Effect of ropivacaine, mepivacaine or the combination of ropivacaine and mepivacaine for epidural anaesthesia on the postoperative recovery in patients undergoing caesarean section: a randomized, prospective, double-blind study.

BACKGROUND: Anaesthetic methods and drugs with rapid onset, rapid recovery and better postoperative analgesia are more suitable for rapid recovery in obstetric anaesthesia. We formulated the following hypothesis: a combination of mepivacaine and ropivacaine could provide a longer analgesic effect and have more advantages in terms of rapid-recovery indicators. METHODS: A total of 180 pregnant women scheduled to undergo elective caesarean sections were randomly assigned to three surgical groups, which received 2% mepivacaine (Group M), 2% mepivacaine + 0.75% ropivacaine (Group MR) (Volume 1:1) or 0.75% ropivacaine (Group R) through an epidural catheter. The situation of postoperative analgesia and other indicators of rapid recovery were recorded. RESULTS: One hundred and fifty patients were included in the final analysis. Their demographic data were similar. The visual analogue scale (VAS) scores of Group MR and Group R were lower than Group M at 1 and 2 h after surgery both at rest and with movement (P < 0.05), and the time to first ambulation in Group MR (17.38 ± 2.06 h) and Group M (17.20 ± 2.09 h) was shorter than that in Group R (22.18 ± 1.74 h) (P < 0.05). CONCLUSION: Application of 2% mepivacaine combined with 0.75% ropivacaine for epidural anaesthesia can provide longer postoperative analgesia and earlier ambulation, these effect may be more suitable than that of 2% mepivacaine or 0.75% ropivacaine alone for caesarean section. TRIAL REGISTRATION: This study was registered at Chinese Clinical Trial Registry (Registration number: ChiCTR 2300078288; date of registration: 04/12/2023).

Evaluation of frontal and infratrochlear nerve blocks for standing sedated frontonasal sinusotomy in horses.

OBJECTIVE: To determine if targeted blocking of frontal and infratrochlear nerves provided anesthesia for the approach to a frontonasal sinusotomy. STUDY DESIGN: Two part study: Part 1 randomized crossover design; Part 2 proof of concept. ANIMALS: N = 12; six each in Parts 1 and 2. METHODS: Part 1: Each horse had either frontal and infratrochlear nerve blocks or a line block performed with 2% mepivacaine hydrochloride. Mechanical nociceptive thresholds (MNT) were obtained at five sites along a proposed frontonasal sinusotomy prior to injection, and at 10, 60, and 120 min after blocking. After a 4 day washout period, the opposite procedure was performed. Order of procedure and side of face were randomized. MNTs were analyzed using mixed-model ANOVA with p < .05. Part 2: Frontal and infratrochlear nerve blocks were performed followed by creation of a skin/periosteal incision, which was closed at 2 h. Ability to create and suture the incision, and the size of the incision were recorded. RESULTS: For part 1, both line and targeted blocks resulted in at least two times an increase in median MNT values at each of the five sites, as compared to baseline MNT values (p < .0025). In Part 2, incisions could be completed in five of six horses, with median incision size of 6.5 × 5 cm. CONCLUSION: Following frontal and infratrochlear nerve blocks, MNTs were increased along a proposed frontonasal sinusotomy, and skin incisions could be created in the majority of horses. CLINICAL SIGNIFICANCE: Frontal and infratrochlear nerve blocks provide an alternative technique to create a frontonasal sinusotomy.

Spinal Versus General Anesthesia for Outpatient Total Hip and Knee Arthroplasty in the Ambulatory Surgery Center: A Matched-Cohort Study.

BACKGROUND: Spinal anesthesia is the predominant regimen in outpatient total joint arthroplasty (TJA), but induction often is unsuccessful, unobtainable, or against patient preference. We compared outcomes of same-day discharge (SDD) TJA with spinal versus general anesthesia in a free-standing ambulatory surgery center (ASC). METHODS: We took 105 general anesthesia TJA and one-to-one nearest-neighbor matched them to 105 spinal anesthesia TJA over 7 years at 1 ASC. The rate of successful SDD, minutes to discharge, postoperative pain and nausea, and 90-day complications were compared. Postanesthesia care unit outcomes were additionally stratified by spinal anesthetic (mepivacaine versus bupivacaine). RESULTS: All spinal anesthetic patients underwent SDD compared with 103 (98%) general anesthetic patients (P = .498). Mepivacaine spinal anesthesia patients spent the fewest minutes in postanesthesia care unit prior to discharge from the facility (206), followed by general anesthesia (227), and bupivacaine spinal anesthesia (291; P < .001). General anesthesia patients had the highest levels of pain at 1 hour (5.2 versus 1.5 versus 1.5) and 2 hours (3.2 versus 2.0 versus 1.3) postoperatively, and rates of nausea (48 versus 22 versus 28%) compared with mepivacaine and bupivacaine spinal anesthesia, respectively. The 90-day complications (6 versus 7), admissions (1 versus 3), and reoperations (5 versus 2) were similar among spinal and general anesthesia, respectively (P ≥ .445). CONCLUSIONS: Both spinal and general anesthesia led to reliable SDD with similar 90-day complication rates. General anesthesia facilitated faster discharge from the ASC compared with bupivacaine spinal anesthesia but led to higher levels of pain and incidence of nausea postoperatively. LEVEL OF EVIDENCE: Level 3, Retrospective Cohort Comparison.

Effects of subconjunctival ropivacaine, liposomal bupivacaine, and mepivacaine on corneal sensitivity in healthy horses.

OBJECTIVE: To evaluate corneal sensitivity and adverse events following subconjunctival administration of three local anesthetics in horses. STUDY DESIGN: Randomized, masked, crossover study. ANIMALS: Twelve healthy adult mares. METHODS: The subconjunctival space of the treated eye was injected with 0.2 mL of liposomal bupivacaine (1.3%), ropivacaine (0.5%), or mepivacaine (2%). All horses received each medication once and the contralateral eye received saline (control). Corneal touch threshold (CTT) was measured using a Cochet-Bonnet esthesiometer before sedation, after sedation, and at specified intervals until it returned to baseline. Ocular examinations were performed at 24-, 72, and 168 h post-injection to monitor for adverse effects. RESULTS: The mean total time of anesthesia (TTA) was 168.3 min for ropivacaine, 169.2 min for liposomal bupivacaine, 103.3 min for mepivacaine and 30.7 min for the control. TTA for liposomal bupivacaine (p < .001) and ropivacaine (p = .001) was longer than the control. TTA for mepivacaine was not different from the control (p = .138), liposomal bupivacaine (p = .075) or ropivacaine (p = .150). Injection site hemorrhage reduced TTA regardless of treatments (p = .047). No adverse effects attributed to injections were noted. CONCLUSION: All three medications were well tolerated. Subconjunctival administration of ropivacaine and liposomal bupivacaine resulted in longer TTAs compared to the control; however, their TTAs were not different from that of mepivacaine. CLINICAL SIGNIFICANCE: Subconjunctivally administered liposomal bupivacaine and ropivacaine are viable options to provide prolonged corneal analgesia in horses. Future studies are needed to assess the efficacy in diseased eyes.

MicroRNA-27a Suppresses the Toxic Action of Mepivacaine on Breast Cancer Cells via Inositol-Requiring Enzyme 1-TNF Receptor-Associated Factor 2.

Objective: To investigate the toxic effects of microRNA-27a on breast cancer cells through inositol-acquiring enzyme 1-TNF receptor-associated factor 2 inhibition by mepivacaine. Methods: The elevation of miR-27a in MCF-7 of BCC lines was measured, and groups were set up as control, mepivacaine, and elevated groups. Cells from each group were examined for inflammatory progression. Results: Elevated miR-27a in MCF-7 cells was able to distinctly augment the cell advancement (P < 0.01) and decline cell progression (P < 0.01). Meanwhile, miR-27a reduced the content of intracellular inflammatory factors IL-1ß (P < 0.01) and IL-6 (P < 0.01), elevated the content of IL-10 (P < 0.01), suppressed levels of cleaved-caspase-3 and p-signal transducer and activator of transcription-3 (STAT3) (P < 0.01), and increased Bcl-2/Bax (P < 0.01). Conclusion: Elevated miR-27a in MCF-7 of BCC lineage was effective in reducing the toxic effects of mepivacaine on cells and enhancing cell progression. This mechanism is thought to be related to the activation of the IRE1-TRAF2 signaling pathway in BCC. The findings may provide a theoretical basis for targeted treatment of BC in clinical practice.

Comprehensive Analysis of Local Anesthetics Affecting Adipose Stem Cells In Vitro.

BACKGROUND: Adipose stem cells (ASCs) hold a great regenerative capacity because of their differentiation capability and their secretory activity. Thus, ASC survival is of great significance during perioperative harvesting. Various local anesthetics are commonly applied during fat grafting procedures. These substances are known to impair cellular viability, which would affect graft survival and final outcomes, but the exact extent of their impact on ASC biology is unknown. METHODS: The authors analyzed the short- and long-term effects of lidocaine, mepivacaine, ropivacaine, and bupivacaine at increasing concentrations (0.1 to 10 mM) on primary human ASC proliferation and metabolic activity. Trilinear differentiation was assessed by oil red O stain (adipogenesis), safranin O (chondrogenesis), and cresolphthalein (osteogenesis) labeling. In supernatants, cytokine [interleukin (IL)-6/IL-8, vascular endothelial growth factor, hepatocyte growth factor] secretion was analyzed by enzyme-linked immunosorbent assay. RESULTS: Bupivacaine at greater than 100 µM demonstrated the strongest anti proliferative effects, whereas lidocaine and ropivacaine did not affect cell numbers. Mepivacaine evoked reciprocal results regarding cell count at greater than 1 mM. Each compound impaired trilinear differentiation. Secretion of hepatocyte growth factor and IL-8 was reduced significantly by local anesthetic exposure; levels were restored after substances were washed out. CONCLUSIONS: In vitro data show that lidocaine, mepivacaine, and ropivacaine could be applied at concentrations of 1 to 10 mM without affecting ASC survival. In contrast, bupivacaine at concentrations greater than 100 µM should be administered with great caution. The differentiation of ASCs and the ASC's secretome might already be decreased by each local anesthetic at 1 mM. CLINICAL RELEVANCE STATEMENT: The authors' experimental data can be of great significance to the clinical practice, as local anesthetics are routinely administered during liposuction as a tumescent anesthesia adjunct. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Comparative study of the anaesthetic efficacy of 4% articaine versus 2% mepivacaine in mandibular third molar germectomy using different anaesthetic techniques: a split-mouth clinical trial.

BACKGROUND: Currently, one of the most discouraging aspects for many patients undergoing dental procedures is the administration of local anaesthesia. Therefore, there is a constant search for new techniques to avoid the invasive and painful nature of the injection. This study aimed to compare the clinical efficacy of local anaesthetics with articaine 4% or mepivacaine 2% (both with epinephrine 1:100.000), using different anaesthetic techniques to perform germectomy of lower third molars and to assess patients' feelings and pain during surgery. METHODS: Totally 50 patients (ranged 11-16 years) who required germectomy of mandibular third molars were recruited. Each patient received local anaesthesia on one side with articaine inoculated with plexus technique while on the other side with mepivacaine using inferior alveolar nerve block technique. The patients' evaluation was performed on pre and intraoperative tactile-pressure feelings and intraoperative pain with four levels on the Visual Analogue Scale (VAS). RESULTS: Surgical operations lasted less with more efficient analgesia when articaine was used. The additional intraosseous injection was required mainly in the mepivacaine group intraoperatively. A few patients had tactile-pressure feelings while intraoperative pain sensation was absent in 90% of cases with articaine. Significant differences were found in the cases who reported "absent" and "moderate" VAS values, favoring the use of articaine. CONCLUSIONS: Articaine injected with a plexus anaesthetic technique seems to be more clinically manageable than mepivacaine for the mandibular third molar germectomy. The discomfort of tactile-pressure feelings and pain experienced was lower using articaine anaesthetic technique used.

Changes in Neuraxial Anesthesia Protocols and Improved Efficiency of Same-Day Discharge Total Knee Arthroplasty in an Ambulatory Surgery Center: A Retrospective Cohort Study.

INTRODUCTION: This study evaluated the effect of bupivacaine versus mepivacaine spinal anesthesia and preoperative adductor canal block (ACB) on recovery, length of stay, pain, and complications of same-day discharge total knee arthroplasty (TKA) at a free-standing ambulatory surgery center. METHODS: We performed a retrospective review of patients who underwent TKA between March 2018 and September 2019. The patients were grouped based on the neuraxial anesthetic regimen: bupivacaine with ACB, bupivacaine without ACB, and mepivacaine without ACB. Preoperative ACBs were discontinued in December 2018, and use of mepivacaine spinal anesthesia was initiated in March 2019. Length of stay in the postanesthesia care unit (PACU), time to controlled void and ambulation, postoperative pain, morphine milligram equivalents (MME), and transient neurologic symptoms were compared. RESULTS: Ninety consecutive patients who underwent TKA were identified. Fifty patients received bupivacaine with ACB, 20 received bupivacaine without ACB, and 20 received mepivacaine without ACB. Mepivacaine spinal anesthesia led to a 93-minute shorter PACU stay (P < 0.001), 115-minute quicker time to void (P < 0.001), 60-minute earlier ambulation (P = 0.024), and 109-minute shorter total facility time (P = 0.003) but increased total MME (P = 0.049) despite nonsignificant difference in pain at discharge (P = 0.908) compared with bupivacaine. Patients receiving bupivacaine with and without ACB had a nonsignificant difference in pain scores at discharge, time to ambulation, and time to discharge (P ≥ 0.1). No transient neurologic symptoms or overnight stays were observed. DISCUSSION: Mepivacaine spinal anesthesia for TKA safely facilitated more rapid same-day discharge through decreased times to controlled void and ambulation but with a slight increase in MME requirements. Discontinuing preoperative ACBs did not negatively affect PACU outcomes.

Patient Comfort, Safety, and Effectiveness of Resilient Hyaluronic Acid Fillers Formulated With Different Local Anesthetics.

BACKGROUND: Maximizing patient comfort during hyaluronic acid gel injection is a common concern that is usually addressed by selecting fillers with lidocaine. OBJECTIVE: Two randomized, double-blinded, split-face trials aimed to demonstrate noninferiority of specific hyaluronic acid fillers incorporating mepivacaine (RHA-M) versus their lidocaine controls, at providing pain relief. METHODS: Thirty subjects per trial received injections of RHA R -M versus RHA R , and RHA4-M versus RHA4, respectively, in the perioral rhytids (PR) and nasolabial folds (NLF). Pain was assessed on a visual analog scale; aesthetic effectiveness was evaluated with validated scales, and safety was monitored based on common treatment responses (CTRs) and adverse events (AEs). RESULTS: RHA-M fillers proved as effective as their lidocaine counterparts at reducing pain (noninferior, p < .0002 and p < .0001). Bilateral wrinkle improvement was measured both in the PR (-1.5 ± 0.6 points on each side) and in the NLF (-1.8 ± 0.6 and -1.9 ± 0.5 points) trials at one month, with virtually identical responder rates (≥96.7%). Common treatment responses and AEs were similar between treated sides, and none was clinically significant. CONCLUSION: Resilient hyaluronic acid fillers with either mepivacaine or lidocaine are equally effective at reducing pain during treatment and equally performant and safe for correction of dynamic facial wrinkles and folds.

Treatment with CoreTherm in 570 patients with prostate volumes of 80-366 ml: an evaluation of short- and long-term retreatment risk.

INTRODUCTION: CoreTherm (ProstaLund AB, Lund, Sweden) is an outpatient treatment option in men with lower urinary tract symptoms and catheter-dependent men with chronic urinary retention caused by benign prostatic obstruction (BPO). CoreTherm is high-energy transurethral microwave thermotherapy with feedback technique. Modern treatment with CoreTherm includes transurethral intraprostatic injections of mepivacaine and adrenaline via the Schelin Catheter (ProstaLund AB, Lund, Sweden) and is often referred to as the CoreTherm Concept. OBJECTIVES: The aim of this study was to evaluate the short- and long-term retreatment risk in men with large prostates and BPO or chronic urinary retention, all primarily treated with CoreTherm. MATERIAL AND METHODS: All men from the same geographical area with prostate volumes ≥ 80 ml treated 1999-2015 with CoreTherm and having BPO or were catheter-dependent due to chronic urinary retention, were included. End of study period was defined as December 31, 2019. RESULTS: We identified and evaluated 570 men treated with CoreTherm, where 12% (71 patients) were surgically retreated during the follow-up. Mean follow-up was 11 years, and maximum follow-up was 20 years. The long-term retreatment rate in our study was 23%. A majority of these could be retreated with CoreTherm or TURP, with only 3% requiring open surgery. CONCLUSION: We conclude that CoreTherm is a suitable outpatient treatment option in patients with profoundly enlarged prostates, regardless of age, prostate size, and reason for treatment.

Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double-blind single-centre clinical trial.

AIM: The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. METHODOLOGY: Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6 ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4 ml 4% articaine hydrochloride with 1:100 000 adrenalin (n = 165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre-disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. RESULTS: Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. CONCLUSIONS: 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

Optimizing Spinal Anesthesia in Same-Day Discharge Knee Arthroplasty Patients: Mepivacaine Versus Ropivacaine.

BACKGROUND: Short-acting spinal anesthetics are playing an increasing role in same-day discharge total joint arthroplasty though their direct comparison remains to be studied. Therefore, this study aims to compare two formulations of spinal anesthesia regarding time to discharge following knee arthroplasty surgery. METHODS: A retrospective study was performed on 207 patients who underwent unicompartmental knee arthroplasty (UKA, n = 172) and total knee arthroplasty (TKA, n = 35) from May 2018 to December 2020 at a single institution and were discharged the same day. Two formulations of the spinal anesthetic were routinely administered in this population: 1) mepivacaine 1.5% 3-4 mL (n = 184) and 2) ropivacaine 0.5% 2.3-2.7 mL (n = 23). Discharge times were subsequently compared between mepivacaine and ropivacaine spinal anesthesia for each surgical procedure and between surgical procedures. RESULTS: There was no significant difference in discharge times between patients receiving mepivacaine versus ropivacaine for UKA (202 minutes [range = 54-449] versus 218 minutes [range = 175-385], P = .45) or TKA (193 minutes [range = 68-384] versus 196 minutes [range = 68-412], P = .93). Similarly, no difference was found in discharge times between UKA and TKA patients receiving mepivacaine (P = .68) or ropivacaine (P = .51). CONCLUSION: There was no significant difference in discharge times between anesthetic agents among knee surgery patients. Therefore, either agent may be recommended for same-day discharge.

Mepivacaine Versus Bupivacaine in Adult Surgical Patients: A Meta-analysis, Trial Sequential Analysis of Randomized Controlled Trials.

PURPOSE: Evidence supporting the choice between mepivacaine and bupivacaine is inconclusive. This meta-analysis aims to determine whether mepivacaine can reach a similar effect to bupivacaine after surgeries. DESIGN: A meta-analysis, trial sequential analysis of randomized controlled trials (RCTs). METHODS: RCTs were identified in PubMed, EMBASE (Ovid), Medline (Ovid), and Cochrane Library using a controlled vocabulary (MeSH) and keywords. There were no date and language restrictions. We strictly included RCTs comparing mepivacaine with bupivacaine. The primary outcome was motor function recovery time. Secondary outcomes included postoperative analgesic requirement, transient neurologic symptoms (TNS), pain score at 24 hours, length of stay (LOS), duration of analgesia, complications, and patient satisfaction. A trial sequential analysis (TSA) was performed for motor function recovery time, postoperative analgesic requirement, and TNS. FINDINGS: Seven RCTs with a total of 672 patients were included. Return of motor function was quicker in patients who received mepivacaine than in those who received bupivacaine (weighted mean differences [WMD] = -2.23 minutes; 95% confidence intervals [CI], -3.58 to -0.88; P = .02; I2 = 97.08%; TSA adjusted CI -17.52 to -10.9). Postoperative analgesic requirement was significantly more with mepivacaine (risk ratio [RR] = 3.23; 95% CI, 1.37-7.62; P = .01; I2 = 55.11%; TSA adjusted CI 5.73-63.27). Duration of analgesia (WMD = -8.83 hours; 95% CI, -11.75 to -7.90; P < .001; I2 = 0%) and LOS (WMD = -3.95 hours; 95% CI, -4.83 to -3.07; P < .001; I2 = 0%) in group mepivacaine was significantly shorter compared with bupivacaine. There were no differences for TNS (RR = 3.90; 95% CI, 0.94-16.22; P = .062; I2 = 72.23%), postoperative pain score (standard mean differences [SMD] = 0; 95% CI, -0.10 to 0.10; P = .972; I2 = 0%), complications (RR = 1; 95% CI, 0.70-1.43; P = .998; I2 = 0%), and satisfaction (RR = 0.97; 95% CI, 0.85-1.11; P = .40; I2 = 45%) between bupivacaine and mepivacaine. CONCLUSIONS: Mepivacaine appears to yield a faster return of motor function and shorter LOS compared with bupivacaine. and may be more popular in short-stay and outpatient surgery. However, the results of TSA indicate that more high-quality trials are needed to confirm the true effects.

Long-term comparison between blind and ultrasound-guided corticoid injections in Morton neuroma.

OBJECTIVES: This work compares the effectiveness of blind versus ultrasound (US)-guided injections for Morton neuroma (MN) up to 3 years of follow-up. METHODS: This is an evaluator-blinded randomised trial in which 33 patients with MN were injected by an experienced orthopaedic surgeon based on anatomical landmarks (blind injection, group 1) and 38 patients were injected by an experienced musculoskeletal radiologist under US guidance (group 2). Patients were assessed using the visual analogue scale and the Manchester Foot Pain and Disability index (MFPDI). Injections consisted of 1 ml of 2% mepivacaine and 40 mg triamcinolone acetonide in each web space with MN. Up to 4 injections were allowed during the first 3 months of follow-up. Follow-up was performed by phone calls and/or scheduled consultations at 15 days, 1 month, 45 days, 2 months, 3 months, 6 months and 1, 2 and 3 years. Statistical analysis was performed using unpaired Student's t tests. RESULTS: No differences in age or clinical measures were found at presentation between group 1 (VAS, 8.5 ± 0.2; MFPDI, 40.9 ± 1.1) and group 2 (VAS, 8.4 ± 0.2; MFPDI, 39.8 ± 1.2). Improvement in VAS was superior in group 2 up to 3 years of follow-up (p < 0.05). Improvement in MFPDI was superior in group 2 from 45 days to 2 years of follow-up (p < 0.05). Satisfaction with the treatment was higher in group 2 (87%) versus group 1 (59.1%) at 3 years of follow-up. CONCLUSION: Ultrasound-guided injections lead to a greater percentage of long-term improvement than blind injections in MN. KEY POINTS: • Ultrasound-guided corticosteroid injections in Morton neuroma provide long-term pain relief in more than 75% of patients. • Ultrasound-guided injections in Morton neuroma led to greater long-term pain relief and less disability than blind injections up to 3 years of follow-up. • The presence of an ipsilateral neuroma is associated with worse long-term disability score.

Anti-Inflammatory Characteristics of Local Anesthetics: Inhibition of TNF-α Secretion of Lipopolysaccharide-Stimulated Leucocytes in Human Blood Samples.

Background. Local anesthetics (LAs) have potent anti-inflammatory properties. Inflammatory down-regulation is crucial in diseases with overactive immune reactions, such as acute respiratory distress syndrome (ARDS) and chronic inflammation. We investigated the influence of four LAs, procaine, lidocaine, mepivacaine, and bupivacaine, on the reduction of tumor necrosis factor-alpha (TNF-α) secretion in lipopolysaccharide (LPS)-activated human leucocytes. Methods. Blood samples of 28 individuals were stimulated with LPS. The reduction of TNF-α production by each of the four LAs added (0.5 mg/mL) was measured and correlated with biometric variables. A response was defined as reduction to <85% of initial levels. Results. All four LAs down-regulated the TNF-α secretion in 44−61%: Bupivacaine (44.4%), lidocaine (61.5%), mepivacaine (44.4%), and procaine (50% of the individuals, "responders"). The TNF-α secretion was reduced to 67.4, 68.0, 63.6, and 67.1% of the initial values in responders. The effects in both patients and healthy persons were the same. Interindividual responses to LAs were not correlated with the duration or type of complaints, basal TNF-α serum level, sex, BMI, or age of responders. Conclusions. Four clinically relevant LAs (amid-LA and ester-LA) attenuate the inflammatory response provoked by LPS. They are potential candidates for drug repositioning in treating overactive immune reactions and chronic inflammation.

Anesthetic Management of a Patient Undergoing Cochlear Implantation With Superficial Cervical Plexus Block and Sedation: A Case Report.

Avoidance of general anesthesia and endotracheal intubation has been shown to reduce respiratory complications in patients with severe lung disease. We describe the case of a 75-year-old patient with chronic obstructive pulmonary disease (COPD) who underwent cochlear implantation managed with nerve block and sedation. A superficial cervical plexus block (SCPB) was performed with 1% mepivacaine before surgery. A small amount of intravenous analgesic and sedative was administered. The patient experienced only slight pain during surgery. A SCPB had a good analgesic effect on the posterior auricle. Cochlear implantation in patients with COPD can be performed using a SCPB and sedation.

Comparison of 2% mepivacaine and a solution of 2% lidocaine/epinephrine administered for median and ulnar nerve blocks in horses with naturally occurring forelimb lameness.

OBJECTIVE: To compare a 2% lidocaine solution containing 5 µg/ml (1:200 000) epinephrine with 2% mepivacaine for reducing lameness in horses after use in proximal nerve blocks. STUDY DESIGN: Experimental randomized crossover. ANIMALS: Six adult horses with naturally occurring forelimb lameness. METHODS: Horses were evaluated using an inertial gait sensor system. Lameness was measured as a vector sum (VS). Following baseline lameness examination, median and ulnar nerve blocks were performed with lidocaine/epinephrine (0.5 mg epinephrine added to 50 ml of 2% lidocaine immediately prior to administration) or an equal volume of 2% mepivacaine. Horses were trotted at 5 min and then at 30 min intervals for 150 min. After 24 h, nerve blocks were repeated using the other local anesthetic. Data were evaluated using linear models. RESULTS: The reduction in the VS did not differ after nerve blocks with lidocaine/epinephrine or mepivacaine (P = .791). Mean time to VS <8.5 mm (n = 5) was 5 and 9.6 min for lidocaine/epinephrine and mepivacaine, respectively. For one horse, VS was not reduced to <8.5 mm with either treatment (this horse had the highest VS before treatments were administered). The decrease in VS to <8.5 mm lasted for 150 min in both treatment groups. CONCLUSION: The outcomes of the median and ulnar nerve blocks performed with 2% lidocaine with epinephrine did not differ from blocks performed with 2% mepivacaine. CLINICAL RELEVANCE: Two percent lidocaine with epinephrine may serve as an adequate replacement for proximal nerve blocks when mepivacaine is unavailable.

Prolonged blockade of the cervical sympathetic nerve by stellate ganglion block accelerates therapeutic efficacy in trigeminal neuropathy.

PURPOSE: Stellate ganglion block (SGB) is effective in treating head and neck pain and neuropathic diseases by increasing tissue blood flow through its sympatholytic effect. This study aimed to investigate the relationship between duration of cervical sympathetic nerve block by SGB and its therapeutic efficacy against trigeminal neuropathy after orthognathic surgery. METHODS: Twenty-eight patients with trigeminal neuropathy were randomly assigned to two groups (mepivacaine and levobupivacaine) according to the drug used for SGB. Increased blood flow, which is a symptom of sympathetic blockade, was recorded for 180 min after SGB. Current perception threshold, warm or cool detection threshold, and tactile detection threshold were measured preoperatively, postoperatively, on day 10 after initiation of SGB, and 3 months postoperatively to compare therapeutic efficacy between the groups. RESULTS: The levobupivacaine group had a significantly longer duration of increased blood flow compared with the mepivacaine group. Values of current perception threshold, warm and cool detection threshold, and tactile detection threshold significantly improved in the levobupivacaine group on day 10 after initiation of SGB and 3 months postoperatively. CONCLUSION: A prolonged increase in blood flow due to long-term sympatholytic effects accelerates the therapeutic efficacy of SGB in trigeminal neuropathy.

Supraclavicular block with Mepivacaine vs Ropivacaine, their impact on postoperative pain: a prospective randomised study.

BACKGROUND: Supraclavicular block (SCB) with long-acting local anaesthetic is commonly used for surgical repair of distal radial fractures (DRF). Studies have shown a risk for rebound pain when the block fades. This randomised single-centre study aimed to compare pain and opioid consumption the first three days post-surgery between SCB-mepivacaine vs. SCB-ropivacaine, with general anaesthesia (GA) as control. METHODS: Patients (n = 90) with ASA physical status 1-3 were prospectively randomised to receive; SCB with mepivacine 1%, 25-30 ml (n = 30), SCB with ropivacaine 0.5%, 25-30 ml (n = 30) or GA (n = 30) with propofol/fentanyl/sevoflurane. Study objectives compared postoperative pain with Numeric Rating Scale (NRS) and sum postoperative Opioid Equivalent Consumption (OEC) during the first 3 days post-surgery between study-groups. RESULTS: The three groups showed significant differences in postoperative pain-profile. Mean NRS at 24 h was significantly lower for the SCB-mepivacaine group (p = 0.018). Further both median NRS and median OEC day 0 to 3 were significanly lower in the SCB-mepivacaine group as compared to the SCB-ropivacaine group during the first three days after surgery; pain NRS 1 (IQR 0.3-3.3) and 2.7 (IQR 1.3-4.2) (p = 0.017) and OEC 30 mg (IQR 10-80) and 85 mg (IQR 45-125) (p = 0.004), respectively. The GA-group was in between both in pain NRS and median sum OEC. Unplanned healthcare contacts were highest among SCB-ropivacaine patients (39.3%) vs. SCB-mepivacaine patients (0%) and GA-patients (3.4%). CONCLUSIONS: The potential benefit of longer duration of analgesia, associated to a long-acting local anaesthetic agent, during the early postoperative course must be put in perspective of potential worse pain progression following block resolution. TRIAL REGISTRATION: NCT03749174 (clinicaltrials.gov, Nov 21, 2018, retrospectively registered).

Mepivacaine vs Bupivacaine Spinal Anesthesia in Total Hip Arthroplasty at an Ambulatory Surgery Center.

BACKGROUND: Mepivacaine spinal anesthetic may facilitate more rapid postoperative recovery in joint arthroplasty than bupivacaine. This study compared recovery, pain, and complications between the 2 anesthetics in anterior-approach total hip arthroplasty (THA) at a free-standing ambulatory surgery center (ASC). METHODS: This retrospective cohort study of 282 consecutive patients with mean age 55.7 ± 8.8 years and body mass index 30.6 ± 5.3 who underwent THA at an ASC from November 2018 to July 2020 compares mepivacaine (n = 141) vs bupivacaine (n = 141) spinal anesthesia, a transition made in March 2019. The main outcomes were length of stay in the postoperative unit (post acute care unit) prior to same-day discharge (SDD), time to controlled void, and ambulation. Secondarily, postoperative pain scores (0-10) with morphine equivalents were required and any postoperative complications were compared. RESULTS: Mepivacaine decreased mean post acute care unit stay (4.0 vs 5.7 hours, P < .001), time to void (3.1 vs 4.9 hours, P < .001), and ambulation (3.2 vs 4.5 hours, P < .001). No patients needed urinary catheterization or overnight stay. Two patients in the bupivacaine group had transient neurologic symptoms, consisting of foot drop and spinal headache, compared to none with mepivacaine (P = .498). Mepivacaine patients had increased postoperative pain at 2 hours (1.7 vs 0.9, P < .001), at discharge (1.1 vs 0.5, P = .004), and morphine equivalent doses received (7.8 vs 3.7 mg, P < .001). CONCLUSION: Mepivacaine spinal anesthesia for anterior-approach THA safely facilitated more rapid SDD from the ASC through decreased times to controlled void and ambulation with only minor increase in pain when compared to bupivacaine. LEVEL OF EVIDENCE: Level III - Retrospective comparative cohort study.