Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialComparison of 0.5% articaine and 0.5% prilocaine in intravenous regional anesthesia of the arm: a cross-over study in volunteers.
Earlier studies of the use of articaine in intravenous regional anesthesia (IVRA) are conflicting. In fact, despite similar physicochemical properties and regional anesthetic action, significant differences between articaine and prilocaine in IVRA have been reported. Articaine, being a potent local anesthetic with low degree of toxicity and being rapidly metabolized by esterases, could be a useful local anesthetic particularly in IVRA and, perhaps, could challenge prilocaine, the present local anesthetic of choice for this technique. ⋯ Both 0.5% articaine and 0.5% prilocaine, in a median dose of 40 mL in adults, injected in 2 minutes, are effective and equipotent local anesthetics in IVRA of the arm. An earlier reported four-time faster onset time of the block by articaine in comparison with prilocaine may be caused by a very rapid injection rate (40 mL/30 sec) by the investigators of that study. The erythematous skin rashes after IVRA, in particular when articaine was used, may be a sign of venous endothelial irritation.
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Clinical TrialThe effect of anesthetic patient education on preoperative patient anxiety.
Preoperative time spent with patients has been abbreviated with the advent of same-day admission requirements and outpatient surgery. This study was conducted to evaluate the effects that materials mailed to the home relating to anesthetic-focused patient education may have on preoperative patient anxiety. ⋯ Increase in preoperative anxiety is diminished when additional anesthesia information in printed and video format is made available. Useful information can be provided to patients to view or read prior to surgery.
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Reg Anesth Pain Med · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of the analgesic efficacy of EMLA cream in volunteers with differing skin pigmentation undergoing venipuncture.
Lidocaine/prilocaine cream (EMLA) applied to intact skin for 60 minutes has been shown to reduce venipuncture pain. Recent studies have suggested that lidocaine/prilocaine cream is less effective on heavily pigmented skin. The objective of this study was to evaluate the topical anesthetic efficacy of lidocaine/prilocaine cream in volunteers with varying skin pigmentation types. ⋯ Lidocaine/prilocaine cream is a safe and effective topical anesthetic for reducing pain associated with venipuncture in individuals, regardless of skin pigmentation.
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Reg Anesth Pain Med · Mar 1999
Case ReportsAnxiety, vocalization, and agitation following peripheral nerve block with ropivacaine.
Central nervous system (CNS) and cardiovascular toxicity are potential side effects of local anesthetics. However, ropivacaine has been reported to be less CNS toxic than bupivacaine in human volunteers. ⋯ This case report shows that ropivacaine may cause CNS toxicity that differs from classical signs of local anesthetic-induced toxicity. This effect might be related to the unique structure of ropivacaine, which is formulated in an S-enantiomer preparation. It has been shown that S-enantiomers bind differently to receptors in both the CNS and cardiovascular systems. This property may account for the disinhibition of select neural pathways that are specifically involved in mediation of anxiety and aggression.