Analgesic and Anti-Inflammatory Effects of Articaine and Perineural Dexamethasone for Mandibular Third Molar Surgery: A Randomized, Double-Blind Study.

PURPOSE: We aimed to investigate the effectiveness of articaine and perineural dexamethasone (DX) in reducing postoperative sequelae such as swelling and maximum mouth opening that are harming the quality of life of patients after impacted mandibular third molar (IMTM) surgery. PATIENTS AND METHODS: We implemented a randomized clinical trial composed of patients undergoing IMTM extraction. The predictor variable was the treatment group. The patients were randomly assigned to 1 of 3 groups: Group A was administered 3.6 mL of articaine mixed with 2 mL of saline solution; group B, 3.6 mL of articaine and 1 mL of DX (4-mg/mL solution) with 1 mL of saline solution; and group C, 3.6 mL of articaine with 2 mL of DX (8-mg/mL solution). The primary outcome variables were swelling (determined by anatomic facial landmarks), pain, and maximum mouth opening. Other variables comprised the duration of surgery, number of analgesics taken in the postoperative period, hygiene, and petechiae. RESULTS: The sample was composed of 60 patients (20 per treatment group), with a mean age of 25.18 ± 5.22 years; 53.3% were women. Postoperative swelling was significantly reduced in groups B and C (P < .05). Maximum mouth opening was significantly increased in groups B and C (P < .05). CONCLUSIONS: The results of this study suggest that combining DX with articaine improves the management of discomfort after IMTM surgery. The use of articaine via a mandibular block was not associated with neural damage in our study.

[Leriche syndrome]. / Leriche sendromu.

Leriche syndrome is a disease characterized by thrombotic occlusion in the aorta, frequently in the distal renal artery. Classic symptoms of this syndrome include pain in the lower extremities emerging during activity (claudication), impalpability of femoral pulses, and impotency in male patients. Definitive diagnosis of claudication due to insufficient circulation as well as claudication that is neurogenic in origin, is difficult. Medical history, physical examination, and monitoring methods are important for definitive diagnosis. Impalpability of bilateral femoral pulses in physical examination may be sign of Leriche syndrome. Color Doppler ultrasonography can be used to demonstrate that there is no circulation in the iliac arteries in cases of Leriche syndrome. In these patients, thrombotic occlusion of the aorta is confirmed by computed tomography angiography. Presently described is a case of Leriche syndrome in which the patient presented at hospital with complaint of claudication and was diagnosed with lumbar disc herniation. Since vascular pathologies were not considered in differential diagnosis, treatment was delayed and it resulted in mortality; for this reason it is important. When patients come to hospital with complaints of leg pain, clinicians should consider vascular pathologies before reaching definitive diagnosis, using detailed patient history and comprehensive physical examination.

Musculocutaneous neuropathy after anaesthesia for thyroid surgery: a case report.

Postoperative isolated injury of the musculocutaneous nerve is a rare disorder and complication. Reported cases are claimed to present with loss of biceps and brachialis power without neuropathic pain. When injury occurs to one of the terminal branches of the brachial plexus, the lateral cutaneous nerve of the forearm, pain is the major symptom and it typically radiates along the radial aspect of the forearm. In the literature, isolated lesions of the musculocutaneous nerve have been attributed to repeated microtrauma, indirect trauma or direct trauma to the nerve. It may also occur due to strenuous extension of the forearm for prolonged periods.

[The effect of perioperative infused dexmedetomidine on postoperative analgesic consumption in mastoidectomy operations]. / Mastoidektomi operasyonlarinda perioperatif verilen deksmedetomidinin postoperatif analjezik tüketimine etkisi.

OBJECTIVES: We aimed to investigate the effect of dexmedetomidine infusion on the amount of opioid that is consumed during the operation, the amount of analgesic that the patient requires after the operation and on pain scores. METHODS: Forty patients who were ASA I-II, between 18-50 years old, and who were scheduled for mastoidectomy operation were included in the study. Patients were randomized into two groups as group Dexmedetomidine (Group D) and group Placebo (Group P). Dexmedetomidine was administered at the rate of 0.5 mcg/kg/hour to the cases in Group D during operation and 9% NaCl was administered at the same rate and volume to the cases in Group P. Patients were connected to a Patient-Controlled Analgesia (PCA) device prepared with tramadol. Patients were followed for 24 hours. Ramsay Sedation Scale, visual analog scale (VAS), non-invasive systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), end-tidal sevoflurane, extubation times, total remifentanil consumption, total demand of PCA, and total tramadol consumption from PCA were recorded. RESULTS: No difference was determined between groups in demographic level and extubation times. Total remifentanil consumption, additional analgesic requirement, total demand of PCA, total amount of PCA consumption, and mean VAS were higher in the control group. First demand time of PCA was longer in the study group. CONCLUSION: Results of our study demonstrated that continuous infusion of dexmedetomidine during the operation could provide postoperative patient comfort without affecting the extubation time while concomitantly decreasing the consumption of tramadol.