DOCSLIB.ORG

The Use of a Continuous Popliteal Sciatic Nerve Block After Surgery Involving the Foot and Ankle: Does It Improve the Quality of Recovery?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Use of a Continuous Popliteal Sciatic Nerve Block After Surgery Involving the Foot and Ankle: Does It Improve the Quality of Recovery? AMBULATORY ANESTHESIA SOCIETY FOR AMBULATORY ANESTHESIA SECTION EDITOR PAUL F. WHITE The Use of a Continuous Popliteal Sciatic Nerve Block After Surgery Involving the Foot and Ankle: Does It Improve the Quality of Recovery? Paul F. White, PhD, MD, FANZCA*, Tijani Issioui, MD*, Gary D. Skrivanek, MD*, John S. Early, MD†, and Cynthia Wakefield* Departments of *Anesthesiology and Pain Management and †Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas Popliteal sciatic nerve block is a commonly used tech- 1 week after surgery to assess pain scores, as well as nique for surgery involving the foot and ankle. How- patient satisfaction with their pain management and ever, pain can be difficult to control as the local anes- quality of recovery, by using a 100-point verbal thetic block wears off. Therefore, we hypothesized that rating scale (1 ϭ highly dissatisfied to 100 ϭ highly extending the block by using a continuous infusion of satisfied). In the bupivacaine group, there was a bupivacaine (0.25%) would provide improved pain statistically significant reduction in the maximal management and might facilitate the recovery process pain scores (Ͼ50%) and in opioid use (Ͼ60%) dur- after foot or ankle surgery. In this randomized, double- ing the postoperative period compared with the blinded, placebo-controlled study, 24 consenting pa- control group. Patient satisfaction with postopera- tients undergoing foot or ankle surgery with a stan- tive pain management (95 Ϯ 3 versus 77 Ϯ 13) and dardized general anesthetic technique were studied. quality of recovery (96 Ϯ 7 versus 83 Ϯ 14) was Before surgery, a popliteal sciatic nerve block was per- significantly improved in the bupivacaine group formed in all patients with an 18-gauge Tuohy epidural (versus control). In addition, 40% of the patients in needle and a peripheral nerve stimulator. After injec- the bupivacaine group (versus none in the control tion of bupivacaine 0.25% 30 mL and placement of a group) were able to be discharged home on the day 20-gauge catheter, patients were randomly assigned to of surgery (P ϭ 0.087). In conclusion, a continuous receive either 0.9% saline (control) or bupivacaine infusion of bupivacaine 0.25% decreased postoper- 0.25% at a constant rate of 5 mL/h for up to 48 h after ative pain and the need for opioid analgesic rescue surgery. An 11-point verbal rating scale (0 ϭ no pain to medication after orthopedic surgery involving the 10 ϭ worst pain imaginable) was used to assess the foot and ankle, leading to improved patient satis- severity of pain. Opioid analgesic use was recorded faction and quality of recovery. at specific time intervals after surgery. Follow-up evaluations were performed at 24 h, 48 h, 72 h, and (Anesth Analg 2003;97:1303–9) ontinuous peripheral neural blockade (CPNB) needle and catheter insertion techniques and simpli- techniques were first described Ͼ50 yr ago for fied drug delivery systems, as well as efforts to facil- C the management of postoperative pain (1). itate an earlier discharge after painful orthopedic pro- However, renewed interest in the use of these CPNB cedures. Many reports have described the potential techniques is a result of the availability of improved usefulness of these techniques in the postoperative period after major orthopedic procedures involving The medical supplies required for this study were provided by I-Flow the lower extremities (2–9). Increasingly, CPNB tech- Corporation (Lake Forest, CA) and B. Braun (Bethlehem, PA). Depart- niques are being used outside the hospital to treat mental resources and funds from the McDermott Chair of Anesthesi- patients undergoing painful ambulatory surgery pro- ology were used to support Dr. White’s clinical research program. Accepted for publication June 3, 2003. cedures (9–12). Address correspondence to Paul F. White, PhD, MD, FANZCA, In a recently published study, Ilfeld et al. (12) dem- Department of Anesthesiology and Pain Management, University of onstrated that the use of a continuous popliteal sciatic Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9068. Address e-mail to [email protected]. No nerve block with an electronic pump for pain control reprints will be available. after lower extremity surgery decreased pain, opioid DOI: 10.1213/01.ANE.0000082242.84015.D4 use, and side effects while improving overall patient ©2003 by the International Anesthesia Research Society 0003-2999/03 Anesth Analg 2003;97:1303–9 1303 1304 AMBULATORY ANESTHESIA WHITE ET AL. ANESTH ANALG CONTINUOUS PERINEURAL BLOCK AFTER FOOT AND ANKLE SURGERY 2003;97:1303–9 satisfaction. Although reports describing the success- imaginable. After standard noninvasive monitors were ful use of CPNB techniques for pain control after applied, midazolam 1–2 mg IV and fentanyl 50–150 ␮g major orthopedic procedures in the ambulatory set- IV were administered for sedation and analgesia, respec- ting are very encouraging (9–12), there have also been tively, before the nerve block procedure was performed. reports describing technical difficulties related to An attending anesthesiologist (GDS) experienced in per- pump malfunctions, as well as misplaced, displaced, forming popliteal nerve blocks for lower extremity sur- and obstructed catheters (13–15). In the study by Ilfeld gery performed all the block procedures by using a et al. (12), 30% of the patients required unscheduled modification of the original technique of Singelyn et al. phone calls after discharge. A recent report by Cap- (2) as described by Brown (18). devila et al. (16) found that the use of disposable The patients were placed in the prone position, and elastomeric pumps for CPNB was associated with the popliteal crease was identified. The cephalo-lateral fewer technical problems and greater patient satisfac- quadrant was identified, and local skin infiltration tion than electronic pumps. Similarly, comparative was performed by using 1% lidocaine at a point 5 cm evaluation of electronic versus nonelectronic patient- above the popliteal crease and 1 cm lateral (Fig. 1A). controlled analgesic (PCA) devices demonstrated that The Stimuplex HNS11 peripheral nerve stimulator (B. the use of a nonelectronic device was associated with Braun Medical Inc., Bethlehem, PA) was connected to an fewer programming errors and greater patient and insulated 18-gauge Tuohy needle; an appropriate motor nurse satisfaction (17). Therefore, additional studies response was initially achieved by using a 1.0-mA cur- are needed to evaluate the effect of CPNB by using rent and was then decreased to 0.5 mA. A total of 30 mL nonelectronic devices on clinically important patient of 0.25% bupivacaine was injected through the needle in outcome variables after orthopedic surgery (e.g., pain all cases. A 20-gauge epidural catheter was inserted ap- scores, hospital discharge, resumption of normal ac- proximately 2–3 cm beyond the tip of the needle, and tivities, and patient satisfaction). after the needle was removed, the catheter was carefully We designed a prospective, randomized, placebo- secured in place (Fig. 1B). Before entering the operating controlled study to assess the benefits of a CPNB after room (OR), patients were assigned to one of two study surgery involving the foot and ankle by using a dis- groups according to a computer-generated randomiza- posable, nonelectronic (elastomeric) device. We hy- tion number table. The control group received an infu- pothesized that the use of a continuous popliteal per- sion of 0.9% saline, and the bupivacaine group received ineural block with bupivacaine 0.25% would improve an infusion of generic bupivacaine 0.25% at 5 mL/h for pain management after these orthopedic procedures. up to 48 h after surgery by using a disposable elasto- We also examined patient outcome with respect to meric pump (C-bloc™ PNB system; I-Flow Corp., Lake their satisfaction with pain management and the qual- Forest, CA) connected to the catheter. The pump reser- ity of their recovery. voir contained 270 mL of the study drug (either 0.9% saline or 0.25% bupivacaine) and was filled by a hospital OR pharmacist who was not directly involved in the study. Methods The patient was promptly transferred to the OR, After we obtained IRB approval at the University of and standard monitors were applied. The presence Texas Southwestern Medical Center and written, in- of hypesthesia in the distribution of the popliteal formed consent, 24 healthy patients (aged 18 to 85 yr) nerve was documented by using a needle tip and undergoing foot (e.g., bunionectomies or clawtoe/ alcohol sponge. General anesthesia was induced hammertoe corrections) or ankle (e.g., bone fusions or within 15 min after the block was performed, by internal fixation) procedures were enrolled in this using propofol 1.75–2.5 mg/kg IV and fentanyl double-blinded, placebo-controlled study. Patients 0.75–1.5 ␮g/kg IV. Anesthesia was maintained with were excluded if they were allergic to local anesthet- desflurane (3% end-tidal concentration) in combina- ics, had an active infection involving their lower ex- tion with air (0.5 L/min) and oxygen (0.5 L/min). tremity, were pregnant (or lactating), had any neuro- Supplemental bolus doses of sufentanil 5 ␮gIV logical dysfunction or diabetes, had a history of were administered as needed to treat acute auto- chronic opioid (narcotic) analgesic use or drug abuse, nomic responses and/or purposeful movements or had unstable cardiovascular, renal, or hepatic dis- during the operation. eases. In addition, patients who were not able and On awakening from general anesthesia, patients willing to comply with the instructions for using the were transferred to the postanesthesia care unit elastomeric pump after surgery were excluded from (PACU). Patients were asked to evaluate the severity participating in the study. of their pain on the 11-point VRS at 1, 2, 4, 8, 24, 48, In the preoperative holding area, patients completed a and 72 h after surgery.
Load more

Recommended publications
  • Extracts and Tinctures of Cannabis
    WHO Expert Committee on Drug Dependence Critical Review …………….. Extracts and tinctures of cannabis This report contains the views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the World Health Organization © World Health Organization 2018 All rights reserved. This is an advance copy distributed to the participants of the 41st Expert Committee on Drug Dependence, before it has been formally published by the World Health Organization. The document may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means without the permission of the World Health Organization. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.
    [Show full text]
  • Thinning Hair and Hair Loss
    Thinning Hair and Hair Loss Background: Hair loss, thinning hair and poor general hair health effects a very large number of people and these problems typically begin to manifest past the age of 40. However, the primary cause of hair loss is not age but a complex interaction between dozens of variables that include hormone imbalances, vitamin and mineral deficiencies, inflammation, free radical damage, poor diet, stress and poor sleep. However, when it comes to supporting hair health to encourage optimal hair growth, there is much that can be done. The key point is that hair loss is normal; the average adult has around 150,000 hairs on their head and loses around 100 of these a day. This is a normal process to allow new healthy hair to re-grow. Thus hair loss only becomes an issue if we lose more hair than we are able to replace. Thus when intervening to address thinning hair or hair loss, the priority is to ensure that the body is receiving all of the nutritional support needed to facilitate optimal hair growth whilst turning to specific herbal medicines to actually speed up the re-growth of new hair. Management Plan for Treating Hair Loss and Thinning Hair 1. Hair Supporting Herbal Tincture: There are many evidence based herbs that have been shown to effectively support general hair health whilst encouraging the growth of new hair. Interestingly, many of these herbs come from within the Ayurvedic system of medicine. When using herbal medicine to address hair loss, it is also really important to target and support liver function which plays an integral role in the breakdown and delivery of nutrients to the hair.
    [Show full text]
  • Clinical Policy: Hyperemesis Gravidarum Treatment Reference Number: PA.CP.MP.34 Effective Date: 01/18 Coding Implications Last Review Date: 04/18 Revision Log
    Clinical Policy: Hyperemesis Gravidarum Treatment Reference Number: PA.CP.MP.34 Effective Date: 01/18 Coding Implications Last Review Date: 04/18 Revision Log Description Hyperemesis gravidarum is a term reserved to describe the most severe cases of nausea and vomiting in pregnancy (NVP). It results from severe nausea and vomiting, and the resultant inability to rehydrate and replenish nutritional reserves. A diagnosis of hyperemesis gravidarum is best made when it is based on objective findings such as moderate to large ketonuria and weight loss. Weight loss of 5% or greater is often described as diagnostic of hyperemesis gravidarum but this is not to suggest that measures to improve nausea and vomiting should not be undertaken prior to this. Hyperemesis gravidarum tends to begin earlier in pregnancy and last longer than those patients with less severe NVP. When the step-approach algorithm does not allow for continued adequate hydration of the patient, intravenous (IV) infusion or subcutaneous (SQ) micropump infusion of metoclopramide or ondansetron can allow for treatment until the patient can reliably take oral medications. The ability to perform activities of daily living, tolerate most food intake, and take oral medications are measures that objectively and subjectively instruct the practitioner as to the value of these therapies. When these therapies have allowed the patient to return to the above states of function, they can be discontinued. Oral therapies can be used in conjunction with IV and SQ infusion if tolerated. There is not a place for continuous, long-term IV or SQ infusion of medications to manage hyperemesis if the patient is functioning as described above.
    [Show full text]
  • Errors Associated with Oxytocin
    February 2020 Volume 18 Issue 2 Now Available from ISMP Errors associated with oxytocin use: A multi- Expanded Smart Pump Guidelines organization analysis by ISMP and ISMP Canada We have just released revised and expanded Guidelines for Optimizing Safe ntravenous (IV) oxytocin used antepartum is indicated to induce labor in patients Implementation and Use of Smart Infusion with a medical indication, to stimulate or reinforce labor in selected cases of uterine Pumps to provide strategies for address - Iinertia, and as an adjunct in the management of incomplete or inevitable abortion. ing potential barriers and integrating this Used postpartum, IV oxytocin is indicated to produce uterine contractions during technology with other electronic systems. expulsion of the placenta and to control postpartum bleeding or hemorrhage. However, The expanded guidelines cover a broad improper administration of oxytocin can cause hyperstimulation of the uterus, which in scope of smart infusion pump usage in turn can result in fetal distress, the need for an emergency cesarean section, or uterine both inpatient and ambulatory settings, rupture. Sadly, a few maternal, fetal, and neonatal deaths have been reported. including perioperative, procedural, and radiology locations. The expanded guide - In October 2019, ISMP Canada published a multi-incident analysis 1 to identify oppor - lines also include recommendations to tunities to improve the safe use of this high-alert medication. A total of 144 reports of employ smart infusion pumps with dose incidents associated with oxytocin were analyzed from voluntary reports submitted error-reduction systems for plain IV fluid to ISMP Canada and the Canadian National System for Incident Reporting (NSIR) infusions.
    [Show full text]
  • A Portable Mechanical Pump Providing Over Four Days of Patient-Controlled Analgesia by Perineural Infusion at Home
    A Portable Mechanical Pump Providing Over Four Days of Patient-Controlled Analgesia by Perineural Infusion at Home Brian M. Ilfeld, M.D., and F. Kayser Enneking, M.D. Background and Objectives: Local anesthetics infused via perineural catheters postoperatively decrease opioid use and side effects while improving analgesia. However, the infusion pumps described for outpatients have been limited by several factors, including the following: limited local anesthetic reservoir volume, fixed infusion rate, and inability to provide patient-controlled doses of local anesthetic in combination with a continuous infusion. We describe a patient undergoing open rotator cuff repair who was discharged home with an interscalene perineural catheter and a mechanical infusion pump that allowed a variable rate of continuous infusion, as well as patient-controlled boluses of local anesthetic for over 4 days. Case Report: A 77-year-old woman, who had previously required a 3-day hospital admission for acute postoperative pain following an open repair of her left rotator cuff, presented for an open repair of her contralateral rotator cuff. Preoperatively she received an interscalene block and perineural catheter. After the procedure she was discharged home with a portable pump that infused ropivacaine continuously at a rate of 6 mL/h and allowed a 2-mL patient-controlled bolus every 20 minutes (550-mL reservoir). The basal infusion was decreased, as tolerated, by having the patient reprogram the pump with instructions given over the telephone. Without the use of any oral opioids, the patient scored her surgical pain 0 to 1 (on a scale of 0 to 10) while at rest and 2 to 3 for 2 physical therapy sessions during which she used the bolus function to reinforce her analgesia.
    [Show full text]
  • ACR Manual on Contrast Media
    ACR Manual On Contrast Media 2021 ACR Committee on Drugs and Contrast Media Preface 2 ACR Manual on Contrast Media 2021 ACR Committee on Drugs and Contrast Media © Copyright 2021 American College of Radiology ISBN: 978-1-55903-012-0 TABLE OF CONTENTS Topic Page 1. Preface 1 2. Version History 2 3. Introduction 4 4. Patient Selection and Preparation Strategies Before Contrast 5 Medium Administration 5. Fasting Prior to Intravascular Contrast Media Administration 14 6. Safe Injection of Contrast Media 15 7. Extravasation of Contrast Media 18 8. Allergic-Like And Physiologic Reactions to Intravascular 22 Iodinated Contrast Media 9. Contrast Media Warming 29 10. Contrast-Associated Acute Kidney Injury and Contrast 33 Induced Acute Kidney Injury in Adults 11. Metformin 45 12. Contrast Media in Children 48 13. Gastrointestinal (GI) Contrast Media in Adults: Indications and 57 Guidelines 14. ACR–ASNR Position Statement On the Use of Gadolinium 78 Contrast Agents 15. Adverse Reactions To Gadolinium-Based Contrast Media 79 16. Nephrogenic Systemic Fibrosis (NSF) 83 17. Ultrasound Contrast Media 92 18. Treatment of Contrast Reactions 95 19. Administration of Contrast Media to Pregnant or Potentially 97 Pregnant Patients 20. Administration of Contrast Media to Women Who are Breast- 101 Feeding Table 1 – Categories Of Acute Reactions 103 Table 2 – Treatment Of Acute Reactions To Contrast Media In 105 Children Table 3 – Management Of Acute Reactions To Contrast Media In 114 Adults Table 4 – Equipment For Contrast Reaction Kits In Radiology 122 Appendix A – Contrast Media Specifications 124 PREFACE This edition of the ACR Manual on Contrast Media replaces all earlier editions.
    [Show full text]
  • Performance Drug List - Standard Control
    October 2020 Performance Drug List - Standard Control The CVS Caremark® Performance Drug List - Standard Control is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. PLAN MEMBER HEALTH CARE PROVIDER Your benefit plan provides you with a prescription benefit program Your patient is covered under a prescription benefit plan administered by CVS Caremark. Ask your doctor to consider administered by CVS Caremark. As a way to help manage health prescribing, when medically appropriate, a preferred medicine from care costs, authorize generic substitution whenever possible. If you this list. Take this list along when you or a covered family member believe a brand-name product is necessary, consider prescribing a sees a doctor. brand name on this list. Please note: Please note: • Your specific prescription benefit plan design may not cover • Generics should be considered the first line of prescribing. certain products or categories, regardless of their appearance in • The member's prescription benefit plan design may alter this document. Products recently approved by the U.S. Food 1 and Drug Administration (FDA) may not be covered upon coverage of certain products or vary copay amounts based on release to the market.
    [Show full text]
  • Coram Infusion Patient Resource Guide
    Infusion Patient Resource Guide Coram Patient Resource Guide 1 Welcome to Coram At Coram® CVS Specialty® Infusion Services (Coram), we’re here to help make things a little easier. We know that starting infusion therapy at home will require some changes for you. At first, you may feel stressed—but we’re ready to help. Coram will provide ongoing education, care and support. We want to help you achieve success with your infusion therapy. We’re here for you every step of the way. Each day, skilled Coram nurses and dietitians work together. We provide complex infusion care to thousands of patients. The skilled staff at Coram will work as a team, along with your doctor, to arrange all aspects of your care. Your Coram care team can be reached 24 hours a day, every day, to answer questions about your health, medications, equipment or supplies. At every turn, Coram will help you stay on your path to better health. We work hard to make sure you always get the best care and personalized support to help you meet your health care needs. This guide will introduce you to the Coram team and provide you with facts about your infusion therapy. Please use this guide as a resource during your therapy. 1 Contents Your Home Infusion Therapy Support ................................. 3 Managing Your Medication and Supplies .............................. 3 Waste Disposal ..................................................... 4 Infusion Therapy .................................................... 5 How to Care For and Manage Your IV Catheter ........................ 6 How to Administer Your Infusion Therapy ............................. 7 Steps for Success with Your Home Infusion Therapy ................... 8 How to Contact Coram .............................................
    [Show full text]
  • Grow Your Own Herbal Remedies
    Grow Your Own Herbal Remedies: How to Create a Customized Herb Garden to Immune and Respiratory Support Your Health and Well-Being Immune SOS Elder, Echinacea, Bee Balm, Garlic By Maria Noël Groves Recipes: Darcey Blue’s Elderberry Syrup, Elder-Rosehip Oxymel, Echinacea Root Tincture, Bee Balm Honey, Bee Balm-Mint Tea REMEDY GARDENS OVERVIEW Daily Tonics Lung Tonics Nutritive Garden Mullein, Horehound, Wild Cherry, Marshmallow, Plantain Nettle, Oat Straw, Calendula, Violet, Rosehips Recipes: Soothing Lung Tea, Horehound Cough Syrup, Raw Wild Recipes: Nettle Oat Super Infusion, Chai Base, Nutri-Tea, Nutri- Cherry Honey Broth Allergy and Sinus Nutritive Forager Nettle, Goldenrod, Horehound, Bee Balm, Goldenseal and Berberines Nettle, Dandelion, Burdock, Horsetail, Violet Recipes: Allergy Tincture Blend, Nettle-Peppermint-Marshmallow Recipes: Multimineral Vinegar, Mineral-Rich “Coffee” Syrup, Tea Dandelion Violet Weed Pesto Skin Care and First Aid The Flavor Garden Super Skin Korean Mint and Anise Hyssop, Lemongrass and Lemon Verbena, Calendula, Rose, Lavender, Gotu Kola, Comfrey Mint, Calendula Recipes: Calendula Oil, Rose Hydrosol, Comfrey Root Liniment, Tea Base Notes: Nettle, Marshmallow, Oat Straw, Violet, Raspberry, Calendula Comfrey Cream Lady’s Mantle, Lemon Balm Recipes: Yummy Teas, Tea Base Notes, Floral Ice Cubes, Seltzer, First Aid Soda, and Infused Water Plantain, Yarrow, Calendula, St. John’s Wort, Thuja Recipes: Super Skin Salve, Ick Stick Thuja Salve, First Aid Simples Energy and Relaxation Stress Support Insect Repellent and Bite Care Holy Basil, Gotu Kola, Ashwagandha, Milky Oat Seed, Roses Lavender, Yarrow, Plantain, Catnip Recipes: Milky Oats Tincture, Stress Support Tincture Blend, Holy Recipes: Herbal Insect Repellent, Plantain Poultice, Plantain-Yarrow Rose Water, Ashwagandha Milk Bite Rub, Poison Ivy Relief Tips Brain Boosters Pain RelieF Gotu Kola, Bacopa, Rosemary, Lemon Balm, Mint Topical Pain RelieF Recipes: Brain Boosting Tincture Blend, Brainiac Bonbons, Minty Meadowsweet and Birch, St.
    [Show full text]
  • Safety Data Sheet According to 29CFR1910/1200 and GHS Rev
    Safety Data Sheet according to 29CFR1910/1200 and GHS Rev. 3 Effective date : 12.16.2014 Page 1 of 7 Iodine, Tincture, ~2% Solution SECTION 1: Identification of the substance/mixture and of the supplier Product name: Iodine, Tincture, ~2% Solution Manufacturer/Supplier Trade name: Manufacturer/Supplier Article number: S25944 Recommended uses of the product and restrictions on use: Manufacturer Details: AquaPhoenix Scientific, Inc 9 Barnhart Drive Hanover, PA 17331 (717) 632-1291 Supplier Details: Fisher Science Education 6771 Silver Crest Road, Nazareth, PA 18064 (724)517-1954 Emergency telephone number: Fisher Science Education Emergency Telephone No.: 800-535-5053 SECTION 2: Hazards identification Classification of the substance or mixture: Irritant Skin irritation, category 2 Eye irritation, category 2A Flammable Flammable liquids, category 2 Skin Irritation, Category 2. Eye Irritation, Category 2. Flam. Liq. 2. Signal word: Danger Hazard statements: Extremely flammable liquid and vapour. Causes serious eye irritation. Causes skin irritation. Precautionary statements: If medical advice is needed, have product container or label at hand. Keep out of reach of children. Read label before use. Wash skin thoroughly after handling. Wear protective gloves/protective clothing/eye protection/face protection. Keep away from heat/sparks/open flames/hot surfaces. No smoking. Keep container tightly closed. Ground/bond container and receiving equipment. Created by Global Safety Management, 1-813-435-5161 - www.GSMSDS.com Safety Data Sheet according to 29CFR1910/1200 and GHS Rev. 3 Effective date : 12.16.2014 Page 2 of 7 Iodine, Tincture, ~2% Solution Use explosion-proof electrical/ventilating/light/…/equipment. Use only non-sparking tools. Take precautionary measures against static discharge.
    [Show full text]
  • Making an Elderberry Syrup Or Elixir
    Making an Elderberry Syrup or Elixir Herbal syrups are water extractions of herbs (usually decoctions—see below) that are concentrated with a sweetener (preferably organic white sugar or raw honey). This sweetener provides a bit of nutritional support as a carbohydrate and also acts as a preservative. The concentration of sugar is particularly important when making syrups and elixirs; when in water, sugar acts as a food source for micro-organisms (especially molds and yeasts). However, at a high enough concentration, the sugar actually restricts the growth ability of micro-organisms. So we are aiming to get our syrup to be saturated enough to preserve, but not so saturated that the sugar overwhelms the liquid and causes crystallization. When preparing a syrup, one of the following ratios should be used: 1 part decoction : 1 part sweetener 1 part decoction : 2 parts sweetener I tend to follow the 1 part water : 1 part sweetener suggestion, as the 1 : 2 ratio is too sweet for me. But I have access to a refrigerator, which will also help with preservation. If you are keeping your syrup at room temperature, the 1:2 ratio is best. Syrups are a great, palatable method for delivery of herbal medicines (especially for children), and are also a great way to mask the flavor of less tasty tinctures--just combine the tincture and the syrup and you get the medicinal benefits of both. Preserving syrups with honey is also a great way to combine the medicinal benefits of the honey with the herbs that are being used. Do not give syrups preserved with honey to children under the age of one.
    [Show full text]
  • Medical Cannabis Tinctures Are Still Popular Among to Be Absorbed Into Patients, Especially Those Who Need to Take Regular the Body Efficiently
    TerrAscend NJ developed a proprietary line of medical cannabis formulations to help patients manage Four Universal Symptoms. Pain Anxiety Sleeplessness Lack of Energy/Focus MEDICAL FORMULATIONS SHINE 1:1 THC/CBD Ratio EASE SATIVA TERPENES SATIVA 1:10 THC/CBD Ratio BREATHE UPLIFTING HOW DO TINCTURES WORK? 2:1 THC/CBD Ratio Most tinctures are taken by placing drops under the HOPE 1 tongue and holding in the mouth for a few seconds, 1:1 THC/CBD Ratio also known as sublingual administration. When you take a tincture sublingually, the cannabinoids are TERPENES FREEDOM absorbed by the blood vessels lining the mouth, 1:1 THC/CBD Ratio resulting in a quick onset of effects. HYBRID Tinctures can be felt as quickly as 15 to 30 minutes after dosing sublingually. Peak effects usually occur HOPE 2 around 90 minutes after consumption and can last 3 5:1 THC/CBD Ratio to 6 hours, depending on the dose. BALANCED SOOTHE Tinctures can also be ingested orally, such as by 5:1 THC/CBD Ratio swallowing. If you consume a tincture orally, the cannabinoids are absorbed through the stomach and gastrointestinal tract and take longer to enter the DREAM bloodstream. 8:1 THC/CBD Ratio Dosing a tincture is easy to control because of the INDICA TERPENES precise measurements on the dropper. A patient can consume a small amount, wait for the effects and THC+ take more if necessary. Full Strength THC No Additives or Flavoring SEDATING As with any form of medical cannabis, you should start with a small dose to gauge how it makes you Products are not intended to diagnose, treat, cure or prevent feel and to avoid the unwanted effects of over- any disease.
    [Show full text]