Periarticular Infiltration Compared to Single Femoral Nerve Block in Total Knee Arthroplasty: A Prospective Randomized Study / Infiltração periarticular comparada ao bloqueio do nervo femoral único na artroplastia total de joelho: Um estudo prospectivo randomizado

Abstract Objective To compare patients undergoing total knee arthroplasty (TKA) under spinal anesthesia and single femoral nerve block (FNB) with subjects undergoing TKA under spinal anesthesia and periarticular infiltration (PAI). Materials and Methods A total of 100 patients undergoing primary TKA were randomized into two groups. Group 1 included patients undergoing surgery under FNB associated with spinal anesthesia, while group 2 included patients undergoing TKA under IPA and spinal anesthesia. The assessment of these subjects in the early postoperative period included pain, active flexion, active extension, elevation of the extended limb, and morphine use. Results There was no significant difference in the types of analgesia concerning pain, the elevation of the extended limb, and morphine use. Active flexion and extension were better in the PAI group (p = 0.04 and p = 0.02 respectively). Conclusion We conclude that the techniques are similar regarding pain control, limb elevation, and morphine use. The use of IPA provided better active flexion and extension during the hospital stay compared to single FNB in patients undergoing TKA.

Resumo Objetivo Avaliar pacientes submetidos a artroplastia total do joelho (ATJ) sob raquianestesia e bloqueio do nervo femoral (BNF) único e comparar com pacientes que submetidos a ATJ sob raquianestesia e infiltração periarticular (IPA). Materiais e Métodos Um total de 100 pacientes submetidos a ATJ foram randomizados em dois grupos. O grupo 1 incluiu pacientes submetidos a ATJ sob BNF associado à raquianestesia, ao passo que o grupo 2 incluiu pacientes submetidos a ATJ sob IPA associada à raquianestesia. Os indivíduos foram avaliados no pós-operatório precoce quanto à dor, à flexão e extensão ativas, à elevação do membro estendido e ao uso de morfina. Resultados Não se observou diferença significativa associada ao tipo de analgesia em relação à dor, à elevação do membro em extensão e ao consumo de morfina. Houve melhor flexão e extensão ativas no grupo que recebeu IPA (p = 0,04 e p = 0,02, respectivamente). Conclusão Concluímos que as técnicas utilizadas são semelhantes quanto ao controle da dor, à elevação de membro e ao uso de morfina. O uso de IPA proporcionou uma melhor flexão e extensão ativas durante o período de internação hospitalar comparado ao uso de BNF único em pacientes submetidos a ATJ.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy

SUMMARY OBJECTIVE: A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. METHODS: Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. RESULTS: The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). CONCLUSION: Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

Effects of dyclonine hydrochloride mucilage on gag reflex in patients with chronic pharyngitis undergoing gastroscopy / 中国基层医药

Objective:To investigate the effects of dyclonine hydrochloride mucilage administered for oropharyngeal anesthesia on gag reflex in patients with chronic pharyngitis during gastroscopy.Methods:A total of 100 patients with chronic pharyngitis who met American Society of Anesthesiologists Classification I-II and received treatment in The First Affiliated Hospital of Ximen University from January to December 2020 were included in this study. Using the principle of voluntariness, these patients were divided into dyclonine hydrochloride mucilage (D) and control (C) groups, with 50 patients in each group. Ten minutes before anesthesia induction, patients in Group D took 10 mL of dyclonine hydrochloride mucilage in the mouth, but did not swallow it, and those in Group C were identically given equal volume of placebo. Ten minutes later, dyclonine hydrochloride mucilage or placebo was swallowed. For anesthesia induction, 20 μg Fentanyl and 2-4 mg/kg Propofol were intravenously administered. A gastroscopy examination was performed after the patient's consciousness disappeared. The patient's cough and body movement response scores during gastroscopy were recorded. Before anesthesia induction (T0), before endoscope insertion (T1), after endoscope insertion (T2), and after endoscope withdrawal (T3), mean arterial pressure and heart rate were recorded.Results:The incidence rate of cough and body movement in Group D were 20% (10/50) and 24% (12/50), which were significantly lower than 72% (36/50) and 68% (34/50) in Group C ( χ2 = 27.21, 19.49, both P < 0.001). At T1, mean arterial pressure in Group D and Group C was (62.21 ± 10.32) mmHg and (63.82 ± 10.51) mmHg(1 mmHg=0.133 kPa), respectively, which were significantly lower than (70.21 ± 13.13) mmHg and (70.91 ± 14.02) mmHg at T0 ( t = 3.15, 5.82, both P < 0.05). At T2, mean arterial pressure and heart rate in Group C were (80.13 ± 11.92) mmHg and (90.02 ± 15.63) beats/minute, respectively, which were significantly higher than (70.91 ± 14.02) mmHg and (78.75 ± 14.93) beats/minute at T0 in the same group ( t = 5.99, 4.03, both P < 0.05) and were also significantly higher than (66.21 ± 12.33) mmHg and (76.53 ± 10.31) beats/minute] at T2 in Group D ( t = 2.07, 2.67, both P < 0.05). Conclusion:Dyclonine hydrochloride mucilage administered for oropharyngeal anesthesia can effectively suppress gag reflex in patients with chronic pharyngitis and increase hemodynamic stability during gastroscopy.

Buffered 2% articaine in buccal infiltration of mandibular molars: a randomized triple-blind clinical trial

Abstract This crossover study aimed to compare the anesthetic effects of buffered 2% articaine with 1:200,000 epinephrine with that of non-buffered 4% articaine with 1:200,000 epinephrine. Forty-seven volunteers were administered two doses of anesthesia in the buccal region of the second mandibular molars in two sessions using 1.8 mL of different local anesthetic solutions. The onset time and duration of pulp anesthesia, soft tissue pressure pain threshold, and the score of pain on puncture and burning during injection were evaluated. The operator, volunteers, and statistician were blinded. There were no significant differences in the parameters: onset of soft tissue anesthesia (p = 0.80), duration of soft tissue anesthesia (p = 0.10), onset of pulpal anesthesia in the second (p = 0.28) and first molars (p = 0.45), duration of pulp anesthesia of the second (p = 0.60) and first molars (p = 0.30), pain during puncture (p = 0.82) and injection (p = 0.80). No significant adverse events were observed. Buffered 2% articaine with 1:200,000 epinephrine did not differ from non-buffered 4% articaine with 1:200,000 epinephrine considering anesthetic success, safety, onset, duration of anesthesia, and pain on injection.

Effects of ultrasound-guided nerve block combined with dexmedetomidine on postoperative oxidative stress in patients with hip fracture and diabetes / 中国医师进修杂志

Objective:To explore the effect of ultrasound-guided nerve block combined with dexmedetomidine (DEX) on postoperative oxidative stress in patients with hip fracture and diabetes.Methods:From March 2017 to December 2019, 78 patients with diabetes who underwent hip fracture surgery were enrolled and divided into two groups by random number table method, with 39 cases in each group. After the operation, the control group was treated with ultrasound-guided femoral nerve combined with lateral femoral cutaneous nerve block with 0.375% ropivacaine, and the study group was treated with ultrasound-guided femoral nerve combined with lateral femoral cutaneous nerve block with 0.375% ropivacaine and DEX 0.5 μg/kg. Patients in both groups were received patient controlling intravenous analgesia (PCIA) after the operation, and visual analogue scoring (VAS) was used to evaluate the resting pain score of the patients at 4 h (T 1), 8 h (T 2), 16 h (T 3), 24 h (T 4), 36 h (T 5) and 48 h after operation (T 6). The levels of serum superoxide dismutase (SOD), malondialdehyde (MDA), 8-hydroxydeoxyuridine (8-OHdG), at T 1 and T 6 were compared between the two groups. The management system of continuous glucose monitoring system (CGMS) was used to calculate the mean amplitude of glycemic excursions(MAGE), largest amplitude of glycemic excursions (LAGE), absolute means of daily differences (MODD) of the patients during 48 h after operation, and the correlation between the blood glucose fluctuation indicators and the oxidative stress of the study group were compared. Results:The scores of VAS in the study group at T 1-T 6 were lower than those in the control group , the difference were statistically significant ( P<0.05). At T 6, the level of serum SOD in the study group was higher than that in the control group: (79.58 ± 13.55) kU/L vs. (64.16 ± 11.95) kU/L; the level of serum MDA and 8-OhdG in the study group were higher than those in the control group: (4.36 ± 0.81) μmol/L vs. (5.64 ± 0.94) μmol/L, (1.06 ± 0.19) μg/L vs.(1.42 ± 0.22) μg/L, the differences were statistically significant ( P<0.05). The levels of MAGE, LAGE, MODD in the study group were lower than those in the control group: (2.42 ± 0.47) mmol/L vs. (5.19 ± 0.96) mmol/L, (3.47 ± 0.64) mmol/L vs. (7.61 ± 1.32) mmol/L, (1.21 ± 0.27) mmol/L vs. (2.74 ± 0.46) mmol/L, the differences were statistically significant ( P<0.05). The correlation analysis showed that the blood glucose fluctuation indicators MAGE, LAGE and MODD of the study group were negatively correlated with SOD, and were positively correlated with MDA, 8-OHdG ( P<0.05). Conclusions:The use of ultrasound-guided nerve block combined with dexmedetomidine (DEX) for patients with hip fracture and diabetes can improve the analgesic effect, reduce oxidative stress of the patients, and improve the blood glucose fluctuation indicators.

Analgesic effects of ultrasound-guided rectus sheath block in open gastrectomy / 中国基层医药

Objective:To investigate the analgesic effects of ultrasound-guided rectus abdominis sheath block (RSB) in open gastrectomy.Methods:Forty-one patients with gastric cancer who underwent open gastrectomy in Binzhou Hospital of Traditional Chinese Medicine from December 2019 to December 2020 were included in this study. They were randomly assigned to undergo either RSB with 40 mL of 0.375% ropivacaine (group A, n = 21) or RSB with 40 mL of 0.9% sodium chloride injection (group B, n = 20) based on total intravenous anesthesia. After skin sutures, patient-controlled analgesia (PCA) was performed. Intraoperative dose of remifentanil and postoperative dose of PCA drug were compared between the two groups. Results:Intraoperative dose of remifentanil was significantly lower in the group A than that in the group B [(1 021.4 ± 172.0) μg vs. (1 415.0 ± 330.6) μg, t = -4.04, P = 0.001]. Postoperative doses of PCA drug used by 1 and 2 hours after surgery were (1.14 ± 0.90) mL and (0.85 ± 0.70) mL respectively in group A, which were significantly lower than (1.85 ± 0.70) mL and (1.45 ± 1.00) mL in the group B ( t = -5.96, -2.75, P < 0.001, P = 0.009). There were no significant differences in postoperative doses of PCA drug used by 3, 6, 12, 24, 48 and 72 hours after surgery between the two groups (both P > 0.05). Conclusion:RSB with 40 mL of ropivacaine applied to both sides of the incision before open gastrectomy can reduce the dose of remifentanil used during surgery and the dose of PCA drug used within 2 hours after surgery.

Perfil de utilização de anestésicos locais por cirurgiões-dentistas em pacientes hipertensos de uma cidade brasileira / Profile of use of local anesthetics by dental surgeons in hypertensive patients in a Brazilian city / Perfil del uso de anestésicos locales por cirujanos dentistas en pacientes hipertensos en una ciudad brasileña

Justificativa e Objetivos: O sucesso da técnica anestésica é fundamental para qualquer procedimento e garantia de segurança ao paciente, sendo sustentado por protocolos e fundamentos de caráter imperativo a fim de conferir o melhor atendimento. Nesse sentido, o presente trabalho verificará a utilização dos anestésicos locais, com ênfase em pacientes hipertensos, nos consultórios particulares da cidade de Palmas/TO. Métodos: Trata-se de um estudo descritivo, do tipo transversal de abordagem quantitativa realizado por meio de um questionário fechado de construção livre aplicado para profissionais do serviço privado de Palmas/TO, após assinatura do Termo de Consentimento Livre e Esclarecido. Foi realizada análise descritiva de 113 questionários por intermédio do Statistical Package for the Social Sciences 22.0. Resultados: Dos entrevistados, 58,4% eram mulheres, a especialidade mais encontrada foi implantodontia (20,4%); 53,1% apontaram que a escolha do anestésico é feita de acordo com a condição do paciente; 47,8% dos profissionais possuem mais de 3 tipos de anestésicos disponíveis para o atendimento; 53,1% apontou ensino de anestesiologia na graduação satisfatório; 65,5% não frequenta cursos e palestras sobre esse tema; 41,6% dos dentistas aferiam a pressão somente em hipertensos, lidocaína foi o sal mais utilizado de forma geral e também de forma especifica ao considerar somente hipertensos. Conclusão: O anestésico local mais utilizado em hipertensos é a lidocaína 2% com adrenalina 1:100.000, porém a maioria dos profissionais só afere a pressão arterial em já diagnosticados com hipertensão, expondo resultados relativamente satisfatórios em virtude de condutas que ainda necessitam ser readequadas.(AU)

Background and Objectives: The success of the anesthetic technique is f undamental to any procedure and guarantees patient safety, being supported by imperative protocols and fundamentals to provide the best care. This study verifies the use of local anesthetics, focusing on hypertensive patients in private offices of the city of Palmas/Tocantins. Methods: This is a quantitative cross-sectional descriptive study supported by a closed questionnaire of free construction applied to professionals from the private health service of Palmas; all participants signed informed consent forms. In total, 113 questionnaires underwent descriptive analysis using the Statistical Package for the Social Sciences 22.0. Results: Of the interviewees, 58.4% were women, the most common specialty was prosthodontics (20.4%); 53.1% answered that the choice of anesthetic is made according to the patient's condition; 47.8% of professionals have more than 3 types of anesthetics available for care; 53.1% indicated teaching anesthesiology in undergraduate courses satisfactory; 65.5% did not attend courses and lectures on this topic; 41.6% of dentists measured pressure only in hypertensive patients, lidocaine was the most widely used salt and specifically when considering only hypertensive. Conclusion: The most commonly used local anesthetic in hypertensive patients is lidocaine 2% with adrenaline 1:100,000, but most professionals only check blood pressure in patients already diagnosed with hypertension, showing relatively satisfactory results due to conducts that still need to be adjusted.(AU)

Justificación y objetivos: El éxito de la técnica anestésica es fundamental para cualquier procedimiento y garantía de seguridad del paciente, lo cual es respaldado por protocolos y fundamentos imperativos para brindar la mejor atención. El presente trabajo tuvo como objetivo verificar el uso de anestésicos locales en pacientes hipertensos en oficinas privadas de la ciudad de Palmas (Tocantins, Brasil). Métodos: Este es un estudio descriptivo, transversal, cuantitativo, en el cual se aplicó un cuestionario cerrado de construcción libre a profesionales del servicio privado de Palmas, después de firmar el término de consentimiento libre y esclarecido. Se analizaron 113 cuestionarios por medio del Statistical Package for the Social Sciences 22.0. Resultados: De los entrevistados, el 58,4% eran mujeres, la especialidad más encontrada fue la implantología (20,4%), el 53,1% señaló que la elección del anestésico se realiza según la condición del paciente, el 47,8% de los profesionales tienen más de 3 tipos de anestésicos disponibles para la atención, el 53,1% indicó que la enseñanza de anestesiología en cursos de grado fue satisfactoria, el 65,5% no asistió a cursos y conferencias sobre este tema, el 41,6% de los dentistas verificaron la presión solo en pacientes hipertensos, lidocaína era la sal más utilizada en general y también de manera específica cuando se consideraban solo pacientes hipertensos. Conclusión: El anestésico local más utilizado en los pacientes hipertensos es la lidocaína 2% con adrenalina 1:100.000, pero la mayoría de los profesionales solo ajustan la presión arterial en los pacientes ya diagnosticados con hipertensión, lo cual apunta resultados relativamente satisfactorios debido a las conductas que aún deben ser ajustadas.(AU)

Eficácia de agentes químicos na desinfecção de tubetes anestésicos odontológicos / Effectiveness of chemical agents in disinfecting dental anesthetic cartridges

Durante o atendimento odontológico, o paciente pode ser exposto a várias fontes de contaminações, por isso a equipe odontológica deve sempre implementar ações de biossegurança. Materiais não autoclaváveis, como os tubetes anestésicos, necessitam ser desinfetados previamente ao seu uso, pois não são estéreis, podendo transmitir patógenos entre os pacientes. Este estudo objetivou avaliar e comparar a eficácia de três soluções desinfetantes na redução da carga microbiana em tubetes de anestésicos odontológicos. Os tubetes anestésicos (n = 31) foram escolhidos aleato-riamente e submetidos a diferentes métodos e agentes desinfetantes (Álcool 70%, Dióxido de Cloro 7%; Cloreto de benzalcônio 5,2% com Polihexametileno biguanida 3,5%). Após a desinfecção por métodos de imersão ou fricção, os tubetes foram semeados em meio de cultura contendo caldo tripticase de soja e incubados (48h/37 ºC). Amostras do meio de cultura líquido foram repicadas e semeadas em ágar tripticase de soja, incubado durante 48h a 37 ºC. O crescimento microbiano foi observado pela presença de unidades formadoras de colônias (UFCs) crescidas no ágar. O estudo concluiu que os produtos Álcool 70% e Cloreto de benzalcônio 5,2% com Polihexametileno biguanida 3,5% demostraram ser mais eficazes na eliminação da carga microbiana dos tubetes pelo método de fricção, e que realmente os tubetes anestésicos tem sua superfície externa contaminada. O estudo comprovou ser o método de fricção do agente desinfetante mais eficaz na redução da carga microbiana comparado a imersão. Dos agentes testados, o Dióxido de Cloro 7% não demonstrou um nível de desinfecção satisfatório.

During dental care, the patient may be exposed to various sources of contamination, so the dental team should always implement biosecurity actions. Non-autoclavable materials such as anesthetic cartridges need to be di-sinfected prior to use because they are not sterile and can transmit pathogens between patients. This study aimed to evaluate and compare the effectiveness of three disinfectant solutions to reduce microbial load in dental anesthetic cartridges. Anesthetic cartridges (n = 31) were randomly chosen and submitted to different methods and disinfectants (70% Alcohol, 7% Chlorine Dioxide; 5.2% Benzalkonium Chloride with 3.5% Polyhexamethylene Biguanide). After immersion or friction methods of disinfection, the tubes were seeded in culture medium containing trypticase soy broth and incubated (48h/37 ºC). Samples of liquid culture medium were picked and seeded in trypticase soy agar, incubated for 48h at 37 ºC. Microbial growth was observed by the number of colonies forming units (CFUs) grown on the agar. The study concluded that 70% Alcohol and 5.2% Benzalko-nium Chloride with 3.5% Polyhexamethylene biguanide have been shown to be most effective in eliminating the microbial contamination of the cartridges by the friction method, and that the anesthetic cartridges actually have contamination of their external surface. The study proved that the friction method is most effective in reducing microbial load compared to immersion. Of the agents tested, 7% Chlorine Dioxide did not show a satisfactory level of disinfection.

Safety of local anesthetics

Abstract Local anesthetics are essential medications for the conduction of dermatological procedures. They stop the depolarization of nerve fibers and are divided into two main categories, the amide and ester types. Systemic toxicity with reflex on the central nervous and cardiovascular systems is their most feared adverse reactions, and the anaphylactic reaction is the most concerning one. Although potentially fatal, these events are extremely rare, so local anesthetics are considered safe for use in in-office procedures.

Small dose of naloxone as an adjuvant to bupivacaine in intrapleural infiltration after thoracotomy surgery: a prospective, controlled study

BACKGROUND: Severe pain always develops after thoracotomy; intrapleural regional analgesia is used as a simple, safe technique to control it. This study was performed to evaluate whether a small dose of naloxone with local anesthetics prolongs sensory blockade. METHODS: A prospective, randomized double-blinded controlled study was conducted on 60 patients of American Society of Anesthesiologists statuses I and II, aged 18 to 60 years, scheduled for unilateral thoracotomy surgery. After surgery, patients were randomly divided into two groups: through the intrapleural catheter, group B received 30 ml of 0.5% bupivacaine, while group N received 30 ml of 0.5% bupivacaine with 100 ng of naloxone. Postoperative pain was assessed using the visual analog pain scale (VAS). Time for the first request for rescue analgesia, total amount consumed, and incidence of postoperative complications were also recorded. RESULTS: The VAS score significantly decreased in group N, at 6 h and 8 h after operation (P < 0.001 for both). At 12 h after injection, the VAS score increased significantly in group N (P < 0.001). The time for the first request of rescue analgesia was significantly longer in group N compared to group B (P < 0.001). The total amount of morphine consumed was significantly lower in group N than in the bupivacaine group (P < 0.001). CONCLUSIONS: Addition of a small dose of naloxone to bupivacaine in intrapleural regional analgesia significantly prolonged pain relief after thoracotomy and delayed the first request for rescue analgesia, without significant adverse effects.

Are steroids required in the treatment of ganglion impar blockade in chronic coccydynia? a prospective double-blinded clinical trial

BACKGROUND: Ganglion impar blockade is a reliable and effective treatment option used in patients with coccydynia. Our primary objective was to specify the role of corticosteroids in impar blockade. We compared applications of local anesthetic with the local anesthetic + corticosteroid combination in terms of treatment efficiency in patients with chronic coccydynia. METHODS: Our study was a prospective randomize double-blind study. The patients were divided into 2 groups after randomization. The first group (group SL) was made up of patients where a corticosteroid + local anesthetic were used during ganglion impar blockade. In the second group (group L) we used only local anesthetic. We evaluated numeric rating scale (NRS) and Beck depression scale, which were employed before the procedure and in 1st and 3rd months after the procedure. RESULTS: Seventy-three patients were included in the final analysis. We detected a significantly greater decrease in NRS values in the 1st month in group SL than in group L (P = 0.001). In the same way, NRS values in the 3rd month were significantly lower in the group with steroids (P = 0.0001). During the evaluation of the Beck test, we detected significantly greater decreases in the 1st month (P = 0.017) and 3rd month (P = 0.021) in the SL group than in the L group. CONCLUSIONS: Ganglion impar blockade decreases pain in the treatment of chronic coccydynia and improve depression. Addition of steroids in a ganglion impar blockade is required for treatment response that should accumulate over a long period of time.

Effect of intrathecal analgesia on labor / 中华围产医学杂志

As an effective analgesic method,intrathecal analgesia has been widely accepted.Though labor analgesia could relieve the labor pain,it remains controversial about its adverse effects on labor progress and delivery outcomes.With the development of labor analgesia technique,a large number of clinical studies have suggested that the protocol,dosage and analgesic methods of local anesthesia may also affect the labor and delivery outcomes.There is a growing need to explore more optimized anesthetics and analgesic methods for clinical and scientific research.

Current status of the anterior middle superior alveolar anesthetic injection for periodontal procedures in the maxilla

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

Posterior quadratus lumborum block for primary total hip arthroplasty analgesia: a comparative study / Bloqueio anestésico do quadrado lombar posterior para analgesia na artroplastia total do quadril primária: estudo comparativo

ABSTRACT Objective To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Methods The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Results For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. Conclusion Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III

RESUMO Objetivo Comparar a analgesia e o uso de opioides em pacientes submetidos à artroplastia total do quadril primária com bloqueio pré-operatório do quadrado lombar posterior e pacientes que não receberam o bloqueio do quadrado lombar. Métodos Revisamos os prontuários de pacientes submetidos à artroplastia total do quadril unilateral entre 1º de janeiro de 2017 e 31 de março de 2018, e 238 pacientes foram incluídos no estudo. O desfecho primário foi o consumo de opioides no pós-operatório nas primeiras 24 horas. Os desfechos secundários foram consumo de opioide no intraoperatório, na sala de recuperação pós-anestésica e nas primeiras 48 horas, escores de Escala Visual Analógica de dor pós-operatória, e tempo de permanência na recuperação pós-anestésica. Os desfechos primário e secundários foram comparados entre os pacientes submetidos à artroplastia total do quadril primária com bloqueio pré-operatório do quadrado lombar posterior e aqueles que não receberam o bloqueio do quadrado lombar. Resultados Para o grupo que recebeu o bloqueio, as doses totais de morfina por via oral em 24 horas foram menores (53,82mg±37,41) em comparação ao grupo sem bloqueio (77,59mg±58,42), com p=0,0011. A utilização de opioides foi consistentemente menor para o grupo que recebeu o bloqueio em cada tempo adicional de avaliação até 48 horas. Os escores da Escala Visual Analógica até 12 horas após a cirurgia para os pacientes que receberam o bloqueio do quadrado lombar posterior e o tempo de permanência na sala de recuperação pós-anestésica foram menores para o grupo que recebeu o bloqueio. Conclusão O bloqueio anestésico do quadrado lombar posterior para artroplastia total do quadril primária está associado à diminuição do uso de opioides nas primeiras 48 horas, diminuição do escore de dor da Escala Visual Analógica em até 12 horas, e menor tempo de permanência na sala de recuperação pós-anestésica. Nível de evidência: III

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction / Comparação da sensação de dor durante a extração de óleo de silicone sob anestesia tópica e retrobulbar

ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.

Analysis of adverse reaction induced by articaine hydrochloride and epinephrine tartrate injection in 75 cases / 中华口腔医学杂志

Objective@#To investigate the causes and clinical manifestation of adverse reaction of articaine hydrochloride and epinephrine tartrate injection.@*Methods@#A retrospective analysis was conducted on the adverse drug reactions (ADR) of local anesthetic articaine hydrochloride and epinephrine tartrate injection.@*Results@#In 75 cases of adverse reactions, there were 40 cases of female and 35 cases of male. Adverse reactions occured more frequently at the age of 3-10 [33% (25/75)] and 1-10 min and one day after injection, respectively accounting for 20% (15/75), and two days, accounting for 15% (15/75), 10-21 days accounting for 8% (6/75). The main manifestations were injection site ulcers, followed by skin reactions such as pain, swelling, necrosis and pruritus at the injection site.@*Conclusions@#The main adverse reactions of articaine hydrochloride and epinephrine tartrate injection are the injection site ulceration, followed by injection site pain, rash, pruritus and drowsiness, nausea and dizziness, palpitations, sweat and hypotension. Doctors should ask the medical history in detail and pay close attention to the patient's medication safety.

Research of median effective dose of levobupivacaine for ultrasound -guided transversus abdominis plane block in pediatric hernia surgery / 中国基层医药

Objective To investigate the median effective dose of levobupivacaine for ultrasound -guided transversus abdominis plane ( TAP ) block in pediatric hernia surgery .Methods Thirty consecutive children scheduled for pediatric hernia surgery were treated by basic anesthesia and ultrasound -guided TAP block .The levobupivacaine dose for a particular patient was determined by the response of the previous patient to a higher or smaller dose (step size of 0.1mg/kg) using Dixon's up-and-down sequential method,starting at levobupivacaine 0.5mg/kg.Block failure was defined as a 20％ increase in heart rate ( HR) or mean arterial pressure ( MAP) from baseline .The ED50 and 95％confidence interval ( CI) of levobupivacaine were calculated by the Dixon's up-and-down method and logistic regression analysis .Results The ED50 and 95％CI of levobupivacaine for TAP block obtained by Dixon's up-and-down sequential method were 0.24(0.22～0.27)mg/kg,the ED50 and 95％CI of levobupivacaine obtained through the probit test were 0.17(0.08～0.24)mg/kg.Adverse effects related to TAP block were not found in all children who underwent herniorrhaphy .Conclusion Ultrasound-guided TAP block can reduce local analgesic dosis and adverse effects ,the ED50 of levobupivacaine for ultrasound -guided TAP block in pediatric hernia surgery is 0.24mg/kg.

Regional anesthetic management of elderly patients

In general, elderly patients are less able to respond to perioperative stress and are more likely to suffer from postoperative complications and even death because of the decline in their functional organ reserve. Although no definitive evidence indicates that regional anesthesia is superior to general anesthesia in terms of the long-term prognosis in the elderly, regional anesthesia appears to be beneficial in many ways because it reduces bleeding during surgery, the stress response, and the incidence of thromboembolic complications, as well as facilitating excellent postoperative pain control. However, some issues specific to the elderly should also be considered. Age-related anatomical changes in elderly patients may make it difficult to perform epidural and spinal anesthesia, and physiologic and pharmacodynamic responses to local anesthetics may change with age. Elderly patients also show a greater extent of sensory and motor block, and are at a greater risk of hypotension after epidural and spinal block. In order to provide optimal anesthetic care and to facilitate a rapid recovery and improved outcomes in elderly patients, clinicians must have a better understanding of age-related changes when regional anesthesia is administered. Additionally, tailored anesthetic techniques should be used, as well as good perioperative care, in accordance with the type of surgery and the individual physical status of elderly patients.