• International Journal of Oral Biology
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• 제32권2호
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• pp.45-49
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• 2007

In this study, the cytotoxicity of commonly used local anesthetics was evaluated on odontoblasts which are essential for pulpal homeostasis in vitro. Local anesthetics, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and procaine, were tested on the odontoblast cell line, MDPC-23. The concentration-and time-dependent cytotoxic effects of local anesthetics on odontoblasts were measured by MTT assay. Among local anesthetics treated for 18 h, only bupivacaine significantly showed cell death in a concentration-($LC_{50}=1.2mM$) and time-dependent manner. To confirm cell death induced by bupivacaine, the observation of cell morphology and FACS using Annexin V and propidium iodide (PI) staining were performed. As a result of Annexin V and PI staining, as well as the morphological change, only bupivacaine induced apoptotic cell death on odontoblasts when compared with levobupivacaine and lidocaine. These results suggest that bupivacaine might affect normal pulpal integrity even after uneventful local anesthesia.

• The Korean Journal of Pain
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• 제9권1호
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• pp.46-56
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• 1996

Many surgeons and anesthesiologists prefer using vasoconstrictor mixed with local anesthetic agent to reduce the incidence of side effects and prolong the duration of analgesia because most local anesthetic agents, except cocaine, were believed to possess vasodilating effect. However, some investigators recently reported vasoconstricting effect of local anesthetic agents. There is still controversy on the vasoactive effect of local anesthetic agents. So this study is aimed to clarify the vasoactive effect of local anesthetics in the animal model resembling clinical settings. Rabbits were anesthesized with ketamine and haloghane, and respirations were controlled with Harvard animal ventilator. Lidocaine (0.5%, 1.0%, 1.5%) and bupivacaine (0.125%, 0.25% and 0.5%) with or without 1:100,000 epinephrine were subdermaly injected on the femoral bupivacaine of the femoral artery were measured with Doppler flow meter in vivo. The mean arterial pressure, pulse rate, arterial blood gases, pH and level of serum electrolytes were measured at every 2 minute interval for 30 minutes. Results were as follows: 1) There was no significant vasoconstriction with 0.5% lidocaine and 0.125% bupivacaine. 2) Statistically significant (p<0.05) vasodilations were observed with lidocaine (1.0~2.0%) and bupivacaine (0.25~0.5%). 3) There were no changes on the duration of vasodilation induced by local anesthetic agents of various concentrations. 4) Onset of vasodilation induced by local anesthetic agents of high concentration were faster than that of lower concentrations. 5) In the mixed injection group of epinephrine and local anesthetic agent, the vasoconstriction induced by epinephrine was completely reversed by local anesthetics, approximately 5 minutes later. In conclusion, local anesthetic agents at dose exceeding 1.0% lidocaine and 0.25% bupivacaine increase local blood flow significantly in animal study in vivo which is applicable in human clinical settings. The increase blood flow may be due to dilatation of blood vessel. Further study on the analysis of association between amount of absorbed local anesthetics in blood vessels and dilatation of blood vessels is needed.

• The Korean Journal of Pain
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• 제13권2호
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• pp.182-186
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• 2000

Background: Ropivacaine is a new amide local anesthetics, having therapeutic properties similar to those of bupivacaine but less cardiovascular toxicity and motor blockade. The aim of this study was to evaluate the effects of ropivacaine used in stellate ganglion block (SGB) compared with those of lidocaine or bupivacaine. Methods: This prospective and crossover study performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB, in the paratracheal approach using 8 ml of 1% lidocaine, 0.2% bupivacaine, and 0.2% ropivacaine respectively without any orders. Onset time and action duration of Horner's syndrome were observed after each SGB. Results: Onset time of ropivacaine was the middle of the three agents; earlier lidocaine and slower bupivacaine. Lidocaine ($3.0{\pm}1.9$ min), bupivacaine ($4.1{\pm}2.9$ min) and ropivacaine ($3.3{\pm}1.3$ min). But there were no significant differences; Action duration of Horner's syndrome of ropivacaine (223.6?105.2 min) was longer than lidocaine ($134.6{\pm}77.3$ min) and shorter than bupivacaine ($241.2{\pm}115.8$ min). There were significant differences in the action duration of each local anesthetics (P<0.05). There was no critical side effects and temporary foreign body sensation was the most common side effect. Conclusions: We conclude that ropivacaine is a good alternative in SGB instead of lidocaine or bupivacaine. Ropivacaine is a long acting local anesthetic similar to those of bupivacaine with wide margin of safety. However, optimal concentration and volume of ropivacaine in SGB should be studied.

• Advances in pediatric surgery
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• 제20권1호
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• pp.7-11
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• 2014

The present study compared the postoperative analgesic effects of ilioinguinal and iliohypogastric nerve block with infiltration of local anesthetics (bupivacaine) into the wound in children after inguinal hernia repair. Ninety children below 7 years old who were scheduled elective inguinal hernia repair were randomly allocated into one of three groups. The patients in nerve block (NB) group, ilioinguinal and iliohypogastric nerve block was done with 0.5 mL/kg of 0.25% bupivacaine. The patients in infiltration of local anesthetics (LI) group, 0.5 mL/kg of 0.25% bupivacaine was infiltrated into the wound after surgery. The patients in control group were allocated as a Control group. Postoperative pain was assessed at 1, 3, 5, and 24 hours after operation with FLACC scale and additional analgesic consumption were counted. The three groups were not significantly different in age, sex, body weight, and duration of operation. Pain scores at 1 hour and 3 hours after operation were significantly higher in Control group than in NB group and LI group (p<0.01), whereas there were no difference between NB group and LI group. The rescue analgesics administration was significantly higher in Control group (n=11) than in NB group (n=6) and LI group (n=7) (p<0.05). There were 2 cases of transient femoral nerve palsy in NB group. Both of ilioinguinal and iliohypogastric nerve block and infiltration of local anesthetics into the wound provided effective postoperative analgesia in early postoperative period following inguinal hernia repair in children. But no difference between the two methods. Technically, infiltration of local anesthetics into the wound was easier and safer than ilioinguinal and iliohypogastric nerve block.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권2호
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• pp.63-72
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• 2020

Dental local anesthesia is performed daily on a global scale. Adverse effects are rare, but the topic of neurotoxicity of local anesthetics deserves to be explored, as publications can be controversial and confusing. Therefore, a need was felt to address and question the evidence for potential neurotoxicity of dental local anesthetics. This review aimed to assess the studies published on the neurotoxicity of dental local anesthetics. A Pubmed^Ⓡ search was conducted between January 2019 and August 2019. This revealed 2802 hits on the topic of neurotoxicity or cytotoxicity of the following anesthetics: lidocaine, prilocaine, mepivacaine, articaine, ropivacaine, and bupivacaine. Only 23 papers were deemed eligible for this review: 17 in vitro studies, 3 reviews and 3 audits of national inquiries. The heterogeneous literature on this topic showed that all dental local anesthetics are potentially neurotoxic in a concentration and/or exposure time fashion. There seems no consensus about what cell lines are to be used to investigate the neurotoxicity of local anesthetics, which makes the comparison between studies difficult and ambiguous. However, the bottom line is that all dental local anesthetics have a neurotoxic potential, but that there is no unanimity in the publications about which local anesthetic is the least or the most neurotoxic.

• The Korean Journal of Pain
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• 제2권2호
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• pp.167-173
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• 1989

Inadequate pain relief after upper abdominal surgery increases the incidence of pulmonary complications due to the difficulty in coughing and deep breathing. Kvalheim and Reiestad (1984) introduced intrapleural administration of local anesthetic solutions to produce analgesia following cholecystectomy performed through a subcostal incision, unilateral breast surgery and renal surgery. We studied continuous intrapleural administration of bupivacaine and epinephrine, and its effect in controlling pain after cholecystectomy. In 9 patients, an intermittent dosage technique was used. An intrapleural catheter was inserted and 20 ml of 0.5% bupivacaine and 1:100,000 epinephrine was administered. Results were as following: 1) Mean analgesic duration from the initial intrapleural injection to secondary administration of supplementary bupivacaine was 13.5 hours. 2) No specific changes were noted on vital signs and arterial blood gases. 3) Effective analgesia, produced by intrapleural bupivacaine resulted in significant improvement in tidal volume as measured by spirometry. 4) No signs of systemic toxicity and complications were encountered. 5) Intrapleural administration of a local anesthetics after cholecystectomy provides a satisfactory duration of analgesia.

• The Korean Journal of Pain
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• 제13권1호
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• pp.1-7
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• 2000

Background: Intraarticular local anesthetic injection has been therapeutically applied for pain control in various arthritis patients. However, little physiologic effects of local anesthetics on their tissue were known. This study was conducted to determine its effects on the cell proliferation and matrix metalloproteinases (MMP) production of cultured fibroblast like synoviocytes (FLS) derived from synovial tissues of rheumatoid arthritis patients. Methods: Bupivacaine with varying concentrations 0 (control), 0.1, 0.25, 0.5% was applied to experimental cell groups growing as monolayers in culture plates for varying durations 0 (control), 30, 90, 180 seconds in the presence and absence of interleukin-$1\beta$. Results: No statistical significances were noted in thymidine incorporation between 0, 30, 90 and 180 seconds exposure groups with 0.5% bupivacaine after 1 day and 2 days. Thymidine incorporation between 0, 0.1, 0.25, 0.5% exposure groups 1 day and 2 days after 90 seconds exposure did not show any differences. After exposure to bupivacaine, there were statistically significant increases in MMP-1 (p=0.025) and MMP-3 productions (p=0.000) of FLS in the absence of IL-$1\beta$, but no differences among the groups in the presence of IL-$1\beta$. Conclusion: We concluded that in this short-term in vitro study, bupivacaine does not have injurious effect on cultured rheumatoid arthritic joint tissues. The long-term effect cannot be known from this investigation.

• The Korean Journal of Physiology and Pharmacology
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• 제7권3호
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• pp.119-124
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• 2003

To elucidate the molecular mechanism of pharmacological action of local anesthetics, we studied membrane actions of tetracaine, bupivacaine, lidocaine, prilocaine and procaine. Fluorescence polarization of n-(9-anthroyloxy)stearic acid (n-AS) was used to examine the effects of these local anesthetics on differential rotational mobility of different positions of the number of synaptosomal plasma membrane vesicle (SPMV) phospholipid carbon atoms. The four membrane components differed with respect to 3, 6, 9 and 16-(9-anthroyloxy)stearic acid (3-AS, 6-AS, 9-AS and 16-AP) probes, indicating that differences in the membrane fluidity might be present. Degrees of the rotational mobility of 3-AS, 6-AS, 9-AS and 16-AP were different depending on depth of hydrocarbon interior. In a dose-dependentmanner, tetracaine, bupivacaine, lidocaine, prilocaine and procaine decreased anisotropy of 3-AS, 6-AS, 9-AS and 16-AP in the hydrocarbon interior of the SPMV. These results indicate that local anesthetics have significant disordering effects on hydrocarbon interior of the SPMV, thus affecting the transport of $Na^+$ and $K^+$ in nerve membranes and leading to anesthetic action.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.209-212
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• 2016

Lidocaine, a local anesthetic commonly used in dental treatments, is capable of causing allergies or adverse effects similar to allergic reactions. However, the frequency of such occurrences in actual clinical settings is very rare, and even clinical tests on patients with known allergies to local anesthetics may often show negative results. When adverse effects, such as allergy to lidocaine, are involved, patients can be treated by testing other local anesthetics and choosing a local anesthetic without any adverse effects, or by performing dental treatment under general anesthesia in cases in which no local anesthetic without adverse effects is available. Along with a literature review, the authors of the present study report on two cases of patients who tested positive on allergy skin tests for lidocaine and bupivacaine and subsequently underwent successful dental treatments with either general anesthesia or a different local anesthetic.

• The Korean Journal of Pain
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• 제32권2호
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• pp.105-112
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• 2019

Background: Severe pain always develops after thoracotomy; intrapleural regional analgesia is used as a simple, safe technique to control it. This study was performed to evaluate whether a small dose of naloxone with local anesthetics prolongs sensory blockade. Methods: A prospective, randomized double-blinded controlled study was conducted on 60 patients of American Society of Anesthesiologists statuses I and II, aged 18 to 60 years, scheduled for unilateral thoracotomy surgery. After surgery, patients were randomly divided into two groups: through the intrapleural catheter, group B received 30 ml of 0.5% bupivacaine, while group N received 30 ml of 0.5% bupivacaine with 100 ng of naloxone. Postoperative pain was assessed using the visual analog pain scale (VAS). Time for the first request for rescue analgesia, total amount consumed, and incidence of postoperative complications were also recorded. Results: The VAS score significantly decreased in group N, at 6 h and 8 h after operation (P < 0.001 for both). At 12 h after injection, the VAS score increased significantly in group N (P < 0.001). The time for the first request of rescue analgesia was significantly longer in group N compared to group B (P < 0.001). The total amount of morphine consumed was significantly lower in group N than in the bupivacaine group (P < 0.001). Conclusions: Addition of a small dose of naloxone to bupivacaine in intrapleural regional analgesia significantly prolonged pain relief after thoracotomy and delayed the first request for rescue analgesia, without significant adverse effects.