Comparative Study between the Combination of Dexamethasone and Bupivacaine for Third Molar Surgery Postoperative Pain: A Triple-Blind, Randomized Clinical Trial.

Objectives: To compare the possible benefits of the combination of dexamethasone-bupivacaine with articaine-epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine-epinephrine and submucosal reinforcement with 0.8 mg dexamethasone-5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine-epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients' scores on the VAS as well as their consumption of analgesic drugs after surgery.

Sevoflurano tópico: una experiencia galena / Topical sevoflurane: a galenic experience

El sevoflurano es un líquido volátil de la familia de los hidrocarburos halogenados derivados del éter que está aprobado para realizar la inducción y elmantenimiento de la anestesia general inhalatoria en ambiente exclusivamentehospitalario. En esta revisión se expone la experiencia pionera de nuestra Unidad del Dolor en el tratamiento domiciliario de heridas dolorosas complejasmediante irrigaciones de sevoflurano tópico según un protocolo aprobadopara su uso fuera de ficha técnica. Se abordan aspectos de seguridad y eficacia, tanto analgésica como antimicrobiana y procicatrizante, y se comentanalgunas líneas de futuro en cuanto a nuevas formulaciones para uso tópico.Tras más de 7 años de vigencia del referido protocolo, contamos con unaexperiencia acumulada de más de 70.000 aplicaciones de sevoflurano tópico.En líneas generales, el efecto analgésico aparece rápidamente en cuestión deminutos, es de gran intensidad, y de duración prolongada por espacio de variashoras; gracias a ello los pacientes pueden reducir el consumo de analgésicossistémicos y, en general, su calidad de vida mejora. Además, existen indiciosque sugieren que también ejerce acción antimicrobiana y procicatrizante. (AU)

Sevoflurane is a volatile liquid from the family of ether-derived halogenated hydrocarbons that is approved for the induction and maintenance ofinhalational general anesthesia in the hospital setting. This review describes the pioneering experience of a Spanish Pain Unit in the home treatmentof complicated painful wounds using topical sevoflurane instillations according to a protocol approved for off-label use. Aspects of safety and efficacy, both analgesic, antimicrobial and pro-healing are addressed, andsome future lines of research are discussed in terms of new formulationsfor topical use. After more than seven years of use of the protocol, anexperience of over 70,000 applications of topical sevoflurane has beengained. In general terms, the analgesic effect appears quickly, is highlyintense and persists for several hours. As a result, patients can reduce theirconsumption of systemic analgesics and benefit from an improvement intheir quality of life. In addition, there are signs that suggest sevofluranealso possesses antimicrobial and pro-healing properties. Regarding safety,pruritus at the level of the periulcerous skin is the most frequently reportedadverse effect, although it is usually transient and well-tolerated, and nosystemic toxicity has been reported. Overall, the risk-benefit balance of thedrug has so far been very favorable. To avoid manipulation of this volatileliquid, we have developed a new formulation of sevoflurane in gel form,which has made it possible to successfully apply sevoflurane in the contextof painful pathologies where the skin remains intact. Furthermore, thesetypes of new formulations, including sevoflurane microspheres, which wehave also developed, could improve the efficacy and safety of topicalsevoflurane while reducing the occupational exposure of healthcare staff.This means that the development of new formulations is a field with a verypromising future. (AU)

Occupational exposure to sevoflurane following topical application to painful wounds.

BACKGROUND: Occupational exposure to halogenated anesthetics employed for general anesthesia has been extensively studied. Conversely, a new modality of treatment of painful wounds with topical sevoflurane lacks exposure studies. OBJECTIVES: To evaluate the magnitude of acute occupational exposure to sevoflurane following topical application to painful wounds. METHODS: Four patients with chronic painful wounds were treated with topical sevoflurane (20, 20, 20 and 10 mL) following an approved therapeutic protocol in our Pain Management Unit. Eight passive dosimeters were placed at different locations of a treatment room with a volume of 163 m3 and 3.3 air changes per hour: 3 for near peak (for 20-50 min) and 1 overall exposure (for 3.4 h) at the nurse's breathing zone, and 4 for area exposure (for 3-3.4 h). Worst-case scenario theoretical concentrations of sevoflurane were also calculated. RESULTS: The highest levels were obtained for two dosimeters worn by the nurse at the breathing zone (8.28 and 9.12 ppm-TWA [parts per million-Time-Weighted Average]), while the lowest level was obtained from the dosimeter placed on the most distant wall from patients (0.73 ppm-TWA). Theoretical concentrations were calculated from standard volatilization principles and were in agreement with the concentrations measured. Discussion-Conclusions: All air concentrations measured were lower than exposure limits set by occupational safety agencies from Finland, Sweden and Norway, which range from 10 ppm for a TWA of 8 hours to 20 ppm for short-term exposures (15 min). Application of topical sevoflurane on wounds seems to be environmentally safe for health-care professionals as it produces exposure levels lower than the established limits for anesthetic procedures.