Optimal local anesthetic regimen for saddle block in ambulatory anorectal surgery: an evidence-based systematic review

2020 ◽  
Vol 45 (9) ◽  
pp. 733-739
Author(s):  
Eric M Yung ◽  
Faraj W Abdallah ◽  
Carla Todaro ◽  
Emily Spence ◽  
Andrew Grant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Median Time ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Motor Block ◽  
Anorectal Surgery ◽  
Quantitative Evidence ◽  
Block Success ◽  
Long Acting ◽  
The Ideal

BackgroundAmbulatory anorectal surgery requires an anesthetic of short duration but profound depth. Saddle block anesthesia (SBA) can provide dense sacral anesthesia with minimal motor blockade, but the ideal local anesthetic agent remains undefined. This systematic review aims to identify the optimal SBA regimen for ambulatory anorectal surgery.MethodsWe sought randomized trials examining SBA for ambulatory anorectal surgery and stratified patients into four subgroups according to local anesthetic type and dose: (1) longer acting, higher dose; (2) longer acting, lower dose; (3) shorter acting, higher dose; and (4) shorter acting, lower dose. Longer acting agents included bupivacaine and levobupivacaine; shorter acting agents included chloroprocaine, mepivacaine, and prilocaine. Lower dose was defined as ≤5 mg and ≤20 mg for longer and shorter acting local anesthetics, respectively. The primary outcome was time to discharge; secondary outcomes included times to sensory and motor block regression, urine voiding, and ambulation, as well as block success.ResultsA total of 11 trials (1063 patients) were included. Overall study quality and reporting consistency was poor. Doses ranged from 1.5–7.5 mg to 3–30 mg of longer and shorter acting local anesthetics, respectively. Hyperbaric local anesthetics were used in eight trials (953 patients, 86%). The median time to discharge appeared similar across all subgroups with an overall time of 182 (IQR 102) min. The use of long-acting, lower dose regimens was associated with a faster median time to motor block regression. Block success approached 99% among all trials.ConclusionsThere is presently insufficient qualitative and quantitative evidence to identify an optimal SBA regimen for ambulatory anorectal surgery. Nonetheless, we found that doses as low as 1.5 and 3 mg of longer and shorter acting hyperbaric local anesthetics, respectively, can achieve effective and reliable SBA with timely hospital discharge. Despite similar discharge times, longer acting, lower dose local anesthetics may produce faster motor block regression following SBA for ambulatory anorectal surgery.

scholarly journals Local Anesthesia - Solution to Pain : An Overview

2020 ◽  
Vol 3 (07) ◽  
pp. 537-548
Author(s):  
Asima Jaan ◽  
Rudhra Munshi ◽  
Kriti Sareen ◽  
Ekta Parmar ◽  
Purnima Thakur ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Local Anesthetics ◽  
Motor Block ◽  
Mechanisms Of Action ◽  
Anesthetic Agents ◽  
Rate Limiting Step ◽  
Limiting Step ◽  
Neuronal Membranes ◽  
Site Of Action ◽  
Rate Limiting

Local anesthetics have been used clinically for more than a century, but new insights into their mechanisms of action and their interaction with biological systems continue to surprise researchers and clinicians alike. Local anesthetics must traverse several tissue barriers to reach their site of action on neuronal membranes. In particular, the perineurium is a major rate-limiting step. Previously it was assumed that patients are rarely allergic to local anesthetic agents, but variation in individual patient’s response to local anesthetics is larger than previously assumed .adjuncts available to block sensory nerver are there, but these typically also prolong motor block.

Mechanisms of Action by Which Local Anesthetics Reduce Cancer Recurrence: A Systematic Review

Pain Medicine ◽  
2019 ◽  
Author(s):  
Ravi K Grandhi ◽  
Barbara Perona
Keyword(s):  
Systematic Review ◽  
Cell Cycle ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Growth Factor Receptor ◽  
Cancer Recurrence ◽  
Mechanisms Of Action ◽  
In Vivo Models ◽  
Anesthetic Agents

Abstract Background Surgery in concert with anesthesia is a key part of the management of advanced-stage cancers. Anesthetic agents such as opioids and volatile anesthetics have been shown to promote recurrence in preclinical models, whereas some animal models have shown that the use of lidocaine may be beneficial in reducing cancer recurrence. The purpose of this article is to review the current literature to highlight the mechanisms of action by which local anesthetics are thought to reduce cancer recurrence. Methods A systematic review was conducted using the PubMed (1966 to 2018) electronic database. Search terms included “lidocaine,” “ropivicaine,” “procaine,” “bupivicaine,” “mepivicaine,” “metastasis,” “cancer recurrence,” “angiogenesis,” and “local anesthetics” in various combinations. The search yielded 146 total abstracts for initial review, 20 of which met criteria for inclusion. Theories for lidocaine’s effect on cancer recurrence were recorded. All studies were reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Results Numerous mechanisms were proposed based on the local anesthetic used and the type of cancer. Mechanisms include those that are centered on endothelial growth factor receptor, voltage-gated sodium and calcium channels, transient receptor melanoplastin 7, hyperthermia, cell cycle, and demyelination. Conclusions In vivo models suggest that local anesthetic administration leads to reduced cancer recurrence. The etiology of this effect is likely multifactorial through both inhibition of certain pathways and direct induction of apoptosis, a decrease in tumor migration, and an association with cell cycle–mediated and DNA-mediated effects. Additional research is required to further define the clinical implications.

scholarly journals Clonidine as an Adjuvant to Local Anesthetics for Peripheral Nerve and Plexus Blocks

2009 ◽  
Vol 111 (2) ◽  
pp. 406-415 ◽  
Author(s):  
Daniel M. Pöpping ◽  
Nadia Elia ◽  
Emmanuel Marret ◽  
Manuel Wenk ◽  
Martin R. Tramèr ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Local Anesthetics ◽  
Odds Ratio ◽  
Motor Block ◽  
Weighted Mean Difference ◽  
Mean Difference ◽  
Single Shot ◽  
Weighted Mean ◽  
Long Acting ◽  
Number Needed To Harm

The effect of adding clonidine to local anesthetics for nerve or plexus blocks remains unclear. The authors searched for randomized placebo-controlled trials testing the impact of adding clonidine to local anesthetics for peripheral single-injection nerve or plexus blocks in adults undergoing any surgery (except eye) without general anesthesia. Twenty trials (1,054 patients, 573 received clonidine) published 1992-2006 tested plexus (14 brachial, 1 cervical) and nerve blocks (2 sciatic/femoral, 1 midhumeral, 1 ilioinguinal/iliohypogastric, 1 ankle). Clonidine doses ranged from 30 to 300 microg; most patients received 150 microg. Clonidine prolonged the duration of postoperative analgesia (weighted mean difference 122 min; 95% confidence interval [CI] 74-169), sensory block (weighted mean difference 74 min; 95% CI 37-111), and motor block (weighted mean difference 141 min; 95% CI 82-199). In a subgroup of patients receiving an axillary plexus block, these effects were independent of whether clonidine was added to an intermediate or a long-acting local anesthetic. Clonidine increased the risk of arterial hypotension (odds ratio 3.61; 95% CI 1.52-8.55; number-needed-to-harm 11), orthostatic hypotension or fainting (odds ratio 5.07; 95% CI 1.20-21.4; number-needed-to-harm 10), bradycardia (odds ratio 3.09; 95% CI 1.10-8.64; number-needed-to-harm 13), and sedation (odds ratio 2.28; 95% CI 1.15-4.51; number-needed-to-harm 5). There was a lack of evidence of dose-responsiveness for beneficial or harmful effects. Clonidine added to intermediate or long-acting local anesthetics for single-shot peripheral nerve or plexus blocks prolongs duration of analgesia and motor block by about 2 h. The increased risk of hypotension, fainting, and sedation may limit its usefulness. Dose-responsiveness remains unclear.

scholarly journals Intravenous versus perineural dexmedetomidine in prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review

Pain medicine ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 10-28
Author(s):  
Yan Feng ◽  
Pan Chang ◽  
Xiao-Bo Chen ◽  
Xiao-Lin Yang ◽  
Yu-Jun Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Local Anesthetic ◽  
Motor Block ◽  
Meta Analysis ◽  
Onset Time ◽  
Sensory Block ◽  
Controlled Trials ◽  
Sedation Scale ◽  
Randomized Controlled ◽  
Ramsay Sedation Scale

Background and Objective. It is unclear whether perineural administration offers advantages when compared to intravenous dexmedetomidine in local anesthesia. To compare the efficacy of perineural versus intravenous dexmedetomidine as local anesthetic adjuvant, we conducted the meta analysis and systematic review. Materials and Methods. Two researchers searched MEDLINE, OVID, PubMed, Embase, Cochrane Central, Web of Science and Wanfang data for randomized controlled trials comparing the effect of intravenous versus perineural dexmedetomidine as local anesthetic adjuvant without any language restrictions. Results. We identified 14 randomized controlled trials (801 patients). The results revealed that the duration of analgesia (SMD: -1.76, 95 % CI, [-2.7, -0.83] P = 0.000, I2 = 96 %), the duration of sensory block (SMD:- 3.99, 95 % CI, [-5.88, -2.0], P = 0.000, I2 = 97.6 %), the duration of motor block (SMD: -1.6, 95 % CI, [-2.78, -0.41] P = 0.008, I 2 = 95.5 %) were significantly longer in the perineural group, when compared to systematic dexmedetomidine. The onset time of sensory block (SMD: 1.55, 95 % CI, [0.16, 2.94] P = 0.028, I2 = 96.7 %) and the onset time of motor block (SMD: 0.84, 95 % CI, [0.17, 1.5] P = 0.013, I2 = 88.3 %) were shorter in perineural group compared to intrave nous dexmedetomidine. Meanwhile, analgesic consumption in 24 hours (SMD: 0.37, 95 % CI, [0.05, 0.69] P = 0.023, I 2 = 55.6 %) and the incidence of patients of Ramsay Sedation Scale > 3 (RR: 3.8, 95 % CI, [1.45, 9.97] P = 0.000, I 2 = 26.9 %), hypotension (RR: 1.74, 95 % CI, [1.15, 2.65] P= 0.009, I2 = 32.7 %) and bradycardia (RR: 3.71, 95 % CI, [1.27, 10.86] P = 0.017, I2 = 0 %) were lower in perineural dexmedetomidine compared to the intravenous group. Conclusions. Our meta-analysis generates the evidence that perineural dexmedetomidine is a superior adminstration for prolonging the duration of analgesia. Perineural dexmedetomidine also shows the advantages in duration of sensory block and the onset time of sensory and motor block, when compared to the intravenous administration. Simultaneously, dexmedetomidine as a local anesthetic adjuvant for perineural injection may be much safer than intravenous application because of the lower incidence of patients of Ramsay Sedation Scale > 3 and lower incidence of hypotension and bradycardia.

Quaternary Ammonium Derivative of Lidocaine as a Long-acting Local Anesthetic

1995 ◽  
Vol 83 (6) ◽  
pp. 1293-1301 ◽  
Author(s):  
G. K. Wang ◽  
C. Quan ◽  
M. Vladimirov ◽  
W. M. Mok ◽  
J. G. Thalhammer
Keyword(s):  
Pain Management ◽  
Organic Synthesis ◽  
Local Anesthetic ◽  
Quaternary Ammonium ◽  
Local Anesthetics ◽  
Functional Testing ◽  
Ammonium Derivative ◽  
Neural Blockade ◽  
Quaternary Ammonium Derivative ◽  
Long Acting

Abstract Background Use of long-acting local anesthetics that elicit complete neural blockade for more than 3 h often is desirable in pain management. Unfortunately, clinically available local anesthetics are in general not suitable for prolonged analgesia. This report describes the organic synthesis and functional testing of a lidocaine derivative that appears to fulfill the criteria of long-acting local anesthetics.

Bupivacaine, a long-acting local anesthetic, in anorectal surgery

1976 ◽  
Vol 19 (2) ◽  
pp. 144-147 ◽  
Author(s):  
Lawrence D. Ramalho ◽  
Eugene P. Salvati ◽  
Robert J. Rubin
Keyword(s):  
Local Anesthetic ◽  
Anorectal Surgery ◽  
Long Acting

Local Anesthetics – Substances with Multiple Application in Medicine

2016 ◽  
Vol 4 (1) ◽  
pp. 17
Author(s):  
Rodica Sîrbu ◽  
Emin Cadar ◽  
Cezar Laurențiu Tomescu ◽  
Cristina Luiza Erimia ◽  
Stelian Paris ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Medical Care ◽  
Local Anesthesia ◽  
Short Duration ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Nerve Roots ◽  
Nervous Control ◽  
Painful Sensation ◽  
Action Groups

Local anesthetics are substances which, by local action groups on the runners, cause loss of reversible a painful sensation, delimited corresponding to the application. They allow small surgery, short in duration and the endoscopic maneuvers. May be useful in soothe teething pain of short duration and in the locking of the nervous disorders in medical care. Local anesthesia is a process useful for the carrying out of surgery and of endoscopic maneuvers, to soothe teething pain in certain conditions, for depriving the temporary structures peripheral nervous control. Reversible locking of the transmission nociceptive, the set of the vegetative and with a local anesthetic at the level of the innervations peripheral nerve, roots and runners, a trunk nervous, around the components of a ganglion or coolant is cefalorahidian practice anesthesia loco-regional. Local anesthetics summary and semi-summary have multiple applications in dentistry, consulting, surgery and obstetrics, constituting "weapons" very useful in the fight against the pain.

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