Nail surgery complications
Dimitris Rigopoulos, Chander Grover, Eckart Haneke in Nail Therapies, 2021
All types of nail surgery, whether diagnostic or therapeutic, should take into account both the functional aspect and the cosmetic appearance. Perfect knowledge of the nail anatomy and its pathology is crucial. Nail surgery is usually performed using local anesthesia and, in most cases, a tourniquet. Epinephrine is not used with a tourniquet, in young children, heavy smokers, and elderly persons (arterial impairment). The volume and concentration are adjusted according to age, size, and general condition. Ropivacaine is the ideal drug as its onset is as fast as that of lidocaine and its duration as long as that of bupivacaine.
Pharmacology of Local Anesthetics
Pamela E. Macintyre, Stephan A. Schug in Acute Pain Management, 2021
Cocaine was the first local anesthetic introduced into medical practice in 1884 by the ophthalmologist Koller, who described its use for topical anesthesia of the cornea. Subsequent developments led to the enantiomer-specific amide local anesthetics, with an increased margin of safety, and, most recently, the introduction of long-acting liposomal bupivacaine. The blockade of sodium channels explains only the effects but also the adverse effects of local anesthetics, which occur primarily due to interference with action potential generation and conduction in the heart and central nervous system. While this has also been attributed to other local anesthetics, lidocaine, chloroprocaine, and mepivacaine have the highest propensity to cause TNS. The enantiomer-specific long-acting local anesthetics, in particular ropivacaine but also levobupivacaine, offer safety advantages in this regard. A differentiation between short-acting amide and the long-acting amide agents, which are most often used for longer-lasting blocks and continuous techniques to provide analgesia, is clinically useful.
Ophthalmology
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Patients are often at extremes of age with coincidental illnesses including diabetes, cardio-respiratory disease and renal impairment. Anaesthesia aims to provide an immobile eye with low to normal intraocular pressure (IOP) avoiding spasm of extraocular muscles, coughing and vomiting. General anaesthesia is usually required in children however in adults most surgery is now performed using regional techniques. Premedication should aim to allay anxiety, prevent nausea and vomiting and avoid raising IOP. Peri-operative monitoring should be employed. A mixture of lidocaine (lignocaine) and bupivacaine with hyaluronidase and epinephrine maybe used to achieve rapid response, long duration and good spread. Rare but serious complications have led to the concept of non-akinetic regional anaesthetic techniques for cataract extraction. Secure control of the airway is required using a tracheal tube or a laryngeal mask.
Dexamethasone versus neostigmine as an adjuvant to bupivacaine 0.25% for caudal analgesia in children undergoing open inguinal hernia repair
Published in Egyptian Journal of Anaesthesia, 2017
Mohamed M. Abu Elyazed, Gehan M. Eid
BackgroundCo-administration of dexamethasone or neostigmine with local anesthetic solution for caudal block (CB) can prolong postoperative analgesia duration. We aimed to evaluate and compare the effectiveness of dexamethasone (0.1 mg/kg) versus neostigmine (2 μg/kg) when used as adjuvant to 0.25% bupivacaine for CB in children undergoing unilateral open inguinal hernia repair on the quality of postoperative analgesia. Methods105 children aged 1–6 years scheduled for unilateral open inguinal hernia repair were randomly allocated into three groups. Ultrasound guided CB was performed with 0.25% bupivacaine (0.75 ml/kg). 1 ml saline, dexamethasone (0.1 mg/kg) in 1 ml saline and neostigmine (2 μg/kg) in 1 ml saline were added in bupivacaine, bupivacaine-dexamethasone and bupivacaine-neostigmine respectively. Duration of postoperative analgesia, postoperative consumption of analgesic, the modified objective pain score, postoperative sedation and side effects were recorded. ResultsDuration of postoperative analgesia was prolonged in bupivacaine-dexamethasone and bupivacaine-neostigmine groups as compared to the bupivacaine group (P
A Review of the Compatibility of Liposome Bupivacaine with Other Drug Products and Commonly Used Implant Materials
Published in Postgraduate Medicine, 2014
The compatibility of a medication with other drugs and implanted materials is an important factor impacting drug safety and efficacy. The liposomal formulation of the local anesthetic bupivacaine is designed to provide prolonged postsurgical analgesia. Its compatibility with other drugs and materials depends on the compatibility of the drug itself, along with the integrity of liposome and liposomal components. A series of studies was conducted to evaluate the compatibility of liposome bupivacaine with diluents, implanted materials, and other drugs likely to be encountered in the surgical settings in which it is used. Liposome bupivacaine demonstrated compatibility with diluents (normal saline, lactated Ringer's solution) and with implanted materials (silicone, stainless steel, titanium, polypropylene, expanded polytetrafluoroethylene), with little or no change in percent of free bupivacaine, packed particle volume, or particle size distribution; liposome bupivacaine exhibited little or no change in the properties of the test materials. Liposome bupivacaine had clinically meaningful interactions with other local anesthetics, including lidocaine, ropivacaine, mepivacaine, or bupivacaine HCl (at liposome bupivacaine to bupivacaine HCl ratios < 2:1), which resulted in substantial displacement and release of free bupivacaine from liposomes. Liposome bupivacaine may be locally administered after ≥ 20 minutes following local administration of lidocaine, ropivacaine, or mepivacaine. Co–administration of liposome bupivacaine and bupivacaine HCl into the same site should be at ratios ≥ 2:1. Interactions between liposome bupivacaine and epinephrine, corticosteroids, antibiotics, non–steroidal anti–inflammatory drugs, tranexamic acid, and opioid analgesics were not clinically meaningful; liposome bupivacaine may be safely co–administered with these agents. No adverse synergistic effects on liposome bupivacaine were observed in evaluations involving multiple medications compared with each drug's individual effects.
New formulations of bupivacaine for the treatment of postoperative pain: liposomal bupivacaine and SABER-Bupivacaine
Published in Expert Opinion on Pharmacotherapy, 2014
Introduction: Although generally considered both safe and effective, local anesthetics are often used in conjunction with opioids postoperatively in part because of the limited duration of drug action of local anesthetics. Much interest exists in extending the duration of local anesthetics’ effects, which may reduce the requirement for opioid pain medications that are frequently associated with side effects, including nausea and vomiting, pruritus and respiratory depression. Areas covered: This article introduces liposomal bupivacaine and SABER®-Bupivacaine, two new formulations of bupivacaine that increase the duration of analgesia postoperatively through two novel slow-release technologies. The pharmacodynamics, pharmacokinetics, efficacy and safety of both preparations of bupivacaine are reviewed. An electronic database search conducted using the Cochrane Central Register of Controlled Trials and MEDLINE/PubMed with the following search terms: ‘bupivacaine,’ ‘liposomal bupivacaine’, ‘liposome bupivacaine’, ‘Exparel’, ‘SABER-Bupivacaine’, ‘SABER Bupivacaine’, and ‘SABER’ yielded 90 articles (no language or date of publication restrictions were imposed). Expert opinion: Clinical trials involving liposomal bupivacaine and SABER-Bupivacaine indicate that both safely prolong analgesia, while decreasing opioid requirements when compared with placebo. However, additional clinical studies are necessary to better determine the efficacy and cost-effectiveness of these long-acting local anesthetic formulations.
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