Patient Comfort with Various Local Infiltration Anesthetics for Minor Oculoplastic Surgery: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures. OBJECTIVES: To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort. METHODS: This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question. RESULTS: Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS. CONCLUSIONS: "Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low. THE CLINICAL TRIAL REGISTRATION NUMBER: CRD42021260332 (PROSPERO).

Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study.

We assessed the effect of 2% lidocaine with 1:80,000 adrenaline (L + AD) and 3% prilocaine with 0.03 IU/mL felypressin (P + FP) on blood pressure and heart rate in older adults with systemic diseases undergoing dental extraction. This double-blind, randomized crossover study included 22 elderly participants, aged over 65 years. The participants were administered L + AD for one dental extraction and P + FP for the other. Blood pressure and heart rate were recorded immediately, 5, and 10 minutes after local anesthetic administration and the data were analyzed. The systolic and diastolic blood pressures in the P + FP group increased at all measurement points (p < .001). In the L + AD group, the diastolic blood pressure decreased at 5 and 10 minutes after local anesthetic administration (p < .05), whereas the heart rate increased at all measured time points (p < .001). There were statistically significant differences in systolic blood pressure at 5 and 10 minutes after local anesthetic administration and in diastolic blood pressure and heart rate at all time points between the 2 groups. In older adults, P + FP administration increased the systolic and diastolic blood pressures. L + AD administration increased the heart rate and decreased the diastolic blood pressure.

Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents.

BACKGROUND: Whilst carrying out dental procedures under general anaesthesia (GA), practitioners routinely give local anaesthetics (LA) intraoperatively to children. Local anaesthetics are used to help manage postoperative pain and reduce bleeding and the physiological response to procedures. Studies of effectiveness of intraoperative LA to date have reported contradictory results. OBJECTIVES: To assess the effects of intraoperative local anaesthesia for reducing postoperative pain following general anaesthesia for dental treatment in children and young people aged 17 years or younger. SEARCH METHODS: We searched the following electronic databases: the Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013, Issue 12), MEDLINE via OVID (1946 to 02 January 2014), EMBASE via OVID (1980 to 02 January 2014) and Web of Science Conference Proceedings (1990 to 02 January 2014). We searched for ongoing trials in the US National Institutes of Health Register, the metaRegister of Controlled Trials (mRCT) and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) Clinical Trials Portal. We did not place any restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials in which local anaesthetic was given intraoperatively under general anaesthesia for dental treatment of children and young people aged 17 years or younger. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of risk of bias independently and in duplicate. We contacted authors to clarify omissions in trial reports. In the 'Summary of findings' tables, we elected to report the outcomes pain, distress, postoperative bleeding, and physiological parameters related to the general anaesthetic, as we considered these to be the outcomes of greatest importance to readers of the review. MAIN RESULTS: We included 14 trials in this review, with 1152 randomised participants. The studies were published between 1990 and 2009 and were conducted in the United Kingdom, Egypt, Saudi Arabia, and the United States. The age of participants ranged from 2 to 40 years. Three studies were at an overall high risk of bias, seven studies were at an unclear risk of bias, and we judged four studies to be at low risk of bias. The clinical heterogeneity of the included studies precluded pooling of studies in terms of method of administration of LA (e.g., intraligamental injection, infiltration injection, or topical delivery) and variation in the use of supplementary analgesics and follow-up time.Of the seven studies where administration of LA was by infiltration injection, six studies (very low-quality body of evidence, 542 participants analysed, 1 study had overall high risk of bias, 4 studies had overall unclear risk of bias, 1 study had overall low risk of bias) measured postoperative pain. The results were equivocal. There was a decrease in bleeding and increase in soft tissue damage in the LA groups, but we did not judge this to be clinically significant.In the 2 studies where administration of LA was by intraligamental injection, there was no difference in mean pain scores, and they did not report any soft tissue damage (very low-quality body of evidence, 115 participants analysed, 1 study had overall high risk of bias, 1 study had overall unclear risk of bias).One 3-armed study (very low-quality body of evidence, 54 participants analysed, overall high risk of bias) compared the effects of intraligamental and infiltration LA injection with no treatment. There was no evidence of a mean difference in pain, distress, or postoperative anxiety among the three groups.Four studies (very low-quality body of evidence, 343 participants analysed, 2 studies had overall low risk of bias, 2 studies had overall unclear risk of bias) evaluated the effects of topical LA compared with no treatment or placebo. One study (overall unclear risk of bias) with a no-treatment comparator reported lower mean pain in the LA group; all other studies reported no difference in mean pain scores. Two studies reported on bleeding (overall unclear risk of bias): One study reported a clinically insignificant increase in bleeding with no treatment; the other reported no difference.None of the studies reported on participant or child satisfaction. AUTHORS' CONCLUSIONS: In this review, it was difficult to reach firm conclusions as to the benefit of using local anaesthetic for dental treatment under general anaesthesia. The information reported in the included studies was comprehensive and applicable to the review question, but ultimately it was not sufficient to address the objective of the review. We were unable to pool the included studies in a meta-analysis because of substantial variation in outcome measures, interventions, and treatment types. The use of supplementary analgesia further obscured the effect of local anaesthetics.Based on the literature review and the results of this review, we recommend further randomised controlled trials that minimise bias through adequate allocation concealment and blinding of participants and assessors, and assess the effect of intraoperative local anaesthetic on the volume and type of anaesthetic used and on the cardiovascular system in participants receiving supplementary analgesics as well. Researchers should give consideration to the impact of any changes on the health and well-being of the participant and report baseline measures of pain or distress, or both, and preoperative anxiety.

Efeitos cardiovasculares da anestesia local de prilocaína 3 por cento com felipressina e lidocaína 2 por cento em normotensos / Cardiovascular effects of local anesthetic prilocaine with felypressin 3 per cent and licocaine 2 per cent in normotensive patients

Este estudo avaliou os efeitos cardiovasculares da anestesia via infiltrativa intrabucal de cloridrato de lidocaína a 2 por cento (20mg/mL) e cloridrato de prilocaína a 3 por cento (30 mg/mL) associado ao cloridrato de felipressina (0,03 U.1/mL) em pacientes normotensos. Foram selecionados 20 pacientes que sofreram dois procedimentos básicos de periodontia (RACR) bilateralmente, na região de molares superiores em consultas separadas com intervalo de uma semana. Na etapa de controle clínico foram monitoradas as pressões arterial sistólica (PAS), arterial distólica (PAD), arterial média (PAM) e a frequência cardíaca (FC) Ppor meio dos métodos oscilométrico e fotopletismográfico. Foram administrados dois tubetes na primeira sessão de Xilocaína 2 por cento (Grupo I) e dois tubetes de Citanest 3 por cento na última sessão (Grupo II). Os valores médios avaliados foram as nove etapas: 1) semana anterior (20 minutos); 2) na sala de espera (5 minutos); 3) na cadeira odontológica (5 minutos); 4) segundo minuto durante a primeira anestesia local (AL); 5) quinto minuto após a remoção da agulha; 6) segundo minuto durante a segunda AL; 7) quinto minuto após a remoção da agulha; 8) durante a execução do porcedimento clínico; 0) cinco minutos em repouso. A análise de variância (ANOVA) demonstrou que a lidocaína isolada não diferiu significativamente (p maior que 0,01) com a prilocaína com felipressina em relação à PS, PD, PM e FC, e mesmo entre as etapas clínicas. Para essa dose e via de administração, ambas soluções se mostram seguras clinicamente.

Prilocaína a 3% associada à felipressina na anestesia peribulbar de gatos / Prilocaine 3% associated with felipressin peribulbar anesthesia in cats

O objetivo deste trabalho foi avaliar os efeitos da prilocaina associada à felipressina na anestesia peribulbar em gatos. Foram utilizados oito gatos adultos, machos e fêmeas, com peso entre 2 e 3 kg. Cada animal recebeu clorpromazina (1,0 mg.kg-1 por via intramuscular) como medicação pré anestésica e propofol (3,0 mg.kg-1 por via intravenoso) para indução anestésica. Foi introduzida uma agulha hipodérmica de 0,38 x 13 mm moldada manualmente até atingir a forma de "L" na porção superior da cavidade orbitária em direção ao fórnice e administrada prilocaína a 3% com vasoconstritor na dose de 5 mg.kg-1. Foi observada proptose após uma média de 2,28 ± 1,52 minutos, e este efeito durou em média 75,22 ± 26,99 minutos. Também ocorreu perda do reflexo corneano após 3,00 ± 1,69 minutos e sua duração foi de 73,75 ± 17,98 minutos em média. A prilocaína 3% com vasoconstritor manteve o globo ocular concêntrico, sem nistagmo e aboliu os reflexos corneanos sem causar efeitos colaterais.

The purpose of this study was to verify the effects of prilocaine 3% associated to felypressin for peribulbar anesthesia in cats. Eight adult cats, male and female, weighing between 2 and 3 kg, received chlorpromazine (1.0 mg.kg-1, intramuscular) and propofol (3.0 mg.kg-1, intravenously). While, prilocaine at 3% (5.0 mg.kg-1) was administered by using an L-shape hypodermic needle (0.38 x 13 mm), which was introduced in the upper portion of the orbital cavity towards the fornix. The onset of proptosis was observed in 2.28 ± 1.52 minutes and lasted 75.22 ± 26.99 minutes. The loss of the corneal reflex occurred after 3.00 ± 1.69 minutes and lasted 73.75 ± 17.98 minutes. It can be concluded that 3% prilocaine with felypressin solution induces centralization of the eyeball without nistagmus and abolition the corneal reflexes without causing any collateral effects in cats.

Estudio histológico del proceso de reparación alveolar después de la aplicación tópica de la solución anestésica prilocaína 3 por ciento con felipresina 003 UI/ML / Histological study of alveolar repair process after topical application of the anesthetic solution with 3 percent prilocaine Felypressin 0.03 IU / ML

El objetivo de este estudio fue evaluar la influencia de una solución anestésica, compuesta por Prilocaina 3% y felipresina 0,03 UI/ml, y el efecto que tiene sobre el proceso de reparación alveolar en ratones después de una exodoncia. Este estudio fue aprobado por el Comité de Etica en Investigación del Programa de Maestría de Cirugía y Traumatologia Bucomaxilofacial de la Universidad de Marilia (UNIMAR) Marília, São Paulo, Brasil. Este estudio fue de tipo experimental, aleatorio controlado, con análisis bifactorial (grupo control en relación al grupo experimental, en función de los tiempos operatorios (2X4)). Se utilizaron 32 ratones (Rattus norvegicus, albinus, Wistar), machos, adultos, pesando entre 280 y 320 gramos. Los animales fueron distribuidos de la siguiente forma: 16 especímenes fueron seleccionados para grupo control (Grupo I), no recibieron ningún tratamiento adicional después de la extracción del incisivo superior derecho; los otros 16 especímenes restantes, después de la exodoncia, un área de la herida quirúrgica fue tamponada con gasa embebida en la solución anestésica de Citocaína 3%® (Clorhidrato de Prilocaína 3% con Felipresina 0,03 UI/ml), y conformaron el grupo experimental (Grupo II). Los animales sufrieron eutanasia transcurridos los períodos de 3, 7, 15, 24 días post operatorios. Através del análisis histológico y con base en la metodología desarrollada, nos permitió concluir que la solución anestésica de Citocaína 3%® aplicada con compresas de gasa sobre la herida quirúrgica post-extracción dentaria, produjo eventos tisulares que comprometieron los principios básicos responsables por la regeneración del epitelio de la mucosa gingival y por el proceso de reparación alveolar. Se observó que en todos los períodos post operatorios estudiados y cuando se compararon los dos Grupos, se confirmó que el Grupo I presentó mejores resultados en relación al proceso de reparación alveolar

O objetivo deste estudo foi avaliar a influência da solução anestésica, composta por Prilocaína 3% com felipressina 0,03 UI/ml, sobre o processo de reparación alveolar em ratos, após a extração dental. O presente estudo foi previamente aprovado pelo comitê de ética em pesquisa do Programa de Mestrado em Cirurgia e Traumatologia Buço-maxilo-faciais da Universidade de Marília (UNIMAR), Marília, São Paulo, Brasil. Tratou-se de um estudo do tipo experimental, aleatório controlado, com análise bifatorial (grupo controle em relação ao grupo experimental, em função dos tempos operatórios (2x4)). Utilizou-se 32 ratos (Rattus norvegicus, albinus, Wistar), machos, adultos, pesando entre 280 e 320 gramas. Os animais foram distribuídos da seguinte forma: 16 espécimes foram selecionados para o grupo controle (Grupo I), não receberam nenhum tratamento adicional após a extração do incisivo superior direito; os outros 16 espécimes restantes, depois da exodontia, a área da ferida cirúrgica foi tamponada com gaze embebida em solução anestésica de Citocaína 3%® (Prilocaína 3% com Felipressina 0,03 UI/ml), e formaram o grupo experimental (Grupo II). Os animais sofreram eutanásia após decorrido os períodos de 3, 7, 15, 24 dias pós-operatórios. Através da análise histológica e com base na metodologia aplicada, permitiu-nos concluir que a solução de Citocaína 3%® aplicada com compressas de gaze sobre a ferida cirúrgica após extração dentária, produz eventos teciduais que comprometeram os princípios básicos responsáveis pela regeneração do epitélio da mucosa gengival e o processo de reparação alveolar em ratos. Observou-se que em todos os períodos pós-operatórios estudados e quando se compararam os dois Grupos, confirmou-se que o Grupo I apresentou melhores resultados em relação ao processo de reparo alveolar

The aim of this study was to evaluate the local anesthetic solution, composed by Prilocaine 3% and felipressin 0,03 UI/ml, influence on the alveolar repair process in rats after dental extraction. This research was previously approved by the Ethic Committee in Research of the Masters Degree Program in Oral and Maxillofacial Surgery of the Marília University (UNIMAR), Marília, São Paulo, Brazil. It was an experimental, randomly controlled study, with bifactorial analysis (group control versus experimental group, in function of the postoperative times (2 X 4)). For the accomplishment of this study 32 rats were used (Rattus norvegicus, albinus, Wistar), males, adults, weighing between 280 and 320 grams. The animals were selected and divided into Group I (control) and Group II (Citocain 3%® - Prilocaine 3% with felipressin 0,03UI/ml) with 16 rats each; being four animals of the Group I and four of the Group II, destined to the euthanasia in the postoperative periods of 3rd, 7th, 15th and 24th days. The histological analysis with base in the developed methodology, allowed us to conclude that the anesthetic solution of Citocain 3%® applied with gauze compress on the surgical dental wound, produced tissue events that committed the basic biological principles, that are responsible for the regeneration of the gingival epithelium and the alveolar process repair in rats. The Group I presented better results in the alveolar repair when compared to the Group II

Estudo comparativo do uso do cloridrato de prilocaína a 3 por cento com felipressina a 0, 03 UI e do cloridrato de lidocaína a 2 por cento com adrenalina a 1: 100000 em pacientes hipertensos / Comparative study of the use of the prilocaine chloridrate at 3 per cent with felipressin at 0, 03UI and the lidocaine chloridrate at 2 per cent with epinephrine at 1: 100000 in the blood pressure of hypertensive patients

Este trabalho tem como objetivo avaliar comparativamente os efeitos da soluçäo anestésica de cloridrato de prilocaína a 3 por cento, com felipressina a 0, 03 UI, com a soluçäo anestésica de cloridrato de lidocaína a 2 por cento, com adrenalina a 1: 100000, sobre a a pressäo arterial (PA) de pacientes hipertensos submetidos a exodontias convencionais

Peribulbar anaesthesia: a double-blind comparison of three local anaesthetic solutions.

A prospective, randomised, double-blinded study comparing three agents for peribulbar anaesthesia is reported. Sixty patients undergoing extracapsular cataract extraction under local anaesthesia were randomly allocated to receive peribulbar anaesthesia with lignocaine 2% with adrenaline; prilocaine 3% with felypressin 0.03 IU.ml-1 or 2% lignocaine and 0.5% bupivacaine in a ratio of 1:1, using a standardised two-injection technique. The pain of injection, time of onset of the block and the operating conditions at the start and finish of surgery were assessed. Peribulbar anaesthesia using lignocaine 2% was significantly more painful than the other solutions. The onset of anaesthesia adequate for surgery was similar in all three groups. Prilocaine 3% with felypressin was associated with the greatest number of blocks providing total akinesia of the eye. Inadequate duration of anaesthesia was seen in only one case; the solution used for this block was 2% lignocaine.

A comparative study of anesthetic techniques for mandibular dental extraction.

PURPOSE: To compare the effectiveness of the intraligamentary technique of anesthetic administration (ILA) with the inferior alveolar nerve block (IANB) in extraction of mandibular teeth. MATERIALS AND METHODS: ILA and IANB injections using Citanest with Octapressin were administered on 16 patients requiring bilateral mandibular dental extractions. Discomfort during needle placement, profoundness of anesthesia obtained, and patient preference were evaluated for both techniques. RESULTS: A total of 45 teeth were extracted. Ten patients (62.5%) reported discomfort during needle placement with ILA injection compared to three patients (18.75%) with IANB (P = 0.031). Fifty percent (12/24) of teeth extracted with ILA injection were removed without discomfort to the patient compared to 85.7% (18/21) using IANB (P = 0.027). No difference in patient preference between the two techniques was noted.

Estudo comparativo de duas soluçöes anestésicas associadas à betametasona, no controle da dor decorrente da remoção de terceiros molares mandibulares inclusos / Compartive study of two anesthetic solutions combination with betamethasone, in the pain control decurrent of mandibular third molar surgery

Este trabalho teve por objetivo avaliar, de forma comparativa, a eficácia da administração pré-anestésica de betametasona, associada a duas preparaçöes anestésicas distintas - bupivacaína 0,5(por cento) com adrenalina 1:200.000 ou prilocaína 3(por cento) com felipressina 0,03 UI/mL -, no controle da dor pós-operatória decorrente da remoção de terceiros molares inferiores inclusos. Participaram deste estudo 30 paciente, de ambos os sexos, com os terceiros molares inferiores inclusos em posição simétrica, que receberam 4 mg de betametasona, em dose única, por via oral, 1 hora antes da intervenção, independente do lado operado. Para a técnica anestésica regional foi empregada uma ou outra das soluçöes anestésicas citadas, de acordo com o lado operado, designadas de forma aleatória e cruzada. A dor pós-operatória foi avaliada por um período de 48 horas, através de uma escala visual analógica (E.V.A) e do consumo de analgésicos (dipirona - comprimidos 500 mg), sendo que ao final do experimento os pacientes eram inquiridos sobre a preferência por um dos tratamentos. Os resultados mostraram a ocorrência de um menor grau de dor pós-operatória, com associação de betametasona à solução anestésica contendo bupivacaína, nas primeira 24 horas que se seguiram ao ato cirúrgico, não havendo uma diferença estatisticamente significante no dia subsequente à intervenção. Do total da amostra, 24 pacientes (80 por cento) preferiram o tratamento com a betametasona/bupivacaína, enquanto apenas 6 pacientes (20 por cento) manifestaram sua preferência pela associação do mesmo corticosteróide com a solução anestésica à base de prilocaína. Concluiu-se que ambos os tratamentos são eficazes - e portanto indicados no controle da dor pós operatória decorrente da remoção dos terceiros molares inferiores inclusos - sendo mais efetivo, nas primeiras 24 horas após a intervenção, o protocolo que incluiu a administração de betametasona e da solução anestésica à base de bupivacaína

Clinically safe dosage of felypressin for patients with essential hypertension.

Hemodynamic changes were evaluated in patients with essential hypertension when felypressin of various concentrations was administered. The parameters studied were systolic pressure, diastolic pressure, heart rate, left ventricular systolic phase, and endocardial viability ratio. Results showed that blood pressure tended to increase, and the value of 1/pre-ejection period2 (PEP2) tended to decrease, upon administration of 3 ml of 2% propitocaine containing 0.06 international units/ml (IU/ml) of felypressin. Significant increase of blood pressure and decrease in 1/PEP2 was noted upon administration of 3 ml of anesthetic solution containing 0.13 IU/ml of felypressin. No ischemic change of the myocardium was detected even with the highest felypressin concentration (3 ml of 2% propitocaine containing 0.25 IU/ml of felypressin). These results suggest that the clinically safe dosage of felypressin for patients with essential hypertension is approximately 0.18 IU. This amount is equivalent to 6 ml of 3% propitocaine with 0.03 IU/ml of felypressin, which is a commercially available local anesthetic for dental use. It seems that the decrease in 1/PEP2 that occurred during blood pressure increase was due to the increase in afterload caused by contraction of the arterioles. Although in the present study no ischemic change was noted, special care should be taken to prevent myocardial ischemia in patients with severe hypertension.

Effects of local anaesthesia on formalin-induced Fos expression in the rat dorsal horn.

A subcutaneous injection of formalin into foot pad of the rat produces a bimodal nociceptive response including an early intense response in the first 5 min and a later moderate response that is exhibited from 20 to 60 min after injection. In this study, we investigated the effects of blocking the early phase and late phase input, respectively, on Fos-like immunoreactivity (Fos-LI) expression in dorsal horn neurones. Rats of the early phase block (EB) group were injected with 5% formalin (0.05 ml) into the footpad 5 min after a s.c. injection of 4% lidocaine (0.15 ml) into the angle. The rats of the late phase block (LB) group were injected with 5% formalin into the footpad 10 min before the s.c. injection of 3% prilocaine (0.20 ml) containing felypressin into the ankle. The rats of the control group were given the formalin injection alone. Fos-LI was detected in the dorsal horn 2 h after the formalin injection. The numbers of Fos-LI neurones in the dorsal horn of both EB and LB group were markedly decreased compared with the control group, being 31.3% (laminae I-III of EB), 37.1% (laminae I-III of LB), 13.9% (laminae IV-VI of EB) and 16.2% (laminae IV-VI of LB) of the control values. No significant difference was observed between EB and LB group. These findings suggested that the early and late phase contribute in concert to the induction of genetic changes in dorsal horn neurones after formalin injection.

Prilocaine: an old anesthetic agent and a new ophthalmic procedure.

We present a new local anesthetic technique for ophthalmic surgery that reduces the risks associated with retrobulbar and peribulbar anesthesia. This method uses topical proparacaine plus 1.5 mL of prilocaine (3%) with felypressin injected into the subconjunctival (sub-Tenon's) space. Of 5210 consecutive adult patients in whom the technique was used, all demonstrated adequate analgesia. Sixty-three (1.2%) of the eyes required supplemental analgesia, provided by a single injection of prilocaine (0.5 mL). Ecchymosis and subconjunctival hemorrhage developed in 63 (1.2%) of the eyes. There were no instances of ptosis.

Avaliaçäo da eficácia e dos efeitos cardiovasculares da associçäo prilocaína + felipressina em procedimentos odontológicos / The evaluate the anesthetic efficacy and cardiovascular effects of the prilocaine + pelipressin association in odontological procedures

Este trabalho tem objetivo a avaliaçäo da eficácia anestésica e dos efeitos cardiovasculares, em pacientes submetidos a procedimentos cirúrgicos odontológicos, sob anestésico local. Foi montado um protocolo de pesquisa onde o Grupo I, de 40 pacientes, foi avaliado para avaliaçäo da eficácia e o Grupo II, de 20 pacientes, foi utilizado para avaliaçäo de eficácia, pressäo arterial e alteraçöes cardíacas. Para tando, estes pacientes foram monitorizados durante os procedimentos cirúrgicos. Os resultados mostraram que a associaçäo anestésica avaliada proporcionou eficácia global excelente e satisfatótia em 88,4 por cento dos casos, sendo que a mesma variou de acordo com o tipo de procedimento realizado. Quanto aos efeitos cardiovasculares, podemos dizer que nas condiçöes em que foi testada, a associaçäo prilocaína-felipressina näo foi responsável por nenhuma alteraçäo significativa e nem houve relato de reaçöes adversas

The effects of two different local anaesthetic solutions administered for oral surgery on plasma potassium levels in patients taking kaliuretic diuretics.

The effects of two different dental local anaesthetic solutions, administered for oral surgery, on the plasma potassium levels of patients taking non-potassium sparing diuretics has been investigated. There was a significant reduction in plasma potassium concentration in eight subjects who received 4.4 ml of 2% lignocaine with 1:80,000 adrenaline; the mean reduction from baseline being 0.30 mmol.l-1 10 min following intraoral extravascular injection of the local anaesthetic. There was no significant difference from the pre-treatment plasma potassium concentration 10 min following similar injections of 3% prilocaine with 0.03 IU.ml-1 felypressin in 8 patients; the mean change in these subjects being -0.05 mmol.l-1. It is suggested that the use of adrenaline-free local anaesthetics would seem to be appropriate in patients receiving kaliuretic diuretics.

[General complications in dental local anesthesia]. / Allgemeine Komplikationen bei der zahnärztlichen Lokalanästhesie.

In a prospective, randomised double blind study we recorded the rate of complications in dental anesthesia in more than 1500 patients using 4 commonly known anesthetic solutions. 228 of our patients (18.3%) noted headaches postoperatively. Furtheron we found syncopes, failures of anesthesia and nausea. Double vision was noticed once intraoperatively (Articain) and postoperatively (Lidocain). We found a high standard of security in dental local anaesthesia.

[Clinical comparison of Xylonest-Octapressin and Scandicain]. / Xylonest-Octapressin und Scandicain im klinischen Vergleich.

The local anaesthetics Xylonest 3% Octapressin and Scandicain have been clinically tested in a series of 220 consecutive patients. Both drugs were well tolerated. Xylonest gives an effect of middle long duration and produces sufficient ischaemia (1 hour). Scandicain is well suited for short interventions. Both drugs can be used in risk patients.

The effects of dental local anaesthetics on blood glucose concentration in healthy volunteers and in patients having third molar surgery.

The effects of adrenaline-containing and adrenaline-free dental local anaesthetic solutions on blood glucose concentration were investigated in single-blind cross-over studies in ten healthy volunteers and in ten patients having lower third molar surgery. The solutions compared were 2% lignocaine containing 1:80,000 adrenaline (Xylocaine) and 3% prilocaine with 0.03 IU/ml felypressin (Citanest). In all cases, 4.4 ml of solution was used. In the volunteer study the blood glucose concentration increased from 4.48 +/- 0.72 mmol/litre immediately before the injection of Xylocaine to 5.07 +/- 0.99 mmol/litre 30 minutes following the injection; with Citanest the pretreatment concentration of 4.56 +/- 0.92 mmol/litre changed to 4.24 +/- 0.62 mmol/litre at 30 minutes. This increase in blood glucose concentration following the administration of Xylocaine was significant (t = 3.39, P less than 0.01), as was the difference between treatments (t = 2.64, P less than 0.05). In the patient study, the blood glucose level prior to the injection of Xylocaine was 4.56 +/- 1.59 mmol/litre and this increased to 5.24 +/- 0.86 mmol/litre 30 minutes after the local anaesthetic was injected. The pretreatment blood glucose level of 4.52 +/- 0.82 mmol/litre in patients when Citanest was used changed to 4.33 +/- 0.71 mmol/litre 30 minutes following the injection. The difference at 30 minutes in the changes in blood glucose concentration between local anaesthetic regimes in patients having third molar surgery was significant (t = 2.60, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)