Study on Epinephrine Used in Local Anesthesia Controversy and certainty

2018 ◽  
Vol 69 (1) ◽  
pp. 169-171
Author(s):  
Mihaela Pertea ◽  
Vladimir Poroch ◽  
Oxana Madalina Grosu ◽  
Sorinel Lunca
Keyword(s):  
Local Anesthesia ◽  
Postoperative Period ◽  
Lower Cost ◽  
Hand Surgery ◽  
Patient Comfort ◽  
Study Group ◽  
Efficacy And Safety ◽  
First Time ◽  
Over Time

Epinephrine (adrenaline) - C9H13NO3 - was synthesized for the first time by Fredrich Stelz in 1904 from phenylalanine. After a hydrolysis and decarboxylation process, active dopamine is obtained. Following the pathway of other hydroxylation followed by N-methylation, epinephrine synthesis is achieved. Epinephrine has initially been administrated together with procaine in local anesthesia in hand surgery. Epinephrine has been considered to be one of causes of ischemia and necrosis in hand and especially fingers surgery. Over time, studies have shown the efficacy and safety of using lidocaine-associated epinephrine in local hand surgery anesthesia. Numerous advantages regarding the use of lidocaine 1% with epinephrine, solution at a concentration of 1:100,000 have been reported, starting with increasing the duration of anesthesia, avoiding the use of tourniquet, leading to increased patient comfort and to the advantage of a much lower cost in terms of surgery as a whole. Our study group consisted of fifty patients with hand and fingers different patologies. In all cases surgery was performed under local anesthesia using lidocaine 1% with epinephrine, solution at a concentration of 1:100,000. The decrease of doses mentioned in the literature was attempted and in some cases the decrease was up to 30%. There have not been reported any ischemic or necrosis complication in the immediate postoperative period.

scholarly journals Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
M Cardell ◽  
F Jung ◽  
N Zechmann-Müller ◽  
M Greminger ◽  
L Kern ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Surgical Procedures ◽  
Flexor Tendon ◽  
Hand Surgery ◽  
Patient Comfort ◽  
Injection Pain ◽  
Tendon Transfers ◽  
Fracture Stabilization ◽  
Wide Awake ◽  
No Tourniquet

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

scholarly journals Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

2019 ◽  
Vol 70 (10) ◽  
pp. 3587-3591
Keyword(s):  
Hospital Stay ◽  
Correlation Coefficient ◽  
Local Anesthesia ◽  
Length Of Hospital Stay ◽  
Hand Surgery ◽  
Patient Comfort ◽  
Tunnel Syndrome ◽  
Positive Direct ◽  
Wide Awake ◽  
No Tourniquet

The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus (FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon’s comfort during surgery, patient’s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) - positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal. Keywords: local anesthesia, epinephrine, Dupuytren disease (DD), carpal tunnel syndrome (CTS), trigger finger (TF)

scholarly journals Romanian dentists’ perception of flexible removable partial dentures

2021 ◽  
Vol 67 (1) ◽  
pp. 53-56
Author(s):  
Georgiana Dragomir ◽  
◽  
Alexandru Titus Farcasiu ◽  
Iulia Pascal ◽  
◽  
...  
Keyword(s):  
Patient Comfort ◽  
Study Group ◽  
Partial Denture ◽  
Clinical Evolution ◽  
Anonymous Questionnaire ◽  
Current Alternative ◽  
Aesthetic Properties ◽  
A Current ◽  
Over Time ◽  
Dental Prosthetics

Introduction. A flexible partial denture, as a treatment solution for partial edentulousness, is a current alternative in dental prosthetics, due to simplified design, aesthetic and biomechanical qualities of resin materials, that contribute to the favourable distribution of masticatory forces on the dental and mucosal support. Objective. This study aims to highlight the medical perception of Romanian dentists regarding the evolution of patients treated with flexible partial dentures. Material and method. The research was carried out over a period of two years (2017-2019), on a study group composed of 84 Romanian dentists. Subjects were asked to answer an anonymous questionnaire consisting of 14 closed questions, to outline frequently aspects encountered in practice related to the clinical evolution of the patient rehabilitated with flexible partial removable dentures. Outcomes. Patient comfort (76%) and higher aesthetic properties (54%) were the main reasons why dentists chose a partially flexible prosthetic for the prosthetic treatment of the patient. In the evolution of prosthetic patient, the main problems found at the partial flexible prosthesis were food pigment impregnation of the base (51%) and limited possibilities of repair (34%). Changes in maintenance, support, stability, aesthetic or possible fractures of base and clasps were seen by 46% of respondents, at approximately 1 to 2 years after the application of flexible partial dentures. Conclusions. Flexible partial prosthesis is a method of treatment, whose main advantages are represented by esthetics and superior adaptation of the patients, but because of the deficiencies that occur over time, it is better to be recommended as a provisional treatment solution.

scholarly journals Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

2019 ◽  
Vol 70 (10) ◽  
pp. 3587-3591
Author(s):  
Mihaela Pertea ◽  
Oxana Madalina Grosu ◽  
Bogdan Veliceasa ◽  
Natalia Velenciuc ◽  
Petru Ciobanu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Correlation Coefficient ◽  
Local Anesthesia ◽  
Length Of Hospital Stay ◽  
Hand Surgery ◽  
Patient Comfort ◽  
Intraoperative Bleeding ◽  
Positive Direct ◽  
Wide Awake ◽  
No Tourniquet

The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus�(FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon�s comfort during surgery, patient�s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) � positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal.

scholarly journals Vitamin D Status and Its Role in First-Time and Recurrent Urinary Tract Infections in Children: A Case-Control Study

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 419
Author(s):  
Carmen Muntean ◽  
Maria Săsăran
Keyword(s):  
Vitamin D ◽  
Urinary Tract ◽  
Case Control Study ◽  
Case Control ◽  
Study Group ◽  
Recurrent Utis ◽  
Vitamin D Levels ◽  
Tract Infections ◽  
First Time ◽  
Control Study

Vitamin D has emerged as a key factor in innate immunity. Its involvement in the pathogenesis of urinary tract infections (UTIs) has gained a lot of attention recently. The objective of this study is to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and first-time or recurrent UTIs in children. A prospective, case-control study was conducted on 101 pediatric patients, who were divided into two groups: 59 patients with UTIs and 42 age-matched healthy controls. Serum 25(OH)D was determined in each child and expressed in ng/mL. Vitamin D presented significantly lower values in study group subjects than in healthy controls (p < 0.01). Moreover, a significantly higher prevalence of vitamin D insufficiency and deficiency was found in children with UTIs (p < 0.01). Patients with recurrent UTIs presented significantly lower levels of vitamin D than those with first-time UTIs (p = 0.04). Urinary tract abnormalities did not seem to exercise an additional effect upon vitamin D levels within the study group. In conclusion, first-time and recurrent UTIs are associated with lower vitamin D levels. Further studies are necessary to validate our findings, as well as future longitudinal research regarding efficacy of vitamin D supplementation in children with UTIs.

scholarly journals Prolonged efficacy of pembrolizumab in a patient presenting a multi-treated metastatic hepatocholangiocarcinoma

2020 ◽  
Vol 13 ◽  
pp. 175628482093518 ◽  
Author(s):  
Angélique Saint ◽  
Maxime Benchetrit ◽  
Sébastien Novellas ◽  
Denis Ouzan ◽  
Alexander Tuan Falk ◽  
...  
Keyword(s):  
Therapeutic Strategy ◽  
Complete Response ◽  
It Management ◽  
Tumor Control ◽  
Line Treatment ◽  
Viral Hepatitis C ◽  
Programmed Cell Death 1 ◽  
First Time ◽  
Inhibitor Treatment ◽  
Over Time

Introduction: Hepatocholangiocarcinoma (HCC-ICC) is a rare tumor presenting the histologic characteristics of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). As there is no consensus on it management, the therapeutic strategy rests on the specific treatments for HCC or ICC. Programmed cell death 1 (PD-1) inhibitors showed encouraging results in the second line treatment of HCC after sorafenib but it efficacy in HCC-ICC has never been reported. Methods and results: We present the case of a 72-year-old male patient treated for metastatic HCC-ICC due to a viral hepatitis C cirrhosis in progression after two lines of treatment. Tumor was characterized by a PDL-1 status of 85%. Patient received pembrolizumab at doses of 200 mg every 21 days by intravenous infusion. After one injection he was presented an immediate clinical benefit, a partial response was observed after two months of treatment and a complete response two months later. This response was maintained over time along with toxicity-free tumor control after 18 months treatment. Conclusion: To our knowledge, we reported for the first time the efficacy of a PD1 inhibitor treatment in a patient presenting metastatic HCC-ICC due to viral cirrhosis and overexpressing PDL-1 after failure of two lines of treatment.

Effect of Time Interval Between Tumescent Local Anesthesia Infiltration and Start of Surgery on Operative Field Visibility in Hand Surgery Without Tourniquet

2015 ◽  
Vol 40 (8) ◽  
pp. 1606-1609 ◽  
Author(s):  
Muhammad Mustehsan Bashir ◽  
Rehan Qayyum ◽  
Muhammad Hammad Saleem ◽  
Kashif Siddique ◽  
Farid Ahmad Khan
Keyword(s):  
Local Anesthesia ◽  
Hand Surgery ◽  
Time Interval ◽  
Operative Field ◽  
Tumescent Local Anesthesia ◽  
Without Tourniquet

International Wool Study Group

1950 ◽  
Vol 4 (3) ◽  
pp. 545-546
Keyword(s):  
World Trade ◽  
Study Group ◽  
Wool Production ◽  
The World ◽  
Intergovernmental Collaboration ◽  
First Time

The International Wool Study Group met at London from November 7 to 9, 1949. The meeting noted that world wool production had increased slightly since the war to a point where it was equal to prewar production. The group for the first time decided to release for publication its report on the world wool situation and reports on the wool situation in member countries, unless requested otherwise; On the basis of review it was decided that no immediate problems called for intergovernmental collaboration in world trade of wool; although it was recognized that the problem of surplus stocks which had led to the establishment of the group in 1946 had largely disappeared, it was felt that the group would prove a useful means for the improvement of wool statistics and a useful body to which world wool problems could be referred.

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