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Anesthetic Agents and Surgery during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Central nervous system (CNS) toxicity is a potentially serious complication of unintentional intravascular injection of local anesthetic. During pregnancy, epidural veins are engorged and large, making them vulnerable to inadvertent puncture with a needle or catheter. CNS toxicity symptoms include slurred speech, dizziness, metallic taste in the mouth, ringing in the ears, facial paresthesia, seizures, and syncope. It is recommended that doses of peripheral and central neuraxial local anesthetics be reduced during pregnancy (El-Boghdadly et al., 2018). In the past three decades, evidence has accumulated that indicates clinical use of certain local anesthetics in pregnancy may cause irreversible conduction blockade to occur (Datta et al., 2010).
Local Anaesthetic Blocks
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Maximal analgesic effect takes approximately 15 minutes for all local anaesthetics. The vasoconstrictive action of adrenaline takes longer (25–30 minutes). It is therefore advisable to wait after giving the anaesthetic before starting any procedure. In practice we advise: Administer the LA before going to gather the things you need – dressings, suture pack, etc. Note that using a LA mixed with adrenaline not only prolongs the anaesthesia time but also reduces bleeding at the wound site due to the vasoconstrictive properties of adrenaline.
Headache
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Stephen Silberstein, Shuhan Zhu
The literature for pregnancy outcomes after local anesthetic exposure comes largely from the dental field. A prospective, comparative observational study in Israel followed 210 pregnant patients who received local anesthetic for dental procedures and found no difference in rates of miscarriages, gestational age at delivery, or birth weight [29]. Both the American College of Obstetrics and Gynecologists [30, 31] categorize the use of local anesthetic for dental procedures to be safe during pregnancy.
Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions
Published in Baylor University Medical Center Proceedings, 2023
Nicholas F. Lombana, Ishan M. Mehta, Caiwei Zheng, Reuben A. Falola, Andrew M. Altman, Michel H. Saint-Cyr
The pharmacokinetics of such drugs is further influenced by the acid dissociation constant, pKa, lipid solubility, and protein binding of each agent.14 Agents with a pKa closer to body acidity, pH 7.4, have a faster onset of action, secondary to ease of passage across the nerve cell membrane.14 The choice of local anesthetic agent is dependent on several factors including patient allergies, desired duration of action, and desired onset. For example, lidocaine has been shown to provide anesthesia for 1 to 3 hours and bupivacaine for up to 10 hours.14,15 It is particularly important to be cognizant of local anesthetic agent dosing to prevent local anesthetic toxicity. The reported maximum dose for lidocaine with epinephrine is 7 mg/kg; for lidocaine without epinephrine, 4.5 mg/kg; and for bupivacaine (with or without epinephrine), 2 to 3 mg/kg.14,15
Synthesis of nanocapsules blended polymeric hydrogel loaded with bupivacaine drug delivery system for local anesthetics and pain management
Published in Drug Delivery, 2022
Wentao Deng, Yu Yan, Peipei Zhuang, Xiaoxu Liu, Ke Tian, Wenfang Huang, Cai Li
Postoperative pain management is still one of the most common problems that have largely gone unexplored (Peccora & Zhou, 2015). Clinically, local anesthetics (LA) are used to control pain after operations (including gastrointestinal surgery) or to treat other acute and chronic pain (Sandhu et al., 2021). Antipyretic analgesics (e.g. acetaminophen and celecoxib) and opioids can be used to provide relief (e.g. morphine and oxycodone). However, many drugs, particularly opioids, have serious adverse effects such as nausea, respiratory suppression, and vomiting as well as the potential to cause sensitization (Nersesyan & Slavin, 2007). However, because anesthetics have a low molecular weight, the duration of analgesia generated by a single injection is typically only very few hours, which does not meet the criteria for clinical use (Becker & Reed, 2012). The use of LA in the field of postoperative analgesia has recently received considerable attention in both scientific and clinical studies. Plain LA drugs, on the other hand, have a short duration of action. LA drugs such as lidocaine, bupivacaine (BPV), ropivacaine, and others exhibit small-molecule features such as limited action duration (1–2 h for lidocaine; 2–4 h for bupivacaine and ropivacaine) and fast relocation and encapsulation of LA agents with nanosystems (El-Boghdadly et al., 2018). As a result, the design and implementation of continuous release systems to extend the analgesic activity for days while reducing side effects are essential.
Comparison of transversus abdominis plane blocks with liposomal bupivacaine versus ropivacaine in open total abdominal hysterectomy
Published in Baylor University Medical Center Proceedings, 2022
John C. Alexander, Mary Sunna, YPaul Goldenmerry, Allison Mootz, Caitlin O’Connor, Jenny Ringqvist, Matthew Bunker, Girish P. Joshi, Irina Gasanova
Bilateral ultrasound-guided transversus abdominis plane (TAP) blocks are a commonly performed regional anesthesia procedure utilized for postoperative analgesia after abdominal surgery.1–3 It is the standard regional anesthesia procedure used at our institution for open total abdominal hysterectomies (TAH) and provides consistent somatic innervation blockage across the T7–L1 dermatomes.2 Bupivacaine and ropivacaine are the most commonly used local anesthetics due to their long duration of action (up to 24 hours).3,4 Ropivacaine has been shown to have lower neurotoxic and cardiotoxic profiles and less motor blockade than regular bupivacaine.5 Liposomal bupivacaine is a relatively recent pharmacologic innovation consisting of a multivesicular liposomal injectable solution of 1.3% bupivacaine that can provide analgesic benefits for up to 48 hours.4 There are no studies comparing the effectiveness of liposomal bupivacaine and ropivacaine TAP blocks in reducing postoperative opioid consumption. This retrospective study compared intraoperative and postoperative opioid consumption, postoperative pain scores, and rescue antiemetic use between patients who received liposomal bupivacaine vs ropivacaine TAP blocks. We hypothesized that patients who received liposomal bupivacaine bilateral TAP blocks would require fewer postoperative opioids to achieve similar pain scores when compared to patients who received ropivacaine bilateral TAP blocks.