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Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Prilocaine is commonly used for intravenous regional anaesthesia (IVRA): Its onset and duration of action are similar to those of lidocaine.The maximum dose is 5 mg/kg (3 mg/kg for bier’s block).The maximum dose with adrenaline is 8 mg/kg. Prilocaine doses over 8 mg/kg may cause methaemoglobinaemia, but this can be treated with methylene blue (2 mg/kg).
Pharmacology of Local Anesthetics
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The initial step in the metabolism of prilocaine forms orthotoluidine. The administration of large doses of prilocaine may lead to the accumulation of this metabolite, which, in turn, leads to an increase in the oxidation of hemoglobin to methemoglobin (Becker & Reed, 2012). If the level of methemoglobin becomes excessive, the patient may appear cyanotic. This metabolic toxicity limits the use of prilocaine in anemic patients and leads to the recommendation to avoid repeat injections or infusions, thereby limiting its use in acute pain therapy.
Prilocaine
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Prilocaine is an intermediate-acting local anesthetic of the amide type chemically related to lidocaine. It is used for local anesthesia by infiltration and is the most often used local anesthetic in dentistry. In pharmaceutical products, both prilocaine and prilocaine hydrochloride (CAS number 1786-81-8, EC number 217-244-0, molecular formula C13H21CIN2O) may be employed (1). It is present, together with lidocaine, in a frequently used anesthetic cream for surface anesthesia called EMLA ® (4,5,7,8,11,12,13,22).
Pulsed dye laser versus Nd:YAG laser in the treatment of recalcitrant plantar warts: an intraindividual comparative study
Published in Journal of Cosmetic and Laser Therapy, 2021
Shady Mahmoud Attia Ibrahim, Mona Soliman, Sahar Khalaf Allah Mohamed, Mohamed Mohsen Soliman
Topical anesthesia in the form of a mixture of pridocaine and prilocaine cream (Global Napi, Pharmaceuticals, Egypt) was applied to the lesions 1 hour before laser treatment. Paring of the wart done by scalpel number 20. One half of the lesions were randomly selected and treated by 595-nm PDL laser (Synchro VasQ, Deka, Florence, Italy) using fluence of 15 J/cm2, pulse duration of 0.5 ms and spot size of 7 mm, while the remaining half treated by 1064-nm long pulsed Nd:YAG laser (Synchro Repla:y Excellium HP, Deka, Florence, Italy) using fluence of 100 J/cm2, pulse duration of 15 ms and spot size of 5 mm. Two stacking laser pulses were applied to each wart, covering the wart itself and a 1-mm margin on the surrounding skin. Subsequent outpatient treatment consisted of topical antibiotics, and analgesic drugs to guard against infection and to relieve pain. All included patients received laser treatment every 2 weeks till complete clearance or for a maximum of six sessions. The patients were appointed for the next session biweekly for assessment of the healing process, detection of the complications, if any. Systemic antibiotic prescribed in case of secondary infection. All patients followed up for 6 months after the end of treatment sessions for observation of recurrence or appearance of new lesions.
Anticoagulation strategy in patients with atrial fibrillation after carotid endarterectomy
Published in Acta Chirurgica Belgica, 2019
Murat Ugurlucan, Hakki Tankut Akay, Ibrahim Erdinc, Didem Melis Oztas, Cenk Conkbayir, Erdal Aslim, Cenk Eray Yildiz, Kubilay Aydin, Ufuk Alpagut
The operations were performed with deep or superficial regional anesthesia. Superficial cervical block was performed with the injection of 10 cc bupivacaine 0.05%, 6 cc lidocaine 2% and 4 cc saline combination along the lateral border of the sternocleidomastoid muscle subcutaneously. Deep cervical plexus block was performed at the level of the transverse processes of cervical vertebrae C2, C3, and C4. A combination of lidocaine hydrochloride and bupivacaine hydrochloride was injected after negative aspiration result for blood. A total amount of bupivacaine hydrochloride 2–3 mg/kg was allowed. Additional prilocaine hydrochloride was used subcutaneously at the incision line as infiltration anesthesia. Additional doses of prilocaine hydrochloride were injected intraoperatively if the patient complained of pain during the procedure. The allowed total dose of prilocaine was 5 mg/kg. Intraoperative remifentanil (0.025–0.05 mg/kg/min) maintained an adequate level of comfort, responsiveness, and cooperation. Continuous infusion of nitroglycerin was used for blood pressure control. Additional diltiazem or metoprolol was administered if needed. After de-clamping occasionally midazolam was given. Systemic heparin (100 IU/kg) was injected before clamping and was not antagonized after the procedure. A shunt was selectively used in the case of neurologic deterioration at cross-clamping test at duration of 2–3 min.
Liposomal-based lidocaine formulation for the improvement of infiltrative buccal anaesthesia
Published in Journal of Liposome Research, 2019
Ana Cláudia Pedreira de Almeida, Luciana Matos Alves Pinto, Giuliana Piovesan Alves, Lígia Nunes de Morais Ribeiro, Maria Helena Andrade Santana, Cíntia Maria Saia Cereda, Leonardo Fernandes Fraceto, Eneida de Paula
Lidocaine (LDC) is a gold standard LA with moderate action that is used in a wide range of dentistry procedures, mainly in association with vasoconstrictors, in order to increase the duration of nerve blockade. Nevertheless, the use of vasoconstrictors is either not recommended or contraindicated in many clinical conditions (Perusse et al.1992a, 1992b, Eidelman et al.2005). In this context, we have previously reported that liposomal formulation with prilocaine is able to prolong the duration of anaesthesia when compared to plain prilocaine (without vasoconstrictor). Also this formulation showed similar effects of felypressin-containing prilocaine suggesting that liposomal encapsulation is able to replace the vasoconstrictor in LA formulations to dentistry uses (Cereda et al.2004), especially when the vasoactive compound is contraindicated.