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To develop an ultrasound (US)-guided ventral approach to the brachial plexus (BP) and evaluate nerve anatomy and staining in barred owl cadavers. Prospective, cadaveric study. Eleven adult male and female barred owl cadavers with a body mass of 0.43–0.98 kg. Eleven frozen cadavers were thawed for 48 hours, weighed and assigned a body condition score. Ten cadavers were placed in dorsal recumbency with wings abducted. US-guided visualization of the BP was achieved by placing a 13-6 MHz linear probe over the ventral aspect of the scapulohumeral joint, parallel to the sternum. A 22 gauge, 50 mm insulated needle was advanced in-plane in a caudal-to-cranial direction. In each owl, injection targeting one BP was performed with 0.4 mL kg–1 of a 1:1 0.5% ropivacaine and 1% methylene blue solution. Dissection was performed 15 minutes postinjection. Nerve staining was deemed successful if ≥ 1 cm of circumferential staining was achieved. The eleventh owl cadaver was injected with a 1:1 solution of 1% methylene blue and 74% ioversol contrast into both wings, and computed tomography (CT) was performed just before and 15 minutes after injection. The BP was clearly identified ultrasonographically in cadavers weighing > 0.5 kg. An injectate volume of 0.4 mL kg–1 provided complete staining of the BP branches in all cadavers. CT scan revealed no contrast within the coelomic cavity. The US-guided BP injection using a ventral approach was easily performed in barred owl cadavers weighing > 0.5 kg. The injection of 0.4 mL kg–1 of a ropivacaine–dye solution resulted in complete staining of the BP branches in all wings, suggesting that this technique could provide analgesia for structures distal to the scapulohumeral joint. Clinical studies are necessary to confirm the safety and efficacy of this technique in barred owls and other bird species. [ABSTRACT FROM AUTHOR]

Brugada syndrome is an inherited cardiovascular disorder, which can affect the rhythm of the heart. Dental treatment can often present as an obstacle for patients with Brugada syndrome as the use of local anaesthetic can have adverse effects on the electrical conduction system of the heart. Aim: The aim of this series is to discuss the aetiopathogenesis, presentation and management of Brugada syndrome and its relevance to dentistry and the dental team. Methods: The authors present a series of three Brugada syndrome patients who underwent dental intervention in a hospital setting. Results and Conclusion: The series highlighted the importance of multidisciplinary care for patients with Brugada syndrome. Liaising with other teams, such as cariologists and GMPs, allows a patient centred approach and better understanding of patient management. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is a significant global public health concern for women and a Modified Radical Mastectomy(MRM) is one of the most popular procedures for treatable breast cancer and involves extensive dissection. Aim: To assess the efficacy of Bupivacaine instillation through surgical drains in control of post-operative pain in modified radical mastectomy (MRM). Methods: 100 female patients with breast cancer planned for an MRM were enrolled in this randomised clinical study. They were randomly divided into 2 groups A & B. At completion of surgery, axillary and chest wall drains were placed. In Group A, instillation with 20ml of 0.25% bupivacaine was done through each drain which were then clamped for 10 mins before extubating. Group B was control group. Pain was assessed using visual analogue scale (VAS) score 2 and 4 hours post op and then every 4th hourly till 24hrs. If the VAS was ≥, Inj. Diclofenac IM was given as rescue analgesia. Data was analysed using IBM SPSS software package version 20.0. Results: The duration of analgesia was extended in bupivacaine group with the mean duration being 16.88h while in control group it was 4.16h. Moreover the mean VAS score remained <4 at every point in Bupivacaine group. The number of analgesic demands was significantly lower in bupivacaine group as compared to control group (P<0.001). Conclusion: Wound instillation with local anaesthetics via drains is easy and effective in providing extended analgesia without any major side-effects. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to analyze the association of the administration of liposomal bupivacaine (Nocita) with postoperative opioid use in cats undergoing gastrointestinal surgery, as well as to analyze the administration of antiemetics postoperatively in this study population to qualify the degree of nausea related to opioid administration. Methods: Records of 187 cats undergoing gastrointestinal surgery across two institutions, the Matthew J Ryan Veterinary Hospital at the University of Pennsylvania and the University of Florida Small Animal Hospital, were analyzed for multilayer liposomal bupivacaine infiltration at the time of abdominal closure, postoperative injectable opioid use and postoperative injectable antiemetic use. Results: Cats that were administered liposomal bupivacaine at the time of abdominal closure received significantly lower doses of full µ-opioid agonists postoperatively. Significantly more cats that received liposomal bupivacaine were managed with full µ + partial µ-opioid agonists postoperatively than any other opioid profile. Cats that received liposomal bupivacaine received lower doses of ondansetron in hospital compared with cats that did not receive liposomal bupivacaine. Conclusions and relevance: This study suggests that in cats requiring analgesia postoperatively, the use of liposomal bupivacaine at closure reduces the use of full µ-opioid agonists postoperatively. In addition, more patients that received liposomal bupivacaine were de-escalated from full µ-opioid agonists to partial µ-opioid agonists during their hospital stay, suggesting that less analgesia was required throughout their hospitalization. Lastly, lower doses of ondansetron, a typical second-line antinausea medication after gastrointestinal surgery, were used in cats that received liposomal bupivacaine, which may suggest less postoperative nausea. Plain language summary: This study analyzed the association between the long-acting local anesthetic, liposomal bupivacaine (Nocita) and the use of opioid pain medication postoperatively for cats undergoing gastrointestinal surgery. Records of 187 cats undergoing gastrointestinal surgery across two institutions, the Matthew J Ryan Veterinary Hospital at the University of Pennsylvania and the University of Florida Small Animal Hospital, were analyzed for liposomal bupivacaine administration, postoperative injectable opioid use, postoperative injectable antiemetic use and length of hospitalization. In cats that required pain medications, those that were administered liposomal bupivacaine at the time of abdominal closure received significantly lower amounts of first-line injectable opioid pain medications postoperatively. Moreover, those that received liposomal bupivacaine were de-escalated from first- to second-line opioid pain medications postoperatively more commonly. In addition, cats that received liposomal bupivacaine received less second-line antinausea medications compared with cats that did not receive liposomal bupivacaine. There was no significant difference in the length of hospitalization between cats that did and did not receive liposomal bupivacaine. This study suggests that in cats requiring pain medications postoperatively, the use of liposomal bupivacaine at closure reduces the use of first-line injectable opioids postoperatively. [ABSTRACT FROM AUTHOR]

Exploration of early practicing dental professionals' awareness and attitude toward inferior alveolar nerve block IANB will directly inform efforts to improve clinical practices and ensure patient safety. The aim was to highlight the students, interns, and junior dentists' awareness and attitude toward the IANB, failure, and related complications in the Kingdom of Saudi Arabia (KSA). An open web-based survey prepared according to the Checklist for reporting results of Internet e-surveys CHERRIES recommendations was designed and carried out across different regions of the KSA. The questionnaire was composed of four main sections including the participant's details, and qualifications; inferior alveolar nerve block delivery; participants' education, and training-related questions; and attitudes toward proposed solutions to overcome the related failure and complications. 262 participants completed the questionnaire (94 dental students, 79 interns, and 89 junior dentists). There was a significant difference in the following findings: males performed IANBs more frequently than females (P < 0.05); females, students, and private practice/University type showed less attendance to workshops and seminars on IANB with more need for training (P < 0.05); females were more in agreement with "continuous education courses" and "workshops done by specialists" to propose solutions to overcome IANB failure (P < 0.05). The multivariate logistic regression analysis showed that qualification and attendance of a training course were strong predictors of participants' readiness to manage IANB complications (P < 0.05). The findings emphasize how crucial it is for early dental practitioners to participate in continuing professional development programs to enhance their capacity to administer IANB and handle complications. [ABSTRACT FROM AUTHOR]

Background: The second COVID-19 wave severely limited access to elective surgery. Methods: Between December 2020 and May 2021, 530 patients underwent a procedure in the elective ambulatory unit (EAU), a walk-in and walk-out model of surgery, and we used a prepandemic cohort of day-case patients for comparison. Results: We have had no confirmed cases of COVID-19 transmission on-site. The infection rate for EAU and day-case units for carpal tunnel decompression was 1.36% and 2%, respectively, and this difference was not significant, P =.696. Patient satisfaction was excellent at 9.8 of 10. The waiting time from primary care referral to carpal tunnel decompression was cut from 36 weeks to 12 weeks during the study period. Significant benefit in efficiency and cost saving was also found. Conclusion: Elective ambulatory unit provides a template to perform high-volume low-complexity hand and wrist surgery in a safe, efficient, and cost-effective manner. [ABSTRACT FROM AUTHOR]

Articaine hydrochloride has steadily gained popularity among the pediatric dental practitioners. Plenty of research advocates that use of articaine in pediatric patients is safe and effective. It is said to be 1.5 times more potent and 0.6 times less toxic local anesthetic. It is also least likely to induce an overdose from the administration of too much anesthetic. This makes articaine one of the most preferred drugs in pediatric use. Newer techniques have emerged that assists clinician to enhance the success of the local anesthetic injections. Alkalizing the anesthetic cartridge is one such technique. Studies have shown that buffered articaine is a better anesthetic agent in terms of efficacy and success. An electronic search of databases (PubMed, Scopus, Web of Science and Google Scholar) was carried out in order to identify all relevant articles using a combination of the following keywords: "Buffered local anesthetics", "buffered articaine", "Articaine" for all clinical studies. All the studies reviewed indicated satisfactory results for the use of buffered articaine. It highlights the advantages such as lack of burning sensation during injection, quick onset on action and good quality of anesthesia on both subjective and objective evaluations. There are only a few studies and varying evidence regarding the effectiveness of buffered articaine in adults and, to the best of our knowledge. Extensive research is warranted to evaluate the efficacy of buffered articaine use in children. [ABSTRACT FROM AUTHOR]

Purpose: Office-based rhinologic procedures (OBRP) have become widely available in North America due to technological advances and appropriate patient selection. Nevertheless, the literature exploring the safety of these procedures remains limited. The objective of this study was to further evaluate the safety, tolerability and efficacy of these procedures with a more robust sample size to allow for capture of rare events. Methods: A retrospective chart review of all patients who underwent OBRP from May 2015 to March 2023. Information regarding patient demographics, the indication for surgery, wait time, tolerability, intra- and postoperative complications, need for revisions, and type of revision (if applicable) was recorded. Results: 1208 patients underwent OBRP during the study period. No patients were excluded. These included turbinoplasties (35%), endoscopic sinus surgeries (ESS) (26%), septoplasties (15%), nasal fracture reductions (7%), and a variety of other procedures. For ESS procedures, the anterior ethmoids and the maxillary sinuses were the most common sinuses treated. 1.1% of procedures were aborted prior to completion. The post-operative complication rate was 3.2%, with 2 major complications (significant bleeding and sepsis) encountered. The mean follow-up overall was 11 months and for ESS it was 15.8 months. Conclusion: Office-based rhinologic procedures are well tolerated and safe for the appropriate patient and associated with shorter wait-times as well as avoidance of general anesthesia. The complication rates are similar to or lower than previously reported rates for rhinologic surgeries done in the operating room. The low rates of revision surgery also demonstrate the efficacy of these procedures. [ABSTRACT FROM AUTHOR]

To describe an ultrasound-guided approach to the sciatic nerve and the distribution of nerve staining using two injectate volumes of dye in barred owls. Descriptive, randomized, assessor-blinded, cadaveric study. Twelve barred owl cadavers. The sciatic nerve was visualized with a 13-6 MHz linear ultrasound probe placed on the medial aspect of the proximal femur in barred owl cadavers. A needle was inserted at the proximal caudal thigh, and cranially advanced in-plane until the tip was immediately adjacent and ventral to the sciatic nerve. Eleven owls were injected bilaterally with a 1:1 solution of 1% methylene blue and 0.5% ropivacaine, with high-volume (HV; 0.4 mL kg–1) and low-volume (LV; 0.2 mL kg–1) treatments. Nerve staining ≥ 1 cm circumferentially was determined by dissection 15 minutes post-injection. The coelom was then opened to inspect for aberrant dye spread. In one barred owl cadaver, a 1:1 solution of 1% methylene blue and 74% ioversol contrast was injected, and computed tomography was performed immediately before and 15 minutes after injection for evaluation of injectate spread. The HV treatment (0.4 mL kg–1) resulted in successful nerve staining in 100% of injections, whereas the LV treatment (0.2 mL kg–1) resulted in successful nerve staining in 91% of injections. There was no leakage of injectate into undesired locations (e.g. coelomic cavity) in any cadaver. In barred owls, the sciatic nerve can be visualized with ultrasound and injecting a ropivacaine/dye solution under ultrasound guidance successfully stained the sciatic nerve in the majority of cases. This technique holds potential for providing analgesia distal to the stifle joint; however, further investigations are necessary to evaluate its practical application in a clinical setting. [ABSTRACT FROM AUTHOR]

Background/purpose: Exploration of early practicing dental professionals' awareness and attitude toward inferior alveolar nerve block IANB will directly inform efforts to improve clinical practices and ensure patient safety. The aim was to highlight the students, interns, and junior dentists’ awareness and attitude toward the IANB, failure, and related complications in the Kingdom of Saudi Arabia (KSA). Materials and methods: An open web-based survey prepared according to the Checklist for reporting results of Internet e-surveys CHERRIES recommendations was designed and carried out across different regions of the KSA. The questionnaire was composed of four main sections including the participant's details, and qualifications; inferior alveolar nerve block delivery; participants' education, and training-related questions; and attitudes toward proposed solutions to overcome the related failure and complications. Results: 262 participants completed the questionnaire (94 dental students, 79 interns, and 89 junior dentists). There was a significant difference in the following findings: males performed IANBs more frequently than females (P

Widespread introduction of ultrasound-guided regional anesthesia has increased the frequency of nerve blocks and the list of available nerves for blocking, particularly on the foot. In the area of the tibiocalcaneal joint, swellings of various etiologies are often found, including in patients with diabetes, who are characterized by high comorbidity. To date, the influence of edema on the effectiveness of local anesthetics is insufficiently studied. To evaluate the ultrasound criteria, we have analyzed and characterized the ultrasound pattern of 110 patients. When performing a nerve block in the area of the tibiocalcaneal joint, the time of the block onset and duration of sensory block in patients who underwent surgery for the diabetic foot depended reliably on the degree of ultrasound-diagnosed edema in the area of the block. The ultrasound method makes it possible to assess the degree of swelling in the area of blockade directly during conduction anesthesia. Further studies are needed to determine the root cause of this phenomenon, which may depend on the pH of the edema fluid or on dilution in the edema volume.

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.

Regional methods of anesthesia are widely used in surgical interventions on the lower limb, in particular on the foot. But to date, the risks associated with performing distal blocks in patients with diabetes are insufficiently studied. We analyzed the 30-day consequences of tibiocalcaneal nerve block in 88 patients who underwent surgery for diabetic foot syndrome. The obtained results indicate the absence of an increased risk of infectious and trophic complications in the block area in the group of patients who underwent tibiocalcaneal nerve block compared to those with popliteal nerve block and the group of spinal anesthesia. The frequency of repeated operations was not significantly different in all 3 groups.

Statement of the Problem: Gag reflex is among the most common problems during dental and endoscopic procedures. Benzydamine hydrochloride is a non-steroidal anti-inflammatory medica-tion and a local anesthetic that might be useful in reducing the gag reflex. Purpose: This study aimed to evaluate the effects of benzydamine hydrochloride mouthwash on the intensity of the gag reflex.Materials and Method: In this randomized clinical trial study, 30 participants aged 21-26 with a gag trigger point index (GTPI) higher than 2 were divided into 2 groups. In the case group, 15 ml of 0.15% benzydamine hydrochloride mouthwash was gargled for 1 minute, and after 10 minutes GTPI test was conducted. In the control group, 4 puffs of 10% lidocaine spray were applied to the mucosa of the targeted area, and after 5 minutes, GTPI was measured. Participants were asked about the taste and smell of the medications. Results: GTPI was significantly reduced in both groups. In the lidocaine group, the GTPI score changed from 4.47 to 2.00 (P

Background: The NOL® system (PMD-200™ Nociception Level Monitor; Medasense Ltd., Ramat Gan, Israel) is used for the real-time detection of physiological nociception in anesthetized patients by assessing the parameters indicative of sympathetic activity, such as photoplethysmography, skin conductance, peripheral temperature, and accelerometry, which are quantified into the NOL®-Index. This index is more sensitive than traditional clinical parameters in estimating pain and stress responses. While its effectiveness in general anesthesia is well documented, its efficacy in epidural anesthesia needs further investigation. Methods: This retrospective study analyzed NOL®-Index dynamics compared to conventional parameters after epidural administration of bupivacaine. Following ethics committee approval, 119 NOL® measurements were retrospectively analyzed after thoracic epidural catheter administration in 40 patients undergoing abdominal and urological surgery. The NOL-Index® was assessed at 0, 1, 3, and 5 min post application and compared to heart rate, blood pressure, and bispectral index dynamics. Results: This study showed a significant decrease in the NOL®-Index post-local-anesthetic administration with better sensitivity than classical clinical parameters (0 min = 38 ± 11; 1 min = 22 ± 13*; 3 min = 17 ± 11*; 5 min = 12 ± 10*). Higher doses of local anesthetics led to a significant, dose-dependent decrease in NOL®-Index (low dose, 5 min = 15 ± 10*; high dose, 5 min = 8 ± 8*). Conclusions: This study is the first to demonstrate the effectiveness of the NOL®-Index in measuring nociceptive effects following epidural administration, highlighting its potential superiority over conventional parameters and its sensitivity to dose variations. [ABSTRACT FROM AUTHOR]

Background & objective: Appropriate perioperative pain management, with multimodal analgesia regimens combining regional anesthesia and systemic analgesics, is crucial for optimum results in individuals undergoing total knee arthroplasty (TKA). We evaluated the efficacy of combined Adductor Canal Block (ACB) and infiltration in the interspace between the popliteal artery and capsule of the knee (IPACK) supplementing against ACB and Periarticular Infiltration (PAI) on postoperative pain scores, use of opioids, and early physical therapy in patients subjected to TKA under spinal anesthesia (SA). Methodology: In the current prospective, randomized, comparative clinical trial, 40 individuals undergoing TKA were arbitrarily distributed in two groups. Group A comprised of patients undergoing ultrasound-guided ACB plus IPACK block; Group B comprised of patients undergoing ACB plus PAI block at the beginning of the surgical procedure. Results: The ACB + IPACK group exhibited notably lower VAS scores (P < 0.05) compared to the ACB plus PAI group. Group A consumed 67.5 ± 21.6 mg of pethidine over the first 48 h, while Group B consumed 87.5 ± 33.9 mg of pethidine. The range of movement of the knee and walking distance also revealed that the values were considerably higher in Group A compared to Group B. Conclusion: The utilization of both adductor canal block and the interspace between the popliteal artery and the knee capsule provides improved analgesia than adductor canal block and periarticular injection, while preserving the knee joint motor power in the postoperative period. [ABSTRACT FROM AUTHOR]

Lidocaine hydrochloride (HCl) 2% with 1:100,000 epinephrine (LW/E) is widely used to prevent pain during dental procedures and has been associated with injection sting, jittering effects, slow onset, and a bitter aftertaste. Since LW/E's introduction in 1948, no significant modifications have been proposed. This study aims to design and characterize an improved dental lidocaine HCl injectable formulation without epinephrine (LW/O/E) via buffers, sweeteners, and amino acids. LW/O/E injections were prepared with pH and osmolality values of 6.5–7.0 and 590–610 mOsm/kg. Using the electronic tongue (ETongue), the LW/O/E injectable formulations were characterized for viscosity, injectability, and taste analysis. The results were compared with the LW/E control. In vivo efficacy and anesthetic duration of the samples were measured through radiant heat tail-flick latency (RHTFL) and hot plate (HP) tests and local toxicity was assessed after a single intra-oral injection in Sprague Dawley rats (SDR). The viscosity and injectability values of the LW/O/E samples were found to be comparable to the LW/E injection. ETongue taste analysis showed an improvement in bitterness reduction of the LW/O/E samples compared to the LW/E formulation. Toxicity studies of samples in SDR showed minor and transient signs of erythema/eschar and edema. Anesthetic duration via RHTFL and HP paw withdrawal latency time in SDR were found to be comparable for the LW/O/E Sample 3A and the LW/E injection (p < 0.05). In conclusion, the buffered, higher osmolality and reduced bitterness developed LW/O/E formulation (Sample 3A) could be considered a promising alternative to the LW/E formulation for dental use. [ABSTRACT FROM AUTHOR]

Management of procedural pain in burn care is challenging. Lidocaine-prilocaine cream 5%, eutectic mixture of local anesthetics (EMLA®), is a widely used, effective local anesthetic cream approved for normal intact skin, genital mucosa for superficial surgical procedures, and debridement of chronic leg ulcers. This comprehensive review aimed to determine the safety, analgesic efficacy, and effects of EMLA on burn pathophysiology to provide evidence-based clinical recommendations for introducing the topical anesthetic into burn care. The PRISMA guidelines were followed for conducting a systematic PubMed search to include all relevant preclinical and clinical studies, according to pre-specified eligibility criteria. Fifteen studies were included in a qualitative synthesis, among which nine were human and six were animal studies. To date, safety and pharmacokinetic data on EMLA application in burns have been limited. Nevertheless, human studies indicated that EMLA is safe and provides adequate procedural-pain relief in adults when applied to smaller burns. Caution should be exercised when using EMLA in younger children, as systemic toxicity, pertaining to prilocaine-induced methemoglobinemia, has been reported owing to overdosing (high doses applied over large burn areas). Furthermore, animal studies demonstrate the potential beneficial effects of EMLA on burn pathophysiology such as anti-inflammatory, decreased capillary permeability to plasma proteins and edema formation, and improved tissue perfusion, which are factors that may impact burn wound progression. Current data on EMLA use in the management of procedural pain in small burns are sparse but suggest that EMLA is safe and effective in adults. Further clinical pharmacokinetic studies are warranted, especially for application on larger burn areas. [ABSTRACT FROM AUTHOR]

Mastectomy is a common and painful procedure in dogs. Wound soaker catheters (WSC) are frequently used to reduce postoperative pain, including pain after mastectomy. The objectives of this case series were to describe the use of WSC for owner administration of postoperative local analgesia in dogs with mammary tumors treated surgically, to identify complications associated with WSC and to determine the frequency of bacterial colonization of the catheters. Twelve WSC were placed in 11 dogs during mastectomy surgery, left in place for three days, protected by a dressing and successfully managed by owners at home. No postoperative antibiotics were administered. No complications were identified in any cases. No bacterial growth was identified on bacteriological analysis of the twelve WSC. These results suggest that the use of WSC is a safe alternative for postoperative analgesia administration following mastectomy in dogs. Future studies comparing dogs with or without WSC with a larger number of dogs are needed to further evaluate efficacy and complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Surgical wound analgesia has been analyzed in many studies, but few have focused on its relationship with inflammatory markers. As such, we aimed to determine the influence of analgesic surgical wound infiltration in open colorectal surgery on the seric levels of pro- and anti-inflammatory markers and the associated efficacy in postoperative pain control. Materials and Methods: Forty patients who underwent open colorectal surgery were prospectively randomized: group 0, epidural analgesia; group 1, intravenous analgesia (control), group 2, preincision and prelaparoraphy infiltration; and, group 3, prelaparoraphy infiltration. Wound infiltration was performed with ropivacaine. We analyzed the levels of IL-6 and IL-10 cytokines before and 6 h after surgery and their correlation with pain scores. Results: The postoperative Il-6 levels were significantly lower in group 0 than in the control (p = 0.041). The postoperative Il-10 levels were significantly higher in group 3 (p = 0.029) than in the control. Six hours after the operation, the pain scores were significantly lower in all groups than in the control (p = 0.005, p = 0.022, and p = 0.017 for groups 0, 2, and 3, respectively). Pain scores were significantly correlated with Il-10 levels in group 2 (p = 0.047); in group 3, IL-10 levels directly correlated with those of Il-6 (p = 0.026). Conclusions: The analgetic effect of preincisional and prelaparoraphy analgetic infiltration was efficient. The analgetic infiltration of the surgical wound prior to closure stimulates both the inflammatory activator and regulator interleukins. [ABSTRACT FROM AUTHOR]

Background: Wound infusion catheters (WICs) have been used in humans and some veterinary species for post-operative local anesthetic administration following a variety of surgical procedures, aiming to reduce post-operative analgesia requirements and improve patient comfort. Benefit in reduction in pain, post-operative analgesia requirements and length of hospital stay are well documented in humans, but use of WICs may not have been widely adopted in veterinary species due to the concern of increased complications, such as dehiscence or surgical site infection (SSI), creating a barrier to their use. This study aimed to evaluate the use of WICs in horses undergoing standing partial ostectomy surgeries, document complications and investigate if the incidence of SSI was equivalent between those horses that did and did not have a WIC. Methods: Clinical records were searched between January 2010-December 2023 for horses undergoing standing partial ostectomy surgery of thoracolumbar vertebral spinous processes at one institution. Population variables (age, breed, bodyweight), placement of a WIC or not, post-operative complications, analgesia protocols and surgical time were recorded. Horses received up to 0.1 mg kg-1 bupivacaine (0.5 mg mL-1) every 6-8 h via the WIC where one was placed. To compare SSI complication incidence between using or not using a WIC, a proportional independent equivalence test was used. Results: There were 64 horses included in the final analysis with a WIC placed in 29/64 horses (45.3%) and 35/64 (54.7%) having no WIC placed at surgery. Incidence of short-term SSI was 11.4% (no WIC used) and 13.8% (WIC used), respectively. The difference in proportion of SSI between the presence or absence of a WIC was not significant [-0.024 (90% CI -0.181; 0.133); p = 0.94]. Conclusion: The incidence of SSIs was equivalent between groups whether a WIC was used or not. WICs should be considered as part of a multi-modal analgesic approach in the post-operative period. Further research into local anesthetic dosing and its impact on rescue analgesia requirements and painscores is warranted. [ABSTRACT FROM AUTHOR]

Effective treatment of postoperative pain lasting for multiple days without opioids is an important clinical need. We previously reported analgesia lasting up to 96 h in a porcine soft tissue model of postoperative pain using SBG004, an extended-release formulation of bupivacaine based on the temperature-responsive polymer poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylamide-co-Jeffamine M-1000 acrylamide) [PNDJ]. Orthopaedic surgical sites such as the knee can involve complex sensory innervation which presents a distinct challenge to local anesthetic delivery. The purpose of this work was to evaluate the pharmacokinetics and efficacy of SBG004 in an orthopaedic surgical model in comparison to currently available local anesthetics. Pharmacokinetics following periarticular (PA) or intraarticular (IA) injection of SBG004 were compared against liposomal bupivacaine (Lip-Bupi) PA in New Zealand White rabbits (all doses 14.5 mg/kg). Analgesic efficacy of SBG004 (IA, PA, or IA + PA), three active comparators, and saline was evaluated following knee surgery in New Zealand White rabbits. Analgesia was assessed via weight-bearing on the operated limb during spontaneous large steps in video recordings. Systemic bupivacaine exposure lasted at least 7 days for SBG004 PA, 4 days for SBG004 IA, and 2 days for Lip-Bupi PA. In the analgesia study, weight-bearing in all active groups except SBG004 IA was more frequent versus saline through 8 h postoperatively (p < 0.05). Only SBG004 IA + PA resulted in a higher proportion of weight-bearing rabbits at 24 h versus saline (6/7 versus 2/10, p = 0.015). Analysis of pooled data from 24–72 h showed significantly greater frequency of weight-bearing in rabbits receiving SBG004 IA + PA (71%) versus saline (37%), ropivacaine cocktail (41%), and Lip-Bupi PA (36%). The results indicate that the release profile from SBG004 PA or IA coincides reasonably with the time course of postoperative pain, and SBG004 may produce longer duration of analgesia than local anesthetics currently used in knee surgery, including during the period of 24–72 h recognized as a target for extended-release local anesthetics. [ABSTRACT FROM AUTHOR]

Bacterial cellulose (BC) can be chemically modified and combined with other materials to create composites with enhanced properties. In the medical field, biomaterials offer advantages, such as biocompatibility and sustainability, enabling improved therapeutic strategies and patient outcomes. Incorporating lidocaine into wound dressings offers significant potential benefits. In this study, transparent BC films were produced in situ with an undefined minimal culture medium with a yeast and bacteria co-culture system on black tea (Camellia sinensis) and white sugar medium for three days. Lidocaine was incorporated ex situ into the BC matrix, and the composite film was sterilized using gamma radiation. Drug-release studies showed a two-stage release profile, with an initial fast release (24.6%) followed by a slower secondary release (27.2% cumulative release). The results confirmed the incorporation of lidocaine into the BC, producing highly transparent films with excellent thermal stability, essential for the storage and transportation of wound dressings. This study highlighted BC properties and drug incorporation and release behavior. The findings contribute towards optimizing wound dressings with controlled drug release, showcasing the potential of transparent BC films as an effective platform for wound care and drug-delivery applications. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Gag reflex is among the most common problems during dental and endoscopic procedures. Benzydamine hydrochloride is a non-steroidal anti-nflammatory medication and a local anesthetic that might be useful in reducing the gag reflex. Purpose: This study aimed to evaluate the effects of benzydamine hydrochloride mouth-wash on the intensity of the gag reflex. Materials and Method: In this randomized clinical trial study, 30 participants aged 21-26 with a gag trigger point index (GTPI) higher than 2 were divided into 2 groups. In the case group, 15 ml of 0.15% benzydamine hydrochloride mouthwash was gargled for 1 minute, and after 10 minutes GTPI test was conducted. In the control group, 4 puffs of 10% lidocaine spray were applied to the mucosa of the targeted area, and after 5 minutes, GTPI was measured. Participants were asked about the taste and smell of the medications. Results: GTPI was significantly reduced in both groups. In the lidocaine group, the GTPI score changed from 4.47 to 2.00 (p< 0.001), and that for the benzydamine group was 4.20 to 1.47 (p< 0.001). The variance rate of the gag reflex was -2.73 and -2.47 in the benzydamine group and lidocaine group, respectively. However, this reduction was not statistically significant between the two groups. Moreover, benzydamine mouthwash has a significantly better taste and smell than lidocaine (p= 0.001). Conclusion: The results of this study showed that benzydamine mouthwash could be used quite effectively in reducing the gag reflex. [ABSTRACT FROM AUTHOR]

Background: Adequate postoperative pain management after cesarean section is important for the prognosis of both mother and infant. However, excessive prescription of opioid analgesics has become a concern. This study evaluated the efficacy of local continuous subfascial infusion of ropivacaine in relieving postoperative pain and reducing opioid requirements in postpartum women with cesarean section. Methods: Seventy eligible women undergoing cesarean section were randomly allocated to the ropivacaine and the normal saline group for continuous subfascial wound infiltration. All patients received additional fentanyl through an intravenous patient-controlled analgesia pump. Pain score using the visual analog scale, opioid consumption through pump, and requirements for other analgesics were postoperatively measured within 8 h, 1 day, and 2 days after surgery. Statistical analysis was performed with independent t-tests for continuous variables and Chi-square tests for categorical variables. Paired Wilcoxon and student's t-tests were used for paired samples. Results: Sixty-nine patients (35 in the study and 34 in the control group) were analyzed. The mean VAS scores were lower in the study group all three periods, with significance achieved at day 2 (2.74 ± 0.95 versus 3.41 ± 1.33, p = 0.028). The intravenous fentanyl consumptions were significantly lower in the study group at all three periods. Total administration of additional non-opioid analgesics including ketorolac, propacetamol, and pethidine was higher in the control group. Conclusions: Continuous subfascial ropivacaine infusion is effective in relieving pain and reducing opioid-based analgesia and other analgesics requirements.

Nerves in patients with diabetic neuropathy (DN) show increased susceptibility to local anesthetics, potentially requiring a decreased dose. We investigated whether the minimum effective anesthetic concentration (MEAC) of mepivacaine for successful axillary block is lower in patients with DN than in those without. This prospective observational study included patients with DN (n = 22) and without diabetes (n = 22) at a tertiary care center. Patients received an ultrasound-guided axillary block with 30 mL of mepivacaine for anesthesia. The mepivacaine concentration used in each patient was calculated using Dixon's up-and-down method. A block was considered successful if all four sensory nerves had a score of 1 or 2 within 30 min with no pain during surgery. The primary outcome was the MEAC of mepivacaine, and the secondary outcomes included the minimal nerve stimulation intensity for the musculocutaneous nerve and the occurrence of adverse events. The MEAC50 was 0.55% (95% CI 0.33–0.77%) in patients without diabetes and 0.58% (95% CI 0.39–0.77%) in patients with DN (p = 0.837). The MEAC90 was 0.98% (95% CI 0.54–1.42%) in patients without diabetes and 0.96% (95% CI 0.57–1.35%) in patients with DN (p = 0.949). The stimulation threshold for the musculocutaneous nerve was significantly different between groups (0.49 mA vs. 0.19 mA for patients with vs. without diabetes; p = 0.002). In conclusion, the MEAC of mepivacaine for a successful axillary block is not lower in patients with DN. [ABSTRACT FROM AUTHOR]

Several statistical models have been proposed in recent years, among them is the semiparametric regression. In medicine, there are several situations in which it is impracticable to consider a linear regression for statistical modeling, especially when the data contain explanatory variables that present a nonlinear relationship with the response variable. Another common situation is when the response variable does not have a unimodal shape, and it is not possible to adopt distributions belonging to the symmetric or asymmetric classes. In this context, a semiparametric heteroskedastic regression is proposed based on an extension of the normal distribution. Then, we show the usefulness of this model to analyze the cost of prostate cancer surgery. The predictor variables refer to two groups of patients such that one group receives a multimodal local anesthetic solution (Preemptive Target Anesthetic Solution) and the second group is treated with neuraxial blockade (spinal anesthesia/traditional standard). The other relevant predictor variables are also evaluated, thus allowing for the in-depth interpretation of the predictor variables with a nonlinear effect on the dependent variable cost. The penalized maximum likelihood method is adopted to estimate the model parameters. The new regression is a useful statistical tool for analyzing medical data. [ABSTRACT FROM AUTHOR]

Background: Penile hypersensitivity is not the whole penis, but rather only a part of the penis. Though local anesthetic can prolong intravaginal ejaculation latency time by reducing penile hypersensitivity, the effect on the hypersensitive and nonsensitive areas of penis is still unclear. Aim: The study aimed to explore whether the effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in premature ejaculation. Methods: Penile neurophysiological tests were performed on 290 patients with primary premature ejaculation. The sensory threshold, latency, and amplitude were recorded before and after the topical application of a local anesthetic (lidocaine cream) on the penis. Outcomes: Local anesthetics increased the sensory thresholds of hypersensitive and nonsensitive areas of the penis without difference but only prolonged the latency of the hypersensitive areas. Results: According to the neurophysiological results, 149 of 290 patients with primary premature ejaculation had normal penile sensitivity and 141 had penile hypersensitivity. While penile hypersensitivity does not necessarily mean that the whole penis is hypersensitive, and may be that only a part of the penis is hypersensitive, and we examined the following hypersensitivities: glans hypersensitivity only (14 cases), shaft hypersensitivity only (77 cases), and whole penis hypersensitivity (50 cases). Local anesthetics (lidocaine cream) increased the sensory thresholds of hypersensitive and nonsensitive areas of the penis without difference (P <.001) but only prolonged the latency of the hypersensitive areas (P <.001), and the latency of the nonsensitive areas was not different (P >.05). Clinical Implications: The present discovery implies that it is possible to improve ejaculation by applying local anesthetics externally to the hypersensitive areas of the penis to reduce the afferent local sensory signals, and improve intravaginal ejaculation latency time through accurately decreasing penile sensibility. Strengths & Limitations: This is the first large-sample study to explore the difference of local anesthetics' effects on the hypersensitive and nonsensitive areas of the penis by means of neurophysiological methods in premature ejaculation. Our study exclusively examines alterations in penile evoked potential following electrical stimulation, which may not entirely encompass shifts in penile receptivity during sexual activity. Conclusion: The effects of local anesthetics on the same penis varied with penile sensitivity, and can only prolong the latency of hypersensitive area of the penis. The effect of local anesthetic on the hypersensitive and nonsensitive areas of the penis is different in premature ejaculation. [ABSTRACT FROM AUTHOR]

Skin inflammatory and allergic conditions often result in symptoms such as erythema, edema, and pruritus, significantly impacting patients’ quality of life. Traditional treatment approaches target either the inflammatory or allergic components individually, leaving the accompanying itch inadequately addressed. This study aims to explore the efficacy and safety of a combination therapy using diphenhydramine and lidocaine for managing inflammatory and allergic skin conditions with coexisting itch. Diphenhydramine, a first-generation antihistamine, exhibits potent antiallergic properties by inhibiting histamine receptors (H1). Lidocaine, a local anesthetic, possesses analgesic effects and alleviates pruritus by blocking sensory neurons and reducing capillary permeability. The synergistic effects of diphenhydramine and lidocaine hold promise in providing a comprehensive treatment option for individuals with inflammatory and allergic skin conditions. In this study, the efficacy and safety of combination therapy with diphenhydramine and lidocaine was evaluated through its effects on symptom relief, inflammatory markers, and patient satisfaction. Furthermore, we analyzed dermatoses where the used combination therapy had the best results. The study also focused on market analysis and formulation availability. This investigation into the diphenhydramine and lidocaine combination therapy represents an innovative approach in dermatology, offering a unique solution for addressing both the underlying inflammation and the troublesome itch associated with inflammatory and allergic skin conditions. [ABSTRACT FROM AUTHOR]

Lidocaine, a local anesthetic widely used in dentistry, is esteemed for its efficacy and safety. Recent research reveals its additional role in modulating the immune system, and particularly in reducing inflammation crucial for protecting tooth-supporting tissues. Notably, monocytes and macrophages, essential cellular components overseeing various physiological and pathological processes, stand as potential mediators of lidocaine's effects. Therefore, this study aimed to investigate how lidocaine influences cell behavior using RNA sequencing. To investigate the effect of lidocaine on THP-1 cells' behavior, we performed an MTT assay and RNA-Seq along with qPCR analyses to evaluate the transcriptomic and proteomic changes in THP-1 cells. Our results showed that a high dose of lidocaine (>1 mM) had a significant cytotoxic effect on THP-1 cells. However, a lidocaine dose lower than 0.5 mM induced a mixed anti-inflammatory profile by significantly upregulating tissue remodeling (GDF15, FGF7, HGF, COL4A3, COL8A2, LAMB2, LAMC2, PDGFRA, and VEGFA) and through the resolution of inflammation (Cpeb4, Socs1, Socs2, Socs3, Dusp1, Tnfaip3, and Gata3) gene cassettes. This study explores the effect of lidocaine on the THP-1 in the M2-like healing phenotype and provides potential applications of lidocaine's therapeutic effectiveness in dental tissue repair. [ABSTRACT FROM AUTHOR]

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

BackgroundWound infusion catheters (WICs) have been used in humans and some veterinary species for post-operative local anesthetic administration following a variety of surgical procedures, aiming to reduce post-operative analgesia requirements and improve patient comfort. Benefit in reduction in pain, post-operative analgesia requirements and length of hospital stay are well documented in humans, but use of WICs may not have been widely adopted in veterinary species due to the concern of increased complications, such as dehiscence or surgical site infection (SSI), creating a barrier to their use. This study aimed to evaluate the use of WICs in horses undergoing standing partial ostectomy surgeries, document complications and investigate if the incidence of SSI was equivalent between those horses that did and did not have a WIC.MethodsClinical records were searched between January 2010–December 2023 for horses undergoing standing partial ostectomy surgery of thoracolumbar vertebral spinous processes at one institution. Population variables (age, breed, bodyweight), placement of a WIC or not, post-operative complications, analgesia protocols and surgical time were recorded. Horses received up to 0.1 mg kg−1 bupivacaine (0.5 mg mL−1) every 6–8 h via the WIC where one was placed. To compare SSI complication incidence between using or not using a WIC, a proportional independent equivalence test was used.ResultsThere were 64 horses included in the final analysis with a WIC placed in 29/64 horses (45.3%) and 35/64 (54.7%) having no WIC placed at surgery. Incidence of short-term SSI was 11.4% (no WIC used) and 13.8% (WIC used), respectively. The difference in proportion of SSI between the presence or absence of a WIC was not significant [−0.024 (90% CI −0.181; 0.133); p = 0.94].ConclusionThe incidence of SSIs was equivalent between groups whether a WIC was used or not. WICs should be considered as part of a multi-modal analgesic approach in the post-operative period. Further research into local anesthetic dosing and its impact on rescue analgesia requirements and pain-scores is warranted.

Introduction . Methemoglobinemia is a rather rare cause of hypoxemia and hypoxia, however, with a severe course of the disease and an increase in the concentration of methemoglobin in the blood of more than 20 %, this can cause the development of multi-organ dysfunction and death.The objective was to descript the case of methemoglobinemia in a child with congenital epidermolysis bullosa with the use of a combined drug containing benzocaine.Materials and methods. Newborn premature baby boy, from the first pregnancy, gestation period 36 weeks, suffering from congenital epidermolysis. Birth weight 2850 g, height 47 cm. Apgar score in the first minute – seven, on the fifth – eight points. As a local treatment, an aerosol for external use «Olazol» was prescribed. At the age of 56 hours from the moment of birth, a sharp deterioration in the child’s condition was noted in the form of a decrease in SpO2 to 72–76 %, pronounced tachycardia, an increase in methemoglobin concentration in the blood (53.7 %).Results. A distinctive feature of this case was the presence of severe methemoglobinemia, which led to severe metabolic acidosis, venous hypoxemia and tissue hypoxia. Timely diagnosis and adequate therapy in the early stages of the pathological process contributed to the complete stabilization of the child’s condition and the normalization of the blood gas composition fifteen hours after the start of therapy.Conclusion. The use of drugs containing benzocaine in the early neonatal period is a risk factor for the development of methemoglobinemia, which requires a dynamic assessment of the level of methemoglobin in the blood in order to prevent tissue hypoxia.

Abstract Chemotherapy can cause severe pain for patients, but there are currently no satisfactory methods of pain relief. Enhancing the efficacy of chemotherapy to reduce the side effects of high-dose chemotherapeutic drugs remains a major challenge. Moreover, the treatment of chemotherapy-induced peripheral neuropathic pain (CIPNP) is separate from chemotherapy in the clinical setting, causing inconvenience to cancer patients. In view of the many obstacles mentioned above, we developed a strategy to incorporate local anesthetic (LA) into a cisplatin-loaded PF127 hydrogel for painless potentiated chemotherapy. We found that multiple administrations of cisplatin-loaded PF127 hydrogels (PFC) evoked severe CIPNP, which correlated with increased pERK-positive neurons in the dorsal root ganglion (DRG). However, incorporating ropivacaine into the PFC relieved PFC-induced CIPNP for more than ten hours and decreased the number of pERK-positive neurons in the DRG. Moreover, incorporating ropivacaine into the PFC for chemotherapy is found to upregulate major histocompatibility complex class I (MHC-I) expression in tumor cells and promote the infiltration of cytotoxic T lymphocytes (CD8+ T cells) in tumors, thereby potentiating chemotherapy efficacy. This study proposes that LA can be used as an immunemodulator to enhance the effectiveness of chemotherapy, providing new ideas for painless cancer treatment.

The aim of this study was to compare the effects of dexmedetomidine and dexamethasone as adjuvants to preoperative epidural administration of local anesthetic (ropivacaine) in thoracic surgery on the postoperative level of pain, use of analgesics, inflammation, and oxidative stress. The study enrolled 42 patients who underwent elective thoracic surgery in a one-year period at the University Hospital Dubrava (Zagreb, Croatia). Based on a computer-generated randomization list the patients were assigned to the dexmedetomidine (n = 18) or dexamethasone (n = 24) group. Postoperatively, patients of dexmedetomidine group reported lower pain (VAS value 1 h post surgery, 3.4 ± 2.7 vs. 5.4 ± 1.8, dexmedetomidine vs. dexamethasone, p < 0.01) and had lower anal-gesic requirements in comparison with dexamethasone group. Thus, dexmedetomidine in comparison with dexamethasone was more efficient in lowering pain and analgesia requirements 24 h after the surgery. On the contrary, dexamethasone had better anti-inflammatory properties (CRP level 24 h post surgery, 131.9 ± 90.7 vs. 26.0 ± 55.2 mg L−1, dexmedetomidine vs. dexamethasone, p < 0.01). Both dexmedetomidine and dexamethasone exhibited antioxidant effects, however, their antioxidant properties should be further explored. The results of this study improve current knowledge of pain control in thoracic surgery.

Simple Summary: Castration is a routine surgical procedure performed on rabbits to prevent reproduction. The use of balanced anesthesia for surgeries is crucial to reduce the doses of anesthetic drugs and their associated adverse effects. The addition of a local anesthetic can further enhance anesthetic performance. The aim of this study was to evaluate the effects of intratesticular lidocaine administration in rabbits undergoing orchiectomy, comparing it with a control group treated with saline solution. Rabbits administered lidocaine exhibited a reduced incidence of responses to surgical stimuli, and a diminished postoperative pain score was observed through evaluation using a composite pain scale, compared to the rabbits administered with saline. No clinically significant adverse effects related to lidocaine were detected. Consequently, the use of intratesticular lidocaine may be considered to improve the anesthetic performance of rabbits undergoing elective orchiectomy. The use of local anesthetics for castration is both simple and cost-effective, and it may contribute to reducing the anesthetic requirements. Despite its common use in clinical practice, the literature regarding the effects of intratesticular lidocaine in rabbits is limited. In this study, nine rabbits per group were assigned to intratesticularly receive either 2% lidocaine (0.05 mL/kg into each testicle) or an equivalent volume of saline prior to elective orchiectomy. Anesthesia was induced by intranasal administration of ketamine, medetomidine, and butorphanol. During intraoperative assessment, no significant differences in vital parameters (heart rate, respiratory rate, and peripheral saturation of oxygen) were observed between the groups. However, rabbits receiving intratesticular saline displayed a higher incidence of responses to surgical stimuli. Postoperative pain was evaluated using the composite Centro Animali Non Convenzionali Rabbit Scale (CANCRS), revealing a significantly lower score at the initial post-surgery assessment in rabbits treated with intratesticular lidocaine. All subjects exhibited rapid resumption of food intake and fecal output. While all rabbits demonstrated satisfactory perioperative performances, the use of intratesticular lidocaine was associated with a diminished response to surgical stimuli. Consequently, this practice has the potential to reduce the requirement for additional anesthetics or analgesics, promoting faster recovery. [ABSTRACT FROM AUTHOR]

The present work proposed an easy, one-pot and green strategy for graphene oxide deoxygenation with the help of quercetin, which acts as a reducing agent in presence of bupivacaine. The Characterization results such as Transmission electron microscopy (TEM), X-ray photo electron spectroscopy (XPS), X-ray diffraction (XRD), Ultraviolet visible spectroscopy revealed the synthesis of reduced graphene oxide (RGO) and its adsorption with bupivacaine. TEM analysis revealed the formation of transparent and thin silk-like graphene sheets. The deoxygenation of GO to RGO was represented by the analysis of XPS and XRD. Furthermore, the local anesthetic activity was studied in guinea pig and frogs, which revealed the substantial local anesthetic activity of prepared BRGO. Additionally, the local anaesthesia recovery for BRGO treatments was found to be 33%, 67% and 100% at a dose of 40 mg, 20 mg and 10 mg, respectively Also, the antimicrobial studies performed using the MTT assay, CFU enumeration, and growth curve analysis, revealed that BRGO exhibited strong antimicrobial activity against dental pathogens. The microbial cell activity was decreased with increase in BRGO concentration from 20 to 80 µg/mL. Additionally, MTT results exhibited a dose dependent decrease in bacterial survival rate with increase in BRGO concentration from 20 to 80 µg/mL. These findings suggest that BRGO could serve as a promising antibacterial material for dental care and therapy. [ABSTRACT FROM AUTHOR]

Background: Anatomical and histological features of the thoracolumbar fascia may play an active role in chronic low back pain (LBP). This study aimed to evaluate the efficacy of interfascial injection in patients with LBP. Methods: Sixty participants with chronic LBP were recruited for this study. The patients were allocated to 2 groups: physical therapy (PT) (n = 30) and PT + interfascial injection (IFI) (n = 31, 10mL (0.25% bupivacaine) + methylprednisolone (40 mg) injection into the middle layer between the quadratus lumborum and erector spinae muscle). Outcome measures involved performing Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) scoring on study participants at pretreatment (PRT), as well as posttreatment at months first, second, fourth, and sixth. Results: In both groups, NRS and ODI scores were statistically significantly lower than PRT values at the first, second, third, fourth, and sixth months. (P < .05) NRS and ODI scores were significantly lower in the IFI and PT groups compared to the PT group at the first, second, fourth, and sixth months. (P < .05). Conclusion: The study result shows that IFI applied to the middle layer of the thoracolumbar fascia may be effective in individuals with chronic LBP. The effect of fascial structures on LBP should be further investigated. [ABSTRACT FROM AUTHOR]

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