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1.
Am J Vet Res ; 81(6): 479-487, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32436793

RESUMO

OBJECTIVE: To compare the extent of inflammation and catabolic collagen response in the middle carpal joints (MCJs) of healthy horses following intra-articular injection of 2% lidocaine, 2% mepivacaine, lactated Ringer solution (LRS), or 0.1% methyl parahydroxybenzoate. ANIMALS: 17 adult horses. PROCEDURES: In the first of 2 experiments, the left middle carpal joint (MCJ) of each of 12 horses was injected with 10 mL of 2% lidocaine (n = 3), 2% mepivacaine (3), or LRS (control; 6). After a 4-week washout period, the right MCJ of the horses that received lidocaine or mepivacaine was injected with 10 mL of LRS, and the right MCJ of horses that received LRS was injected with 10 mL of 2% lidocaine (n = 3) or 2% mepivacaine (3). In experiment 2, the left MCJ of each of 5 horses was injected with 10 mL of 0.1% methyl parahydroxybenzoate. After a 48-hour washout period, the right MCJ of each horse was injected with 10 mL of LRS. Synovial fluid (SF) samples were aseptically collected before and at predetermined times after each injection. Synovial fluid WBC count, neutrophil percentage, and total protein, neutrophil myeloperoxidase, neutrophil elastase, and Coll2-1 concentrations were compared among treatments. RESULTS: Both lidocaine and mepivacaine induced SF changes indicative of inflammation and a catabolic collagen response, but the magnitude of those changes was more pronounced for lidocaine. Methyl parahydroxybenzoate did not cause any SF changes indicative of inflammation. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that mepivacaine was safer than lidocaine for intra-articular injection in horses.


Assuntos
Doenças dos Cavalos/tratamento farmacológico , Mepivacaína/uso terapêutico , Animais , Biomarcadores , Cavalos , Injeções Intra-Articulares/veterinária , Lidocaína/uso terapêutico , Líquido Sinovial
2.
Am J Vet Res ; 81(5): 394-399, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32343179

RESUMO

OBJECTIVE: To compare the speed of onset and analgesic effect of mepivacaine deposited within or immediately outside the neurovascular bundle at the base of the proximal sesamoid bones in horses. ANIMALS: 6 horses with naturally occurring forefoot-related lameness. PROCEDURES: In a crossover study design, horses were randomly assigned to receive 1 of 2 treatments first, with the second treatment administered 3 to 7 days later. Trotting gait was analyzed with an inertial sensor-based motion analysis system immediately before treatment to determine degree of lameness. Afterward, ultrasound guidance was used to inject 2% mepivacaine hydrochloride around the palmar digital nerves of the affected forelimb at the level of the base of the proximal sesamoid bones either within the subcircumneural space or outside the circumneural sheath. After injection, gait was reevaluated at 5-minute intervals for 45 minutes. RESULTS: Mepivacaine deposition outside the circumneural sheath did not resolve lameness in any horse; for 3 horses, the mean time to 70% reduction of initial vertical head movement was 13.3 minutes, and the remaining 3 horses had no such reduction at any point. Mepivacaine deposition within the subcircumneural space resulted in a mean time to 70% reduction of initial vertical head movement of 6.7 minutes and mean time to resolution of lameness of 21.7 minutes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that when peripheral nerves of horses lie within a sheath, local anesthetic solution should be deposited within the sheath for an effective nerve block. If local anesthetic solution is deposited outside the sheath, the nerve block may yield erroneous results.


Assuntos
Doenças dos Cavalos , Ossos Sesamoides , Analgésicos/farmacologia , Animais , Estudos Cross-Over , Membro Anterior , Marcha/efeitos dos fármacos , Cavalos , Coxeadura Animal , Mepivacaína/farmacologia
3.
Odontology ; 108(4): 626-635, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32040654

RESUMO

We sought to elucidate how the local administration of mepivacaine hydrochloride and vasopressin via the tail affects the peripheral blood flow volume, tissue dynamics, and mepivacaine's anesthetic effect in mice. Two-hundred and twenty-six male ICR mice were used in this study. Blood flow was measured after administering mepivacaine alone or mepivacaine with either 0.03, 0.3, or 3.0 U/mL vasopressin or 10 µg/mL epinephrine via the tail tissue. The tail tissue and blood dynamics were measured using 3H-labeled mepivacaine hydrochloride with vasopressin or epinephrine. The compound nerve action potential (CNAP) was measured to clarify the anesthetic effect after administering mepivacaine with 0.3 U/mL vasopressin. The statistical methods employed were Steel-Dwass test, Mann-Whitney U test, Dunnett's test, and Tukey test. P < 0.05 indicated statistical significance. The results revealed that the local administration of ≥ 0.03 U/mL vasopressin reduced local blood flow and prolonged 3H-M localization in the tail tissue in a concentration-dependent manner. Addition of 0.3 U/mL vasopressin enhanced and prolonged the anesthetic effect of mepivacaine. The findings suggest that adding vasopressin to a local anesthetic regimen may be effective, and thus it could be applied as a vasoconstrictor.


Assuntos
Anestésicos Locais , Mepivacaína , Anestesia Local , Animais , Masculino , Camundongos , Camundongos Endogâmicos ICR , Vasopressinas
4.
An Bras Dermatol ; 95(1): 82-90, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31952994

RESUMO

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.


Assuntos
Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Lidocaína/uso terapêutico , Mepivacaína/uso terapêutico , Hipersensibilidade a Drogas , Epinefrina/uso terapêutico , Humanos , Fatores de Risco , Fatores de Tempo
5.
Equine Vet J ; 52(5): 743-751, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31972065

RESUMO

BACKGROUND: Local anaesthetics are being combined clinically with amikacin in intravenous regional limb perfusion (IVRLP), with limited knowledge on the analgesia provided and its onset and duration of action after tourniquet application and release. OBJECTIVE: To evaluate the systemic clinical effect, limb withdrawal to nociceptive stimulation, and plasma and synovial fluid concentrations after IVRLP with lidocaine or mepivacaine in standing sedated horses. STUDY DESIGN: Prospective, controlled, randomised, cross-over study. METHODS: Six healthy adult horses were sedated and received IVRLP with lidocaine, mepivacaine or saline (negative control), or perineural anaesthesia of the medial and lateral palmar and palmar metacarpal nerves (positive control) in one forelimb with a 3-week washout period between trials. Electrical and mechanical stimuli were used to test nociceptive threshold of the limb before and after IVRLP/perineural anaesthesia. For lidocaine and mepivacaine trials, blood was collected from the jugular vein and synovial fluid from the radiocarpal joint before, during and out to 24 hours after IVRLP. Drug concentrations were measured using high-performance liquid chromatography. RESULTS: Nociceptive thresholds for lidocaine, mepivacaine and perineural anaesthesia trials were significantly increased compared with saline and baseline values at 10, 20 and 30 minutes, with no differences between anaesthetic trials. During this time, horses had lower heart rates than IVRLP with saline. After tourniquet release at 30 minutes, nociceptive thresholds for lidocaine and mepivacaine trials gradually returned to baselines, whereas perineural anaesthesia trial remained unchanged out to an hour. Plasma lidocaine and mepivacaine concentrations were ≤50 ng/mL while the tourniquet was in place, significantly increasing 10 minutes after tourniquet release. Maximal lidocaine and mepivacaine concentrations in synovial fluid were reached 25 minutes after IVRLP injection. MAIN LIMITATIONS: Amikacin was not included in the perfusate. CONCLUSION: Similar to perineural anaesthesia, IVRLP with lidocaine or mepivacaine provides anti-nociception to the distal limb in standing sedated horses while a tourniquet is applied with concentrations remaining below toxic levels in plasma and synovial fluid.


Assuntos
Anestesia por Condução/veterinária , Mepivacaína , Anestésicos Locais , Animais , Antibacterianos , Estudos Cross-Over , Membro Anterior , Cavalos , Lidocaína , Estudos Prospectivos , Líquido Sinovial
6.
Am J Vet Res ; 81(1): 13-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887088

RESUMO

OBJECTIVE: To assess onset of analgesia for 3% chloroprocaine hydrochloride and 2% mepivacaine hydrochloride when used for median and ulnar nerve blocks in lame horses. ANIMALS: 6 naturally lame horses. PROCEDURES: A crossover experiment was conducted. Horses were assigned to 1 of 2 treatment groups (3% chloroprocaine or 2% mepivacaine first). Median and ulnar nerve blocks were performed in the lame limb with the assigned treatment. Lameness was objectively evaluated before treatment administration and at various points for 120 minutes after treatment with a wireless inertial sensor-based motion analysis system. Following a 7-day washout period, horses then received the other treatment and lameness evaluations were repeated. RESULTS: Median and ulnar nerve blocks performed with 3% chloroprocaine resulted in more consistent, rapid, and profound amelioration of lameness than did blocks performed with 2% mepivacaine. Lameness decreased more between 20 and 40 minutes after injection when 3% chloroprocaine was used than when 2% mepivacaine was used. Complete resolution of lameness was detected a mean of 9 minutes after injection when median and ulnar nerve blocks were performed with 3% chloroprocaine and a mean of 28 minutes after injection when performed with 2% mepivacaine. CONCLUSIONS AND CLINICAL RELEVANCE: 3% chloroprocaine had a more rapid onset and provided better analgesia for median and ulnar nerve blocks in horses with naturally occurring lameness, compared with 2% mepivacaine. These favorable properties suggest that 3% chloroprocaine would be useful for performance of median and ulnar regional nerve blocks during complicated lameness evaluations.


Assuntos
Marcha/efeitos dos fármacos , Doenças dos Cavalos/tratamento farmacológico , Coxeadura Animal/tratamento farmacológico , Bloqueio Nervoso/veterinária , Dor/veterinária , Procaína/análogos & derivados , Analgesia/veterinária , Anestésicos Locais/farmacologia , Anestésicos Locais/uso terapêutico , Animais , Estudos Cross-Over , Cavalos , Masculino , Mepivacaína/farmacologia , Mepivacaína/uso terapêutico , Dor/tratamento farmacológico , Procaína/farmacologia , Procaína/uso terapêutico
7.
Stomatologiia (Mosk) ; 98(5): 99-103, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31701937

RESUMO

AIM: To study the reaction of the mental nerve to selective stimulation of thin nerve fibers by thermal stimuli during conduction anesthesia. MATERIAL AND METHOD: The pilot study involved 24 healthy volunteers: 13 subjects were injected with a 4% solution of articaine-containing anesthetic with a vasoconstrictor in a ratio of 1:200 000 (pH 4.8-5.4) and 11 subjects - a 3% solution of mepivacaine-containing local anesthetic without a vasoconstrictor (pH value 5.8-6.4). The registration of evoked potentials was performed twice: before local anesthesia and 5 minutes after anesthesia. With the help of disposable carpal dental injectors, local anesthesia was performed near the mental foramen in order to anesthetize the innervation region of the mental nerve through a conductive type. The evoked potentials (VP) were recorded on a Nicolet instrument (USA) with Bravo evoked potentials software. The study of thermal EPs was performed using a Contact heat evoked potential stimulator (CHEPS) device ('Medoc Ltd, Ramat Yishai', Israel). The base and peak temperature were set at 33 and 54 °C, correspondingly. RESULTS: The evoked potentials for thermal stimulation demonstrated a significant decrease in the amplitude of all components and the elongation of the LP of the main negative-positive N2-P2 complex after anesthesia compared with the initial thermal EP. The complete disappearance of thermal responses was observed in 14 (58%) of 24 study participants, minor changes were seen in 3 (12.5%) cases only. The total response disappearance was observed in 10 (77%) of 13 participants after articaine and in 3 (27%) of 11 - after mepivacaine (p<0.05), weak changes were registered in 2 (15%) cases in the articaine group and in 1 (9%) case in the mepivacaine group. CONCLUSION: A 4% solution of articaine is somewhat more effective for pain relief of teeth and bone since it often causes deeper anesthesia, and a 3% solution of mepivacaine without a vasoconstrictor is physiologically more suitable for working with soft tissues.


Assuntos
Anestesia Dentária , Anestesia Local , Anestésicos Locais , Carticaína , Mepivacaína , Projetos Piloto
8.
BMC Infect Dis ; 19(1): 883, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646969

RESUMO

BACKGROUND: Penicillin G Benzathine (PGB) is the cornerstone of syphilis treatment. However, its intramuscular (IM) administration is associated with pain at the site of injection. The dilution of PGB with local anesthetics is recommended in some guidelines, but the evidence that supports it, particularly in adults and in HIV infection, is scarce. Preliminary clinical experience also suggests that the IM administration of PGB through increased needle gauges might improve its tolerability. The aim of the study to identify less painful ways of administering IM PGB in the treatment of syphilis in adults. METHODS: Multicenter, randomized, double-blinded clinical trial in patients diagnosed with primary syphilis that required a single IM injection of PGB 2400,00 IU. Patients were randomized to receive PGB diluted with 0.5 mL mepivacaine 1% (MV) or PGB alone, and both groups either with a long 19G or short 21G IM needle. The primary objective was the effect on local pain immediately after the administration through a visual scale questionnaire on pain (0 to 10). RESULTS: One hundred eight patients were included, 27 in each group. Ninety-four (94.4%) were male, and 41.7% were also HIV-infected. Mean age 36.6 years (SD 11). Significant differences in immediate pain intensity were observed when comparing the long 19G group with anesthesia (mean pain intensity, [MPI] 2.92 [CI 95% 1.08-4.07]) vs long 19G without anesthesia (MPI 5.56 [CI 95% 4.39-6.73), p < 0.001; and also between short 21G group with anesthesia (MPI 3.36 [CI 95% 2.22-4.50]) vs short 21G without anesthesia (MPI 5.06 [CI 95% 3.93-6.19]), p = 0.015). No significant differences in immediate pain were observed between 19G and 21G in the presence or absence of anesthesia (p = 1.0 in both cases). No differences were found between study arms after 6 and 24 h. CONCLUSIONS: The IM administration of 1% mepivacaine-diluted PGB induces significantly less immediate local pain as compared to PGB alone. The needle gauge did not have any effect on the pain. Based on these results, we suggest anesthetic-diluted IM PGB as the standard treatment for primary syphilis. TRIAL REGISTRATION: EudraCT 2014-003969-24 (Date of registration 18/09/2014).


Assuntos
Anestésicos Locais/uso terapêutico , Mepivacaína/uso terapêutico , Dor/tratamento farmacológico , Penicilina G Benzatina/uso terapêutico , Sífilis/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Infecções por HIV/microbiologia , Humanos , Injeções Intramusculares/instrumentação , Masculino , Mepivacaína/administração & dosagem , Mepivacaína/efeitos adversos , Agulhas , Penicilina G Benzatina/administração & dosagem , Penicilina G Benzatina/efeitos adversos
9.
BMC Ophthalmol ; 19(1): 195, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455285

RESUMO

BACKGROUND: The subconjunctival anesthesia with local anesthetics is considered as a low-risk procedure allowing ocular surgery without serious complications typical for retro- or parabulbar anesthesia, especially in patients with preexisting Optic Nerve damage. We report development of ipsilateral transient amaurosis accompanied with mydriasis and both, direct and consensual light response absence. CASE PRESENTATION: Three patients with advanced refractory glaucoma undergoing laser cyclophotocoagulation (CPC) for intraocular pressure lowering experienced these adverse effects just few minutes after subconjunctival injection of mepivacaine 2% solution (Scandicaine® 2%, without vasoconstrictor supplementation). The vision was completely recovered to usual values in up to 20 h after mepivacaine application. Extensive ophthalmological examination, including cranial magnetic resonance imaging (MRI), revealed no further ocular abnormalities, especially no vascular constriction or thrombotic signs as well as no retinal detachment. The oculomotor function remained intact. The blockade of ipsilateral ciliary ganglion parasympathetic fibers by mepivacaine may be the responsible mechanism. Systemic pathways as drug-drug interactions seem to be unlikely involved. Importantly, all three patients tolerated the same procedure previously or at a later date without any complication. Overall, our thoroughly elaborated risk management could not determine the causative factor explaining the observed ocular complications just in the current occasion and not at other time points. CONCLUSIONS: Doctors should be aware and patients should be informed about such rare complications after subconjunctival local anesthetics administration. Adequate risk management should insure patients' safety.


Assuntos
Anestésicos Locais/efeitos adversos , Cegueira/induzido quimicamente , Túnica Conjuntiva/efeitos dos fármacos , Glaucoma de Ângulo Aberto/cirurgia , Mepivacaína/efeitos adversos , Midríase/induzido quimicamente , Distúrbios Pupilares/induzido quimicamente , Idoso , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Cegueira/fisiopatologia , Corpo Ciliar/cirurgia , Humanos , Injeções Intraoculares , Pressão Intraocular , Fotocoagulação a Laser , Masculino , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Midríase/fisiopatologia , Distúrbios Pupilares/fisiopatologia
11.
Eur J Pharmacol ; 860: 172544, 2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31319069

RESUMO

Brompheniramine as an antihistamine blocked sodium channels, and local anesthetics by blocking sodium channels produced the local anesthetic effects. The authors aimed to assess local anesthetic quality and duration of brompheniramine when compared to the local anesthetic mepivacaine. After rats were shaved and injected subcutaneously on the dorsal skin, the panniculus reflex, induced via applying a noxious pinprick to the skin (injected area), was scored. The dose-response curve and nociceptive block duration of brompheniramine were constructed and compared with mepivacaine. The cutaneous analgesic effects in both brompheniramine and mepivacaine groups were concentration-dependent. On the basis of the amount required to produce a 50% block effect (ED50, 50% effective dose), the drug's potency was brompheniramine (0.89 [0.82-0.96] µmol) better than mepivacaine (2.45 [2.17-2.76] µmol) (P < 0.01). Full recovery time of brompheniramine was more prolonged than mepivacaine's (P < 0.01) on infiltrative cutaneous analgesia when comparing ED25s, ED50s and ED75s. Our preclinical data demonstrated that subcutaneous brompheniramine induces dose-relatedly analgesic effects, and brompheniramine induces prolonged analgesic duration when compared with mepivacaine. Brompheniramine also provokes better cutaneous analgesia than mepivacaine.


Assuntos
Analgésicos/administração & dosagem , Analgésicos/farmacologia , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Bromofeniramina/administração & dosagem , Bromofeniramina/farmacologia , Administração Cutânea , Animais , Relação Dose-Resposta a Droga , Masculino , Mepivacaína/administração & dosagem , Mepivacaína/farmacologia , Ratos , Ratos Sprague-Dawley , Fatores de Tempo
12.
Eur Radiol ; 29(12): 6965-6970, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31250168

RESUMO

OBJECTIVES: To evaluate different analgesic techniques in MRI-guided in-bore prostate biopsy (IB-GB) regarding the influence on patient procedural experience of pain. METHODS: Two hundred fifty-two consecutive patients who had received an IB-GB either with intrarectal instillation of 2% lidocaine gel (n = 126, group A) or with periprostatic nerve block (PPNB) with 2% mepivacaine (n = 126, group B) were retrospectively included in this study. Pain scores were measured on a visual analog scale, the operating room time (ORT) was recorded for each biopsy and correlations between the parameters were analysed. RESULTS: Pain scores for IB-GB were slightly lower in group B compared with group A (2.0 ± 1.9; 2.4 ± 1.7; p = 0.02). In group A, significantly more targeted biopsy cores were acquired (group B: 5.2 ± 1.1; group A: 5.6 ± 0.8; p < 0.01). ORT was comparable and not significantly different in both groups. There was only a weak correlation between pain scores and ORT in group B (rS = 0.22; p = 0.01), but no correlation between pain scores and the number of biopsy cores or the prostate volume. CONCLUSIONS: Pain levels are generally low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel. A statistically significant, slightly lower pain score was documented for PPNB and might be preferred when the focus is analgesia. On the other hand, due to the minor difference and easier administration, intrarectal gel instillation seems to be a reasonable practice for standard analgesia for MRI-guided in-bore biopsy. KEY POINTS: • Pain levels were low for MRI-guided in-bore biopsy using either PPNB or intrarectal instillation of lidocaine gel as analgesic method. • PPNB prior to IB-GB resulted in a slightly lower pain score but required a higher effort. • Intrarectal gel anaesthesia seems to be a reasonable practice for standard analgesia for IB-GB in an outpatient setting.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Mepivacaína/administração & dosagem , Dor/prevenção & controle , Próstata/patologia , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Analgesia/métodos , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Duração da Cirurgia , Manejo da Dor , Medição da Dor , Estudos Retrospectivos
13.
Artigo em Alemão | MEDLINE | ID: mdl-30999352

RESUMO

In 2018, no new active pharmaceutical ingredients were released on the German market for horses or food-producing animals. One established veterinary active pharmaceutical ingredient became available for an additional species: the inhalant anesthetic Isoflurane (Isofluran Baxter® vet) from the group of halogenated hydrocarbon compounds was additionally authorized for pigs (piglets). With Acepromazine, Mepivacaine and Oxyclozanide, three temporarily non-available active ingredients were reapproved in new drugs. Additionally, one drug with a new combination of active ingredients and one drug with a new pharmaceutical form were launched on the market for horses and food-producing animals.


Assuntos
Animais Domésticos , Tratamento Farmacológico/veterinária , Cavalos , Drogas Veterinárias , Acepromazina , Anestésicos Inalatórios , Anestésicos Locais , Animais , Antibacterianos , Anti-Inflamatórios não Esteroides , Antiplatelmínticos , Abelhas , Antagonistas de Dopamina , Tratamento Farmacológico/tendências , Alemanha , Isoflurano , Meloxicam , Mepivacaína , Ácido Oxálico , Oxiclozanida , Suínos , Tianfenicol/análogos & derivados
14.
Br J Anaesth ; 122(4): 518-524, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30857608

RESUMO

BACKGROUND: Regional anaesthesia for upper limb surgery is routinely performed with brachial plexus blocks. A retroclavicular brachial plexus block has recently been described, but has not been adequately compared with another approach. This randomised controlled single-blinded trial tested the hypothesis that the retroclavicular approach, when compared with the supraclavicular approach, would increase the success rate. METHODS: One hundred and twenty ASA physical status 1-3 patients undergoing distal upper limb surgery were randomised to receive an ultrasound-guided retroclavicular or supraclavicular brachial plexus block with 30 mL of a 1:1 mixture of mepivacaine 1% and ropivacaine 0.5%, using a single-injection technique without needle tip repositioning. The primary outcome was block success rate 30 min after local anaesthetic injection, defined as a composite score of 14 of 16 points, inclusive of sensory and motor components. Secondary outcomes included needling time, time to first opioid request, oxycodone consumption, and pain scores (numeric rating scale, 0-10) at 24 h postoperatively. RESULTS: Success rates were 98.3% [95% confidence interval (CI): 90.8%, 99.9%] and 98.3% [95% CI: 90.9%, 99.9%] in the supraclavicular and retroclavicular groups, respectively (P=0.99). The mean needling time was reduced in the supraclavicular group [supraclavicular: 5.0 (95% CI: 4.7, 5.4) min; retroclavicular: 6.0 (95% CI: 5.4, 6.6) min; P=0.006]. The mean time to first opioid request was similar between groups [supraclavicular: 439 (95% CI: 399, 479) min; retroclavicular: 447 (95% CI: 397, 498) min; P=0.19] as were oxycodone consumption [supraclavicular: 10.0 (95% CI: 6.5, 13.5 mg; retroclavicular: 7.9 (95% CI: 4.8, 11.0) mg; P=0.80] and pain scores at 24 h postoperatively [supraclavicular: 1.2 (95% CI: 2.1, 2.7); retroclavicular: 1.5 (95% CI: 1.6, 2.4); P=0.09]. CONCLUSIONS: Ultrasound-guided retroclavicular and supraclavicular brachial plexus blocks share identical success rates, while providing similar pain relief. Reduced needling time in the supraclavicular approach is not clinically relevant. CLINICAL TRIAL REGISTRATION: NCT02641613.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/métodos , Extremidade Superior/cirurgia , Adulto , Idoso , Anestésicos Combinados/administração & dosagem , Plexo Braquial/diagnóstico por imagem , Feminino , Humanos , Masculino , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Ropivacaina/administração & dosagem , Método Simples-Cego , Ultrassonografia de Intervenção/métodos
15.
Arch. Health Invest ; 8(2): 57-62, fev. 2019. tab, graf
Artigo em Português | BBO - Odontologia | ID: biblio-1006711

RESUMO

Ao serem administrados, os Anestésicos Locais e Vasoconstritores (VC) iniciam os processos de absorção e eliminação, passando pela circulação sanguínea podendo atingir níveis tóxicos ou induzir alterações cardiovasculares. Objetivou-se avaliar o comportamento da atividade cardiovascular nas cirurgias para a remoção de terceiros molares utilizando a mepivacaína 2% com adrenalina na concentração de 1:100.000 em um período de até 120 min após a injeção anestésica. Trata-se de um estudo longitudinal, interventivo com caráter quantitativo e descritivo, com dados mensuráveis para análise e interpretação, realizado com pacientes da disciplina de clínica cirúrgica do curso de odontologia da UniCatólica. Os resultados obtidos foram analisados através do teste de normalidade de Kolmogorov-Smirnov e comparados ao longo do trans-operatório pelos testes ANOVA para medidas repetidas seguidas do pós-teste de Bonferroni ou Friedman seguido do pós-teste de Dunn adotando um nível de 5% de significância (p < 0,05). O procedimento com o anestésico utilizado não provocou alterações na Pressão Arterial Sistólica (PAS) (p=0,712), Pressão Arterial Diastólica (PAD) (p=0,098) bem como da diferença de PAS e PAD (p=0,546). Na Frequência Cardíaca (FC) houve diferença significante nos tempos de 10 min (p=0,013) e 120 min (p=0,013). Já na Saturação Periférica O2 (SPO2) houve diferença estatística significante nos tempos da 1ª visita (p=0,001), 0 (p=0,001), 5 (p=0,001) e 20 (p=0,001). Conclui-se assim, que o anestésico local pode ser utilizado em pacientes normotensivos durante a realização de procedimentos cirúrgicos odontológicos, e este leve aumento na FC e SPO2 pode estar relacionado à ansiedade e/ou ao estresse emocional dos pacientes(AU)


When injected into the tissues, Local Anesthetics and Vasoconstrictors (VC) initiate the process of absorption and elimination, passing through the bloodstream to reach toxic levels or induce cardiovascular changes. The aim of this study was to evaluate the behavior of cardiovascular activity in the surgeries for the removal of third molars using mepivacaine 2% with adrenaline at a concentration of 1: 100,000 in a period of up to 120 min after the anesthetic injection. It is a longitudinal, interventional study with a quantitative and descriptive character, with measurable data for analysis and interpretation, carried out with patients of the discipline of surgical clinic of the dentistry course of the UniCatólica. The results obtained were analyzed using the normality test of Kolmogorov-Smirnov and compared during the trans-operative period by ANOVA for repeated measurements followed by the Bonferroni or Friedman post-test followed by the Dunn post-test adopting a 5% level of significance (p <0.05). The procedure with the anesthetic used did not cause changes in systolic blood pressure (SBP) (p = 0.712), diastolic blood pressure (DBP) (p = 0.098) as well as SBP and DBP difference (p = 0.546). In heart rate (HR) there was a significant difference in the time of 10 min (p = 0.013) and 120 min (p = 0.013). In the O2 Peripheral Saturation (SPO2) there was a statistically significant difference at the time of the first visit (p = 0.001), 0 (p = 0.001), 5 (p = 0.001) and 20 (p = 0.001). It is concluded that the local anesthetic can be used in normotensive patients during dental surgical procedures, and this slight increase in HR and SPO2 may be related to the anxiety and / or emotional stress of the patients(AU)


Al ser administrados, los anestésicos locales y vasoconstrictores (VC) inician los procesos de absorción y eliminación, pasando por la circulación sanguínea pudiendo alcanzar niveles tóxicos o inducir alteraciones cardiovasculares. Se objetivó evaluar el comportamiento de la actividad cardiovascular en las cirugías para la remoción de terceros molares utilizando la mepivacaína 2% con adrenalina en la concentración de 1: 100.000 en un período de hasta 120 minutos después de la inyección anestésica. Se trata de un estudio longitudinal, interventivo con carácter cuantitativo y descriptivo, con datos mensurables para análisis e interpretación, realizado con pacientes de la disciplina de clínica quirúrgica del curso de odontología de la UniCatólica. Los resultados obtenidos fueron analizados a través del test de normalidad de Kolmogorov-Smirnov y comparados a lo largo del trans-operatorio por las pruebas ANOVA para medidas repetidas seguidas del post-test de Bonferroni o Friedman seguido del post-test de Dunn adoptando un nivel del 5% de significancia (p <0,05). El procedimiento con el anestésico utilizado no provocó cambios en la presión arterial sistólica (PAS) (p = 0,712), presión arterial diastólica (PAD) (p = 0,098), así como de la diferencia de PAS y PAD (p = 0,546). En la Frecuencia Cardiaca (FC) hubo diferencia significante en los tiempos de 10 min (p = 0,013) y 120 min (p = 0,013). En la Saturación Periférica O2 (SPO2) hubo diferencia estadística significante en los tiempos de la 1ª visita (p = 0,001), 0 (p = 0,001), 5 (p = 0,001) y 20 (p = 0,001). Se concluye así que el anestésico local puede ser utilizado en pacientes normotensivos durante la realización de procedimientos quirúrgicos odontológicos, y este leve aumento en la FC y SPO2 puede estar relacionado a la ansiedad y / o al estrés emocional de los pacientes(AU)


Assuntos
Sistema Cardiovascular , Mepivacaína , Dente Serotino/cirurgia , Pressão Arterial , Frequência Cardíaca , Anestésicos Locais
16.
Vet Rec ; 184(5): 155, 2019 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-30661018

RESUMO

The objective of this study was to determine if buffering mepivacaine HCL (mepHCl) with sodium bicarbonate (NaHCO3) would significantly decrease the time to onset of analgesia when performing median and ulnar nerve blocks in naturally lame horses. Median and ulnar nerve blocks were performed on the naturally lame limb of nine horses during two separate study periods, with a minimum washout period of three days between study periods. Nerve blocks were performed by administering mepHCl alone or mepHCl mixed with NaHCO3 (nine parts 2 per cent mepHCl to one part 8.4 per cent NaHCO3). Lameness was evaluated objectively using a wireless, inertial, sensor-based, motion analysis system (Lameness Locator) prior to the high regional nerve block and every five minutes following administration of the nerve block for 75 min. Resolution of lameness occurred earlier and was more profound for horses administered median and ulnar nerve blocks performed with mepHCl and NaHCO3 than when these nerve blocks were performed using only mepHCl.


Assuntos
Analgesia/veterinária , Anestésicos Locais/farmacologia , Doenças dos Cavalos/tratamento farmacológico , Coxeadura Animal/tratamento farmacológico , Mepivacaína/farmacologia , Bloqueio Nervoso/veterinária , Bicarbonato de Sódio/farmacologia , Analgesia/métodos , Animais , Feminino , Cavalos , Masculino , Fatores de Tempo , Resultado do Tratamento
17.
A A Pract ; 12(11): 430-432, 2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30633002

RESUMO

Local anesthetics are used throughout the health care system. In the perioperative setting and in other settings of exposure to local anesthetics, true allergy is reported very rarely. We present an unusual case of immediate-type perioperative hypersensitivity to lidocaine with cross-reaction to mepivacaine, which was missed on initial investigation. This case illustrates that lidocaine may be a "hidden allergen" in the perioperative setting and should always be considered a potential culprit in cases of suspected perioperative hypersensitivity. The case also demonstrates that suspected perioperative hypersensitivity requires highly specialized investigation and close collaboration between allergists and anesthesiologists.


Assuntos
Alérgenos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Lidocaína/efeitos adversos , Mepivacaína/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Interações Medicamentosas , Feminino , Humanos , Pessoa de Meia-Idade , Período Perioperatório
18.
Anesth Analg ; 129(2): 526-535, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30234517

RESUMO

BACKGROUND: Periarticular injections (PAIs) are becoming a staple component of multimodal joint pathways. Motor-sparing peripheral nerve blocks, such as the infiltration between the popliteal artery and capsule of the posterior knee (IPACK) and the adductor canal block (ACB), may augment PAI in multimodal analgesic pathways for knee arthroplasty, but supporting literature remains rare. We hypothesized that the addition of ACB and IPACK to PAI would lower pain on ambulation on postoperative day (POD) 1 compared to PAI alone. METHODS: This triple-blinded randomized controlled trial included 86 patients undergoing unilateral total knee arthroplasty. Patients either received (1) a PAI (control group, n = 43) or (2) an IPACK with an ACB and modified PAI (intervention group, n = 43). The primary outcome was pain on ambulation on POD 1. Secondary outcomes included numeric rating scale (NRS) pain scores, patient satisfaction, and opioid consumption. RESULTS: The intervention group reported significantly lower NRS pain scores on ambulation than the control group on POD 1 (difference in means [95% confidence interval], -3.3 [-4.0 to -2.7]; P < .001). In addition, NRS pain scores on ambulation on POD 0 (-3.5 [-4.3 to -2.7]; P < .001) and POD 2 (-1.0 [-1.9 to -0.1]; P = .033) were significantly lower. Patients in the intervention group were more satisfied, had less opioid consumption (P = .005, postanesthesia care unit, P = .028, POD 0), less intravenous opioids (P < .001), and reduced need for intravenous patient-controlled analgesia (P = .037). CONCLUSIONS: The addition of IPACK and ACB to PAI significantly improves analgesia and reduces opioid consumption after total knee arthroplasty compared to PAI alone. This study strongly supports IPACK and ACB use within a multimodal analgesic pathway.


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Mepivacaína/administração & dosagem , Bloqueio Nervoso , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Pontos de Referência Anatômicos , Anestésicos Locais/efeitos adversos , Feminino , Humanos , Injeções Intra-Arteriais , Cápsula Articular , Masculino , Mepivacaína/efeitos adversos , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos , Cidade de Nova Iorque , Manejo da Dor/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Artéria Poplítea , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Odontology ; 107(1): 29-36, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29948489

RESUMO

The present study investigated the regional blood flow, tissue distribution, local anesthetic action, and hemodynamic effects of mepivacaine containing dexmedetomidine hydrochloride (DEX) in rats. Blood flow was measured after injection of 0.5% mepivacaine (M group), 12.5 µg/ml DEX (D group), or 0.5% mepivacaine containing 12.5 µg/ml DEX (DM group) into the upper lip. Mepivacaine distribution was autoradiographically observed in maxillary bone resected after injection of 0.5% 3H-mepivacaine (HM group) or 0.5% 3H-mepivacaine containing 12.5 µg/ml DEX (DHM group) into the palatal mucosa adjacent to the right maxillary first molar. Radioactivity was also measured using a liquid scintillation counter. SEP were measured to analyze anesthetic action. Blood pressure and heart rate were measured to compare hemodynamic effect. The addition of DEX significantly decreased blood flow compared to M group from 10 to 60 min after injection. The addition of DEX significantly increased the amount of radioactivity compared to HM group in the palatal mucosa from 5 to 60 min after injection and in the body of the maxilla from 2 to 60 min after injection. Maximum blood radioactivity was measured at 5 min after injection in HM group and 50 min after injection in DHM group. The addition of DEX significantly decreased peak-to-peak amplitudes compared to M group until 60 min after injection. No significant hemodynamic differences were observed. DEX enhances the action of mepivacaine in reducing regional blood flow prolongs its tissue retention, and increases the local anesthetic action without affecting hemodynamics on local administration.


Assuntos
Analgésicos não Entorpecentes/farmacologia , Anestésicos Locais/farmacologia , Dexmedetomidina/farmacologia , Hemodinâmica/efeitos dos fármacos , Mepivacaína/farmacologia , Distribuição Tecidual/efeitos dos fármacos , Analgésicos não Entorpecentes/farmacocinética , Anestésicos Locais/farmacocinética , Animais , Autorradiografia , Dexmedetomidina/farmacocinética , Combinação de Medicamentos , Masculino , Mepivacaína/farmacocinética , Ratos , Ratos Wistar , Fluxo Sanguíneo Regional/efeitos dos fármacos , Contagem de Cintilação
20.
Eur Radiol ; 29(2): 620-627, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30062527

RESUMO

OBJECTIVE: The aim of this work is to compare the effectiveness of blind and ultrasound-guided injection for Morton's neuroma (MN) to determine which is more appropriate as the initial procedure in conservative treatment. METHODS: This is an evaluator-blinded randomised trial. Of the 56 included patients, 27 were assigned to the blind group (A) and 29 to the ultrasound-guided group (B). Injection includes 1 ml of 2% mepivacaine and 40 mg of triamcinolone in each web space with MN. The included patients were assessed clinically by VAS score and the Manchester Foot Pain and Disability Score (MFPDS). The follow-up was performed at 15 days, 1 month, 45 days, 2 months, 3 months and 6 months after the initial injection. RESULTS: No differences in age or clinical measurements were found at presentation between group A and group B. At the follow-up, the ultrasound-guided group showed greater symptomatic relief at several stages of the follow-up: 45 days (VAS 3.0 ± 0.5 versus 5.5 ± 0.5, p = 0.001; MFPDS: 32.2 ± 1.8 versus 38.8 ± 2.0, p = 0.018), 2 months (VAS: 3.1 ± 0.5 versus 5.6 ± 0.5, p = 0.002; MFPDS: 31.5 ± 1.9 versus 38.5 ± 2.1, p = 0.020) and 3 months (VAS: 3.1 ± 0.4 versus 5.2 ± 0.6, p = 0.010; MFPDS: 31.2 ± 1.9 versus 37.7 ± 2.4, p = 0.047). CONCLUSION: Injection of MN under ultrasound guidance provides a statistically significant improvement at some stages of the follow-up (45 days, 2 and 3 months), compared with blind injection. KEY POINTS: • Ultrasound-guided steroid injections in Morton's neuroma provide short-term pain relief to over 60% of the patients. • Ultrasound-guided injections in Morton's neuroma lead to a higher percentage of short-term pain relief than blind injections. • Ultrasound-guided injections in Morton's neuroma lead to a lower percentage of skin side effects than blind injections.


Assuntos
Neuroma Intermetatársico/diagnóstico por imagem , Neuroma Intermetatársico/tratamento farmacológico , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Quimioterapia Combinada , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Injeções Intralesionais , Masculino , Mepivacaína/administração & dosagem , Mepivacaína/uso terapêutico , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Medição da Dor/métodos , Método Simples-Cego , Triancinolona/administração & dosagem , Triancinolona/uso terapêutico , Ultrassonografia de Intervenção/métodos
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