DOCSLIB.ORG

Topical Intrapocket Anesthesia During Scaling and Root Planing

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Topical Intrapocket Anesthesia During Scaling and Root Planing Brazilian Dental Journal (2015) 26(1): 26-32 ISSN 0103-6440 http://dx.doi.org/10.1590/0103-6440201300131 1Dental School, Franciscan University Topical Intrapocket Anesthesia Center, Santa Maria, RS, Brazil 2Postgraduate Program in Dentistry, During Scaling and Root Planing: UFSM - Federal University of Santa Maria, Santa Maria, a Randomized Clinical Trial RS, Brazil 3Postgraduate Program in Dentistry, ULBRA - Lutheran University of Brazil, Canoas, RS, Brazil Raquel Pippi Antoniazzi1, Bruna Cargnelutti1, Daniela Napoleão Freitas2, Magáli Beck Guimarães1, Fabricio Batistin Zanatta2, Carlos Alberto Feldens3 Correspondence: Dra. Raquel Pippi Antoniazzi, Rua Silva Jardim, 1175, 97010-491 Santa Maria, RS, Brasil. Tel: +55-55-3025-1202. e-mail: [email protected] Although the use of injectable anesthesia prior to subgingival scaling and root planing (SRP) reduces pain, many patients report fear and prolonged numbness of adjacent tissues. The aim of the present study was to compare the effects of a eutectic mixture containing 25 mg/g of lidocaine and 25 mg/g of prilocaine, injectable 2% lidocaine, topical 2% benzocaine and a placebo substance on reducing pain during SRP. In this randomized, split-mouth, masked clinical trial, thirty-two patients presenting more than two teeth with probing depth and clinical attachment level ≥5 mm in at least 4 sextants were randomly allocated to four groups: EMLA®; injectable 2% lidocaine; topical 2% benzocaine and placebo. Pain and discomfort were measured using a visual analogue scale (VAS) and verbal scale (VS). Repeated-measures analysis of variance and Poisson regression were used for analysis. Patient satisfaction with the anesthesia was determined at the end of each treatment session. VAS and VS scores did not differ between injectable 2% lidocaine and EMLA (p>0.05) and both substances showed significantly better pain control compared to 2% benzocaine and placebo (p<0.05). 93.7% and 81.2% of the individuals were satisfied with the injectable anesthetic and EMLA, respectively (p=0.158). Dissatisfaction with benzocaine and placebo was approximately 10 times greater than injectable anesthesia (p=0.001). In conclusion, EMLA showed an equivalent effect on pain control when compared to the injectable anesthesia and performed better than 2% benzocaine in SRP. Thus, EMLA is a viable anesthetic option during scaling and root Key Words: local anesthesia, planning, despite the frequent need for second application. periodontitis, root planing, pain. Introduction lower cost. To date, no studies have compared the efficacy It is often necessary to use anesthesia during of EMLA to another inexpensive, commonly used anesthetic subgingival scaling and root planing (SRP) to control pain (2% benzocaine) during subgingival SRP procedures. and discomfort (1). An injectable anesthetic is considered Moreover, few studies have compared the effects of EMLA the gold standard in such cases and may or may not be to injectable anesthesia using pain scores for the purposes used in conjunction with a topical anesthetic (2). While of evaluation. injectable anesthetics are effective in controlling pain, many The study hypothesis is that topical anesthetics are patients report fear of the needle, long-lasting effects and equivalent to injectable anesthetic regarding the control the prolonged numbness of adjacent tissues, such as the of pain during SRP. The aim of the present study was to lips and tongue (3-5). The need for painless, noninvasive, compare the effects of EMLA, injectable 2% lidocaine, fast-acting anesthetics with effectiveness only during topical 2% benzocaine and a placebo substance on reducing the procedure has led to the investigation of the use of pain during subgingival scaling and root planing. substances with topical application during SRP (3,6-11) and periodontal maintenance (12). It has recently been Material and Methods demonstrated that the use of a topical anesthetic does Study Design and Subjects not compromise subgingival treatment and offers similar A masked, randomized clinical trial with a split-mouth benefits to pocket probing and clinical attachment gain design was carried out. Forty-one patients were recruited to an injectable anesthetic (13). from the Dental School of the Franciscan University Center, Oraqix® is a topical anesthetic containing lidocaine Santa Maria, RS, Brazil, from June 2010 to March 2012. This (25 mg/g) and prilocaine (25 mg/g) that is commercially study received approval from the Human Research Ethics available as an anesthetic for subgingival SRP. This product Committee of the university and all participants signed a has proven to be a reliable alternative to injectable statement of informed consent. The registration number anesthesia (7-9). A eutectic mixture denominated EMLA® is NCT01860235 (www.clinicaltrials.gov). has the same composition as Oraqix, but is offered at a For gingivitis treatment, all patients received two Braz Dent J 26(1) 2015 to four supragingival scaling and polishing sessions and procedures being conducted during the first four sessions. meticulous self-care oral hygiene training. After treatment Therefore all patients received the four interventions. and the achievement of the goal of a low percentage of The two teeth with the deepest PD were selected from visible plaque and gingival bleeding (<15%), an examination each sextant. Following the treatment of those teeth and was performed for the assessment of probing depth (PD), administration of the pain scales, SRP was performed on clinical attachment level (CAL) and bleeding on probing other teeth in the sextant that required the procedure (BOP) at six sites per tooth to determine the sites that using the same type of anesthetic. required SRP treatment. Eligible individuals were selected Randomization was conducted by a researcher not from those requiring SRP with at least two teeth in four involved in the eligibility and entry of subjects into the sextants with ≥1 site with PD and CAL ≥5 mm and BOP study to warrant treatment allocation concealment. following treatment for gingivitis (without marginal Block randomization was performed for the allocation bleeding). The other inclusion criteria were aged 18 years or of the participants to the different groups: injectable 2% older, adequate understanding of the pain scales employed lidocaine with epinephrine 1:100,000 (Alphacaine; DFL, and no history of previous periodontal treatment. The Rio de Janeiro, RJ, Brazil); topical 5% eutetic mixture of following were the exclusion criteria: history of allergies 25 mg/g of lidocaine and 25 mg/g of prilocaine (EMLA; or sensitivity reaction to any amide or ester anesthetic; AstraZeneca, Cotia, SP, Brazil); topical 200 mg/g of 2% having received anesthesia or sedation 12 h prior to SRP; benzocaine (Benzotop; DFL) or a placebo substance with be using pain medication (i.e., sedative, muscle relaxant, same appearance and viscosity as the topical anesthetics. anti-inflammatory medication, and narcotic analgesic); One set of opaque envelopes contained a card stipulating ulcerations or abscesses in the oral cavity; oral disease the sextant to undergo treatment and a second set with immediate need for surgery; history of alcohol of envelopes contained a card stipulating the type of abuse; current pregnancy; uncontrolled hypertension; and anesthesia to be administered. Each participant received participation in a clinical trial of an investigational drug an envelope from each set immediately prior to the start within four months after the onset of the present study. of the subgingival SRP session. The technique used for injectable anesthesia was Experimental Design nerve block with at most two anesthetic cartridges per Figure 1 displays the flow chart of the study. After the session SRP. When a topical substance was administered, clinical parameters had been recorded, the four sextants the patient was masked to the type. All anesthetics were containing teeth with the deepest PD were chosen to administered by the same operators (BC and DNF). Prior Topical intrapocket anesthesia intrapocket Topical participate in the experiment. Treatment with SRP was to administration, relative isolation was performed with performed over six weekly sessions with the experimental cotton rolls. The selected anesthetic was applied to the Figure 1. Study flow chart. 27 Braz Dent J 26(1) 2015 two teeth with a deepest PD and BOP (regardless of the kappa (K) statistic. K values for intra-examiner agreement severity of PD). For topical anesthetics, the maximum dose regarding PD and CAL were 0.79 and 0.76 for Examiner 1 used in the sextant was 2.5 mL. The anesthetic was applied and 0.74 and 0.80 for Examiner 2, respectively. K values for directly into the periodontal pocket of each tooth with a inter-examiner agreement were 0.75 and 0.78 for PD and millimeter syringe and a blunt needle and inserted until CAL, respectively. Both intra-examiner and inter-examiner overflowing the gingival margin. reliability were determined a second time eight months Different operators performed the subgingival SRP after the onset of the study and all K values were ≥0.8. and assessment of the main outcome. The operator who performed the subgingival SRP was blinded to the type of Sample Size anesthesia to ensure that the procedure was performed The sample size was calculated based on a clinically similarly in all groups. For the operators masked were relevant difference in VAS scores (15 mm) between groups put under the clinic table all anesthetic types and it was with a standard deviation (SD) of 25 mm. Considering a requested him/her to walked away from dental chair until significance level of 5%, 90% study power and the paired that was completed the anesthesia so that operator does design, it was determined that a minimum of 31 patients not know the type of anesthesia that was administered. were needed for each group. This number was increased to Two minutes after administration of the anesthetic 41 patients to compensate for a possible 25% dropout rate. administration, the operator began the SRP procedure in the sextant using curettes and periodontal files (Neumar, Data Analysis São Paulo, SP, Brazil).
Load more

Recommended publications
  • Evaluation of Liposomal Delivery System for Topical Anesthesia
    THERAPEUTICS FOR THE CLINICIAN Evaluation of Liposomal Delivery System for Topical Anesthesia Mohamed L. Elsaie, MD, MBA; Leslie S. Baumann, MD Local anesthesia is an integral aspect of cutane- infiltrative anesthetics, now can be accomplished ous surgery. Its effects provide a reversible loss safely and comfortably with the use of topi- of sensation in a limited area of skin, allowing cal anesthetics.1 Topical anesthetics originated in dermatologists to perform diagnostic and thera- South America; native Peruvians noted perioral peutic procedures safely, with minimal discomfort numbness when chewing the leaf of the cocoa plant and risk to the patient. Moreover, the skin acts (Erythroxylon coca). The active alkaloid, cocaine, was as a major target as well as principle barrier for isolated by Niemann in 1860 and applied to con- topical/transdermal (TT) drug delivery. The stra- junctival mucosa for topical anesthesia by Koller in tum corneum (SC) plays a crucial role in barrier 1884. The development of similar benzoic acid esters function for TT drug delivery. Despite the major continued until 1943 when Loefgren synthesized lido- research and development efforts in TT systems caine hydrochloride, the first amide anesthetic.2 and their implementation for use of topical anes- We review the administration of local anes- thetics, low SC permeability limits the useful- thetics, specifically the liposomal delivery system ness of topical delivery, which has led to other for topical anesthesia, based on a review of the delivery system developments, including vesicu- literature and clinical experience. lar systems such as liposomes, niosomes, and proniosomes, with effectiveness relying on their Anatomy physiochemical properties.
    [Show full text]
  • Prolonged Duration Topical Corneal Anesthesia with the Cationic Lidocaine Derivative QX-314
    https://doi.org/10.1167/tvst.8.5.28 Article Prolonged Duration Topical Corneal Anesthesia With the Cationic Lidocaine Derivative QX-314 Alan G. Woodruff1,2, Claudia M. Santamaria1, Manisha Mehta1,2, Grant L. Pemberton1, Kathleen Cullion1,2,4, and Daniel S. Kohane1,2,3 1 Kohane Lab for Biomaterials and Drug Delivery, Department of Anesthesia, Perioperative and Pain Medicine, Division of Critical Care, Boston Children’s Hospital, Boston, MA, USA 2 Harvard Medical School, Boston, MA, USA 3 David H. Koch Institute, Massachusetts Institute of Technology, Cambridge, MA, USA 4 Department of Medicine, Division of Medicine Critical Care, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA Correspondence: Daniel S. Kohane, Purpose: Topical corneal local anesthetics are short acting and may impair corneal Laboratory for Biomaterials and healing. In this study we compared corneal anesthesia and toxicity of topically applied Drug Delivery, Department of Anes- N-ethyl lidocaine (QX-314) versus the conventional local anesthetic, proparacaine thesia, Division of Critical Care (PPC). Medicine, Boston Children’s Hospi- tal, Harvard Medical School, 61 Methods: Various concentrations of QX-314 and 15 mM (0.5%) PPC were topically Binney Street, Room 361, Boston, applied to rat corneas. Corneal anesthesia was assessed with a Cochet-Bonnet MA 02115, USA. e-mail: Daniel. esthesiometer at predetermined time points. PC12 cells were exposed to the same [email protected] solutions to assess cytotoxicity. Repeated topical corneal administration in rats was then used to assess for histologic evidence of toxicity. Finally, we created uniform Received: 6 May 2019 corneal epithelial defects in rats and assessed the effect of repeated administration of Accepted: 15 August 2019 these compounds on the defect healing rate.
    [Show full text]
  • Safety Alert: Risks Associated with Ophthalmic Anesthetics
    WRHA Pharmacy Program Health Sciences Centre MS-189 820 Sherbrook St. Winnipeg, Manitoba R3A 1R9 CANADA TEL: 204-787-7183 Fax: 204-787-3195 FAX: 204-787-3195 Safety Alert: Risks associated with Ophthalmic Anesthetics The self-administration of ophthalmic anesthetics by patients for the relief of eye pain should be avoided and they should not be given to patients to take home for pain relief. Vision threatening complications of topical anesthetic abuse are common. There is no indication for the use of ophthalmic anesthetics except for diagnostic and short term therapeutic purposes (the removal of a foreign body or ocular surgery) and therefore, these products should only be used under a physician’s supervision. Eye trauma resulting in a corneal abrasion (epithelial injury) is a common complaint in the Emergency department (1). A superficial corneal injury can cause intense pain causing a patient to seek medical help or immediate relief from available over the counter remedies. In Canada, only two topical ophthalmic anesthetic drugs are available commercially as single entities, proparacaine (proxymetacaine) and tetracaine (available in bottle and minim forms). Benoxinate (oxybuprocaine) is only available in combination with fluorescein (3). Lidocaine is also used in ophthalmic surgical procedures however, it is not available in the Canadian market as an ophthalmic preparation. Topical ophthalmic anesthetics function by blocking nerve conduction when applied to the cornea and conjunctiva. The ocular surface is innervated by the multiple branches of the trigeminal nerve. The cornea is supplied by the long and short ciliary nerves, the nasociliary nerve and the lacrimal nerve (4). Topical anesthetics reduce sodium permeability preventing generation and conduction of nerve impulses, increasing excitation threshold, and slowing the nerve impulse propagation.
    [Show full text]
  • Midazolam Injection, USP
    Midazolam Injection, USP Rx only PHARMACY BULK PACKAGE – NOT FOR DIRECT INFUSION WARNING ADULTS AND PEDIATRICS: Intravenous midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. In some cases, where this was not recognized promptly and treated effectively, death or hypoxic encephalopathy has resulted. Intravenous midazolam should be used only in hospital or ambulatory care settings, including physicians’ and dental offices, that provide for continuous monitoring of respiratory and cardiac function, i.e., pulse oximetry. Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured (see WARNINGS). For deeply sedated pediatric patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedures. The initial intravenous dose for sedation in adult patients may be as little as 1 mg, but should not exceed 2.5 mg in a normal healthy adult. Lower doses are necessary for older (over 60 years) or debilitated patients and in patients receiving concomitant narcotics or other central nervous system (CNS) depressants. The initial dose and all subsequent doses should always be titrated slowly; administer over at least 2 minutes and 1 allow an additional 2 or more minutes to fully evaluate the sedative effect. The dilution of the 5 mg/mL formulation is recommended to facilitate slower injection. Doses of sedative medications in pediatric patients must be calculated on a mg/kg basis, and initial doses and all subsequent doses should always be titrated slowly.
    [Show full text]
  • Lidocaine Hcl) Solution
    451424/Issued: September 2014 ® 2% Xylocaine Viscous (lidocaine HCl) Solution A Topical Anesthetic for the Mucous Membranes of the Mouth and Pharynx. WARNING: Life-threatening and fatal events in infants and young children Postmarketing cases of seizures, cardiopulmonary arrest, and death in patients under the age of 3 years have been reported with use of Xylocaine 2% Viscous Solution when it was not administered in strict adherence to the dosing and administration recommendations. In the setting of teething pain, Xylocaine 2% Viscous Solution should generally not be used. For other conditions, the use of the product in patients less than 3 years of age should be limited to those situations where safer alternatives are not available or have been tried but failed. To decrease the risk of serious adverse events with use of Xylocaine 2% Viscous Solution, instruct caregivers to strictly adhere to the prescribed dose and frequency of administration and store the prescription bottle safely out of reach of children. DESCRIPTION: Xylocaine (lidocaine HCl) 2% Viscous Solution contains a local anesthetic agent and is administered topically. Xylocaine 2% Viscous Solution contains lidocaine HCl, which is chemically designated as acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl)-, monohydrochloride and has the following structural formula: 1 Reference ID: 3633341 The molecular formula of lidocaine is C14H22N2O. The molecular weight is 234.34. COMPOSITION OF SOLUTION: Each mL contains 20 mg of lidocaine HCl, flavoring, saccharin sodium, methylparaben, propylparaben and sodium carboxymethylcellulose in purified water. The pH is adjusted to 6.0 to 7.0 with sodium hydroxide. CLINICAL PHARMACOLOGY Mechanism of Action Lidocaine stabilizes the neuronal membrane by inhibiting the ionic fluxes required for the initiation and conduction of impulses, thereby effecting local anesthetic action.
    [Show full text]
  • Preoperative Evaluation, Premedication, and Induction of Anesthesia ELIZABETH A
    Preoperative Evaluation, Premedication, and Induction of Anesthesia ELIZABETH A. GHAZAL, MARISSA G. VADI, LINDA J. MASON, 4 AND CHARLES J. COTÉ Preparation of Children for Anesthesia Rectal Induction Fasting Full Stomach and Rapid-Sequence Induction Piercings Special Problems Primary and Secondary Smoking The Fearful Child Psychological Preparation of Children for Surgery Autism History of Present Illness Anemia Past/Other Medical History Upper Respiratory Tract Infection Laboratory Data Obesity Pregnancy Testing Obstructive Sleep Apnea Syndrome Premedication and Induction Principles Asymptomatic Cardiac Murmurs General Principles Fever Medications Postanesthesia Apnea in Former Preterm Infants Induction of Anesthesia Hyperalimentation Preparation for Induction Diabetes Inhalation Induction Bronchopulmonary Dysplasia Intravenous Induction Seizure Disorder Intramuscular Induction Sickle Cell Disease Preparation of Children for Anesthesia clear fluids from the stomach is approximately15 minutes (Fig. 4.1); as a result, 98% of clear fluids exit the stomach in children FASTING by 1 hour. Clear liquids include water, fruit juices without pulp, Infants and children are fasted before sedation and anesthesia to carbonated beverages, clear tea, and black coffee. Although fasting minimize the risk of pulmonary aspiration of gastric contents. In for 2 hours after clear fluids ensures nearly complete emptying a fasted child, only the basal secretions of gastric juice should be of the residual volume, extending the fasting interval to 3 hours present
    [Show full text]
  • Anesthesiology Primer for SIU Medical Students
    An Anesthesiology Primer for SIU medical students Part 1. What do anesthesiologists do? Part 2. Preoperative evaluation - Airway Exam - ASA physical status - NPO guidelines - Medication review Part 3. Anesthetic drugs - Sedatives/Induction agents - Volatile anesthetics - Opioids - Muscle relaxants - Local anesthetics Part 4. Airway management - Airway support - Mask ventilation - Laryngeal mask airway - Endotracheal intubation/Endotracheal tubes Part 5. Regional anesthesia - Subarachnoid blocks - Epidural blocks - Peripheral nerve blocks - Compartment blocks Part 6. Intraoperative care - Monitoring equipment - Fluid management Part 7. Anesthesia complications - Postoperative nausea and vomiting - Dental injury - Aspiration - Nerve injury - Malignant hyperthermia Part 1. What do anesthesiologists do? Anesthesiologists are experts in perioperative medicine. On a simplistic level, we put patients to sleep and wake them up. But really we are in charge of the patient’s entire operative experience, including preoperative assessment and medical optimization, intraoperative management of medical problems, and postoperative care including pain management. The field of anesthesiology is closely aligned with critical care medicine. Knowledge of cardiopulmonary support is key to a successful anesthetic. In addition, we function as the patient’s primary care provider during surgery and must be able to manage both common and rare medical issues that may emerge. Anesthesiologists provide services throughout the hospital. In addition to operating room procedures, we also provide patient assessment and management of procedural care for labor and delivery, radiology, gastroenterology, and ECT. Because of our expertise in airway management, we may be consulted emergently by the ED or ICU for endotracheal intubation in a patient with a difficult airway, or for other procedures such as vascular access, pain blocks, or epidural blood patches.
    [Show full text]
  • Topical Anesthesia for Endoscopic Office-Based Procedures of The
    Topical Anesthesia for Endoscopic Office-based Procedures of the Upper Aerodigestive Tract *David J. Wellenstein, †Raymond A.B. van der Wal, *Henrieke W. Schutte, *Jimmie Honings, *Frank J.A. van den Hoogen, *Henri A.M. Marres, *Robert P. Takes, and *Guido B. van den Broek, *yNijmegen, The Netherlands Summary: Objective. Over the last two decades, an increase in office-based procedures under topical anesthesia in laryngology and head and neck oncology has occurred. Adequate anesthesia in the nasal cavity, pharynx, and larynx is essential for successful performance of these procedures. Our goal is to provide an objective summary on the avail- able local anesthetics, methods of application, local secondary effects, efficacy, and complications. Material and Methods. A descriptive review of literature on topical anesthesia for office-based procedures in laryn- gology and head and neck oncology was performed. Results. Lidocaine is the most applied and investigated topical anesthetic. Topical anesthesia results in decreased sen- sory function without impairing motor function of the pharynx and larynx. For the nasal cavity, cotton pledgets soaked in anesthetic spray and decongestant, or anesthetic gel, are effective. For the pharynx, anesthetic spray is the most frequently used and effective method. For the larynx, applying local anesthesia through a catheter through the working channel of the endoscope or anesthetic injection through the cricothyroid membrane is effective. Studies com- paring the most effective application methods for each anatomical site are lacking. Complications of topical lidocaine administration are rare. Conclusions. By properly applying topical anesthesia to the upper aerodigestive tract, several surgical procedures in laryngology and head and neck oncology can be performed in the outpatient clinic under topical anesthesia instead of the operating room under general anesthesia.
    [Show full text]
  • EMLA CREAM (Lidocaine 2.5% and Prilocaine 2.5%)
    EMLA CREAM (lidocaine 2.5% and Prilocaine 2.5%) DESCRIPTION EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) is an emulsion in which the oil phase is a eutectic mixture of lidocaine and prilocaine in a ratio of 1:1 by weight. This eutectic mixture has a melting point below room temperature and therefore both local anesthetics exist as a liquid oil rather than as crystals. It is packaged in 5 gram and 30 gram tubes. Lidocaine is chemically designated as acetamide, 2-(diethylamino)-N-(2,6-dimethylphenyl), has an octanol: water partition ratio of 43 at pH 7.4, and has the following structure: Prilocaine is chemically designated as propanamide, N-(2-methylphenyl)-2-(propylamino), has an octanol: water partition ratio of 25 at pH 7.4, and has the following structure: Each gram of EMLA Cream contains lidocaine 25 mg, prilocaine 25 mg, polyoxyethylene fatty acid esters (as emulsifiers), carboxypolymethylene (as a thickening agent), sodium hydroxide to adjust to a pH approximating 9, and purified water to 1 gram. EMLA Cream contains no preservative, however it passes the USP antimicrobial effectiveness test due to the pH. The specific gravity of EMLA Cream is 1.00. CLINICAL PHARMACOLOGY Mechanism of Action: EMLA Cream (lidocaine 2.5% and prilocaine 2.5%), applied to intact skin under occlusive dressing, provides dermal analgesia by the release of lidocaine and prilocaine from the cream into the epidermal and dermal layers of the skin and by the accumulation of lidocaine and prilocaine in the vicinity of dermal pain receptors and nerve endings. Lidocaine and prilocaine are amide-type local anesthetic agents.
    [Show full text]
  • How to Use Local and Regional Anesthesia for Procedures of the Head and Perineum in the Horse
    HOW-TO SESSION: FIELD ANESTHESIA AND PAIN MANAGEMENT How to Use Local and Regional Anesthesia for Procedures of the Head and Perineum in the Horse J. Brett Woodie, DVM Author’s address: Rood and Riddle Equine Hospital, PO Box 12070, Lexington, KY 40580–2070; e-mail: [email protected]. © 2013 AAEP. 1. Introduction cost.1 Peripheral nerve blocks and epidural anes- Combining local or regional anesthetic techniques thesia are typically performed with the use of a 2% with sedation will allow many diagnostic and surgi- lidocaine solution. The onset of action for periph- cal procedures to be safely performed in the horse. eral nerve blocks is typically 5 to 10 minutes. The Drugs used for local anesthesia are designed to pen- duration of action has been reported to be 1.5 to 3 hours, but clinical experience would suggest that the etrate peripheral nerves and interrupt nerve con- 1,2 duction resulting in reversible anesthesia for a duration of action is shorter. Repeated dosing or predictable period of time.1 It is important for the excessive amount of lidocaine can lead to toxicity. clinician to have a thorough understanding of the Total dosage should be kept less than 250 mL of 2% pertinent anatomy in order to be successful with lidocaine in a 500-kg horse. these techniques. Mepivacaine is very similar to lidocaine. It has a similar onset of action, but the duration of action is 1 2. Local Anesthetics longer. Mepivacaine has less vasodilatory activity compared with lidocaine, and mepivacaine is less The mechanism of action of local anesthetic drugs is effective as a topical anesthetic compared with to prevent transfer of nociceptive information by lidocaine.
    [Show full text]
  • Topical Lidocaine-Prilocaine Cream (Emla) Versus Mepivacaine Infiltration for Reducing Pain During Repair of Mediolateral Episio
    AL-AZHAR ASSIUT MEDICAL JOURNAL AAMJ ,VOL 13 , NO 4 , OCTOPER 2015 SUPPL-2 TOPICAL LIDOCAINE-PRILOCAINE CREAM (EMLA) VERSUS MEPIVACAINE INFILTRATION FOR REDUCING PAIN DURING REPAIR OF MEDIOLATERAL EPISIOTOMY AFTER SPONTANEOUS VAGINAL DELIVERY Hossam M Abdelnaby and Ahmed Mahmoud Abdou Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ABSTRACT Objective: to compare the efficacy of lidocaine-prilocaine cream (EMLA cream) versus ordinary local infiltration anesthetic mepivacaine in pain relief during repair of mediolateral episiotomy. Patients and methods: This study was conducted during the period from 1 January 2015 to 31 July 2015 in Zagazig University Maternity Hospital, Egypt. It comprised 82 vaginally laboring women. They were randomly allocated into 2 groups; group a (mepivacaine 1% infiltration just before performing the episiotomy) and group B (lidocaine-prilocaine cream applied as a thick layer to perineum approximately one hour before the predictable time of childbirth). Primary outcome measure was pain scores during repair of episiotomy after childbirth. Secondary outcome measures were the need for additional intra-operative anesthetic or post-operative analgesia and patient satisfaction. Results: There was a statistically significant more pain score during the suture of episiotomy in mepivacaine
    [Show full text]
  • ASGE Guidelines
    Sedation and anesthesia in GI endoscopy This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using MEDLINE and PubMed databases through May 2008 that related to the topic of "sedation and anesthesia for gastrointestinal endoscopy" by using the key word(s) "sedation," "anesthesia," "propofol," "gastrointestinal endoscopy," "endoscopy," "endoscopic procedures," and "procedures." The search was supplemented by accessing the "related articles" feature of PubMed, with articles identified on MEDLINE and PubMed as the references. Pertinent studies published in English were reviewed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1). This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment.
    [Show full text]