Lumbar plexus conduction anesthesia Degenhardt (Zentr. f. Chir., 1926, № 25)

Degenhardt (Zentr. F. Chir., 1926, No. 25) in 48 cases successfully applied conduction anesthesia of the lumbar plexus according to Stchlesinger y during operations in the groin and pelvic regions and on the lower extremities, and for inguinal hernias he had to additionally anesthetize D12, and for operations in the pelvic region - n. ischiadicus.

Experience of using local anesthetic combinations

Background. The general toxic effects of local anesthe­tics on vital organs are the most severe side effects of regional blockades. The purpose was to study the effectiveness and safety of combined solutions of local anesthetics in the brachial plexus block. Materials and methods. Forty-nine patients were divided into 2 study groups. The first group (controls) consisted of 24 individuals who received a solution of 0.5% bupivacaine 36 ml (180 mg) with adrenaline 1 : 200,000 as an adjuvant to block the brachial plexus. The second group (main) consisted of 25 patients, who were treated with a mixture of 2% lidocaine 12 ml (240 mg) and 0.5% bupivacaine 12 ml (60 mg) diluted with a solution of 0.9% NaCl 12 ml and adrenaline 1 : 200,000 as an adjuvant. Results. In the first group (bupivacaine), the onset time of sensory block averaged 11.3 ± 4.3 minutes, motor block — 21.0 ± 7.8 minutes. The motor block duration was 894 ± 237 minutes. In the second group (mixture), the onset time of sensory block averaged 8.0 ± 3.6 minutes, motor block — 14.0 ± 6.2 minutes, which was significantly less than in the first group. The duration of the motor block was 539 ± 186 minutes. The longest postoperative analgesia was registered in the bupivacaine group — 984 ± 263 minutes. The duration of postoperative analgesia in the main group was slightly shorter — 612 ± 210 minu­tes. Conclusions. The proposed combination of local anesthe­tics bupivacaine and lidocaine allows reducing the bupivacaine dose by three times, which decreases the toxic complications of conduction anesthesia. The clinical use of the proposed drug combination reduces the duration of the latent period and provides long-term postoperative analgesia.

Impact of Two Distinct Dental Anesthesia Simulation Models on the Perception of Learning by Students

We evaluated an infiltration anesthesia simulation model (IAM) and a conduction anesthesia simulation model (CAM) on the perception of learning by Mexican dental students. Our aim was to compare the perception of learning by dental students trained with two distinct dental anesthesia simulation model (DASM) with dental students who were not trained with a DASM. 3 groups participated in the study: G1 (N=12 students) learned to block the mental nerve (BMN) by participating in a theoretical lecture (stage 1) and a clinical demonstration (stage 2); G2 (N=12 students) learned the BMN by participating in the stage 1, stage 2, and training with the CAM; G3 (N=12 students) learned the BMN by participating in the stage 1, stage 2, and training with the IAM. The groups performed the BMN in a clinical exercise. Working-time of all participants was timed. Perception of learning for all participants was evaluated with a 5-point Likert Scale. The results showed that statistically significant differences were found between score of G1 and score of G2 and score of G3 (P<0.05). No statistically significant differences were found between scores of G2 and scores of G3. G1, G2 and G3 showed an average working-time of 12:42 minutes, 9.75 minutes and 8:03 minutes, respectively (P<0.05). We concluded that the IAM and CAM showed a positive impact on the perception of learning, and the students trained with the IAM showed a shorter working time compared with the students trained with the CAM.

On local anesthetic action of some dimethylacetamide compounds

The study aim was to explore local anesthetic properties of some tertiary and quaternary derivatives of dimethylacetamide. Materials and methods. The study was performed on white laboratory mice and rats of both sexes, male Agouti guinea pigs, and isolated sciatic nerves of lake frog. In the focus of the study there were two quaternary and eight tertiary compounds of dimethylacetamide with substituted anion with some amino and carbonic acids residue. A local anesthetic property was predicted by computational analysis. Acute toxicity of the most promising substances was studied in mice through subcutaneous route. Local anesthetic activity of tertiary compounds LKhT-3-00, LKhT-4-00 and quaternary LKhT-12-02 was studied on models of terminal, infiltration and conduction anesthesia. The influence of substances on mixed nerve conduction was investigated on lake frog’s isolated sciatic nerves. Results and discussion. The greatest probability of the local anesthetic activity during computational analysis was estimated for the tertiary derivatives of dimethylacetamide LKhT-3-00 and LKhT-4-00 and for the quaternary compound LKhT-12-02. According to their toxicological profile, the compounds belong to moderately toxic substances (class 3). On the model of terminal and infiltration anesthesia, substances LKhT-3-00 and LKhT-4-00 at concentrations of 0.5-1% rapidly cause deep and prolonged anesthesia. On the models of conduction anesthesia, the quaternary derivative of dimethylacetamide LKhT-12-02 has the greatest analgesic effect. The duration of the effect of the substance is over 3 hours. All the investigated compounds block sciatic nerve conduction. The longest effect is registered for LKhT-12-02. Conclusions. Dimethylacetamide derivatives at concentrations of 0.5-1.0% exhibit a local anesthetic activity, and are effective for terminal, conduction and infiltration anesthesia. Their effect is due to blockade of nerve conduction.

Оптимізація місцевого знеболювання м’яких тканин бокової ділянки обличчя шляхом застосування розроблених методик анестезій лицевих гілок поверхневого шийного нервового сплетення

The lateral facial region including zygomatic, parotid and buccal regions is innervated by trigeminal nerve branches: zygomatic, auriculotemporal, buccal, mental nerves as well as by branches of cervical plexus: great auricular and transverse cervical nerves. According to the classical Brown’s method, great auricular and transverse cervical nerves can be blocked at Erb’s point on the posterior border of the sternocleidomastoid muscle.Anesthesia of the listed nerves is commonly attained in the contemporary surgical practice during superfi cial cervical plexus block. However, due to the high probability of local complications such as external jugular veindamaging by the injection needle this technique can’t be used in the outpatient surgical dental practice.The aim of the study – to develop methods of conduction anesthesia of facial branches of cervical plexus (great auricular and transverse cervical nerves) on patient’s face considering individual topographic anatomical peculiarities.Materias and Methods. Clinical observation was conducted in 39 sheduled patients of different sex and age (18–60 years old) that were being on stationary treatment. In case the localization of pathological processes (benign tumors, keloid scars, fi stulas of migrating granulomas) in the parotid region (21 cases) surgical interventions were conducted under local conduction anesthesia of auriculotemporal nerve as well as facial branches of great auricular and transverse cervical nerves. In case the localization of pathological processes in the buccal region (18 cases) surgical interventions were conducted under local conduction anesthesia of buccal, mental nerves and facial branches of transverse cervical nerve (if necessary). Facial branches of great auricular nerve were blocked along the posterior border of mandible ramus – from the gonial angle to the neck of mandibular condyle. Anesthesia of facial branches of transverse cervical nerve was conducted along the inferior border of mandible. Individual topographic anatomical peculiarities of the facial part of the head in patients were determined by computing the facial index of each patient using Garson’s algorithm. Tactile and pain sensitivity were explored. In order to assess objectively the developed method of great auricular nerve block it was used stimulating electromyography. It is established that pathological processes did not infl uence the sensory function (tactile and pain sensitivity) of the zygomatic, parotid and buccal regions in patients before the planned surgical interventions on the lateral facial region.Results and Discussion. After the block of facial branches of great auricular nerve according to the developed technique it is revealed that in all cases the posterior part of the parotid region adjoining the mandible angleand posterior part of mandible ramus became insensitive. In 19 cases (93.1 %) an absolute anesthesia of this topographic anatomical region occurred. In 7 cases (33.4 %) the conduction anesthesia of facial branches oftransverse cervical nerve was carried out when this nerve took part in the innervation of the parotid region. It is clinically confi rmed that there are three types of ramifying on the human face of branches of great auricular and transverse cervical nerves (Bruno Ella classifi cation, 2015). The fi rst type of the lateral facial region innervation by the rami of cervical plexus occurred the most frequently, in 11 cases (52.4 %), and prevailed in patients with mesoprosopic form of facial part of the head. The second type of ramifying was observed in 7 cases (33.4 %), in patients with euriprosopic and mesoprosopic face shapes. The third type occurred in 14. 3 % cases in patients with mesoprosopic and leptoprosopic face shapes. In those people a major part of the lateral facial region was innervated by auriculotemporal nerve. In 55. 6 % cases a scattered type of buccal nerve ramifying was found on the face in patients prevailing in leptoprosops. In three patients transverse cervical nerve took part in the buccal region innervation. In all cases they were individuals with euriprosopic face shape. The loss of tactile and pain sensitivity on the skin cover of both the parotid and buccal regions as well as temporary absence of conductance along the facial branches of great auricular nerve that was detected during stimulating electromyography absolutely confi rmed the effectiveness of the developed methods of local conduction anesthesia. During surgical treatment the effi ciency of used methods of local anesthesia was evaluated on 4.7 ± 0.5 points – it was observed a stable anesthesia, without psychosomatic peculiarities as well as local and general complications, in patients; sometimes weakly expressed affective reactions took place, but they didn’t infl uence the course of the operation.Conclusions. The results of clinical observations confi rm the signifi cant variability of sensitive innervation of soft tissues of the lateral facial area, it varies in patients depending on their individual anatomical features.There are three types of branching in the parietal-chewing area of the facial branches of the surface cervical nerve plexus, which can spread to the cheek area. The use of techniques, conductive anesthetics of the facial branches of the large anus and transverse nerve of the neck, in combination with the traditional methods of local anesthesia, which we developed, provided painless surgical interventions on the lateral face of the face.