scholarly journals Dexmedetomidine was Better at Lowering Intraocular Pressure than Magnesium when Combined with Local Anesthetics in Peribulbar Blocks for Posterior Segment Eye Surgery

2018 ◽  
Vol 12 (1) ◽  
pp. 42-48
Author(s):  
Dalia Ahmed Ibrahim ◽  
Dina Salah
Keyword(s):  
Intraocular Pressure ◽  
Local Anesthetic ◽  
Normal Saline ◽  
Local Anesthetics ◽  
Posterior Segment ◽  
The Other ◽  
Controlled Clinical Trial ◽  
Peribulbar Block ◽  
Analgesic Dose ◽  
Group D

Background and Aim: Many medications are combined with local anesthetics for peribulbar blocks to improve the quality of the block, however, few studies have compared the effect of dexmedetomidine and magnesium on intraocular pressure when combined with local anesthetics which was the primary endpoint of this double blinded study. Materials and Methods: A randomized controlled clinical trial was conducted on 60 ASA Physical Status (ASA PS) I-II patients scheduled for elective posterior segment eye surgeries under peribulbar anesthesia. Patients were randomly allocated to one of three groups of 20 each according to the medications they received. Local anesthetic solution was prepared using 8 ml of bupivacaine 0.5% and lidocaine 2% in a 1: 1 ratio plus 1ml of hyaluronidase (150 units) making a total volume of 9 ml: Group D received: local anesthetic + 20 µg dexmedetomidine diluted with 1 mL of normal saline. Group M received: local anesthetic + magnesium sulphate 50 mg in 1 ml normal saline. Group C received local anesthetic + 1 ml normal saline. Intraocular pressure was measured with the Perkins applanation tonometer immediately before injection and at 1, 5, 10, 15 minutes (min) after injection and then at the end of the procedure, the onset and duration of lid and globe akinesia were assessed. Postoperative analgesia and the first dose of analgesic medication were also assessed. Results: Intraocular pressure measurements were statistically lower in group D than the other two groups at 10 and 15mins. The onset of globe and lid akinesia was the most rapid in Group D compared to the other two groups. The duration of globe and lid akinesia was the longest in group D. Time to first analgesic dose request was significantly longer in group D followed by group M then group C. Visual analogue score for pain was significantly less between group D and other two groups. There were no episodes of hypotension or bradycardia in the three groups. No side effects or complications as hemorrhage, globe perforation, brain stem anesthesia sedation were observed. Conclusion: In our study addition of dexmedetomidine to a peribulbar block was statistically better at reducing IOP, increasing the duration of optic anesthesia and delaying the need for postoperative analgesic dose request than magnesium.

scholarly journals Fentanyl versus midazolam as additive to local anesthetic mixture for peribulbar block during posterior segment surgery in adult patients a prospective randomized double-blind study

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmed Abdalla Mohamed ◽  
Tamer Fayez Safan
Keyword(s):  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Posterior Segment ◽  
Adult Patients ◽  
The Other ◽  
Control Group ◽  
Double Blind ◽  
Rescue Analgesia ◽  
Number Of Patients ◽  
Peribulbar Block

Abstract Objectives To evaluate analgesic and hemodynamic outcome of fentanyl or midazolam as additives to local anesthetic mixture (LAM) for peribulbar block (PBB) during posterior chamber surgery. Methods One hundred thirty-two ASA status I to III adult patients aged 50–75 years scheduled for posterior segment surgery (intraocular foreign body and elective vitrectomy) were enrolled in this prospective, randomized, double-blind trial from which 12 patients were excluded. After signing a written fully informed consent for study participation, patients were grouped into 3 groups (40 patients in each group); group C received local anesthetic mixture plus 1 ml plain saline, group F received local anesthetic mixture plus 25 μg fentanyl in 1 ml saline and group M received local anesthetic mixture plus 1 mg midazolam in 1 ml saline. The primary outcome was the onset time of eyelid and globe akinesia. Also, the duration of the block was assessed in the three studied groups. Intraoperative and postoperative hemodynamic measures were assessed. Postoperative analgesia was hourly-assessed using Visual analogue scale (VAS) and rescue analgesia was provided at visual analogue score of > 3. Results The number of patients who had fast eyelid and globe akinesia was significantly higher with significantly lower total 15-min score in group F than the other groups. Intraoperative and postoperative hemodynamic measures were non-significantly different between studied groups. Duration of the block was significantly longer in groups F and M than group C with significantly longer duration in group F. The number of patients who required postoperative rescue analgesia was significantly lower with significantly lower number of requests in group F than the other groups. Conclusion Additives to local anesthetic mixture during peribulbar block provided satisfactory anesthetic outcome than local anesthetic mixture alone. Fentanyl was superior to midazolam in terms of significantly speed up onset, longer block duration with significantly longer postoperative analgesia and lesser consumption of rescue analgesia. Both additives provided adjusted hemodynamic measures comparable to the control group. Trial registration Pan African Clinical Trials Registry (PACTR201708002496243) registered 03/08/2017 retrospectively.

scholarly journals Brachial Plexus Block For Ambulatory Upper Limb Surgeries: Comparison of the Effects of Nalbuphine Versus Dexamethasone: Prospective, randomized, double-blinded, controlled clinical trial

2020 ◽  
Vol 11 (2) ◽  
pp. 2626-2631
Author(s):  
Mohamed Gaber Mohamed El-Sayed ◽  
Ahmed Mohamed Salama ◽  
Ayman Abd-El Salam Hassan ◽  
Fatma Mahmoud Ahmed
Keyword(s):  
Normal Saline ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Controlled Clinical Trial ◽  
Total Consumption ◽  
Significant Prolongation ◽  
Double Blinded ◽  
Plexus Block ◽  
Group D

Addition of an to local anesthetics improves the quality of nerve block and reduces the need for postoperative intake. The study was aimed to compare the efficiency of versus as to local mixture in plexus block. The study included 45 patients scheduled for ambulatory upper extremities operations under the plexus block. The patients were allocated to three equal groups (n=15): (i) Group C: patients received 30 of local anesthetics ( 0.5% + 2% 1:1 mixture) + 2 ml normal saline. (ii) Group D: patients received 30 volume of local anesthetics ( 0.5% + 2% 1:1 mixture) + 8 mg 0.4% (2 ). (iii) Group N: patients received 30 of ( 0.5% + 2% 1:1 mixture) +10 mg (completed to 2 with normal saline). We compared the duration of postoperative analgesia, total consumption, and complications in the first 24 hours. Statistically significant prolongation in the duration of analgesia was noticed in group D and group N with the least consumption in group N. Addition of or to / mixture can prolong the duration of analgesia and reduce consumption after plexus block.

scholarly journals Efficacy and Safety of Magnesium versus Dexmedetomidine as Additives to Local Anesthetic Mixture Using Single Injection Percutaneous Peribulbar Anesthesia in Vitreoretinal Surgeries

2018 ◽  
Vol 12 (1) ◽  
pp. 94-100
Author(s):  
Aktham Shoukry ◽  
Amr Sobhy Abd el Kawy
Keyword(s):  
Local Anesthetic ◽  
Normal Saline ◽  
Magnesium Sulphate ◽  
Motor Block ◽  
Vitreoretinal Surgery ◽  
Control Group ◽  
Peribulbar Block ◽  
Ocular Pressure ◽  
Peribulbar Anesthesia ◽  
Group D

Background: Peribulbar block for vitreoretinal surgery is rather associated with delayed onset of globe anesthesia, akinesia and short duration of analgesia. Objective: To compare the effect of addition of Magnesium sulphate vs dexmedetomidine to standard local anesthetics mixtures on the time of onset of Globe Anesthesia, Akinesia & analgesia duration. Patients and Methods: Ninety patients of both sexes, aged 25- 75 years, ASA I-III scheduled for vitreoretinal surgery. They were randomly allocated into 3 equal groups each received peribulbar block a mixture of Levo- bupivacaine 0.5% (3 ml) + lidocaine 2% (3 ml) +120 IU hyaluronidase + Control group (C): 0.5 ml of Normal saline. Group (M): 50 mg of Magnesium sulphate in 0.5 ml normal saline. Group (D): 50 μic of dexmedetomidine in 0.5 ml normal saline. The duration of sensory, motor block, Sedation level, Intra-ocular Pressure (IOP) and surgeon satisfaction were assessed. Results: The onset of globe anesthesia and akinesia was significantly shorter in M group in comparison with D and C Groups, with a significant increase in the duration of globe analgesia and akinesia in the D Group when compared to both M & C groups. Groups D and M showed a statistically significant decrease in the IOP at 5 min and 10 min when compared to the baseline measurement of the same groups & to C Group, no complications or adverse effects related to the drug or technique were recorded. Conclusion: Magnesium sulphate as a local anesthetic adjuvant in peribulbar block is safe and comparable to dexmedetomidine regarding the sensory and motor block duration with better cost-effectiveness and availability.

scholarly journals Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052199953
Author(s):  
Gehui Li ◽  
Hao Wang ◽  
Xiaofei Qi ◽  
Xiaolei Huang ◽  
Yuantao Li
Keyword(s):  
Local Anesthetic ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Onset Time ◽  
Labor Analgesia ◽  
Controlled Clinical Trial ◽  
Time Duration ◽  
Clinical Registry ◽  
Randomized Controlled ◽  
Group D

Objective α2‑agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. Methods A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. Results The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. Conclusion Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects. This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/ ).

Pigmentary Glaucoma After Cataract Surgery with Single-Piece Hydrophobic Intraocular Lens Implanted into the Ciliary Sulcus: Case Report

2021 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Corneal Endothelium ◽  
Surgical Intervention ◽  
Posterior Segment ◽  
The Other ◽  
Pigmentary Glaucoma ◽  
Single Piece ◽  
History Of ◽  
Capsular Bag

A 59 years old man presented with a history of phacoemulsification with an hydrophobic intraocular lens implant in his left eye 4 years ago. The biomicroscopy revealed pigments in the corneal endothelium (Krukenberg’s spindle), peripheral transillumination of the iris and intraocular pressure of 52 mmHg in the left eye. Gonioscopy revealed hyperpigmentation of the posterior trabeculate. Posterior segment examination and visual field revealed a cup/disc 0.9 with significant field damage in strategy 10-2. Biomicroscopic ultrasonography showed asymmetric implantation of the IOL loops in the left eye (one loop in the ciliary sulcus and the other in the capsular bag). He underwent antiglaucomatous treatment with adequate control of intraocular pressure, with no need for surgical intervention.

The effectiveness of waist-shaped and straight-shaped interdental brushes in cleaning implant overdenture attachments: a self-controlled clinical trial

2020 ◽  
Author(s):  
Qiuwen Chen ◽  
Yanjun Ge ◽  
Jinyou Chai ◽  
Hailan Feng ◽  
Jianzhang Liu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Oral Hygiene ◽  
Respiratory Diseases ◽  
The Other ◽  
Controlled Clinical Trial ◽  
Cleaning Procedure ◽  
Plaque Removal ◽  
Line Angle ◽  
Implant Overdenture ◽  
Interdental Brush

Elderly patients often find it challenging to remove plaque accumulated on the attachments of implant overdentures (IOD) using conventional cleaning instruments. Further, excessive plaque accumulation can lead to peri-implant diseases and occasionally to respiratory diseases. Therefore, here, we aimed to compare the effectiveness of waist-shaped interdental brushes (WIB) with that of straight-shaped ones (SIB) in plaque removal from the locator attachments of IOD. Twenty participants with two locator attachments retaining mandibular IOD participated in this study. After the baseline cleaning, the participants refrained from oral hygiene maintenance for 3 days. A dentist cleaned one of the attachments using the WIB and the other attachment using the SIB. The pre- and post-cleaning modified plaque index (mPLI) scores were recorded. Following another 3 days free from oral hygiene maintenance, the trained participants repeated the same cleaning procedure using the WIB and SIB. Pre- and post-cleaning mPLI scores were recorded. Regardless of the type of brush used, the post-cleaning mPLI scores were lower than the pre-cleaning ones. After the cleaning procedure, the overall mean mPLI score was lower in the WIB group than in the SIB group. The post-cleaning mPLI scores at the line-angles and on the axial surfaces of the attachments were also lower in the WIB group than in the SIB group. There was no difference in the cleaning effectiveness between the dentist and participants when they used the same type of interdental brush. The WIB was significantly more efficient in plaque removal than the SIB, especially at the line-angle sites.

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.

scholarly journals Lidocaine: A Local Anesthetic, Its Adverse Effects and Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 782
Author(s):  
Entaz Bahar ◽  
Hyonok Yoon
Keyword(s):  
Adverse Effects ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Adverse Reactions ◽  
Rapid Diagnosis ◽  
Diagnosis And Treatment ◽  
Allergic Reactions ◽  
Life Threatening

The most widely used medications in dentistry are local anesthetics (LA), especially lidocaine, and the number of recorded adverse allergic responses, particularly of hazardous responses, is quite low. However, allergic reactions can range from moderate to life-threatening, requiring rapid diagnosis and treatment. This article serves as a review to provide information on LA, their adverse reactions, causes, and management.

scholarly journals Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1013
Author(s):  
Daniel Spitzer ◽  
Katharina J. Wenger ◽  
Vanessa Neef ◽  
Iris Divé ◽  
Martin A. Schaller-Paule ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brachial Plexus ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Brachial Plexus Block ◽  
Central Nervous System Toxicity ◽  
Interscalene Brachial Plexus Block ◽  
Plexus Block ◽  
System Toxicity

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

Sign in / Sign up

Export Citation Format

Share Document