PubMed · 307680
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K R Murrin. 1978. Local anaesthesia.. https://pubmed.ncbi.nlm.nih.gov/307680/
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Glucocorticoids prolong block duration from polymeric microspheres containing bupivacaine, but not from unencapsulated drug. Here we investigate this effect applies to particles with much more rapid drug release and improved long-term biocompatibility. Male Sprague-Dawley rats were given sciatic nerve blocks with 75 mg of 3% or 60% (w/w) dipalmitoylphosphatidylcholine (DPPC) spray-dried lipid-protein-sugar particles (LPSPs) containing 10% (w/w) bupivacaine and 0%, 0.05%, or 0.1% (w/w) dexamethasone. Sensory nerve block from bupivacaine-containing 3% and 60% (w/w) DPPC particles without dexamethasone yielded blocks lasting 301 +/- 56 and 321 +/- 127 min, respectively. Addition of 0.05% (w/w) dexamethasone increased block durations to 610 +/- 182 and 538 +/- 222 min, respectively; increasing dexamethasone loading to 0.1% did not further increase duration. One day after injection, dexamethasone-containing particles resulted in lower inflammation scores and capsule thickness than dexamethasone-free particles, but the difference was gone by day 4. Excipient composition had prominent effects at all time points. For all groups, inflammation was largely resolved by 2 weeks after injection. Dexamethasone approximately doubled the duration of nerve block from bupivacaine-loaded LPSPs, while maintaining excellent biocompatibility. Such formulations could be useful in clinical applications when nerve blockade is needed for 24 hours or less.
In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called "held in mesh repair". From 1990 to 2003 we treated 3,520 cases of primary hernia with the "held in mesh repair". 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the "held in mesh repair" and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.
Behavioural and cortisol responses of calves were used as indicators of pain to assess short- and long-term effects of bloodless castration methods with and without local anaesthesia. Seventy calves, aged 21-28 days, were control handled (20) or castrated using the Burdizzo (25) or rubber ring technique (25). Either 10 mL lidocaine or NaCl were distributed in both spermatic cords and the scrotal neck. The plasma cortisol response was recorded for 72 h, and behavioural and clinical traits monitored over a three month period. Local anaesthesia reduced the level of indicators of acute pain after both the Burdizzo and rubber ring techniques. It did not, however, result in a totally painless castration. As there was evidence of chronic pain lasting for several weeks after rubber ring castration, the Burdizzo method is judged to be preferable to the rubber ring technique.