Ultrasonographic approach for a foot ganglion after sewing masks in the COVID-19 pandemic: Blessing in disguise.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. OBJECTIVE AND METHODS: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. RESULTS: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. CONCLUSION: In short, we highlight the importance of ultrasound examination in the management of work (overuse)-related disorders in occupational medicine practice.

Efficacy and tolerability of injectable collagen-containing products in comparison to trimecaine in patients with acute lumbar spine pain (Study FUTURE-MD-Back Pain).

Low back pain (LBP) represents an important subgroup of vertebrogenic pain with estimated prevalence around 80 %. Locally acting injectable collagen for topical application has recently extended the limited range of treatment options. The aim of the study was to evaluate the efficacy and safety of injectable collagen in patients with LBP. Patients suffering from LBP (< three months) were enrolled. They were administered either collagen 4 ml or trimecaine 1 % 4 ml in the form of subcutaneous paravertebral injections into eight pre-specified points (0.5 ml per each point) in the following schedule: two administrations in the first and second week, one in the third week. The pain intensity, Thomayer distance, Oswestry disability index, Lasseque test, quality of life, consumption of rescue medication and safety were evaluated. Exertional and rest pain, evaluated by a visual analogue scale, gradually decreased in both groups. Both treatments showed a statistically significant improvement in mobility and quality of life. The consumption of paracetamol as a rescue medication was significantly lower in patients treated with collagen than in the group treated with trimecaine (p=0.048). The analgesic efficacy of locally acting injectable collagen, as well as an analgesic sparing effect when compared to local anesthetics were demonstrated.

[Injection of anaesthetic-corticosteroid to relieve sacroiliac joint pain after lumbar stabilisation]. / Injekce anestetika s kortikoidem pri resení bolestí sakroilických kloubu po lumbálních stabilizacích.

PURPOSE OF THE STUDY: Both the range of motion and load transfer of the sacroiliac (SI) joint improve considerably after lumbar spine surgery. When, following surgery, SI joint pain develops in spite of appropriate physical therapy, injection of an anaesthetic with added corticosteroid into the SI joint is a first choice treatment. The aim of this presentation is to provide information on our experience with this therapy. MATERIAL AND METHODS: Thirty-four patients after lumbar spine fusion reported lumbalgia different form pain before surgery. In 14 (41%) of them, pain in one of the SI joints was diagnosed as the cause. This group included 12 women and two men at an average age of 56 (range, 47 to 68) years. Ten patients underwent lumbosacral fixation and four had segmental ("floating") lumbar spine fusion. All patients experienced lumbalgia at more than 3 months following surgery, at 8 months on the average (range, 4 to 12 months). None of them had SI joint pain before surgery. The diagnosis was based on specific manoeuvres on physical examination of the joint. Each patient was given an injection of 20 mg (0.5 ml) Methylprednisolone (Depo-Medrol®, Pfizer, Puurs, Belgium) and 4.5 ml 1% Mesocain (Zentiva, Praha, CR).They were inquired as to pain relief 24 h later and then at 1, 3 and 6 months after injection. Subjective feelings were assessed by a visual analogue scale (VAS). The results were analysed using descriptive statistics. RESULTS: All patients reported pain relief within 24 h of injection, but not its complete resolution. The average VAS score before and after the blockage of the SI joint was 9.1 points (8-10) and 4.8 points (2-7), respectively; this implies improvement by an average of 4.3 points (1-6), i.e., approximately by 47.3% (12.5-62.5). The duration of effects varied greatly from patient to patient. The average interval between injection and pain recurrence lasted for 5 weeks (1-28). Most frequently, relief was experienced for 2 weeks, or for 6.8 weeks with the standard deviation included. DISCUSSION Sacroiliac joint dysfunction is a very frequent cause of lumbalgia, particularly after lumbar spine surgery. Physical therapy may not always be effective. SI joint arthrodesis is indicated only in rare cases. One of the few possibilities of pain relief involves intra-articular injection of an anaesthetic with corticosteroid for booster effect. The treatment of SI joint blockage after spinal fusion has recently been dealt with in three reports in the international literature; their conclusions are in accordance with the results of this study. CONCLUSIONS: Lumbar spine stabilisation surgery may result in overloading the SI joints as the "adjacent segments". An intra-articular injection of anaesthetic can be considered a reliable method for ascertaining the SI joint as the source of a patient's problems. However, even with corticosteroid added, pain relief is not usually long-lasting.

Errors associated with the concentration of epinephrine in endonasal surgery.

This paper presents two cases of using erroneous concentrations of epinephrine during endonasal surgery. The two patients discussed were part of a larger study aimed at monitoring the absorption of epinephrine upon injection into the nasal mucosa. During this study, we observed major cardiovascular reactions in two consecutive patients--ventricular tachycardia with ventricular extrasystole and a significant rise in systolic and diastolic blood pressure and pulse rate. This state required pharmacological intervention. In hindsight, it was found that an erroneous application of ten times higher (1:10,000) concentration of epinephrine than the usual was injected. The applied solution was prepared in our institutional pharmacy and was labelled incorrectly (1:100,000 instead of 1:10,000). The authors have analysed the steps leading to the erroneous applications and recommend safety precautions for the prevention of errors in the concentration levels of epinephrine. Epinephrine injections in concentrations of 1:10,000, followed by analyses of epinephrine levels in venous blood, have not yet been described in available literature.

The epidural postoperative analgesia after a major urological procedures--a comparison of trimecaine and morphine to bupivacaine and fentanyl.

OBJECTIVES: To compare the analgesic potency and side effects of epidural combination trimecaine with morphine and bupivacaine with fentanyl in postoperative analgesia after a major urological surgery. METHODS: We randomised 150 consecutive patients. In the trimecain/morphine group (n = 75) trimecaine 50 mg with 4 mg morphine was given epidurally in 8 hour intervals. In the bupivacain/fentanyl group (n = 75) the infusion of 0.25 % bupivacaine and fentanyl 2 microg/ml was administered at an infusion rate of 8 ml/h. RESULTS: The postoperative pain scores were lower in the trimecain/morphine group, the difference was significant during the first 6 hours after surgery, there was also a trend toward higher postoperative SpO2 values in this group, the difference was significant 36 hours after surgery. The total sum of postoperative complications and side effects was significantly higher in the bupivacian/fentanyl group (p = 0.002). CONCLUSION: The combination of epidural trimecaine with morphine after a major urological surgery provides a superior analgesia with fewer side effects when compared to epidurally delivered bupivacaine with fentanyl (Tab. 2, Fig. 5, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Local administration of 2% trimecaine affects the content of fucosylated glycoconjugates in goblet cells in rabbit tracheal epithelium.

The proportion of fucosylated glycoconjugate-containing rabbit tracheal goblet cells after intratracheal application of trimecaine was studied to evaluate its possible unfavourable effects. This lapine model is comparable with diagnostic findings in humans because airway epithelia in humans and rabbits are similar; tracheal epithelium is also practically identical to bronchial epithelium in both species. Local trimecaine anaesthesia caused a proportional decrease in percentage of the tracheal goblet cells containing both alpha(1-2)- and alpha(1-6)-, alpha(1-3)- and alpha(1-4)-fucosylated glycoconjugates as revealed 10 min postexposure using lectin histochemistry. In previous studies, only mild ultrastructural damage to the airway's epithelium was revealed, but a conspicuous decrease in sialylated glycoconjugate-containing tracheal goblet cells and the dominance of acidic sulphated glycoconjugates were observed as after-effects of the same treatment. Glycoconjugate changes can influence the inner environment of airways (e.g. viscoelastic properties of the airways' mucus and mucosal barrier functions) and thus the patient's defence barriers in airways may be weakened. Concurrently, the histochemical properties of goblet cells can be altered in bronchoscopic specimens. Since trimecaine is widely used as local anaesthesia in airways in bronchoscopy, it is necessary to heed these aforementioned effects.

[Laboratory and clinical study of therapeutic efficacy of medicinal films for surgical procedures]. / Laboratorno-klinicheskoe issledovanie terapevticheskoi éffektivnosti lekarstvennykh plenok khirurgicheskogo naznacheniia.

An analysis of the experimental data showed that anesthetic medicinal films (AMFs) offer an effective medicinal form for the treatment of suppurative inflammatory disorders(SIDs) of soft tissues. The results of preclinical experiments with AMFs showed evidence of anesthetic, antimicrobial, and hemostatic effects. The therapeutic effect was established in the course of clinical investigations and confirmed by the results of cytological, histological, morphological, and bacteriological testing. The experimental data indicate that AMF application offers a promising means of SID treatment. Further development of this medicinal form must lead to an increase in the therapeutic efficacy, decrease the drug dose, and reduce the probability of side effects during the treatment of SIDs in soft tissues of various localization.

[Magnetically-guided anesthetics based on highly dispersed iron powders coated by polyacrylamide]. / Magnitoupravliaemye anestetiki na osnove vysokodispersnykh poroshkov zheleza s poliakrilamidnym pokrytiem.

The effect of external magnetic field (direct and alternating) on the targeted delivery and distribution in body tissues of experimental animals of anesthetics (novocain, lidocaine, and trimecaine) immobilized on highly dispersed ferromagnetics with biocompatible coating was studied by the method of emission spectral analysis. The results are compared with the results obtained earlier on highly dispersed iron powders with dextran coating. The parameters for the powders with dextran coating are considerably lower than those for the magnetic carriers with the polyacrylamide coating.

[Infiltration of local anesthetics into the thyroid gland capsule for surgery and the postoperative period]. / Prínos infiltrace pouzdra stítné zlázy lokálním anestetikem pro operacní a bezprostrední pooperacní prubeh.

In a prospective randomized study the hypothesis was tested whether infiltration of the thyroid capsule by a local anaesthetic will reduce the haemodynamic response to surgical trauma, consumption of anaesthetics and opioids during surgery and will shorten the time of arousal. A total of 64 patients indicated for planned goitre surgery were divided at random into a control group (C, n = 32) and experimental group (LA, n = 32). The preoperative medication and anesthesia did not differ in the two groups. In group C into the thyroid capsule a maximum of 40 ml saline was administered, in LA the same volume of 0.5% trimecain. A highly significant difference was found (p < 0.001) in the incidence of hypertension during surgery (21 C vs. 5 LA) and the need of further pharmacological interventions (21 vs. 8). In the control group was a higher consumption (p < 0.95) of the opioid phentanyl (167.5 +/- 111 micrograms vs. 125 +/- 93.5 micrograms), a trend of longer arousal and the need to antagonize the effect of opioid (p < 0.1). The substitution of saline by a local anaesthetic for infiltration of the thyroid capsule is a safe and simple method leading to a reduction of cardiovascular complications during surgery.

[Some aspects of epidural anesthesia in patients with chronic renal insufficiency]. / Osobennosti epidural'noi anestezii u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

In 231 patient with chronic renal impairment (CRI) the quality was studied of epidural anesthesia with different doses and concentrations of lidocaine hydrochloride, prilocaine hydrochloride, trimecaine hydrochloride, and bupivacaine. In patients in the terminal stage of CRI placed on the program-hemodialysis, the use of standard concentrations and volumes of the local anesthetsic (LA) has been found out to be associated with lower levels of the sensory and motor blocks than in CRI-free patients or in other stages of CRI. Intensification of epidural anesthesia in the above patients is achieved through employing a higher concentration of LA or epidural administration of narcotic analgesics and/or cloffelin. Patients with other stages of CRI do not require the renal-insufficiency stage-dependent correction of LA dose, an optimum option being administration of 2% solution of lidocaine and prilocaine, 2.5% solution of trimecaine and 0.5% solution of bupivacaine, 1.5% ml, on the spinal segment in combination with adjuvant drugs.

The role of local anaesthetic inhalation during premedication before bronchoscopy.

In a prospective randomized study, the efficacy of local anaesthetic inhalation during premedication before bronchoscopic examination was evaluated. Eighty patients with chronic nonproductive cough were inhaling either nebulized anaesthetics (10 ml of 1% trimecain; 40 patients--group A) or an isotonic chlorine solution (40 patients--group B). This was followed by topical anaesthesia using spray and laryngeal syringe. Comparing the score of cough and episodes of gagging, the inhalation of local anaesthetics appeared to make the procedure slightly more comfortable for some patients. Additional anaesthesia was less frequently needed in group A than in group B (12 vs. 19 patients). However, none of the observed differences reached statistical significance. In conclusion, the inhalation of local anaesthetics at the beginning of premedication before bronchoscopy was not confirmed as a useful method that made the examination more comfortable for patients with chronic non-productive cough, but did produce a moderately beneficial effect in some of them.

[Epidural anesthesia using local anesthetics and clopheline in geriatric urology]. / Epidural'naia anesteziia s ispol'zovaniem mestnykh anestetikov i klofelina v geriatricheskoi urologii.

Study of pharmacokinetics of lidocaine, trimecaine, and clofelin demonstrated rapid resorption of these drugs in the postoperative period. Comparison of two methods of epidural anesthesia in high-risk patients (ASA 3) subjected to urologic surgery showed the objective advantages of adrenergic regional anesthesia, ensuring the stability of vital functions during surgery and allowing operations in awaken patients with adequate spontaneous respiration.

[A new method of administering analgesic sedation before gastroscopy--a comparative study of 100 patients]. / Nová forma aplikace analgosedace pred gastroskopií--srovnávací studie 100 nemocných.

The authors administered to two groups (56 and 44) patients before gastroscopy analgosedation-5 mg diazepam and local anaesthesia of the throat. To the first group diazepam was administered by the i.v., to the second group by the sublingual route. The objective was to find out whether analgosedation is desirable from the patients aspect and whether the sublingual form of premedication is accepted by the patients. The authors found that 90% of the patients wish to have analgosedation and anaesthesia before the procedure. The sublingual form of administration was accepted by 89% of the patients.

[Distribution of anesthetics immobilized on finely dispersed iron powders in the organism of experimental animals]. / Raspredelenie immobilizovannykh na vysokodispersnykh poroshkakh zhelezaanestetikov v organizme eksperimental'nykh zhivotnykh.

Directed delivery and distribution of anaesthetics (novocaine, lidocaine, trimecaine) immobilized on finely dispersed iron powders under the influence of an external magnetic field in body tissues of test animals have been studied. The data of emission spectral analysis relating to concentration of iron in soft and bone tissues of animals influenced by constant and alternating magnetic field on front and reverse sides over a period from 0 to 180 min are given.

[Anatomic distribution of anesthetic solutions in the orbit after subconjuctival, parabulbar and retrobulbar administration]. / Anatomická distribúcia anestetického roztoku v orbite pri subkonjunktiválnej, parabulbárnej a retrobulbárnej aplikácii.

Authors evaluated anatomical distribution of 1% Mesocain solution with subconjuctival (SC), parabulbar (PB) and retrobulbar (RB) applications by ultrasonographic orbital examination. At SC application was not expressive mobilization of bolus. At PB and RB applications were observed dependence between bolus dislocation (mm) and quantity injected bolus (ml). At PB and RB applications were recorded expressive mobilization of injected bolus at orbit.

[The effect of trimecaine on allergic reactions in rabbits]. / Vliianie trimekaina na allergicheskie reaktsii krolikov.

The topical anesthetic trimecaine given to rabbits in a dose of 10 mg/kg attenuated the severity of anaphylaxis, lowered the anaphylactic index, substantially reduced the rates of animals' death from anaphylactic shock. The drug used in a dose of 1 mg/kg slightly had effects on experimental anaphylaxis. Trimecaine affected the rabbit total lipid/phospholipid ratio which had its own specific features in intact, sensitized and anaphylactic animals. It is suggested that the antiallergic effects of trimecaine are associated with the ability of the agent to change the receptor characteristics of target cells in allergy enhanced by its interaction with lipid complexes of the cell membrane.

[A comparative evaluation of the effects of local anesthetics combined with morphine and administered epidurally]. / Sravnitel'naia otsenka deistviia mestnykh anestetikov v sochetannii s morfinom pri ikh épidural'nom vvedenii.

The authors compare the efficacies of trimecaine (8 mg/kg), lidocaine (8 mg/kg), azacaine (2 and 3 mg/kg) alone and in combination with morphine (1.2 mg/kg), administered epidurally. Analgesia efficacy and duration were assessed by the electrostimulation method in experimental rabbits. First the pain threshold was defined, then the tested drugs were injected epidurally; the degree of the pain threshold rise permitted a judgment on the analgetic effect of the drugs. Combined injection of morphine and any of the tested anesthetics to the epidural space considerably prolonged the analgesia. The duration of the analgetic effect was the longest (over 24 h) with azacaine-based mixtures. Preliminary injection of morphine (1 h before azacaine) was conducive to a more rapid development of the epidural block and a more smooth course of analgesia. Experiments with mice have shown that addition of morphine to azacaine in the before volumes did not change azacaine toxicity.

[Combined action of anti-arrhythmia agents]. / Sochetannoe kombinirovannoe deistvie antiaritmicheskikh sredstv.

A significant potentiation of antiarrhythmic effect was observed in 121 dogs with arrhythmias 24 and 48 hours after the coronary artery ligation when the following drugs were combined: N-propylajmaline bromide (1A class) and trimecaine (1B class), quinidine (1A class) and trimecaine, N-propylajmaline bromide and anaprilin (2 class). The potentiation is attributed to the different molecular mechanisms of action of the drugs.

[Sacral epidural anesthesia as a method in technically complicated abortions]. / Epidural'no-sakral'naia anesteziia kak metod obezbolivaniia tekhnicheski slozhnykh abortov.

An experience is reported with the use of epidural-sacral anesthesia for artificial abortion in 102 primiparae+- and nulligravidas and in 86 patients with scarring deformity or partial atresia of the endocervix. Two percent trimecaine was used in a single dose 6 mg/kg. A high efficiency of anesthesia was seen in 92% of cases. There was a significant relaxation of the cervix which facilitated cervical dilation and reduced the incidence of tissue injury. The population under study showed a lower incidence of intraoperative blood loss and early postabortal complications as compared with a population which received other anesthesia. These results suggest that epidural-sacral anesthesia is a promising technique for artificial abortion in primiparae+- and nulliparous women and in women with scarring cervical lesions.