Injectable and topical local anesthetics for acute dental pain: 2 systematic reviews.

BACKGROUND: Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction and in patients with symptomatic irreversible pulpitis. TYPES OF STUDIES REVIEWED: The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the US Clinical Trials registry through November 21, 2020. The authors included randomized controlled trials (RCTs) comparing long- vs short-acting injectable anesthetics to reduce pain after tooth extraction (systematic review 1) and evaluated the effect of topical anesthetics in patients with symptomatic pulpitis (systematic review 2). Pairs of reviewers screened articles, abstracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. The authors assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Fourteen RCTs comparing long- vs short-acting local anesthetics suggest that bupivacaine may decrease the use of rescue analgesia and may not result in additional adverse effects (low certainty evidence). Bupivacaine probably reduces the amount of analgesic consumption compared with lidocaine with epinephrine (mean difference, -1.91 doses; 95% CI, -3.35 to -0.46; moderate certainty) and mepivacaine (mean difference, -1.58 doses; 95% CI, -2.21 to -0.95; moderate certainty). Five RCTs suggest that both benzocaine 10% and 20% may increase the number of people experiencing pain reduction compared with placebo when managing acute irreversible pulpitis (low certainty). PRACTICAL IMPLICATIONS: Bupivacaine may be superior to lidocaine with epinephrine and mepivacaine with regard to time to and amount of analgesic consumption. Benzocaine may be superior to placebo in reducing pain for 20 through 30 minutes after application.

Complications following equine sacroiliac region analgesia are uncommon: A study in 118 horses.

BACKGROUND: Diagnosis of sacroiliac region pain is supported by a positive response to sacroiliac region analgesia (SIRA). Varying techniques have been described for SIRA; with clinician preference often dictating method. Potential complications following SIRA include ataxia and recumbency. No study has specifically evaluated the prevalence of complications. OBJECTIVES: To describe the complication prevalence following SIRA in a referral clinic. STUDY DESIGN: Retrospective cohort study. METHODS: Review of records from horses presented to two of the authors at Rossdales, Newmarket, between January 2014 and December 2018, that underwent SIRA. Injection was performed using a blind midline approach with 20 mL mepivacaine (Intra-Epicaine 20mg/ml; Dechra) infiltrated through a straight 18 gauge 8.9cm spinal needle subdivided into four sub-locations per block. RESULTS: 118 horses were included, with 167 individual blocks. One horse showed a mild hindlimb gait abnormality following SIRA, which resolved uneventfully over 3 hours; complication rate 1/118 horses (0.85%; 95% CI: 0,2.5%), 1/167 joints (0.60%; 95% CI: 0,1.8%). SIRA subjectively improved lameness/performance in 132/167 (79%) joints. 49/118 (42%) received bilateral SIRA with 53/118 (45%) evaluated ridden following SIRA. MAIN LIMITATIONS: Small population numbers with low complication prevalence rate. CONCLUSIONS: SIRA, using the described technique, has a low (0.85%) prevalence of complications.

Capsaicin-Cyclodextrin Complex Enhances Mepivacaine Targeting and Improves Local Anesthesia in Inflamed Tissues.

Acidic environments, such as in inflamed tissues, favor the charged form of local anesthetics (LA). Hence, these drugs show less cell permeation and diminished potency. Since the analgesic capsaicin (CAP) triggers opening of the TRPV1 receptor pore, its combination with LAs could result in better uptake and improved anesthesia. We tested the above hypothesis and report here for the first time the analgesia effect of a two-drug combination (LA and CAP) on an inflamed tissue. First, CAP solubility increased up to 20 times with hydroxypropyl-beta-cyclodextrin (HP-ß-CD), as shown by the phase solubility study. The resulting complex (HP-ß-CD-CAP) showed 1:1 stoichiometry and high association constant, according to phase-solubility diagrams and isothermal titration calorimetry data. The inclusion complex formation was also confirmed and characterized by differential scanning calorimetry (DSC), X-ray diffraction, and 1H-NMR. The freeze-dried complex showed physicochemical stability for at least 12 months. To test in vivo performance, we used a pain model based on mouse paw edema. Results showed that 2% mepivacaine injection failed to anesthetize mice inflamed paw, but its combination with complexed CAP resulted in pain control up to 45 min. These promising results encourages deeper research of CAP as an adjuvant for anesthesia in inflamed tissues and cyclodextrin as a solubilizing agent for targeting molecules in drug delivery.

Using chloroprocaine for spinal anaesthesia in outpatient knee-arthroscopy results in earlier discharge and improved operating room efficiency compared to mepivacaine and prilocaine.

PURPOSE: Knee arthroscopies are regularly carried out in an outpatient setting. The purpose of this retrospective analysis was to investigate the impact of different local anaesthetics for spinal anaesthesia on operating room efficiency (perioperative process times) and postoperative recovery. This study aims to determine the optimal LA for SPA in patients undergoing knee arthroscopy at a day-surgery centre. METHODS: Anaesthesia records of all patients undergoing knee arthroscopy under spinal anaesthesia from 2010 until 2017 were analysed. Patients were categorised as having received spinal anaesthesia with prilocaine, mepivacaine or chloroprocaine. RESULTS: Three-hundred and nine patients were included. Postoperative recovery was significantly faster for chloroprocaine 1% compared with both other local anaesthetics regarding all stages of recovery until discharge. Perioperative processes and surgery time were significantly shorter when chloroprocaine was used. Early postoperative pain occurred more frequently and earlier after spinal anaesthesia with chloroprocaine. Nevertheless, pain intensity did not differ between groups. CONCLUSION: Spinal anaesthesia provides reliable blocks for outpatient knee arthroscopy. Considerations on the choice of local anaesthetic for spinal anaesthesia must include not only the recovery profile, but also the impact on operating room efficiency. Due to a superior recovery profile, low incidences of adverse side effects and raised operating room efficiency, chloroprocaine is the recommendable local anaesthetic for spinal anaesthesia in patients undergoing knee arthroscopy in an ambulatory setting. Since the frequency of SPA in patients undergoing outpatient knee arthroscopy is rising yearly, the results of this study are of high clinical relevance. The use of chloroprocaine leads to improved recovery, optimized perioperative processes and consecutively to a raised OR efficiency. LEVEL OF EVIDENCE: III.

Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial.

The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia. Seventy-two volunteers completed all parts of the study. Significant differences, which indicated better effectiveness of Me2 compared to Ar4, were observed in the following tests: reduction in blood flow (larger in the Me2 group); anaesthetized area at 30min (larger in the Me2 group); pressure tests; temperature tests after 20min; fine and discriminatory proprioception tests after 20min. The volunteers' perception of anaesthesia at 30, 40, 50, and 60min was superior for Me2 at all recorded time points. The duration of anaesthesia was also superior for Me2. The overall performance of Me2 was superior to Ar4, implying that Me2 provides a more effective anaesthesia in terms of depth, extent, and duration.

Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years' follow up.

The aim was to analyse the short-term and long-term therapeutic efficacy of dextrose prolotherapy for dislocation or subluxation (hypermobility) of the temporomandibular joint (TMJ). Sixty-one patients with symptomatic hypermobility of the TMJ were included in this single-arm prospective study, in which they were each given four sessions of intra-articular and pericapsular injections six weeks apart. Each injection comprised 10% dextrose/mepivacaine solution 3ml. Clinical outcomes including severity of pain on movement according to the numerical rating scale (NRS), maximal interincisal opening, clicking, and frequency of locking were measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment). Condylar translation and osseous changes of each joint were evaluated at T1 and T4 using tomography. There was significant reduction in all variables by T2 (p<0.001, p<0.001, p=0.006, and p<0.001). The pain scores (p<0.001) and clicking (p<0.001) had decreased significantly by T3. Linear tomograms of each joint at T1 and T4 showed no alteration in the morphology of the bony components of the joint, and at T4, tomographic open views of all joints showed condylar hypertranslation. Dextrose prolotherapy provided significant and sustained reduction of pain and recovery of constitutional symptoms associated with symptomatic hypermobility of the TMJ without changing either the position of the condyle or the morphology of the bony components of the joint.

Duración de bloqueo axilar con mepivacaína 1.5% en pacientes con insuficiencia renal crónica programados para fístula arteriovenosa. Estudio casos-controles / Axillary brachial plexus block duration with mepivacaine in patients with chronic renal failure. Case-control study

Introducción. El bloqueo del plexo braquial para la creación de fístula arteriovenosa (FAV) ha demostrado buenos resultados, si bien algunos autores han evidenciado una duración del bloqueo inferior al de los individuos sanos, probablemente por cambios en el flujo arterial regional. Nuestro objetivo fue evaluar la duración del bloqueo axilar con mepivacaína al 1,5 % en pacientes con insuficiencia renal crónica programados para FAV y compararlo con controles sanos. Métodos. Se incluyó a pacientes con insuficiencia renal crónica en hemodiálisis, llevados por primera vez para la creación de una FAV (GIRC). Se compararon con pacientes sin insuficiencia renal (GC), con características antropométricas similares; todos bajo bloqueo axilar ecoguiado con 20mL de mepivacaína al 1,5%. Se evaluaron el tiempo de latencia, el flujo y el diámetro de la arteria humeral pre y posbloqueo, así como la duración del bloqueo. Resultados. Se incluyó a 23 pacientes (GIRC: 12 y GC: 11). No se observaron diferencias en la latencia (GIRC: 13±5min vs. GC: 12,2±3min, p=0,477) ni en la duración del bloqueo (GIRC: 227±43min vs. GC: 229±27min, p=0,781). El flujo pre y posbloqueo fue significativamente menor en el GIRC (prebloqueo: GIRC: 52±21ml/min, GC: 100±62ml/min, p=0,034, y posbloqueo: GIRC: 130±57ml/min y GC: 274±182ml/min, p=0,010). No existió una correlación significativa entre la duración y el flujo arterial de la extremidad prebloqueo (rho de Spearman: 0,106; p=0,657) ni posbloqueo (rho de Spearman: 0,267; p=0,254). Conclusión. La duración del bloqueo axilar con mepivacaína al 1,5% en pacientes con insuficiencia renal crónica llevados por primera vez para creación de fístula arteriovenosa no es menor con respecto al grupo control y el flujo vascular como variable hemodinámica de la extremidad bloqueada no parece desempeñar un papel importante en la duración del mismo (AU)

Introduction. Regional anaesthesia is commonly preferred for arteriovenous fistula (AVF) creation. Previous studies suggest a shorter block duration in patients with chronic renal failure, maybe because of the changes in regional blood flow. The aim of our study was to evaluate the duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure scheduled for AVF compared with healthy controls. Methods. Patients scheduled for AVF creation for the first time (GIRC) were included. They were compared with patients without renal failure (GC), with similar anthropometric characteristics. Ultrasound-guided axillary blocks with 20mL of 1.5% mepivacaine were performed on all patients. We evaluated onset time, humeral artery diameter and blood flow before and after the block, as well as the block duration. Results. Twenty-three patients (GIRC: 12 and GC: 11) were included. No differences between groups were observed in block duration (GIRC: 227±43min vs GC: 229±27min; P=.781), or in onset time (GIRC: 13±5min vs GC: 12.2±3min; P=.477). The humeral blood flow before and after block was significantly lower in the GIRC (pre-block: GIRC: 52±21ml/min GC: 100±62ml/min; P=.034 and p ost block: GIRC: 130±57ml/min and GC: 274±182ml/min; P=.010). There was no significant correlation between the duration of the block and the preblock humeral blood flow (Spearman Rho: 0.106; P=.657) or the postblock humeral blood flow (Spearman Rho: 0.267; P=.254). Conclusion. The duration of the axillary block with 1.5% mepivacaine in patients with chronic renal failure was similar to that of the control patients. The duration of axillary brachial plexus block seems not to be related to changes in regional blood flow (AU)

Estimación del volumen de anestésico local en contacto con el nervio ciático en el bloqueo poplíteo / 3D ultrasound estimation of the effective volume for popliteal block at the level of division

La administración del anestésico local en el tejido conectivo que une los componentes tibial y peroneo del nervio ciático a nivel de su división en el hueco poplíteo produce una distribución muy eficiente de anestésico para conseguir un bloqueo efectivo. Mediante ecografía en 3dimensiones podemos cuantificar este volumen de contacto en una longitud determinada del nervio. Métodos. Se incluyó a 20 pacientes consecutivos programados para cirugía de hallux valgus. En todos los casos se realizó un bloqueo poplíteo ecoguiado en la división del nervio ciático, en abordaje «fuera de plano» con el paciente en decúbito prono. Se administraron 30ml de anestésico local y se evaluó su difusión. Se realizó una adquisición volumétrica del nervio ciático antes e inmediatamente después de finalizar la inyección del fármaco para cuantificar el volumen del nervio ciático y el volumen contenido en el interior del tejido conectivo que envuelve ambos componentes del nervio ciático; todo ello en un segmento de 5cm de nervio. Resultados. Todos los bloqueos fueron efectivos a los 20 min. El volumen de anestésico local contenido en el interior del tejido conectivo fue de 6,8±2,6cm3. De este volumen, 4,4±1,7cm3 se situaban en el halo que envolvía los componentes del nervio y 2,4±1,7cm3 se ubicaban en el interior del nervio ciático o sus componentes. Conclusiones. El volumen en contacto con el nervio ciático puede ser estimado mediante la adquisición volumétrica. Nuestros resultados indican que el volumen para el bloqueo efectivo del nervio ciático a nivel poplíteo quizás se podrá reducir de forma significativa en un futuro (AU)

Local anaesthetic injection between the tibial and commmon peroneal nerves within connective tissue sheath results in a predictable diffusion and allows for a reduction in the volume needed to achieve a consistent sciatic popliteal block. Using 3D ultrasound volumetric acquisition, we quantified the visible volume in contact with the nerve along a 5cm segment. Methods. We included 20 consecutive patients scheduled for bunion surgery. Ultrasound guided popliteal block was performed using a posterior, out of plane approach at the level of división of the sciatic nerve. Thirty ml of mepivacaine 1.5% and levobupivacaine 0.5% were slowly injected while assessing the injection pressure and the diffusion of the local anaesthetic. Volumetric acquisition was performed before and after the block to quantify the the volume of the sciatic nerve and the volume of the surrounding hypoechoic halo contained inside the connective tissue in a 5cm segment. Results. All blocks were successful within 20min after the injection. The total estimated volume contained inside the common connective tissue sheath was 6.8±2.6cm3. Of this, the volume of the halo sorrounding the nerve was 4.4±1.7cm3 and the volume inside the sciatic nerve was 2.4±1.7cm3. Conclusions. The volume of local anaesthetic in close contact with the sciatic nerve can be estimated by volumetric acquisition. Our results suggest that the effective volume of local anaesthetic needed for a successful sciatic popliteal block could be reduced to less than 7ml (AU)

Multi-Acupuncture Point Injections and Their Anatomical Study in Relation to Neck and Shoulder Pain Syndrome (So-Called Katakori) in Japan.

Katakori is a symptom name that is unique to Japan, and refers to myofascial pain syndrome-like clinical signs in the shoulder girdle. Various methods of pain relief for katakori have been reported, but in the present study, we examined the clinical effects of multi-acupuncture point injections (MAPI) in the acupuncture points with which we empirically achieved an effect, as well as the anatomical sites affected by liquid medicine. The subjects were idiopathic katakori patients (n = 9), and three cadavers for anatomical investigation. BL-10, GB-21, LI-16, SI-14, and BL-38 as the WHO notation were selected as the acupuncture point. Injections of 1 mL of 1% w/v mepivacaine were introduced at the same time into each of these points in the patients. Assessment items were the Pain Relief Score and the therapeutic effect period. Dissections were centered at the puncture sites of cadavers. India ink was similarly injected into each point, and each site that was darkly-stained with India ink was evaluated. Katakori pain in the present study was significantly reduced by MAPI. Regardless of the presence or absence of trigger points, pain was significantly reduced in these cases. Dark staining with India ink at each of the points in the anatomical analysis was as follows: BL-10: over the rectus capitis posterior minor muscle and rectus capitis posterior major muscle fascia; GB-21: over the supraspinatus muscle fascia; LI-16: over the supraspinatus muscle fascia; SI-14: over the rhomboid muscle fascia; and BL-38: over the rhomboid muscle fascia. The anatomical study suggested that the drug effect was exerted on the muscles above and below the muscle fascia, as well as the peripheral nerves because the points of action in acupuncture were darkly-stained in the spaces between the muscle and the muscle fascia.

Safety of CT-Guided Lumbar Nerve Root Infiltrations. Analysis of a Two-Year Period.

Selective nerve root infiltrations are frequently performed in patients with lumbar radiculopathy. Computed tomography (CT) is now commonly used for image guidance. Despite the widespread use of CT-guided lumbar nerve root infiltrations few studies have systematically examined the safety of this approach. In a two-year period, 231 lumbar nerve root infiltrations were performed on in-patients and were retrospectively reviewed. No major complications like inflammation (especially spondylodiscitis), large haematomas requiring surgery, severe allergic reactions or spinal ischaemia occurred. In accordance with other published studies, CT-guided lumbar nerve root infiltrations seem to be safe. To minimize the risk of catastrophic neurological complications due to spinal ischaemia, careful needle placement dorsal to the nerve root and the use of a non-particulate corticosteroid, like dexamethasone, are advocated.

High-energy feedback microwave thermotherapy and intraprostatic injections of mepivacaine and adrenaline: an evaluation of calculated cell kill accuracy and responder rate.

OBJECTIVE: The aim of this study was to evaluate cell kill accuracy and responder rate when using injections of intraprostatic mepivacaine and adrenaline (MA) before high-energy microwave thermotherapy (HE-TUMT). MATERIAL AND METHODS: This retrospective evaluation encompassed 283 treatments in men with lower urinary tract symptoms or urinary retention due to benign prostatic hyperplasia. They were treated consecutively during 2003-2008 using HE-TUMT with a feedback technique. Immediately before treatment, MA was administered into the prostate via a Schelin Catheter®. Clinical outcome was evaluated 3 months after treatment using a validated symptom score, transrectal ultrasound, peak urinary flow and postvoid residual. RESULTS: Systematic underestimation of the resulting coagulation necrosis was a consistent finding when using MA, a calculated cell kill of 21% yielding a volume reduction of 26% for prostate volumes less than 100 ml and 31% for prostate volumes greater than or equal to 100 ml. Mean prostate volume was 74 ml and mean treatment time was 13 min. Less than 1% of the patients needed analgesics or sedatives on demand. Analysis of the data showed an estimated clinical responder rate of approximately 87%. CONCLUSIONS: The resulting prostate volume reduction corresponds to the earlier empirically recommended 30% cell kill for CoreTherm® without MA. The treatment concept combining CoreTherm with intraprostatic injections of MA corresponds to the clinical outcome of thermotherapy without MA, with the benefits of reduced pain, shortened treatment time and decreased energy consumption.

Effect of anesthetizing individual compartments of the stifle joint in horses with experimentally induced stifle joint lameness.

OBJECTIVE: To evaluate the effects of sequential anesthesia of the individual compartments of the equine stifle joint on lameness induced by intra-articular deposition of interleukin (IL)-1ß. ANIMALS: 6 horses. PROCEDURES: For each horse, baseline hind limb lameness was first evaluated. A randomly selected compartment of 1 stifle joint was then injected with IL-1ß to induce synovitis and lameness; subsequently, the same compartment was anesthetized with 2% mepivacaine hydrochloride, and lameness was reevaluated. Two weeks later, baseline lameness was evaluated, and lameness was similarly induced; thereafter, the 2 synovial compartments of the stifle joint not injected with IL-1ß were anesthetized sequentially in random order (ie, first and second blocks); lameness was evaluated after each block. Finally, the IL-1ß-treated compartment was anesthetized (third block); lameness was again evaluated. This second experiment was repeated for the contralateral stifle joint 2 weeks later. Throughout the study, lameness was quantified objectively by assessing vertical pelvic movement asymmetry with a wireless, inertial sensor-based system. RESULTS: Intra-articular deposition of IL-1ß induced lameness in all injected limbs. In the first experiment, anesthesia of the compartment injected with IL-1ß resulted in a significant decrease in lameness, with vertical pelvic movement asymmetry approaching baseline. In the second experiment, lameness improved significantly after the second and third blocks and was almost completely abolished after all 3 synovial compartments were anesthetized. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, lameness caused by a lesion in 1 compartment of a stifle joint can be improved more by instillation of local anesthetic solution into that compartment than by anesthesia of the other compartments.

Comparación de la eficacia analgésica postoperatoria del bloqueo de los nervios tibial (a nivel de maléolo interno) y peroneo común con la infiltración de la herida quirúrgica en cirugía ambulatoria del hallux valgus / Comparison of the post-surgical analgesic effectiveness of tibial (at internal malleolus level) and common peroneal nerve block with infiltration of the surgical wound in Outpatient Surgery of the hallux valgus

Introducción. Comparar la eficacia analgésica postoperatoria del bloqueo de los nervios tibial a nivel del maléolo interno y peroneo común frente a la infiltración de la herida con anestésico local, en la cirugía ambulatoria del hallux valgus. Material y método. Ensayo clínico aleatorizado. Dos grupos de estudio, grupo BNP, bloqueo de los nervios peroneo común y tibial (con lidocaína 80mg y mepivacaína 100mg + levobupivacaína 25mg). y grupo INF, cirugía con anestesia intradural más infiltración de la herida quirúrgica (con 50mg de levobupivacaína). Se valoró mediante la escala visual analógica (1-10) el dolor durante las primeras 24h del postoperatorio, las necesidades de analgesia de rescate (tramadol), la incidencia de efectos secundarios y los reingresos por dolor. Resultados. Fueron incluidos un total de 111 pacientes (55 en el grupo BNP, 56 en el grupo INF). El 93% fueron mujeres con edad media de 59 (DE 10) años. El valor en la escala visual analógica promedio en las primeras 24h fue de 2,9 (DE 1,7) para el grupo BNP y de 2,7 (DE1,6) para el grupo INF (p=0,62). El 42% de los pacientes precisó analgesia de rescate con tramadol, sin que hubiera diferencias significativas entre grupos (p=0,28). Un 33% presentó efectos secundarios postoperatorios: náuseas, vómitos, retención urinaria, cefalea o dolor en la zona de punción, sin que existieran diferencias entre los 2 grupos. Un paciente del grupo INF tuvo que ingresar para tratamiento del dolor. Conclusiones. El bloqueo nervioso periférico y la infiltración de la herida son técnicas eficaces y equivalentes en el control domiciliario del dolor en la cirugía ambulatoria del hallux valgus, haciendo posible que estos procedimientos puedan ser realizados de forma segura en régimen ambulatorio(AU)

Introduction. To compare the post-operative analgesic effectiveness of blocking the posterior tibial and the common peroneal nerves against that of wound infiltration using local anaesthesia, in ambulatory surgery of hallux valgus. Material and methods. A randomised clinical study was conducted on ambulatory patients subjected to Hallux valgus surgery, assigned into two groups: BNP: peripheral nerve blockage: posterior tibial and the common peroneal with 80mg of lidocaine, 100mg of mepivacaine and 25mg of levobupivacaine. INF: surgical wound infiltration with 50mg of levobupivacaine. The following aspects were evaluated during the first 24h after surgery: pain level using a visual analogue scale (VAS), the need to use rescue analgesia, and the incidence of secondary effects and readmissions due to pain. Results. A total of 111 Patients were included (55 BNP, 56 INF), 93 per cent were women and the average age was 59 (SD10) years. The average VAS score in the first 24h was 2.9 (SD1.7) for the BNP group and 2.7 (SD1.6) for the INF group (P=.62). Less than half (42%) of patients needed rescue anaesthetic with tramadol, with no significant differences between the groups (P=.28). A 33 per cent had secondary postoperative effects were observed in 33% of cases, with a significant difference between INF and BNP (P=.01). One patient from INF group, had to be admitted for pain. Conclusions. The peripheral nerve block and wound infiltration are valid techniques for controlling pain at home after ambulatory surgery of hallux valgus, therefore both methods appear to be safe in an outpatient setting(AU)

Extracción de cuerpo extraño guiada con ecografía / No disponible

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Intraurethral prostate injections with mepivacaine epinephrine: effects on patient comfort, treatment time and energy consumption during high-energy transurethral microwave thermotherapy.

OBJECTIVE: To investigate the effects of intraprostatic mepivacaine epinephrine injections administered by the Schelin catheter during high-energy transurethral microwave thermotherapy (TUMT) using the CoreTherm Prostalund Feedback Treatment (PLFT) system. MATERIAL AND METHODS: The study included 85 men with lower urinary tract symptoms due to benign prostatic enlargement. One group had intraprostatic injections with mepivacaine epinephrine by the new Schelin catheter, while patients in the other group were treated without intraprostatic injections. All men were treated by TUMT using the PLFT system. Before treatment, transrectal ultrasound (TRUS) volume was measured. During the procedure, treatment time, energy consumption, cell-kill parameter and maximal prostate temperature were recorded. Patients who needed perioperative intravenous analgesics and the rate of perioperative and postoperative complications were registered. RESULTS: The patients who had intraprostatic and periprostatic injections with mepivacaine epinephrine had shorter effective treatment time and reduced energy consumption. There was also a difference between the two groups in that 70% of patients without intraprostatic injections and only 11% of injected patients needed intravenous analgesics. No differences were found in TRUS volume, estimated cell-kill, maximal prostate temperature or complication rates. CONCLUSIONS: Intraprostatic injections with mepivacaine epinephrine distributed by the Schelin catheter reduce the number of patients needing intravenous analgesics during PLFT, as well as the treatment time and energy consumption during treatment. Besides improved patient comfort, intraprostatic and periprostatic injections condense the treatment time without side-effects, making PLFT less cumbersome for most patients.

Efecto de la anestesia local en la respuesta al dolor. Estudio en la herniotomía inguinal / Effect of the local anesthesia in the response to the pain. Study in the inguinal herniotomy

Introducción. La herniotomía inguinal es un procedimiento quirúrgico común en cirugía pediátrica y como en cualquier intervención quirúrgica es fundamental el control del dolor. El objetivo de este estudio es comprobar el efecto de la anestesia local junto a la anestesia general, en el control del dolor postquirúrgico. Material y método. Se realiza un estudio prospectivo en 60 pacientes sometidos a reparación de hernia inguinal e hidrocele unilateral, bajo anestesia general. Los pacientes fueron designados al azar en tres grupos iguales después de la inducción anestésica. En el grupo I se realiza bloqueo ilio-inguinal, antes de la incisión quirúrgica. En el grupo IIse realiza infiltración local tras el cierre de la aponeurosis y en el grupo III no se infiltra anestésico local. La edad de los pacientes estuvo comprendida entre 1 y 13 años. Para la valoración del dolor y comparación entre los tres grupos utilizamos: 1) Mediciones de tipo conductuales.2) Mediciones de tipo biológico antes y después de la intervención: Tensión arterial, frecuencia cardiaca, frecuencia respiratoria… 3)Mediciones de laboratorio: niveles de cortisol, prolactina, insulina y glucosa. Se realizan dos extracciones, la primera después de la inducción anestésica y la segunda 60 minutos después de la intervención. Los resultados fueron analizados empleando el programa informático-estadístico SPSS. Un valor de probabilidad < 0,05 fue considerado significativo. Resultados. 1) Mediciones de tipo conductuales: Las diferencias entre los grupos I y II en relación con el III fueron significativas. Esta diferencia conductual también estuvo relacionada con la edad de los pacientes. 2) Mediciones de tipo biológico. En los grupos I y II la tensión arterial media postoperatoria fue menor, pero solo en el grupo Il a diferencia fue significativa. La frecuencia cardiaca disminuyó en los tres grupos, pero significativa solo en el grupo I, al igual que la frecuencia respiratoria. 3) Mediciones de laboratorio: En los grupos I y II los niveles de cortisol y glucosa disminuyeron en el postoperatorio, pero sólo en el grupo I la diferencia fue significativa. Los valores de prolactina sólo disminuyeron en el postoperatorio en el grupo I pero no fue significativo. La insulina experimentó un aumento en los tres grupos, aunque menor en el grupo I. Conclusiones. 1) Los resultados del estudio demuestran que la infiltración local de anestésico disminuye la respuesta metabólica y reduce la intensidad del dolor postoperatorio, especialmente cuando se realiza antes del comienzo de la cirugía. 2) En la respuesta conductual al dolor no solo influye la utilización de anestésico local si no también la edad del paciente (AU)

Introduction. The inguinal herniotomy is a surgical procedure common in pediátric surgery and as in any operation the control of the pain is fundamental. The aim of this study is to verify the effect of the local anesthesia next to the general anesthesia, in the control of postsurgicalpain. Material and method. A prospective study is made in 60 patients submitted for unilateral repair of hernia inguinal and hydrocele, undergeneral anesthesia. The patients were designated at random in three equal groups after the anesthetic induction. In group I ilio-inguinal blockade is made, before the surgical incision. In group II local infiltration is made after the closing of the aponeurosis and in group III the anesthetic is not infiltrate. The age of the patients included was between 1and 13 years. For the valuation of the pain and comparison between the three groups we used: 1) Measurements of conductual type. 2) Measurements of biological type before and after the intervention: Arterial tension, cardiac frequency, respiratory frequency… 3) Laboratory measurements: cortisol levels, prolactose, insulin and glucose. Two extractions are made, first after the anesthetic induction and second60 minutes after the intervention. The results were analyzed using computer statistical program SPSS. A probability value of < 0,05 was consideredsignificant. Results. 1) Conductual measurements: The differences between groups I and II in relation to the III were significant. This conductual difference also was related to the age of the patients. 2) Measurements of biological type. In groups I and II the postoperative arterial tension average was smaller, but only in group I the difference was significant. The heart rate decreased in the three groups, but was significant only in group I, like the respiratory frequency. 3) Laboratory measurements: In groups I and II the levels of cortisol and glucose diminished in the postoperative period, but only in group I the difference was significant. The values of prolactose diminished in the postoperative period in group I but was not significant. Insulin experienced an increase in the three groups, although smaller in group I. Conclusions. 1) The results of the study demonstrate specially that the local infiltration of anesthetic diminishes the metabolic answer and reduces the intensity of the post operating pain, when is made before the beginning of the surgery. 2) In the conductual answer to the pain not only influences the use of the anaesthetics but the age of the patient (AU)

Toothache of nonodontogenic origin: a case report.

This article describes the diagnosis and treatment of a patient exhibiting nonodontogenic tooth pain. A 25-yr-old female patient presented to postgraduate endodontics, SUNY at Stony Brook, for evaluation and treatment of pain associated with the upper and lower left quadrants. After thorough intraoral and extraoral examinations, it was determined that the pain was referred to the dentition from a trigger point in the masseter muscle. An extraoral injection of 3% Carbocaine was administered into the trigger point, and the pain abated within 5 min. The patient has experienced no recurrence of this pain for 12 months. Consideration of nonodontogenic dental pain should be included in a differential diagnosis.

[Comparative efficiency of local anesthetics from the group of complex amides during therapeutic stomatological interventions]. / Sravnitel'naia éffektivnost' mestnykh anestetikov gruppy slozhnykh amidov pri vypolnenii terapevticheskikh stomatologicheskikh vmeshatel'stv.

The efficiency of infiltration, conduction, and intraligamental anesthesia with different drugs for dental interventions was evaluated in 331 patients without concomitant somatic diseases. The efficiency of local anesthesia depends primarily on the drug; other essential factors are the route of this drug administration and type of intervention in the oral cavity. The most effective of the studied anesthetics was 4% artisane with epinephrine 1:100,000; 3% prolocaine with epinephrine 1:100,000 ranked second. These anesthetics maximally realized their effects at intraligamental injection during the treatment of caries and periodontitis.