What You Need for a Trichology Consultation
Rubina Alves, Ramon Grimalt in Techniques in the Evaluation and Management of Hair Diseases, 2021
For the treatment of hair disorders, local drug infiltration may be necessary. It is especially useful to have corticosteroids ready to be infiltrated to any autoimmune alopecia. There are essentially two corticosteroids that are used for infiltration: triamcinolone acetonide and mometasone acetate. While the procedure and concentration of intralesional corticosteroid administration escapes the objective of this chapter, we must mention that we prefer the use of the corticosteroid diluted in an amide anaesthetic (usually lidocaine 5%) in an insulin syringe (30 G, 1 mL). In addition, other molecules can be administered to stimulate hair growth. In general, these drugs (e.g. dutasteride or minoxidil) must be formulated in excipients for their correct stability at the time of administration. Usually 1-mL luer-lock syringes are used, which are then attached to 30 G 0.30 × 4 mm needles (Figure 18.3). The administration of local anesthetics may be indicated prior to some procedures such as mesotherapy. It may be especially useful to have amides such as mepivacaine and lidocaine rapidly available to anesthetize the area. Both lidocaine and mepivacaine are excellent anesthetics due to their rapid action and safety. We usually inject them into syringes and needles of similar characteristics to the previously mentioned drugs.
Obstetrical Pathophysiology of Cocaine
Richard J. Konkol, George D. Olsen in Prenatal Cocaine Exposure, 2020
Cocaine is highly protein bound in the human,2,115 although possibly less so in other species.14 Protein binding is often reduced during pregnancy, and this could result in elevated free cocaine concentrations with increased bioactivity. This effect has been variable with other drugs in the “caine” family of local anesthetics. Bupivacaine is 73% bound to protein in nonpregnant sheep but only 51% protein bound in pregnant sheep,116 and a constant infusion of bupivacaine at 0.5 mg/kg/minute caused cardiovascular collapse at a lower mean dose and lower total serum concentration in pregnant sheep when compared with nonpregnant sheep.117 However, mepivacaine and lidocaine do not appear to have increased cardiovascular toxicity during pregnancy, so not all local anesthetics are equally affected by the changes occurring during pregnancy.118
Local Anesthetics
Sahab Uddin, Rashid Mamunur in Advances in Neuropharmacology, 2020
Mepivacaine (Fig. 15.8) is an intermediate-acting and fast onset local amide anesthetic belonging to pipecoloxylidide family (PPX) like bupivacaine and ropivacaine. Mepivacaine has an anesthetic capacity comparable to that of lidocaine but with a lower vasodilator power, which gives it a longer duration of action. Mepivacaine is marketed as an injectable solution without or with vasoconstrictor (epinephrine). It is indicated for LA in dentistry by infiltration and truncal block as well as for therapeutic and diagnostic purposes by central and peripheral nerve block, infiltration, epidural anesthesia, and regional IV anesthesia. Regarding its pharmacokinetic properties, its percentage of plasma protein binding for mepivacaine is around 75%, it is metabolized by liver microsomal enzymes to p-hydroxymepivacaine and m-hydroxymepivacaine, and it is mainly excreted as glucuronide conjugates by bile (Brockmann, 2014). Sensitivity to mepivacaine can be increased in prolonged treatments with anticonvulsants, antiarrhythmics, and psychotropic drugs (AEMPS).
Salivary VEGF and post-extraction wound healing in type 2 diabetic immediate denture wearers
Published in Acta Odontologica Scandinavica, 2022
Katarina Radović, Božidar Brković, Jelena Roganović, Jugoslav Ilić, Aleksandra Milić Lemić, Boris Jovanović
Pre-prosthetic procedures included: attendance of a program of professional dental hygiene to nullify differences in preoperative hygiene conditions and atraumatic extractions of remaining 3 maxillary teeth without elevation of the full-thickness flap to preserve the bone ridges and soft tissue. The alveolar nerve block was obtained by using 2% mepivacaine. Both groups of participants, with and without diabetes, were indicated for immediate complete denture in order to provide T2DM participants with adequate mastication and to standardize the study conditions. The existing mandibular complete dentures were replaced on the day of receiving maxillary immediate complete dentures. The surgical protocol and clinical evaluation were conducted at the Clinic of Oral Surgery, School of Dental Medicine in Belgrade. The fabrication of new dentures (maxillary immediate complete dentures and mandibular complete dentures) and post-insertion denture adjustments necessary for removing difficulties that included pain and discomfort were performed at the Department of Prosthodontics, School of Dental Medicine in Belgrade. The study received approval from the Ethics Committee of the School of Dental Medicine, University of Belgrade (No. 32/36 in 2012 year) and was conducted in accordance with the Helsinki Declaration.
Recent Advances in Biomaterials for the Treatment of Bone Defects
Published in Organogenesis, 2020
Le-Yi Zhang, Qing Bi, Chen Zhao, Jin-Yang Chen, Mao-Hua Cai, Xiao-Yi Chen
Biomaterials also show promise to circumvent the pain associated with severe bone trauma. Pain management for bone regeneration interventions typically involves non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and local anesthetics.75 NSAIDs can however delay bone healing and amplify the risk of other complications, whilst opioids are legally controlled compounds with major side effects and addictive properties. Local anesthetics can relieve pain, but their short duration of action limits their efficacy.77 To circumvent these issues, Subaie et al. developed a bone regeneration biomaterial that could relieve pain through minimally-invasive procedures.78 In their study, sodium magnesium phosphate nanocrystal gels were used as osteoinductive colloidal suspensions that were injected through high gauge needles to control the release of the local anesthetic mepivacaine, producing an injectable bone regeneration biomaterial with analgesic properties. When the system was assessed in vivo using the mouse-hindpaw model,78 the gel controlled mepivacaine release for up to 24 h, prolonging its activity. No structural changes occurred for the drug, highlighting its compatibility with the gel. This biomaterial therefore holds promise for minimizing the invasiveness of bone regeneration procedures, and could limit the healing period of bone defects. Ultimately, this could eliminate the need for systemic drugs and NSAIDs during bone pain management procedures.
Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report
Published in Canadian Journal of Pain, 2018
Sean D. Christie, Nelofar Kureshi, Ian Beauprie, Renn O. Holness
Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia, and injections are commonly performed by both family physicians and specialists. Ultrasound-guided approaches are superior to landmark techniques for favorable outcome with occipital nerve block.11 The greater occipital nerve (GON) provides cutaneous innervation to the posterior scalp, whereas the lesser occipital nerve supplies scalp sensation lateral to the GON to the posterior auricle. In patients with occipital neuralgia, the GON may be blocked alone or with the lesser occipital nerve for peripheral nerve block. Local anesthetics including lidocaine, mepivacaine, and bupivacaine may be injected as monotherapy or as combinations. Corticosteroids may be added for patients who do not respond to infiltration with local anesthetic only.
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