• Journal of Dental Anesthesia and Pain Medicine
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• 제22권1호
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• pp.11-18
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• 2022

Background: The vasoconstrictive effect of epinephrine in local anesthetics affects the heart, which leads to hesitation among dentists in injecting local anesthetics into patients with cardiovascular disease. Due to its vasoconstrictive effects, the present study investigated the effects of vasopressin administration on cardiac function in rats. Methods: Experiment 1 aimed to determine the vasopressin concentration that could affect cardiac function. An arterial catheter was inserted into the male Wistar rats. Next, 0.03, 0.3, and 3.0 U/mL arginine vasopressin (AVP) (0.03V, 0.3V, and 3.0V) was injected into the tongue, and the blood pressure was measured. The control group received normal saline only. In Experiment 2, following anesthesia infiltration, a pressure-volume catheter was placed in the left ventricle. Baseline values of end-systolic elastance, end-diastolic volume, end-systolic pressure, stroke work, stroke volume, and end-systolic elastance were recorded. Next, normal saline and 3.0V AVP were injected into the tongue to measure their effect on hemodynamic and cardiac function. Results: After 3.0V administration, systolic blood pressures at 10 and 15 min were higher than those of the control group; they increased at 10 min compared with those at baseline. The diastolic blood pressures at 5-15 min were higher than those of the control group; they increased at 5 and 10 min compared with those at baseline. The preload decreased at 5 and 10 min compared to that at baseline. However, the afterload increased from 5 to 15 min compared with that of the control group; it increased at 10 min compared with that at baseline. Stroke volume decreased at 10 and 15 min compared with that of the control group; it decreased from 5 to 15 min compared with that at baseline. Stroke work decreased from 5 to 15 min compared with that of the control group; it decreased from 5 to 15 min compared with that at baseline. Conclusion: Our results showed that 3.0 U/mL concentration of vasopressin resulted in increased blood pressure, decreased stroke volume and stoke work, decreased preload and increased afterload, without any effect on myocardial contractility.

• 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.

• The Korean Journal of Pain
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• 제8권1호
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• pp.60-64
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• 1995

Stellate ganglion block is a selective sympathetic blockade affecting the head and neck, and the upper extemity. It is an important method which has been used most frequently in neuro-pain clinic due to its wide range of indications. The authors attermpted to define the minimal volume of local anesthetic which need for successful stellate ganglion block by using 1% mepivacaine HCl mixed with dye. In 40 heathy volunteers, two different volumes, 3 ml in the group 1 (n=20) and 4 ml in the group 2 (n=20), were injected by an anterior paratracheal technique at the sixth cervical vertebral level. We compared the degree in sympathetic blockade by clinical sings and symptoms and also checked the spread range of dye by plain X-ray. With seven criteria for an effective block. mean score was 5.7 in group 2, while 3.4 in group 1. These results suggest that 4 ml of local anesthetic are adequate for a successful stellate ganglion block.

• Restorative Dentistry and Endodontics
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• 제31권4호
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• pp.257-262
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• 2006

에피네프린을 함유한 국소마취제가 치수혈류량에 미치는 영향을 관찰하고, 이 국소마취가 와동 형성에 의해 야기되는 치수의 혈류변화에 미치는 영향을 평가하고자 전신마취 된 아홉 마리의 고양이 견치에서 1 : 100.000 에피네프린이 함유된 2% 리도카인 용액으로의 국소 침윤마취 전후 및 와동형성 전후의 치수혈류를 laser Doppler flowmetry (Periflux 4001, Perimed Co.. Sweden)를 사용하여 측정하고 paired t-test 로 통계 분석하였다 . 상아질 와동의 형성은 치수혈류의 현저한 증가를 초래하였다 (p < 0.05). 에피네프린을 함유한 리도카인의 침윤마취는 치수혈류를 유의하게 감소시켰다 (p < 0.05). 국소마취 한 치아에서는 마취되지 않은 치아에 비해 와동형성 시 유의하게 적은 치수혈류의 증가를 나타내었다 (p < 0.05). 따라서 본 연구에서는 혈관수축제를 포함한 국소마취가 와동 형성에 의해 초래되는 혈류량의 증가를 효과적으로 억제할 수 있음을 보여주고 있다.

• 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.

• 공업화학
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• 제9권7호
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• pp.1090-1097
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• 1998

국부 마취제로 이용되는 lidocaine 화합물들이 마취 효과를 나타내는 과정을 알아보기 위하여 세포벽을 구성하는 지질 이중막의 모사 시스템으로 공기/물 계면에 형성된 지질 단분자 막을 이용하여 lidocaine 화합물들이 지질 단분자 막의 팽창에 미치는 영향을 연구하였다. Lidocaine이 신경 세포와 접하게 되면 세포벽을 구성하는 지질 이중막을 팽창시켜 이중막에 함침된 단백질을 압축하여 이를 통한 이온 통과가 차단되어 신경 전달이 마비된다는 가설과, 단백질 이온 통로에 존재하는 lidocaine receptor에 직접 흡착되어 이온 통로를 막는다는 가설이 구체적 실험 없이 제안되었다. 본 연구에서는 두 가설 타당성을 증명하고자 리피드 단분자 막팽창에 lidocaine이 미치는 영향을 조사하였다. 실험 결과 유용성인 lidocaine은 phosphatidyl choline, sphingomyelin, DS-PL95E, lipoid의 단분자 막을 수축시켰으며 phosphatidyl ethanolamine은 특정 조성 범위에서만 단분자 막을 팽창시켰다. 반면 수용성인 lidocaine-HCl 염은 실험에 사용된 모든 지질의 단분자 막을 팽창시켰다.

• The Korean Journal of Pain
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• 제14권1호
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• pp.26-31
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• 2001

Background: Sympathetic blocks with local anesthetics are used to differentiate sympathetically- maintained pain (SMP) from sympathetically-independent pain (SIP). However, systemic lidocaine is also used in the management of neuropathic pain. Therefore, there may be possibility of a false positive response in relieving their pain by systemic absorption of lidocaine following a diagnostic sympathetic block in patients with SIP. In this study, we measured the plasma lidocaine concentrations after a stellate ganglion block (SGB) using three volumes of 1% lidocaine. Methods: This prospective, crossover study was performed in 3 patients who experience sudden hearing loss and in 4 volunteers. Each person received SGB three times using three different volumes (6 ml, 12 ml and 16 ml) of 1% lidocaine at one week intervals. SGB was performed using a 23 G butterfly needle via a paratracheal approach by two persons. Two ml of venous blood was obtained from a prepared contra-lateral sided venous route at 1, 3, 5, 7, 10, 20 and 60 min after SGB. Plasma lidocaine level was analyzed by immunoassay. Results: Mean plasma lidocaine concentrations correlated well with the volumes of 1% lidocaine used in SGB; larger volumes showed higher concentrations (P < 0.01). Mean peak plasma concentrations were $1.08{\pm}0.18$ in 6 ml, $1.90{\pm}0.47$ in the 12 ml and $2.74{\pm}0.67{\mu}g/ml$ in the 16 ml groups (P < 0.01). The mean time to reach peak plasma concentration was not significantly different between the three groups. Conclusions: The peak plasma lidocaine concentrations in SGB using large volume were found to be similar to that of IV lidocaine infusion in the management of neuropathic pain. These data suggest that diagnostic sympathetic block may result in many false positive responses for SMP. Part of its effect may be related to systemic local anesthetic absorption and not to a sympathetic block. Therefore, physicians may be required to use optimal volumes and minimal concentration of local anesthetic in diagnostic sympathetic block procedures and also make a careful assessment of the performance of a permanent sympathetic block.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권2호
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• pp.121-127
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• 2017

Background: There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. Method: This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. Results: The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P<0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. Conclusion: We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.

• Macromolecular Research
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• 제10권5호
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• pp.246-252
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• 2002

In order to the development of the delivery device of long-acting local anesthetics for postoperative analgesia and control of chronic pain of cancer patient, fentnyl-loaded poly (L-lactide-co-glycolido) (PLGA, molecular weight, 5,000 g/mole; 50 : 50 mole ratio by lactide to glycolide) microspheres (FMS) were studied. FMS were prepared by an emulsion solvent-evaporation method. The influence of several preparation parameters such as initial drug loading, PLGA concentration, emulsifier concentration, oil phase volume, and fabrication temperature has been investigated on the fentanyl release profiles. Generally, the drug showed the biphasic release patterns, with an initial diffusion followed by a lag period before the onset of the degradation phase, but there was no lag time in our system. Fentanyl was slowly released from FMS over 10 days in vitro with a quasi-zero order property. The release rate increased with increasing drug loading as well as decreasing polymer concentration with relatively small initial burst effect. From the results, FMS may be a good formulation to deliver the anesthetic for the treatment of chronic pain.

• The Korean Journal of Pain
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• 제9권1호
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• pp.135-139
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• 1996

Intercostal nerve blockade with local anesthetics has been used extensively in the past to provide pain relief following thoracotomy. Its popularity fell, for a period, probably due to increasing use of epidural analgesia. More recently, interest has focused on intercostal nerve block with the introduction of variously sited catheters. Two epidural catheters were placed under direct vision, in the intercostal spaces just above and below the wound by feeding the catheters posteriorly from the wound edges, superficial to the parietal pleura. Bupivacaine 0.25%. Was infused continuously at a rate of 5 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml of 0.25% bupivacaine. Postoperative vital signs resembled preoperation data. Arterial carbon dioxide pressure ($PaCO_2$) was unchanged and arterial oxygen pressure ($PaO_2$) was increased during two days after surgery because oxygen was administered at 21/min. Forced vital capacities (FVC) and forced expiratory volume in 1 second ($FEV_1$) were decreased the day of operation but restored to preoperative value from second operation day. VAS were increased on operation day but decreased from second operation day. Motion range of arms were not impaired. We concluded that continuous intercostal nerve block through catheters placed during thoracotomy in the adjacent intercostal spaces is a simple and effective method for management of the post-thoracotomy pain.