Comparison of infiltration (INF) and inferior alveolar nerve block (IANB) injection techniques in bilateral therapeutic removal of mandibular premolars

Background. The present study aimed to evaluate and compare the anesthetic effect of infiltration (INF) and inferior alveolar nerve block (IANB) techniques for bilateral therapeutic extraction of mandibular premolars. Methods. One hundred patients requiring bilateral therapeutic removal of mandibular premolars were included in the study. For the extraction of the mandibular right premolar tooth, INF was used, and after one week, the mandibular left premolar tooth was extracted using the IANB. The effect of anesthesia between the two techniques was compared and evaluated by ANOVA using SPSS. Results. INF was successful in 78% of cases, whereas IANB was successful only in 22% of cases. Furthermore, INF had a significantly better anesthetic effect than IANB (P<0.05). During pain assessment during the anesthetic drug injection and the procedure, two patients in the INF and five patients in the IANB group reported minimal pain during extraction (P>0.05). The onset of the anesthetic effect was faster in the INF group, while the duration of the effect was longer in the IANB group. Conclusion. INF was a more efficacious local anesthetic technique with high success rate than the IANB technique.

Preliminary evaluation of the efficacy and safety of brimonidine for general anesthesia

Background To determine the hypnotic and analgesic effects of brimonidine, and evaluate its efficacy and safety for general anesthesia. Potentiation of pentobarbital sleeping time following brimonidine administration was observed in mice, as was the analgesic activity of brimonidine. Methods The median effective dose (ED50) and lethal dose (LD50) of intraperitoneally injected brimonidine were determined in hypnotized mice. In addition, the LD50 of intravenously injected brimonidine, and ED50 of intravenously, intramuscularly, and intrarectally injected brimonidine in hypnotized rabbits were determined. Finally, the synergistic anesthetic effect of brimonidine and chloral hydrate was evaluated in rabbits. Results Intraperitoneal injection of 10 mg/kg brimonidine enhanced the hypnotic effect of a threshold dose of pentobarbital. Intraperitoneally injected brimonidine produced dose-related analgesic effects in mice. The ED50 of intraperitoneally administered brimonidine in hypnotized mice was 75.7 mg/kg and the LD50 was 379 mg/kg. ED50 values of intravenous, intramuscular, and intrarectal brimonidine for hypnosis in rabbits were 5.2 mg/kg, 8.8 mg/kg, and 8.7 mg/kg, respectively; the LD50 of intravenous brimonidine was 146 mg/kg. Combined intravenous administration of 0.6 mg/kg brimonidine and 0.03 g/kg chloral hydrate had a synergistic anesthetic effect. Conclusions Brimonidine elicited hypnotic and analgesic effects after systemic administration and exhibited safety. Moreover, brimonidine enhanced the effects of other types of narcotics when combined.

Clinical efficacy of a combination of propofol and etomidate in pediatric anesthesia, and its effect on vital indices in patients

Purpose: To study the clinical effectiveness of a combination of propofol and etomidate as pediatricanesthesia, and its influence on some vital factors in the patients.Methods: A total of 104 children who underwent appendectomy, hepatobiliary surgery and excision ofbone tumor in Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, China from June 2018 to June 2020, were selected for this retrospective study. The patients were divided into groups A, B and C. In group A, 40 patients received the combination of propofol and etomidate, 32 patients received propofol only, while group C comprised 32 patients who received etomidate only. Vital indices such asanesthesia induction time, wake-up time after surgery, anesthetic effect, and adverse reactions were determined.Results: In group A, the mean arterial pressure (MAP) and heart rate (HR) were improved; anesthesia induction time and wake-up time after surgery were shorter, and anesthetic effect was more obvious in children with grades I and II. However, there was no grade III anesthetic effect, although there was a lower incidence of adverse reactions in this group.Conclusion: The use of a combination of propofol and etomidate results in higher clinical efficacy of pediatric anesthesia than either propofol or etomidate alone. Furthermore, the combination produces better quality of vital indices in the patients

Ropivacaine magnetic nanoparticles: An efficient local anesthetic nerve conduction blocker

Ropivacaine (Rop) is one of the commonly used local nerve blocks in clinical anesthesia and postoperative analgesia and it inhibits the stimulation of peripheral nociceptive pain. However, Rop alone is not effective enough to exert a controllable anesthetic effect in patients with peripheral nociceptive pain. Therefore, there is an urgent need to improve the targeting of the local anesthetic effect of Rop and reduce its potential chronic or acute toxicity. In this study, a novel Rop nanocomposite hydrogel drug, N-isopropylacrylamide-methacrylic acid/ropivacaine magnetic nanoparticles (NIP-MAA/Rop MNPs), was constructed on magnetic iron oxide. The unique pH and temperature response of NIP-MAA can effectively retain magnetic properties, improve the stability and targeting controllability of magnetic nanoparticles, and avoid excessive drug diffusion. Therefore, the NIP-MAA/Rop MNPs is expected to open a new field of vision for the research of clinical anesthesia and postoperative analgesia.

Cesarean section incisional infiltration with lidocaine and Epinephrine versus Lidocaine alone in reducing postoperative pain. A randomized controlled double-blinded clinical trial

Background Cesarean section delivery is becoming more frequent. Childbirth is an emotion-filled event and the mother needs to bond with her newborn baby as early as possible. Any intervention that leads to improvement in pain relief is worthy of investigation Aim of the Work to assess the efficacy and safety adding ef Epinephrine to lidocaine 2% in dose-related manner 1:200.000 in prolongation of anesthetic effect of lidocaine as a local anesthetic to reduce post; caesarean section pain after general anesthesia. Patients and Methods A total number of 200 women planned for elective caesarean section at Shams University Maternity Hospital Was recruited, 2 groups were randomized with a study group included 100 women received lidocaine 2% and epinephrine in dose-related manner and a control group included 100 women received lidocaine 2% only. Results women who received lidocaine and epinephrine were more satisfied and hadsignificant more time after caesarean section free of pain in comparison to women who received lidocaine only by 120 minutes. Also. adding Of epinephrine helped in decrease in amount of analgesic consumption after caesarean section. Women who received lidocaine and epinephrine started breast feeding and mobilization earlier than women who received lidocaine only. Epinephrine prolonged the action of lidocaine as a local anesthetic, this prolongation of action of local anesthetic had a significant effect in early mobilization and breast feeding and decrease in cost of analgesics. Nobody in our candidate had a post-operative infection, past operative pyrexia, Allergic reactions tar general anesthesia or complications with local anesthesia. Conclusion Adding of epinephrine to local anesthetics (such as lidocaine 2% in dose-related manner 1:200.0000) prolonged anesthetic effect by more than double of its original anesthetic time, This prolongation on anesthetic effect of local anesthesia by epinephrine helps in eariy mobilization; early breast feeding and less hospital duration stays. No complications (local nor systemic) developed with local infiltration of post-caesarean section incision with lidocaine 2% even aficr adding epinephrine in dose-related manner 1:200.000

Preparation and In Vivo Evaluation of a Lidocaine Self-Nanoemulsifying Ointment with Glycerol Monostearate for Local Delivery

Lidocaine, a commonly used local anesthetic, has recently been developed into a number of ointment products to treat hemorrhoids. This study examined its efficient delivery to the dermis through the pharmaceutical improvement of hemorrhoid treatment ointments. We attempted to increase the amount of skin deposition of lidocaine by forming a nanoemulsion through the self-nanoemulsifying effect that occurs when glycerol monostearate (GMS) is saturated with water. Using Raman mapping, the depth of penetration of lidocaine was visualized and confirmed, and the local anesthetic effect was evaluated via an in vivo tail-flick test. Evaluation of the physicochemical properties confirmed that lidocaine was amorphous and evenly dispersed in the ointment. The in vitro dissolution test confirmed that the nanoemulsifying effect of GMS accelerated the release of the drug from the ointment. At a specific concentration of GMS, lidocaine penetrated deeper into the dermis; the in vitro permeation test showed similar results. When compared with reference product A in the tail-flick test, the L5 and L6 compounds containing GMS had a significantly higher anesthetic effect. Altogether, the self-nanoemulsifying effect of GMS accelerated the release of lidocaine from the ointment. The compound with 5% GMS, the lowest concentration that saturated the dermis, was deemed most appropriate.