was conducted using the number cruncher statistical systems version 9.0.8 software. Results: All three groups showed comparable hemodynamic response and surgical field scores. The recovery time was notably longer in the magnesium sulfate group [10.94 min (2.45)] than in the lignocaine [4.37 min (1.03)] [95% confidence interval (CI) -7.32, -5.83; P=0.000] and propofol groups [4.60 min (0.60)] (95% CI 5.60, 7.095; P=0.000). Moreover, the total neuromuscular blocking agent used was significantly lower in the magnesium sulfate group [5.89 mg (0.47)] than in the lignocaine [6.26 mg (0.56)] (95% CI 0.66, 0.03; P=0.035). Conclusion: Propofol, magnesium sulfate, and lignocaine exerted equal efficacy in attenuating hemodynamic responses during surgery and ensuring a satisfactory surgical field. However, magnesium sulfate led to significantly longer recovery timescompared withpropofol and lignocaine. In addition, magnesium sulfate required a significantly lower total dose of neuromuscular blocking agentsthan lignocaine.

Background: Post-operative sore throat (POST) is a very common anesthesia-related event which may hamper patient satisfaction and increase treatment cost. Aims and Objectives: This study aimed to compare the effectiveness of nebulization with dexamethasone and lignocaine to prevent POST. Materials and Methods: This randomized controlled study involved 135 patients randomly divided into three equal groups: Group D – (n=45) received 8 mg (2 mL) dexamethasone plus 3 mL of distilled water, Group L – (n=45) received 80 mg (4% lignocaine 2 mL) plus 3 mL distilled, and Group S – (n=45) received nebulization with 5 mL normal saline. Results: At 4 h postoperatively, the incidence of POST was 15.6% in the dexamethasone group, 33.3% in the lignocaine group, and 73.3% in the saline group. The score was significantly higher in the saline group (P=0.001) compared to the dexamethasone and lignocaine group, while it was comparable between dexamethasone and lignocaine group (P=0.188). Similarly, dexamethasone and lignocaine groups were comparable at immediately post-operative, 2, 8, 12, and 24 h post-operative time points. Post-operative hoarseness scores of all three groups were comparable at all-time points. A significant increase in the heart rate (HR) and mean arterial pressure (MAP) after intubation was observed in the saline and dexamethasone group as compared to the lignocaine group (P=0.001) while HR and MAP were comparable in dexamethasone and saline group (P=1.000). Conclusion: Dexamethasone and lignocaine nebulization are both effective and comparable prophylaxis for POST and lignocaine nebulization has added advantage of blunting pressor response to endotracheal intubation over dexamethasone nebulization.

Background: Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Methods: Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4–8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. Results: There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Conclusions: Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy.

Background: Dexmedetomidine is frequently used as an adjuvant analgesic in both intrathecal and intravenous infusions. Recently, the role of perineural dexmedetomidine has also been addressed. However, existing literature data is scarce concerning the issue. Aim: The present study aimed to assess the efficacy of intravenous Dexmedetomidine sedation to Perineural Dexmedetomidine on Supraclavicular Approach Brachial Plexus Block during upper limb orthopedic surgery. Methods: 80 subjects were randomly divided into two groups of 40 subjects each where Group I subjects were given 1mcg/kg/IV dexmedetomidine as a loading dose for 10 minutes followed by continuous 0.4mcg/kg/hr IV dexmedetomidine infusion and Group II subjects were given 1mcg/kg perineural dexmedetomidine. In both the groups, duration and onset of motor and sensory block, postoperative analgesia need, hemodynamic parameters, and Ramsay sedation scores were assessed along with any encountered side-effect. Results: Mean sensory block onset was significantly higher in Group I with p<0.05, however, mean motor block onset was comparable in two groups with p>0.05. Motor and sensory blockade duration was significantly longer in Group I (p<0.05). Group I subjects showed lower systolic and diastolic blood pressure and lower pulse rate throughout the duration, and SpO2 levels were comparable. No difference in Ramsay sedation score was seen in either group, however, significantly lesser scores were seen at 9, 12, and 15 hours postoperatively in Group I (p<0.05). Mean analgesia rescue time with VAS >4 was higher in Group I significantly (p<0.05). Conclusions: The present study concludes that early sensory block onset was seen in IV dexmedetomidine with significantly longer duration of analgesia, motor, and sensory block in comparison to perineural dexmedetomidine used as an adjuvant to supraclavicular block using 2% of 5mg/kg Lidocaine and 0.5% of 2mg/kg bupivacaine used for upper limb orthopedic surgeries. [ABSTRACT FROM AUTHOR]

Background: Post-operative sore throat (POST) is a very common anesthesia-related event which may hamper patient satisfaction and increase treatment cost. Aims and Objectives: This study aimed to compare the effectiveness of nebulization with dexamethasone and lignocaine to prevent POST. Materials and Methods: This randomized controlled study involved 135 patients randomly divided into three equal groups: Group D - (n=45) received 8 mg (2 mL) dexamethasone plus 3 mL of distilled water, Group L - (n=45) received 80 mg (4% lignocaine 2 mL) plus 3 mL distilled, and Group S - (n=45) received nebulization with 5 mL normal saline. Results: At 4 h postoperatively, the incidence of POST was 15.6% in the dexamethasone group, 33.3% in the lignocaine group, and 73.3% in the saline group. The score was significantly higher in the saline group (P=0.001) compared to the dexamethasone and lignocaine group, while it was comparable between dexamethasone and lignocaine group (P=0.188). Similarly, dexamethasone and lignocaine groups were comparable at immediately post-operative, 2, 8, 12, and 24 h post-operative time points. Post-operative hoarseness scores of all three groups were comparable at all-time points. A significant increase in the heart rate (HR) and mean arterial pressure (MAP) after intubation was observed in the saline and dexamethasone group as compared to the lignocaine group (P=0.001) while HR and MAP were comparable in dexamethasone and saline group (P=1.000). Conclusion: Dexamethasone and lignocaine nebulization are both effective and comparable prophylaxis for POST and lignocaine nebulization has added advantage of blunting pressor response to endotracheal intubation over dexamethasone nebulization. [ABSTRACT FROM AUTHOR]

Background: Goals of anesthesia in neurosurgery include stable cerebral hemodynamics and provide relaxed brain to surgeon. Dexmedetomidine and lignocaine as an adjuvant can fulfill these criteria but literature comparing the two are sparse. We compared the effects of intravenous infusion of dexmedetomidine or lignocaine on stress response, postoperative pain, and recovery in patients undergoing craniotomy for intracranial tumors. Methods: Approval was obtained from IEC, and the study was prospectively registered (CTRI/2022/11/047434). Written and informed consent was obtained from 105 patients fulfilling inclusion criteria, and they were divided into three groups. Group D Group L received intravenous infusion of lignocaine 2 mg/kg over 15 minutes followed by infusion at rate of 1.5 mg/kg/h, received intravenous infusion of dexmedetomidine 1 mcg/kg over 15 minutes followed by infusion at rate of 0.5 mcg/kg/h, and Group N received intravenous infusion of normal saline at the rate of 4-8 ml/h till skin suturing. SPSS v23 (IBM Corp.) was used for data analysis. Results: There was a significant difference between groups in terms of intraoperative hemodynamic variations, brain relaxation score, extubation criteria, postoperative pain, stress indicator response, and quality of recovery. Conclusions: Dexmedetomidine as an adjuvant to anesthetic drugs has a better profile than lignocaine in suppressing stress response and preventing hemodynamic variations at intubation, skull pin application, and surgical incision. Dexmedetomidine increases the duration of effective analgesia more than lignocaine, in postoperative period in patients undergoing craniotomy. [ABSTRACT FROM AUTHOR]

AbstractAnesthetic drug permeation across biological membranes is commonly analyzed by customized side-by-side diffusion cells, and their availability in the commercial market is limited. Hence, the present study has designed and validated a novel static horizontally aligned drug diffusion cell (Shan DDC) for in vitro permeation studies. The diffusion chambers in Shan DDC are rectangular, measuring 28 × 12 × 15 mm in length, width, and thickness, respectively, to hold a volume of 5 mL separately in each chamber and a 3.36 cm2 opening for drug diffusion, offering a surface area to volume ratio of 0.67. The performance of the device was validated. The temperature inside the chamber was maintained within a narrow range of 37 ± 1.2 °C. The leak fraction was 1.6% (162 ± 45 µL) of the total chamber volume (10 ml). The optimal stirring efficiency inside the individual chamber was achieved within 36 ± 14 s at 200 rpm. The coefficient variation of lignocaine drug flux through the model membrane (nitrocellulose) was 4.2%. Thus, Shan-DDC has been demonstrated to provide reproducible permeation data in vitro. [ABSTRACT FROM AUTHOR]

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration. [ABSTRACT FROM AUTHOR]

Introduction: Migraine is a prevalent and debilitating neurological disorder characterized by recurrent headaches and associated symptoms such as nausea, photophobia, and phonophobia. While conventional treatments exist, a significant subset of patients suffers from refractory migraines, prompting the exploration of alternative therapies like lignocaine. Purpose of the work: This review examines the mechanisms by which lignocaine modulatespain and underscores the potential of lignocaine as a therapeutic option for refractory migraines, while also highlighting the need for continued research to refine its clinical application. Materials and methods: A comprehensive analysis of research papers available on PubMed, Google Scholar, Web of Science, Embase and Scopus was undertaken using the searchterms encompassing the following keywords: chronic migraine / lignocaine migraine / migraine treatment/ migraine pain mechanism / migraine chronic pain mechanism / lignocaine and ketamine migraine / lignocaine adverse effects / lignocaine safety / refractory migraine. Results: Lignocainehas shown promise in alleviating both acute and chronic migraine pain. However, its use requires careful patient selection and monitoring due to potential side effects, such as cardiac and central nervous system toxicity. Despite these risks, the favorable safety profile and efficacy of lignocaine make it a valuable option in migraine management. Future research should focus on optimizing dosing protocols, evaluating long-term outcomes, and identifying biomarkers to guide patient selection.

Background Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine, and 1.5% lignocaine for FNB in fracture femur patients. Methods Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction. Results Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P

Background and Aim: There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. Methods: A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Results: Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Conclusion: Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

Background: Supraclavicular block is a popular technique for upper limb surgeries. It can be performed with landmark, nerve stimulator (NS), ultrasound (US) guidance or a combination of techniques. NS can be an invaluable tool even in low resource set up. There are limited studies to compare NS guided supraclavicular block with (dual technique; Group NS+US) and without (Group NS) US guidance. Although US is gaining popularity, its availability at all times can be limited. Whenever available, the combination of two technique can improve the success rate. Material and Methods: Thirty patients (n=30) were included each in group NS and NS+US in the study. Both groups received 30 ml of 1:1 mixture of 2% adrenalized lignocaine and 0.5% bupivacaine. Both techniques were assessed in terms of ease of block execution (block execution time, number of skin punctures and needle redirections), block success rates and patient satisfaction. Onset and duration of block as well as complications were noted. Results: Both the groups were comparable in terms of age, gender, and mean weight. The block execution times were comparable but the dual technique group had significantly lower number of skin punctures and needle redirections. Both groups had similar success rates. The dual technique group had significantly earlier onset of motor and sensory blockade. No statistically significant difference in the incidence of complications was noted. The dual technique group had better patient satisfaction. Conclusion: A successful supraclavicular block can be performed with NS with or without US safely. The combination of two techniques eases the block execution, hastens the onset and provides better patient satisfaction.

Background: An endotracheal tube is commonly used during General Anesthesia (GA) and is associated with hemo-dynamic changes during and after surgery alongside other throat-related difficulties. Aim and Objectives: To compare the effect of intracuff air and alkalinized lignocaine on cuff pressure under anesthesia maintained by nitrous oxide and to assess the tube tolerance while emergence from anesthesia. To evaluate intraoperative hemodynamic changes and incidence of Post Operative Sore Throat (POST) and hoarseness. Materials and Methods: The present study was a prospective randomized single blinded study conducted among adult patients undergoing GA at a tertiary healthcare located in Coimbatore. After selecting participants based on the inclusion and exclusion criteria, 80 participants were randomized into two groups of 40 subjects each, with Group A: Air inflation up to 20 cm of water and Group B: Alkalinized lignocaine inflation up to 20 cm of water. The selected variables were checked just before surgery, during extubation, and as per follow-up periods, and collected variables were then analyzed using SPSS version 22.0 software. Results: Both the groups were comparable in their demographic profile. The mean cuff pressures in Group A were higher than Group B at all points. The cuff pressures at end of surgery were 39.17 ± 1.752 vs 27.13 ± 1.017 cm of water and this was statistically significant (p = 0.001). The mean Systolic Blood Pressure, Diastolic Blood Pressure, and pulse rate at the time of extubation showed a significant difference with p < 0.05. Better tube tolerance at the time of extubation was observed in Group B with p < 0.05. The incidence of POST and hoarseness was found to be reduced in Group B and this was found to be statistically significant (p < 0.05). Conclusion: Intracuff injection of alkalinized lignocaine is superior to the standard practice of injecting air when using nitrous oxide for GA. It resulted in lower cuff pressures which translated to better tube tolerance, improved hemodynamics, smoother emergence, and reduced incidence of POST.

Introduction: Anaesthetic sedatives are widely used for bronchoscopy and Endobronchial Ultrasound (EBUS) to ensure patient cooperation and minimise patient discomfort. Dexmedetomidine is an α2 adrenergic agonist used for sedation. Aim: To evaluate the safety and efficacy of nebulised dexmedetomidine in EBUS. Materials and Methods: In this randomised double-blinded controlled study, conducted in the Department of Anaesthesiology and Pulmonary Medicine at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India from 2020 to 2022, 52 patients aged between 18 and 70 years undergoing EBUS were included. Patients were randomly assigned to the study group (S) and the control group (C). Group C received nebulised lidocaine (2%) 10 mL for 10-15 minutes in a sitting position. Group S received nebulised lidocaine (2%) 8 mL + Dexmedetomidine 2 mL (1 mcg/kg) for 10-15 minutes in a sitting position. Haemodynamic parameters, cough severity scores, patient and operator satisfaction scores, Midazolam requirements, and any complications were recorded and compared. The data were analysed statistically using the Student’s t-test and Chi-square test, whichever was feasible. A p-value of

This study aims to characterise and assess the stability of an optimised lignocaine–adrenaline nanogel using central composite design (CCD). Compatibility studies were conducted using Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) and Ultraviolet–visible (UV–vis) spectroscopy. Eighteen lignocaine–adrenaline Nanoemulsion (LANE) formulations derived using CCD were characterised for particle size, polydispersity index (PDI), zeta potential and pH. All LANE formulations were transformed into lignocaine-adrenaline Nanoemulsion-based Gel (NBG) by adding 0.1 % Carbopol 940. Stability studies for LANE and NBG were conducted for 12 months storage at 25 °C. The results of long-term stability assessment of LANEs and NBGs were integrated with CCD predictions to produce the optimised NBG, lignocaine–adrenaline Nanogel. The optimised NBG model was validated in triplicates. The optimised NBG was subjected to 5000 rpm centrifugation for 30 min, repeated heating-cooling cycles (40 °C and 4 °C), and a freeze-thaw cycle (-5 °C and 25 °C). ATR-FTIR and UV–vis results indicated compatibility between lignocaine, adrenaline and the excipients. The viscosity of the nanogel corresponded to that of ferric sulphate solution (24 ± 1 mPa·s at 20 °C). The LANE and NBG formulations showed no drug precipitation or phase separation after the stability study. The optimised NBG had particle size (61.76 ± 0.25 nm), PDI (0.36 ± 0.01), zeta potential (−26.47 ± 0.02 mV) and pH (6.28 ± 0.02). The optimised NBG remained stable in stress-induced environments. CCD enabled optimisation of a stable NBG formulation.

The combination of local anesthetic drugs with epinephrine has conventionally been contraindicated in acral regions due to concerns of potential necrosis caused by compromised blood flow. However, this belief has been challenged since 2001, when studies demonstrated the safety and effectiveness of the combination. This review aims to analyze reported cases of acral area necrosis following the use of local anesthesia with epinephrine since 2001. A thorough search was conducted on PubMed and Google Scholar using specific keywords to identify articles reporting acral area necrosis caused using local anesthesia and epinephrine. Our search yielded eight publications describing a total of 13 cases of ischemic events in acral areas. These cases involved finger necrosis (five cases), scrotal skin necrosis (two cases), and eyelid necrosis (six cases), following the injection of a combination of epinephrine and lignocaine. The majority of affected patients were female who underwent surgical intervention and reconstruction. The use of epinephrine in local anesthesia offers significant advantages and is generally safe for acral areas. However, the risk of necrosis cannot be entirely eliminated, particularly in patients with compromised vascular function. Adhering to proper guidelines and selecting suitable patients can help mitigate the risk. Phentolamine serves as a potential rescue agent if vascular compromise occurs. Precautionary measures must be taken when using this combination in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine, and 1.5% lignocaine for FNB in fracture femur patients. Methods: Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction. Results: Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P<0.001). In group B, 12 patients required additional fentanyl to achieve a VAS <4. Patient positioning was reported to be satisfactory in all patients in group R and L, while in B it was satisfactory in 13 (52%) patients only. Patient acceptance of FNB was 100% in group R and L, but only 64% in group B. Conclusions: Based on our findings, 0.5% ropivacaine is a favorable choice for FNB due to early onset, ability to yield a good quality block, and good safety profile. [ABSTRACT FROM AUTHOR]

One of the most frequent problems that patients bring to a dental clinic is pain in the orofacial region or within the tooth. To identify and solve the issue, a proficient practitioner needs to be equipped with the necessary information and resources. Comprehending the history of pain control in dentistry can provide valuable understanding into the development of the present techniques. Newer and more effective pain management treatments have been created as dentistry continues to advance. Several modalities have been developed to reduce and eliminate this, including pharmacological and nonpharmacological treatment modalities. The goal of the present review of the literature's findings is to provide dentists with reliable information regarding the application of contemporary local anesthetics, alternative methods, and strategies to reduce pain during anesthesia administration, thereby improving patient comfort. [ABSTRACT FROM AUTHOR]

Background: An endotracheal tube is commonly used during General Anesthesia (GA) and is associated with hemodynamic changes during and after surgery alongside other throat-related difficulties. Aim and Objectives: To compare the effect of intracuff air and alkalinized lignocaine on cuff pressure under anesthesia maintained by nitrous oxide and to assess the tube tolerance while emergence from anesthesia. To evaluate intraoperative hemodynamic changes and incidence of Post Operative Sore Throat (POST) and hoarseness. Materials and Methods: The present study was a prospective randomized single blinded study conducted among adult patients undergoing GAat a tertiary healthcare located in Coimbatore. After selecting participants based on the inclusion and exclusion criteria, 80 participants were randomized into two groups of 40 subjects each, with Group A: Air inflation up to 20 cm of water and Group B: Alkalinized lignocaine inflation up to 20 cm of water. The selected variables were checked just before surgery, during extubation, and as per follow-up periods, and collected variables were then analyzed using SPSS version 22.0 software. Results: Both the groups were comparable in their demographic profile. The mean cuff pressures in Group A were higher than Group B at all points. The cuff pressures at end of surgery were 39.17 ± 1.752 vs 27.13 ± 1.017 cm of water and this was statistically significant (p = 0.001). The mean Systolic Blood Pressure, Diastolic Blood Pressure, and pulse rate at the time of extubation showed a significant difference with p < 0.05. Better tube tolerance at the time of extubation was observed in Group B with p < 0.05. The incidence of POSTand hoarseness was found to be reduced in Group B and this was found to be statistically significant (p < 0.05). Conclusion: Intracuff injection of alkalinized lignocaine is superior to the standard practice of injecting air when using nitrous oxide for GA. It resulted in lower cuff pressures which translated to better tube tolerance, improved hemodynamics, smoother emergence, and reduced incidence of POST [ABSTRACT FROM AUTHOR]

Background: Supraclavicular block is a popular technique for upper limb surgeries. It can be performed with landmark, nerve stimulator (NS), ultrasound (US) guidance or a combination of techniques. NS can be an invaluable tool even in low resource set up. There are limited studies to compare NS guided supraclavicular block with (dual technique; Group NS+US) and without (Group NS) US guidance. Although US is gaining popularity, its availability at all times can be limited. Whenever available, the combination of two technique can improve the success rate. Material and Methods: Thirty patients (n=30) were included each in group NS and NS+US in the study. Both groups received 30 ml of 1:1 mixture of 2% adrenalized lignocaine and 0.5% bupivacaine. Both techniques were assessed in terms of ease of block execution (block execution time, number of skin punctures and needle redirections), block success rates and patient satisfaction. Onset and duration of block as well as complications were noted. Results: Both the groups were comparable in terms of age, gender, and mean weight. The block execution times were comparable but the dual technique group had significantly lower number of skin punctures and needle redirections. Both groups had similar success rates. The dual technique group had significantly earlier onset of motor and sensory blockade. No statistically significant difference in the incidence of complications was noted. The dual technique group had better patient satisfaction. Conclusion: Asuccessful supraclavicular block can be performed with NS with or without US safely. The combination of two techniques eases the block execution, hastens the onset and provides better patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the addition of dexmedetomidine (BLD) to retrobulbar blockade with combined lignocaine and bupivacaine on nociception. Animals: A total of 17 eyes from 15 dogs. Methods: Prospective, randomized, masked clinical comparison study. Dogs undergoing unilateral enucleation were randomly assigned into two groups; a retrobulbar administration of lignocaine and bupivacaine in a 1:2 volume ratio combined with either BLD or 0.9% saline (BLS). The total volume of the intraconal injection was calculated at 0.1 mL/cm cranial length. Intraoperative parameters were recorded: heart rate (HR), respiratory rate (RR), end‐tidal CO2 (EtCO2) arterial blood pressure (BP), and inspired isoflurane concentration (ISOinsp). Pain scores, heart rate and RR were recorded postoperatively. Results: Dogs receiving BLD (n = 8) had significantly lower intraoperative RR (p = 0.007), and significantly lower ISOinsp (p = 0.037) than dogs in the BLS group (n = 9). Postoperatively heart rate was significantly lower in the BLD group at 1 min (p = 0.025) and 1 h (p = 0.022). There were no other significant differences in intraoperative or postoperative parameters, or in postoperative pain scores (p = 0.354). Dogs receiving BLD had a higher rate of anesthetic events of bradycardia and hypertension (p = 0.027). Analgesic rescue was not needed in either group. Conclusions: The addition of BLD to retrobulbar anesthesia did not result in a detectable difference in pain scores relative to blockade with lignocaine and bupivacaine alone. Dogs receiving retrobulbar BLD had a significantly lower intraoperative RR and isoflurane requirement and an increased incidence of intraoperative bradycardia and hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Anaesthetic sedatives are widely used for bronchoscopy and Endobronchial Ultrasound (EBUS) to ensure patient cooperation and minimise patient discomfort. Dexmedetomidine is an α2 adrenergic agonist used for sedation. Aim: To evaluate the safety and efficacy of nebulised dexmedetomidine in EBUS. Materials and Methods: In this randomised doubleblinded controlled study, conducted in the Department of Anaesthesiology and Pulmonary Medicine at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India from 2020 to 2022, 52 patients aged between 18 and 70 years undergoing EBUS were included. Patients were randomly assigned to the study group (S) and the control group (C). Group C received nebulised lidocaine (2%) 10 mL for 10-15 minutes in a sitting position. Group S received nebulised lidocaine (2%) 8 mL + Dexmedetomidine 2 mL (1 mcg/kg) for 10-15 minutes in a sitting position. Haemodynamic parameters, cough severity scores, patient and operator satisfaction scores, Midazolam requirements, and any complications were recorded and compared. The data were analysed statistically using the Student's t-test and Chi-square test, whichever was feasible. A p-value of <0.05 was considered statistically significant. Results: The demographic parameters including the mean age (years) of 46.3±14.01 in Group C vs. 44.5±14.35 in Group S, mean weight (kg) of 61.6±8.27 in Group C vs. 63.5±10.06 in Group S, and male/female ratio of 12/14 in Group C vs. 9/17 in Group S were comparable. Haemodynamic parameters were better postnebulisation in Group S compared to Group C. The authors observed that the incidence of coughing was significantly higher in Group C compared to Group S (73.1% vs. 46.2%). It was found that Group C had a significantly higher requirement for midazolam doses compared to Group S (53.8% vs. 19.2%). When the patient satisfaction score assessed on the Numerical Rating Scale (NRS) was analysed, it was found that Group S patients were highly satisfied compared to Group C patients, and the difference was highly significant (p-value <0.05). No drug or procedure-related complications were observed in the two groups. Conclusion: The present study demonstrated that nebulised dexmedetomidine-lidocaine was well-tolerated during bronchoscopies under moderated sedation and was associated with stable Haemodynamics, decreased incidence of severe coughing, and a lower consumption of sedation drugs. [ABSTRACT FROM AUTHOR]

ObjectiveThe World Health Organization (WHO) recommended addition of local anesthetic to reduce the intense pain of intramuscular injection of 50% Magnesium Sulphate (MgSO4) salt solution has been found to be ineffective. We tested whether giving the local anesthetic 5 min before the MgSO4 injection would reduce pain.MethodsWe conducted a prospective cross-over trial where each participant with pre-eclampsia or eclampsia received sequential and mixed injection methods in random sequence during sequential MgSO4 administrations. Pain and preference were assessed using descriptive words, a numeric pain scale and direct comparison between the two injection methods. Differences were measured using the Wilcoxon signed rank test, risk ratios with 95% confidence intervals and the Chi squared or Fisher's test. The administration techniques were refined based on an initial pilot of 8 participants.ResultsWe enrolled 49 consented participants and analysed data from 41 post-pilot participants The sequential injection method had a non-significantly lower mean pain score than the mixed injection method (3.1 vs. 3.3, p = 0.44). Severe pain was reported for 3/41 vs. 9/41, p = 0.12. The sequential injection method was perceived to be more painful by 13 (37%) vs. 22 (63%) participants (p = 0.03). The sequential injection was preferred by 21(60%) vs. 14 participants (40%) (p = 0.1).ConclusionOur results consistently favoured the novel sequential injection method. The lack of statistical significance for most results is not surprising given the small sample size. Given the potential for clinically important benefits to women, a larger study to confirm these results is justified. Clinical Trial Registrationhttps://pactr.samrc.ac.za/, Identifier (PACTR202201521544765).

Background: Low back pain syndrome is associated with muscular and myofascial pain and is linked with muscle overstrain or a lack of regular physical activity as well as a habitual bad posture, which cause the overload of perispinal soft tissues. One of the forms of therapy of LBP is the mesotherapy of the spine, which consists of multi-point micro-injections of drugs or medicine mixtures, which include preparations of collagen type I. The aim of the study was to assess the efficacy and safety of mesotherapy with collagen type I. Methods: A retrospective analysis of the results of the treatment of patients with chronic low back pain syndrome using mesotherapy was performed. A total of 130 patients (83 women and 47 men; mean age: 51 ± 14 years) were divided into two groups: group I (n = 65), treated with collagen type I, and group II (n = 65), treated with lignocaine 1%. Mesotherapy was performed weekly over five weeks. Patients were assessed using the following scales: the VAS, Laitinen Scale, and Revised Oswestry Low Back Pain Disability Scale before the start of the treatment, after five treatments, and at the three-month follow-up visit. Results: A statistically significant improvement was observed after the use of spinal mesotherapy both with collagen type I and lignocaine, with the collagen treatment having better results at the three-month follow-up visit. No adverse effects were observed after the procedures. Conclusions: Spinal mesotherapy using collagen type I and lignocaine seems to be an effective method in the treatment of chronic LBP. Collagen mesotherapy gives better results in the long term. Mesotherapy is a safe form of therapy. [ABSTRACT FROM AUTHOR]

Background: To reduce airway and circulatory responses during extubation, various pharmacological and non-pharmacological methods have been used such as opioids, inhalational agents, local anaesthetics, vasodilators, alpha blockers, beta blockers, and calcium channel blockers. Present study was aimed to compare the hemodynamic effects of esmolol and lidocaine in attenuation of haemodynamic responses to tracheal extubation in neurosurgical patients. Material and Methods: Present study was single centric, observational, prospective, comparative study, conducted in patients with ASA 1 & 2, undergoing neurosurgical procedure (elective and emergency) with invasive blood pressure monitoring. Patients were divided in two group as Group 1 (Esmolol, n=30) & Group 2 (Lignocaine, n=30). Results: No significant difference was seen in the age wise distribution, gender wise distribution, mean weight & ASA grade distribution of patients enrolled in both groups. No significant difference in heart rate was seen among patients in both the group at baseline and at pre reversal stage. Average heart rate was significantly higher among patients in lignocaine after pre reversal stage from min 1 to 15 min. No significant difference in SBP was seen among patients in both the group at baseline and at pre reversal stage. Average SBP was significantly higher among patients in lignocaine after pre reversal stage from min 1 to 15 min. Nausea - vomiting were the two most common side effect seen among patients in both the group. No significant difference was seen among the reported side effect. Majority of patients in both the group has no coughing at extubation. No significant difference in the quality of extubation was seen among patients in both group Conclusion: No difference in the side effect was seen among patients in both group & majority of patients has smooth extubation with no coughing episode. [ABSTRACT FROM AUTHOR]

Background: To compare efficacy between oral lignocaine viscous 2% and oral lignocaine spray 10% in attenuating the hemodynamic response for laryngoscopy & endotracheal intubation prior to general anaesthesia. Materials and Methods: This study was carried out in 60 patients belonging to ASA I& II, aged between 20 to50 years undergoing elective surgeries. The study will be conducted for a period of 1year in Department of Anaesthesia in Kurnool Medical College, Kurnool. Patients who had hypersensitivity to study drug, patients with severe renal, hepatic, respiratory, cardiac disease, neurological, psychiatric disorders, Difficult Airway-Cormack & Lehane grade 3 and 4 were excluded from the study. Divided in to two groups. Group V receives 10ml of 2% or a lignocaine viscous gargle for 5 minutes prior to induction. Group S receives five puffs of oral lignocaine spray 10% prior to induction. The values for HR, SBP, DBP, and MAP, SPO2 were obtained baseline, after induction, immediately after intubation and 1,3,5 and10 minutes after intubation and compared among the groups. Results: In the current study, after induction the mean HEART RATE starts increasing in group S and in group V mean heart rates tart decreasing after induction and slightly raised after immediately after intubation and gradually decreasing till 10 min after intubation. In group S immediately after intubation highest mean heart rate was observed, and start decreasing at 1 minute, 3 minute, 5minute and 10 minute after intubation but not reached baseline level, the mean heart rate between two groups from after induction to 10 minutes after intubation was significant. (p<0.05). In group S mean SBP start increasing immediately after intubation and gradually start decreasing from 1 minute after intubation to 10 minutes after intubation. The mean SBP between two groups from 1 minute after induction to 10 minutes after intubation was significant. (p<0.05). In group V mean DBP start decreasing immediately after intubation and slightly increased immediately after intubation and gradually decreasing till 10 min after intubation. The mean DBP between two groups from after induction to 10 minutes after intubation was significant. (p<0.05). The mean MAP starts increasing in group S till immediately after intubation and gradually start decreasing from 1 minute after intubation to 10 minutes after intubation but reached baseline level at 3minutes.However, in group V mean MAP start decreasing immediately after intubation and slightly increased immediately after intubation and gradually decreasing till 10 min after intubation. The mean MAP between two groups from after induction to 10 minutes after intubation was significant. (p<0.05). After induction the mean SPO2 starts increasing in both groups and reached to 100% in both groups. Conclusion: The study concluded that oral lignocaine viscous 2% was more effective in blunting the haemodynamic response to laryngoscopy and endotracheal intubation than lignocaine spray 10% No significant adverse events occurred during the study. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and intubation are critical procedures that can cause significant hemodynamic changes. This study compares the effectiveness of lignocaine and two different doses of dexmedetomidine in managing these hemodynamic changes. Objectives: To evaluate and compare the efficacy of 1.5 mg/kg lignocaine and two doses of dexmedetomidine (0.5 μg/kg and 1 μg/kg) in attenuating the hemodynamic responses during laryngoscopy and intubation. Methods: This randomized, controlled trial involved 200 patients scheduled for elective surgeries requiring general anesthesia. The patients were divided into four groups based on the medication and dosage they received: Group LL (Lignocaine - Low Dose) was given 1 mg/kg lignocaine, Group LH (Lignocaine - High Dose) received 2 mg/kg lignocaine, Group DL (Dexmedetomidine - Low Dose) was administered 0.5 μg/kg dexmedetomidine, and Group DH (Dexmedetomidine - High Dose) received 1 μg/kg dexmedetomidine. Hemodynamic parameters, such as heart rate and blood pressure, were recorded before, during, and after the intubation process. Results: The trial revealed significant variations in hemodynamic responses among the four groups. Group DH (Dexmedetomidine - High Dose) exhibited the most substantial attenuation of hemodynamic responses, with a 45% reduction in heart rate variability and a 40% decrease in systolic blood pressure spikes during intubation. Group DL (Dexmedetomidine - Low Dose) also showed notable effectiveness, with a 30% reduction in heart rate variability and a 25% decrease in systolic blood pressure changes. The lignocaine groups displayed varying levels of effectiveness; Group LH (Lignocaine - High Dose) achieved a 20% reduction in heart rate variability and a 15% decrease in systolic blood pressure, whereas Group LL (Lignocaine - Low Dose) showed a 10% reduction in heart rate variability and a 5% decrease in systolic blood pressure. These results indicate a more pronounced dose-dependent efficacy of dexmedetomidine in managing hemodynamic responses during intubation compared to lignocaine. Conclusion: Both lignocaine and dexmedetomidine are effective in attenuating hemodynamic responses during laryngoscopy and intubation. The comparison between the two drugs and their doses provides valuable insights for clinical practice in anesthesia. [ABSTRACT FROM AUTHOR]

Background: One of the most common painful disorders is lower back pain with the lifetime prevalence of around 54% to 80%. Annual prevalence of chronic back pain is around 15% to 45% and 25% - 60% of patients have persisting low back pain with one year beyond initial episode. This condition often disrupts work, social activities, and daily living. Our study aimed to assess the outcomes of inter-laminar epidural steroid injection versus caudal epidural steroid injection in patients experiencing chronic lower back pain, focusing on pain relief and potential complications. Methods: A total of 60 individuals with chronic low back pain were selected. Among these, 30 patients were randomly assigned to the first group, receiving caudal epidural steroid injection, and 30 patients to the second group, receiving inter-laminar epidural steroid injection under fluoroscopy control. Follow-up assessments for both groups were conducted at 1 hour post injection, 1 week, 4 weeks, 8 weeks and 12 weeks. Results: Pain score was analysed with Visual Analog Scale score. Inter-laminar epidural steroid injection exhibited excellent results in early follow-ups with VAS score <3, transitioning to a moderate pain relief with VAS score of 4 at 8 weeks and VAS score of 5 by the 12-weeks post procedure. Conversely, caudal steroid injection provided moderate degree pain relief at early weeks and also at 12 weeks post procedure with average VAS score of 4to5. Conclusion: Caudal epidural steroid injection proves to be cost-effective, easy to administer, and associated with fewer complications compared to interlaminar steroid injection. Both procedures are considered safe, well-tolerated outpatient interventions. [ABSTRACT FROM AUTHOR]

Background: The subcutaneous administration of nitroglycerin is a straight forward and inexpensive technique that allows a high concentration and long persistence of the vasoactive agent at the spasm site level without entering the bloodstream significantly. Objectives: Aim of this study to compare the effect of subcutaneous infiltration of nitroglycerine-lignocaine combination versus Lignocaine alone for facilitating radial artery cannulation Methods: This was a randomized controlled study. A total of 104 patients were enrolled, all the participants were allocated randomly into two groups:. Group LN (n=52): received subcutaneous injection of Nitroglycerin 100 μg (o.2ml)-Lignocaine (0.8ml) 2%. Group L (n=52): received subcutaneous injection of 2% Lignocaine (1ml) Patient age, body weight, height, BMI and baseline vital parameters were recorded. History regarding previous surgery, Anaesthesia, significant comorbities, medications and radial artery diameter before and after infiltration were recorded. Results: Mean age and BMI in LN group was 44.0 ± 11.48 and 24.66 ± 2.74, 41.1% were males in LN group while 63.5% were males in L group. There is no statistical significant difference in terms of age, gender, BMI, co morbidities, ASA status and hemodynamic parameters. Radial artery catheterisation in the first attempt was 68.6% in LN group and 30.8% in L group, statistically significant (p<0.05). The palpability pulse index was better in nitroglycerine-lignocaine group compared to lignocaine group. The results are statistically significant (p<0.05). Conclusion: Subcutaneous infiltration of nitroglycerin-lignocaine before radial artery cannulation improved the first-attempt success rate and reduced the overall complication rates. [ABSTRACT FROM AUTHOR]

Introduction: Intravenous opioids have been frequently used to provide analgesia and supplemental sedation during general anaesthesia or monitored anaesthesia care. Opioid Free Anaesthesia (OFA) is a multimodal approach which combines different drugs likes lignocaine, dexamethasone, paracetamol and dexmedetomidine with different techniquessuch as hypnosis, sedation, analgesia and sympatholysis. Thus, reducing and avoiding opioids perioperatively will lead to decrease in opioid related adverse effects with better postoperative outcomes. Aim: To compare OFA and Opioid-based Anaesthesia (OBA) in terms of haemodynamic stability, speed and quality of recovery, postoperative pain score and analgesic requirement. Material and Methods: The present study was a randomised study conducted over a period from June 2021 to September 2022, in which 90 patients of American Society of Anaesthesiologists (ASA) Grade I,II, 20-60 years of age undergoing elective Laparoscopic Cholecystectomy (LC) were divided into OBA fentanyl and OFA-lignocaine and dexmedetomidine. A standard general anaesthesia protocol of the institute was followed. OBA group received fentanyl (2 μg/kg) over 10 minutes before induction of anaesthesia and OFA group received lignocaine (2 mg/kg) and dexmedetomidine (0.5 μg/kg) both intravenously over 10 minutes before induction of anaesthesia. In OFA group analgesia was maintained by infusion of lignocaine 2 mg/kg/hr and dexmedetomidine 0.5 μg/kg/hr whereas in OBA group fentanyl 0.5 μg/kg was given whenever required till the gallbladder was resected. Postoperative intraperitoneal instillation of gallbaldder fossa was done with 20 mL 0.5% bupivacaine. Intraoperative mean Heart Rate (HR) and Mean Arterial Pressure (MAP) were recorded. Postoperative speed and quality of recovery, pain score, analgesic requirements and incidence of Postoperative Nausea and Vomiting (PONV) were noted. Paracetamol 15 mg/kg was given intravenously whenever Numerical Rating Scale (NRS) score was ≥6. Comparison of means between the two groups was done using unpaired t-test, association between two non parametric variables was done using Pearson Chi-square (χ2 test) test. Results: The mean age, sex, weight, ASA and duration of surgery were comparable in both the groups. The mean HR and mean MAP were significantly lower in OFA group compared to the OBA group at all the time points (p-value=0.001). Although postoperative speed of recovery was slower in OFA group, the overall quality of recovery was better (p-value=0.001). The postoperative pain score, analgesic requirement and incidence of nausea and vomiting were all significantly less in OFA group as compared to OBA group with p-values of 0.02, 0.001 and 0.02, respectively. Conclusion: OFA is new anaesthetic approach that provides better perioperative haemodynamic stability, postoperative pain control with less PONV and thus can be used safely and successfully.

Background: Endotracheal intubation is a common procedure during general anesthesia, often associated with post-operative complications such as sore throat and emergence cough. This study aimed to investigate the efficacy of three intra-cuff solutions—air, normal saline, and 2% lignocaine—in mitigating these complications and their impact on intubation attempts and hemodynamic parameters. Methods: A randomized clinical trial was conducted involving 114 patients undergoing elective surgeries. Participants were divided into three groups based on the intra-cuff solution used. Intubation attempts, post-operative sore throat, emergence cough, and physiological parameters were assessed and statistically analysed. Results: The use of 2% lignocaine significantly reduced the number of intubation attempts (p < 0.001*) compared to air and normal saline. Additionally, lignocaine was associated with a significantly lower incidence of post-operative sore throat (p = 0.011*) and emergence cough (p = 0.010*) compared to the other solutions. However, there were no significant differences in hemodynamic parameters between the groups. Conclusion: This study suggests that 2% lignocaine may be a preferable intra-cuff solution for endotracheal intubation, as it reduces intubation attempts and the incidence of postoperative complications. Further research and clinical trials are needed to validate these findings and refine the selection criteria for intra-cuff solutions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to compare the anesthetic efficacy of 4% articaine and 2% lidocaine as supplementary buccal infiltration after failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Methods: MESH terms and specific keywords were used to search Scopus, EBSCOhost, Cochrane Library, and PubMed. Randomized clinical trials were among the included articles that compared the anesthetic efficacy of 4% articaine or 2% lignocaine as supplementary buccal infiltration following a failed IANB in patients with chronic irreversible pulpitis. Results: Five of the 871 studies that were reviewed were given full-text reading considerations, and three studies were subjected to qualitative analysis after meeting the inclusion and exclusion criteria. In 234 patients altogether, patients anesthetized with 4% articaine buccal infiltration had a success rate of 61%–83.3% in the 118 patients in the 4% articaine BI group and 116 patients in the 2% lidocaine BI group. Conclusion: Supplemental buccal infiltration with 4% articaine in permanent mandibular molars was associated with greater anesthetic efficacy than the 2% lignocaine in patients with symptomatic irreversible pulpitis after unsuccessful IANB. [ABSTRACT FROM AUTHOR]

Background: Extensive surgical dissection, hemodynamic alterations associated with cytoreductive surgery (CRS), and hyperthermic intraperitoneal chemotherapy (HIPEC) make pain management challenging. We hypothesized that infusions of intravenous lignocaine and fentanyl provide comparable analgesia to epidural ropivacaine and fentanyl in these patients. Methods: Fifty patients scheduled to undergo CRS and HIPEC were enrolled in the study. The patients in group IV (Intravenous) received a bolus dose of 1.5 mg/kg lignocaine over 15 min, starting approximately 15 min before the surgical incision and fentanyl 0.5 mcg/kg, about 2 min before the surgical incision, following which patient received lignocaine infusion at 1 mg/kg/hr and fentanyl infusion at 0.5 mcg/kg/hr intraoperatively. Patients in group EPI (Epidural) received 6 mL of Ropivacaine 0.2% and fentanyl (2mcg/mL) approximately 15 min before surgical incision, followed by continuous infusion at the rate of 5 mL/hr. The procedure for induction and maintenance of anesthesia was standardized for both groups. In the postoperative period, the infusion of analgesics was reduced to half the intraoperative rates and continued for 24 h. Results: Demographic profile and clinical parameters were comparable between both groups (p > 0.05). There was no difference between the number of fentanyl doses given in the IV group [Langenbecks Arch Chir 373(3):189–196, 4, IQR (2–11)] and the EPI group [Reg Anesth Pain Med 35(4):370–376, 12, IQR (5–21)] in the postoperative period (p = 0.229). The need for intraoperative rescue analgesia was comparable among the groups (p = 0.882). Conclusion: The two techniques, epidural (ropivacaine and fentanyl) and IV (lignocaine and fentanyl) infusions, provide comparable analgesia in patients undergoing CRS and HIPEC. Trial registration number: CTRI/2020/08/027052 dated 09/08/2020. [ABSTRACT FROM AUTHOR]

Drug impurities are now seen as a major threat to drug safety around the world, especially when it comes to carcinogenic impurities. Here, we present the first spectrophotometric approach for the quantification of lignocaine and fluorescein in the presence of 2,6-xylidine, lignocaine's carcinogenic impurity. The approach depends on overcoming unresolved bands through a data processing strategy employing 10 affordable, simple, and sensitive spectrophotometric methods. Fluorescein analysis (1-16 µg mL-1) was performed using direct ultraviolet spectrophotometry (D0) at 478 nm; then, the ratio subtraction method allowed the removal of interference caused by the fluorescein spectrum. From the resulting ratio spectra, 2,6-xylidine (40-160 µg mL-1) can be efficiently determined at 280 nm. However, lignocaine (72-320 µg mL-1) was analyzed using different ultraviolet-based methods, including continuous wavelet transform, ratio derivative by Savitzky-Golay filters, mean centering, second derivative of ratio spectra, ratio spectra difference spectrophotometry, extended ratio subtraction, absorbance subtraction, Q-absorbance ratio, and area under the curve. In line with International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH), the presented approach was evaluated by its coefficients of determination, detection limits, quantification limits, and relative standard deviations. Similarly, the developed approach was assessed for whiteness, greenness, and sustainability using five assessment tools, including National Environmental Method Index, Eco-Scale Assessment, Complementary Green Analytical Procedure Index, Analytical Greenness Metric, and RGBI2, offering promising results. Owing to the satisfactory analytical performance, besides the sustainability, affordability, simplicity, and cost efficiency of the presented methods, their application for quality control and in situ analysis in minimal-infrastructure laboratories increases, increasing the surveillance potential. [ABSTRACT FROM AUTHOR]

Background: Propofol long-chain triglyceride (LCT) is the most commonly used intravenous anesthetic drug, which has pain on injection as its major disadvantage. Many drugs have been used to alleviate this pain with variable efficacy, among them lidocaine pretreatment is most popular. Propofol medium-chain triglyceride (MCT)/LCT emulsion has the ability to decrease pain on injection. The availability of propofol with two different formulations necessitates a comparison of pain on injection with lidocaine pretreatment. Aim: The aim of this study was to study the incidence and intensity of pain on injection with propofol LCTs versus propofol MCT/LCTs with lignocaine. Materials and Methods: This prospective, double-blind, and randomized controlled study included 120 American Society of Anesthesiology Grade I and II participants undergoing General Anesthesia. In Group A, patients were induced with 1% propofol LCT (2 mg/kg) with 2% lidocaine 2 ml and in Group B 1% propofol MCT/LCT (2 mg/kg) with 2% lidocaine 2 ml. Assessment of pain on injection was performed after 30% of total induction dose was injected at a rate of 1 ml/s by Verbal Rating Scale. Results: Group A reported an incidence of pain in 28.4% and Group B with 13.3%. There was a statistically significant difference in the incidence and intensity of pain with propofol MCT/LCT along with lignocaine. Sixteen patients in Group A and eight patients in Group B had mild pain, whereas one patient in Group A and none of them in Group B had moderate pain. Conclusion: Premixing lignocaine with MCT/LCT propofol significantly reduces both the incidence and intensity of pain as compared to LCT propofol with lignocaine. [ABSTRACT FROM AUTHOR]

The present study was conducted for clinical evaluation of a multimodal anaesthetic protocol using butorphanol-dexmedetomidine-midazolam-ketamine-isoflurane and lignocaine continuous rate infusion (CRI) in six cross-bred female cattle. Preanaesthetics used were butorphanol and dexmedetomidine which were administered intravenously at dose rates of 0.05 mg/kg and 1 μg/ kg body weight, respectively. Ketamine and midazolam were intravenously administered at dose rates of 4.0 and 0.2 mg/kg body weight respectively, to induce anaesthesia. Isoflurane was used to maintain anaesthesia after endotracheal intubation, at a concentration of 1.05 ± 0.97 per cent concentration in 100 per cent oxygen using a large animal anaesthesia machine. Simultaneously, intravenous lignocaine was administered at a bolus dose of 2 mg/kg body weight followed by a CRI of 3 mg/kg body weight/hour using a volumetric infusion pump. Isoflurane sparing effect of intravenous lignocaine reduced the required concentration of isoflurane for maintenance. The third plane of surgical anaesthesia was maintained and various surgical procedures were done. Recovery was smooth. Other than the mild regurgitation of ruminal fluid in an animal, no anaesthetic complications were noticed.

The present investigation was conducted on 12 clinical cases of cattle reported to the Veterinary Clinical Complex at College of Veterinary and Animal Sciences, Parbhani. These cases randomly divided in to two groups. Group 1 treated with combination of lignocaine hydrochloride @ 0.2 mg/kg and xylazine hydrochloride @ 0.025 mg/kg. Whereas, 0.75 % ropivacaine hydrochloride @ 0.2 mg/kg. and xylazine hydrochloride @ 0.025 mg/kg used in group 2 by dorsolumbar epidural route in cattle. The onset of action and distribution of analgesia was significantly (p<0.01) quicker in group 1 than in group 2. However, the duration of anaesthesia in group 2 was significantly (p<0.01) higher in group 1. The clinico-physiological and haemato-biochemical parameters were taken at 0, 15, 30, 60 and 120 minutes intervals. The clinico-physiological and haematological parameters showed momentary changes which were within normal physiological range. [ABSTRACT FROM AUTHOR]

Two simple, sensitive, accurate and precise spectrophotometric methods were developed and validated for the quantitative determination of Diflunisal (DIF) and Lignocaine (LIG) in bulk and pharmaceutical dosage form. Method A is based on the first-order derivative (D1), and Method B is based on the second-order derivative (D2) spectrophotometric method. In Method A, absorbance was measured at 224nm and 264nm being the zero crossing points for DIF and LIG, respectively. In Method B, absorbance was measured at 232nm and 273nm being the zero crossing points for DIF and LIG, respectively. For Method A, the two drugs obeyed Beer's law in the concentration range of 3-39µg/ml for DIF and 4-40 µg/ml for LIG with correlation coefficients 0.999 and 0.995, respectively. For Method B, the two drugs obeyed Beer's law in the concentration range of 3-30µg/ml for DIF and 4-48µg/ml for LIG with correlation coefficients 0.998 and 0.996, respectively. Both methods can be used for routine analysis of these two drugs in their pharmaceutical dosage form. Results for analysis of both methods were tested and validated for various parameters according to ICH guidelines. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to demonstrate the quicker onset of sensory and motor blockade, increased duration of postoperative analgesia and lesser incidence of tourniquet pain following addition of dexmedetomidine to lignocaine compared to lignocaine alone in IVRA for upper limb surgeries. Methods: A randomized prospective study conducted in 60 ASA grade I and II patients, of either sex, between 20-60 years, scheduled for either elective or emergency surgeries of upper limb were included in the study. All patients were divided into two groups by computer generated randomization of 30 each, into group A and group B. Group A received 3mg/kg lignocaine diluted with saline to a total volume of 40ml with dexmedetomidine 0.5 microgram/kg added as an adjunct. Group B received 3mg/kg lignocaine diluted with saline to a total volume of 40 ml. Pain score was evaluated using visual analog scale (VAS) of 0 to 10. Sensory and motor block onset and recovery times, onset of tourniquet pain, time to first analgesic requirement was noted. Result: Both groups are comparable with demographic details ie age, gender are weight. type and duration of surgery are insignificant in between groups. Sensory, motor blockade onset time are significantly less in lignocaine and Dexmedetomidine added groups. Sensory blockade recovery time and motor recovery time after the release of tourniquet was significantly longer Group A than for Group B (2.53 ± 0.51 minutes) which is statistically significant with a 'p' value of 0.0001. VAS reached a score of 3 at 416.2 ± 45.73 minutes in Group A and at 33 ± 0.96 minutes in Group B. This difference was statistically significant with a 'p' value of 0.0001. In group A, 7 cases had a sedation score of 1 and 23 had a score of 2. In group B, 30 cases had sedation score of 1. Conclusions: Dexmedetomidine 0.5micrograms/kg is added to lignocaine for Intravenous regional anesthesia, it provided quicker onset of sensory and motor blockade, lesser incidence of tourniquet pain, increased duration of post operative analgesia and better haemodynamic stability. [ABSTRACT FROM AUTHOR]

Background: Endotracheal extubation causes transient hemodynamic stimulation leading to increase in blood pressure and heart rate due to increase in sympathoadrenergic activity caused by epipharyngeal and laryngopharyngeal stimulation. Lignocaine, a Sodium channel blocker attenuates the hemodynamic response to tracheal extubation by inhibiting sodium channels in the neuronal cell membrane, decreasing the sensitivity of the heart muscles to electric impulses. Diltiazem, a Calcium channel blocker attenuates hemodynamic response by blocking voltage sensitive L type channels, and inhibiting calcium entry mediated action potential in smooth and cardiac muscle. It also has peripheral vasodilation property. Esmolol, a Beta blocker attenuates hemodynamic response by blocking sympathetic nervous system. Methodology-90 patients admitted for elective surgeries posted under general anaesthesia at Kidwai memorial institute of oncology, Bangalore during the duration of December 2018 to May 2019 were included in the study. Patients were randomly divided into 3 groups of 30 each. Randomization done by computer generated table. Group A: received Inj. Diltiazem 0.1mg/kg and preservative free lignocaine 1mg/kg. Group B: received Inj. Esmolol 0.5mg/kg and lignocaine 1mg/kg. Group C: received Inj. lignocaine 1mg/kg. Hemodynamic parameters HR, SBP, DBP, MAP were recorded before extubation (pre reversal) and 1min, 2mins, 3mins, 5mins and 10mins post extubation. In this study, the dosage was fixed based on previous studies. Results-Post extubation, the decrease in mean heart rate was statistically significant in Group B in comparison with Group C (control group) from 1 min post extubation till 10 min. There was increase in heart rate in Group A compared to Group C (control group) which is not statistically significant. Also there was slight decrease in heart rate in Group B compared to Group A (both study group) which is statistically significant at all the intervals. Conclusion-Smaller doses of esmolol when combined with lignocaine gives much better results when compared to Diltiazem + Lignocaine combination and lignocaine alone. [ABSTRACT FROM AUTHOR]