COMPARISON BETWEEN SINGLE BUCCAL INFILTRATION VERSUS CONVENTIONAL BUCCAL AND PALATAL INFILTRATION FOR REMOVAL OF MAXILLARY MOLAR TEETH.

Background: Although less painful injection techniques have been developed, most individuals still find palatal injection to be unpleasant. Aims: The purpose of this study was to evaluate the efficacy of single buccal infiltration versus conventional buccal and palatal infiltration for the removal of maxillary molar teeth. Fifty patie Materials and Methods: nts participated in a prospective randomized, split-mouth study, Group 1: 4% Articaine HCL infiltration – Only buccal, Group 2: 2% Lignocaine HCL – Buccal and palatal infiltration. Checking VAS score and Facial pain scale during Infiltration and during extraction. Factor analysis was used to determine the significance of the difference in mean scores between the two groups using both the independent sample t-test. Even though the Results: difference was not statistically significant (P > 0.05), patients in the articaine group reported much less discomfort during having their vital maxillary molars extracted compared to the lignocaine group. As was previously m Conclusion: entioned, it is feasible to avoid the palatal injection while removing molars from the maxilla. Specifically, the extraction of the upper molars, and buccal infiltration with articaine is a viable alternative to the use of traditional local anaesthetic.

Scorpion venom component: AGAP exhibits local anaesthetic effects and attenuates nociceptive pain

The incidences of systemic toxicity and other complications associated with existing local anaesthetics can occur at clinical concentration level and vary with the anaesthetic techniques, types of surgery and patient factors. This evidence suggests the need for therapeutic interventions in peripheral and regional anaesthesia. Buthus martensii Karsch (BmK) scorpion venom is a compound that contains mixtures of peptides that have analgesic properties. This study aimed to investigate the local anaesthetic activity of scorpion venom peptide, AGAP (analgesic-antitumor peptide) in mechanical hyperalgesia or acute inflammatory pain. Method: Formalin was injected into the left hind paw after 20 minutes of infiltration of drugs. The time of licking or flinching of the injected hind paw was recorded as indicative of nociceptive or acute inflammatory pain. Paw flinching or quick withdrawal was considered a positive response to pain in the partial sciatic nerve ligation. The paw-withdrawal threshold (PWT) was determined by consecutively increasing and decreasing the magnitude of the stimulus. Results: The results indicated that AGAP exhibited a 67.9% inhibition in licking or flinching time and an 88.1% inhibition in paw withdrawal in mechanical hyperalgesia. The addition of AGAP to lidocaine showed an 89.5% inhibition in paw withdrawal. Conclusion: The data presented in this study suggest that local infiltration of AGAP significantly reduced mechanical hyperalgesia and acute inflammatory pain

Awake Fiberoptic Assisted Nasotracheal Intubation in Oral Malignancies - A Comparison between Airway Blocks and LA Spray - A Randomized, Interventional Crossover Trial

Awake fiberoptic assisted nasal intubation is the gold standard for securing airway in cases of oral malignancy posted for radical surgeries. Different techniques such as airway blocks, LA gargles, spray, nebulization along with light sedation are in practice. We wanted to evaluate the efficacy of airway blocks over airway spray for intubation conditions, time taken to intubation, patient comfort and complications. METHODSThis randomized, interventional and crossover study was conducted at Chirayu Medical College and Hospital. A total of 60 patients of ASA grade I-II with Mallampati score 3 & 4 undergoing wide local excision and neck dissection were selected after fulfilling of the selection criterion and were divided into two groups, Airway Block (AB, n-30) and Airway Spray group (AS, n-30). AB group received bilateral superior and transtracheal recurrent laryngeal nerve blocks and group AS local anaesthetic spray through the working channel of the fiberoptic scope. Haemodynamics, time taken for intubation, intubating conditions, patients’ comfort, and complications if any were noted. All data was tabulated and analysed using software SPSS 17.0. RESULTSMean total time taken for intubation in seconds was less. Intubating conditions were optimal in 90 % cases. 5-point comfort during and 3-point score immediately after intubation were excellent in AB compared AS group. Haemodynamically both the groups were comparable. CONCLUSIONSCombined block of the superior and recurrent laryngeal nerves provides optimal conditions to facilitate a successful fibreoptic assisted awake nasotracheal intubation in anticipated difficult airway

A Comparison of the Postoperative Analgesic Efficacy of Two Different Doses of Caudal Clonidine as Adjunct to Caudal Bupivacaine in Infraumbilical Surgeries in Younger Children.

Managing peri operative pain in smaller children is challenging but beneficial. Caudal epidural block with local anaesthetic and adjuvant in proper dose can significantly prolong the duration of analgesia while avoiding dose related side effects of both the drugs. We selected clonidine as adjuvant to bupivacaine in caudal blocks for perioperative pain management in 80 children during infra umbilical surgeries performed under general anaesthesia. MethodsThe children were randomly allocated into two groups, Group A (n=40) and Group B (n=40). Group A received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 1 μg/Kg in 1 mL normal saline and Group B received caudal bupivacaine (0.125%) 0.75 mL/Kg plus clonidine 0.5 μg/Kg in 1 mL normal saline, after inhalational anaesthesia. Heart rate, blood pressure, respiratory rate, oxygen saturation, sedation score, Bromage score and pain score were monitored and recorded peri-operatively. Time to first rescue analgesic at pain score of 12, total number of rescue analgesic doses required, and side effects were also recorded. Data was analysed using appropriate statistical tests. ResultsGroup B patients had significantly higher heart rates, systolic and diastolic blood pressures, respiratory rates and pain scores compared to Group A patients at 50 mins post operatively. The requirement of rescue analgesics in Group B was earlier and higher than Group A. Group A patients remained haemodynamically stable and pain free for longer period. There was no significant difference in side effects between the groups. ConclusionsAddition of 1 μg/Kg clonidine to caudal epidural bupivacaine improves the quality and prolongs the duration of postoperative analgesia compared to addition of 0.5 μg/Kg clonidine without causing significant side effects.

Comparative Study of Dexmedetomidine versus Dexamethasone as an adjuvant for supraclavicular brachial plexus block

Introduction: Brachial plexus block is the most preferred anaesthetic technique for upper limb surgeries. Adding adjuvant to local anaesthetics for achial plexus block may enhance the duration and quality of analgesia and also to decrease the dose of postoperative opioid analgesic. Aims and Objectives: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine when added as adjuvant during supraclavicular achial plexus blocks (BPB) in respect to the onset and duration of sensory and motor block along with duration of analgesia. Methods: Sixty ASA physical status I-II patients of age group between 20 to 60 years with elective forearm and hand surgery under achial plexus blocks were randomly allocated into two equal groups in a randomised double blind fashion. Group DM (n = 30), to receive 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with Adr + 1 ml of Dexmedetomidine (50mcg) + 1ml distilled water, making a total of 32 ml and another Group DX (n = 25), to receive 15 ml of 0.5% bupivacaine and 15 ml of 2% lignocaine with Adr. + 2ml of Dexamethasone (8 mg). A nerve stimulation technique was used in all patients. The onset time and duration of sensory and motor blocks, quality of intraoperative analgesia and duration of analgesia were assessed. Results: The time of onset of sensory and motor block was significantly less in group DM as compared to group DX (P ＜ 0.05). The duration of the sensory and motor block as well as duration of post operative analgesia was significantly more in group DM as compared with group DX (P＜0.05), but there was no statistically significant difference between both the groups with respect to the heart rate, mean arterial pressure and spo2. Conclusions: Dexmedetomidine 50 g was more effective than dexamethasone 8 mg in extending the duration of supraclavicular achial plexus block and prolonging the duration of post operative analgesia and it also significantly decreases the onset time of block.

Ropivacaine promotes apoptosis of hepatocellular carcinoma cells through damaging mitochondria and activating caspase-3 activity

BACKGROUND: Recent evidences indicated that some local anaesthetic agents played a role in inhibiting the proliferation of cancer cells; Whether ropivacaine is able to promote apoptosis of hepatocellular carcinoma (HCC) cells is still unclear. The aim of this study was to investigate the effect of ropivacaine on the apoptosis of HCC cells. METHODS: In the present study, we treated the HCC cell lines, Bel7402 and HLE with ropivacaine. MTT, DAPI stain, trypan blue exclusion dye assay, flow cytometry, electron microscopy, computational simulation, laser confocal microscope, Western blotting, and enzyme activity analysis of caspase-3 were applied to detect the growth and apoptosis of HCC cells and to explore the role mechanism of ropivacaine. RESULTS: Ropivacaine was able to inhibit proliferation and promote apoptosis of HCC cells in a dose- and time-dependent manner. Ropivacaine also has a trait to inhibit the migration of HCC cells; ropivacaine damaged the mitochondria of HCC cells. The results also indicated that ropivacaine was able to interact with caspase-3, promote cytoplasmic caspase-3 migration into the nucleus, stimulate cleavage of caspase-3 and PARP-1, caspase-9 proteins, inhibit the expression of Bcl-2, promote expression of Apaf-1 and mitochondria release cytochrome C, and activate the activity of caspase-3. CONCLUSIONS: Ropivacaine has a novel role in promoting apoptosis of HCC cells; The role mechanism of ropivacaine maybe involve in damaging the function of mitochondria and activating the caspase-3 signalling pathway in HCC cells. Our findings provide novel insights into the local anaesthetic agents in the therapy of HCC patients.

Minimum Effective Volume Of A Combination Of Bupivacaine And Lignocaine For Supraclavicular Brachial Plexus Block Using Ultrasound Guided Technique

Background: To determine the effective volume of a combination of bupivacaine and lignocaine for supraclavicular achial plexus block using ultrasonography (USG). Methods: This study is an intervention study to determine the minimum effective volume of a drug combination. The principle statistical method applied in this study is Staircase Up-down method as described by Dixon and Massey.([i]) Results: By using the log transformation of the data of required volume and outcome as successful or unsuccessful we have calculated EV 50 = 11ml and EV 90 = 14ml. Conclusion: Minimum Effective Volume in 90% individuals (MEV 90) for a combination of 0.25% bupivacaine and 1% lignocaine for ultrasound guided achial plexus block via supraclavicular approach is 14ml.

Comparison of intrathecal morphine and surgical-site infusion of ropivacaine as adjuncts to intravenous patient-controlled analgesia in living-donor kidney transplant recipients

<p><b>INTRODUCTION</b>This prospective observational study compared the postoperative analgesic effectiveness of intrathecal morphine (ITM) and surgical-site infusion (SSI) of ropivacaine as adjuncts to intravenous (IV) patient-controlled analgesia (PCA) (fentanyl) in living-donor kidney transplant recipients.</p><p><b>METHODS</b>Patients undergoing living-donor kidney transplantation who received ITM or SSI in addition to IV PCA were included. Rescue analgesia was achieved with IV meperidine as required. The primary outcome, measured using the Numeric Pain Rating Scale (NRS), was pain at rest and when coughing. Patients were assessed for 48 hours after surgery.</p><p><b>RESULTS</b>A total of 53 patients (32 ITM, 21 SSI) were included in the study. The ITM group showed significantly lower NRS scores, at rest and when coughing, for up to 12 and eight hours. NRS scores were comparable between the groups at other times. The ITM group had significantly less postoperative systemic opioid requirement in the first 24 hours, but there was no significant difference between the systemic opioid consumption of the groups on postoperative Day 2. In the ITM group, 3 (9.4%) patients presented with bradypnoea and 1 (3.1%) with excessive sedation in the first 12 postoperative hours. More patients in the ITM group developed pruritus requiring treatment during the first 24 hours. There were no differences between the groups in other outcomes (e.g. nausea/vomiting, change in pulmonary or kidney functions).</p><p><b>CONCLUSION</b>Compared with SSI, ITM reduced immediate postoperative pain and IV opioid consumption on postoperative Day 1 after living-donor kidney transplantation, but at the cost of increased pruritus and respiratory depression.</p>

Double Trouble: A Case of Local Anaesthetic Toxicity Followed By Tension Pneumothorax in a Patient of Marfan Syndrome.

Spontaneous pneumothorax in patients with Marfan syndrome is common. Even a small pneumothorax can become a tension pneumothorax under positive pressure ventilation. Sometimes anaesthesiologists have to cater to more than one complication intraoperatively. Thorough knowledge of the subject and availability of monitors and anaesthesiologist in the operation theater as in general anaesthesia during locoregional anaesthesia is mandatory to avoid occurrence of catastrophy.