Local Anaesthetics and Pain Management

Local anaesthetics and other pharmacological approaches

Neuropathic Pain ◽

10.1093/med/9780199563678.003.0012 ◽

2010 ◽

pp. 105-113

Author(s):

Gary McCleane

Keyword(s):

Neuropathic Pain ◽

Pain Management ◽

Side Effects ◽

Local Anaesthetics ◽

Analgesic Effects ◽

Management Alternative ◽

Alternative Approaches

While antidepressants, antiepileptics, and opioids form the mainstay of neuropathic pain management, alternative approaches are needed because not all patients respond to these drugs and side-effects can limit their use in others Topically applied drugs such a lidocaine 5% patches and capsaicin cream can produce local analgesic effects, though lidocaine is better tolerated...

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Regional and local anaesthetics and spinal narcotics for postoperative pain management

Current Opinion in Anaesthesiology ◽

10.1097/00001503-198809000-00015 ◽

1988 ◽

Vol 1 (3) ◽

pp. 352-358 ◽

Cited By ~ 1

Author(s):

A. R. Aitkenhead

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Postoperative Pain Management ◽

Local Anaesthetics

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Is Saline Injection a True Sham/Placebo Treatment in Randomized Controlled Trials? A Systematic Review

Neurology and Neurobiology ◽

10.31487/j.nnb.2021.02.04 ◽

2021 ◽

pp. 1-7

Author(s):

Nagy Mekhail ◽

Youssef Saweris ◽

Lou-Anne Acevedo-Moreno

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Randomized Controlled Trials ◽

Saline Solution ◽

Local Anaesthetics ◽

Placebo Treatment ◽

Controlled Trials ◽

Chronic Pain Management ◽

Saline Injection ◽

Randomized Controlled

Objective: To explore whether saline is a real sham/placebo agent, or it has potential therapeutic effects when used as control treatment in randomized controlled trials for the management of discogenic low back pain. Methods: A comprehensive literature search was conducted investigating the effects of saline as a placebo in the treatment of chronic pain when administered into the intervertebral disc. Following stepwise filtering, selected articles were assessed for their levels of evidence, followed by a discussion of their contribution to the understanding of the role of saline in chronic pain management. Results: Out of 95 articles that described the administration of intradiscal saline solution used as a placebo for chronic pain management, 8 articles met all of the inclusion criteria. Their levels of evidence ranged from 1a to 4 (Oxford Centre CEBM). Intradiscal administration of saline solution was found to have measurable therapeutic benefits. In some studies, the pain relief was similar to that provided by local anaesthetics and steroids. Conclusion: Although the exact mechanism of the analgesic effects of saline is not clear, yet the use of intradiscal saline appears to have some analgesic benefits like local anaesthetics and steroids when used individually. Researchers should practice caution when designing RCTs using intradiscal saline injection as a sham/placebo treatment for the control arm or maybe, when possible, avoid the use of intradiscal saline injection as a sham treatment.

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Experimental Evaluation of Hyaluronidase Activity in Combination with Specific Drugs Applied in Clinical Techniques of Interventional Pain Management and Local Anaesthesia

January 2018 - Pain Physician ◽

10.36076/ppj.2008/11/877 ◽

2008 ◽

Vol 6;11 (12;6) ◽

pp. 877-883

Author(s):

Thomas Bittorf

Keyword(s):

Pain Management ◽

Contrast Media ◽

Local Anaesthesia ◽

Local Anaesthetics ◽

Scar Tissue ◽

Maximum Effect ◽

Iodinated Contrast Media ◽

Hyaluronidase Activity ◽

Microtiter Plates ◽

Iodinated Contrast

Background: Hyaluronidase is an enzyme additive used in local anaesthesia and interventional pain reducing procedures such as adhesiolysis of epidural scar tissue after spinal surgery. Only a limited number of studies describe the influence of drugs on hyaluronidase activity. Postulated effects and effectiveness of hyaluronidase are only based on clinical observations. Objective: The aim of this study is to investigate the influence of the combined drugs on the activity of hyaluronidase under standardized conditions and to verify the effectiveness of the enzyme. Design: An ELISA-based microtiter-technique is used to evaluate the activity of hyaluronidase in combination with local anaesthetics, corticosteroids, NaCl 10%, and iodinated contrast media. Methods: Microtiter plates were coated with biotinylated hyaluronate and incubated with hyaluronidase in combination with the above-mentioned drugs. The activity of hyaluronidase was determined by an avidin-peroxidase-based procedure using an ELISA reader. Incubations were carried out at room temperature as well as at 37°C. Results: The data show that drugs affect the activity of hyaluronidase in different ways. Iodinated contrast media, NaCl (10%), and the absence of corticosteroids reduce hyaluronidase activity. In contrast, higher activities were detected at a lower NaCl concentration (0.9%). We cannot attribute a significant influence to local anaesthetics. Conclusions: Hyaluronidase is effective in all combinations with drugs. To get the maximum effect calculated use of accompanying drugs is necessary. Key words: Hyaluronidase, enzymatic activity, adhesiolysis, local anaesthesia, pain management

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The role of local anaesthesia in intra-operative pain management in dental practice

Ból ◽

10.5604/01.3001.0014.9018 ◽

2021 ◽

Vol 22 (1) ◽

pp. 24-35

Author(s):

Marcin Pasternak ◽

Jarosław Woroń

Keyword(s):

Pain Management ◽

Mechanism Of Action ◽

Local Anaesthesia ◽

Local Anaesthetics ◽

Dental Practice ◽

Sodium Cations ◽

Historical Outline ◽

Voltage Dependent ◽

Physical And Chemical

Intra-operative pain management with the means of local anaesthesia is an important of dental practice. Local anaesthetics are drugs the most commonly used drugs in dentistry, being, at the same time, the safest and most effective pain preventing and pain relieving agents known to medicine.The mechanism of action of local anaesthetics involves interruption of the conduction of nerve impulses. These agents show high affinity for the voltage-dependent sodium channels (Nav), they block them, thus preventing the influx of sodium cations through the membranes of the neuron. The potential threshold is not reached and the potential itself is not present. The potency of local anaesthetic drugs depends primarily on the concentration of the solutions used, while possible side effects depend on the dose. In this paper the characteristics of local anaesthetics used in dental practice were presented as well as characteristics of vasoconstrictors added to anaesthetic solutions. The historical outline, the mechanism of action of local anaesthetics and the currently used both basic and additional methods of anaesthesia are discussed. Possible strategies for improving the effectiveness of anaesthesia by the means of physical and chemical methods were explained. General and local adverse reactions of dental anaesthetics were also discussed, along with ways to prevent and treat them.

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