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Local anesthetics toxicity

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https://www.readbyqxmd.com/read/28919152/erector-spinae-plane-esp-block-in-the-management-of-post-thoracotomy-pain-syndrome-a-case-series
#1
Mauricio Forero, Manikandan Rajarathinam, Sanjib Adhikary, Ki Jinn Chin
BACKGROUND AND AIMS: Post thoracotomy pain syndrome (PTPS) remains a common complication of thoracic surgery with significant impact on patients' quality of life. Management usually involves a multidisciplinary approach that includes oral and topical analgesics, performing appropriate interventional techniques, and coordinating additional care such as physiotherapy, psychotherapy and rehabilitation. A variety of interventional procedures have been described to treat PTPS that is inadequately managed with systemic or topical analgesics...
September 11, 2017: Scandinavian Journal of Pain
https://www.readbyqxmd.com/read/28917061/use-of-lipid-emulsion-therapy-in-local-anesthetic-overdose
#2
Ozgur Karcioglu
The use of intravenous lipid emulsion (ILE) therapy as antidote in systemic toxicity of certain agents has gained widespread support. There are increasing data suggesting use of ILE in reversing from local anesthetic-induced systemic toxicity severe, life-threatening cardiotoxicity, although findings are contradictory. Efficiency of ILE was demonstrated in animal studies in the treatment of severe impairment of cardiac functions, via a mechanism for trapping lipophilic drugs in an expanded plasma lipid compartment ("lipid sink")...
October 2017: Saudi Medical Journal
https://www.readbyqxmd.com/read/28881313/lc-ms-ms-method-for-preclinical-pharmacokinetic-study-of-qx-oh-a-novel-long-acting-local-anesthetic-in-sciatic-nerve-blockade-in-rats
#3
YuJun Zhang, DeYing Gong, QingShan Zheng, Jin Liu, WenSheng Zhang
QX-OH, a new synthetic local anesthetic, produced concentration-dependent, reversible, and long-acting local anesthesia in animal models, with moderate local toxicity. As part of preclinical research for drug development, we developed and validated a method for the determination of QX-OH in the plasma, muscle, and sciatic nerve using liquid chromatography-mass spectrometry. After a simple protein precipitation procedure, analysis was performed on an Extend C18 column (100mm×3mm, 3.5μm) by isocratic elution with 0...
July 29, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/28844768/systemic-safety-of-liposomal-bupivacaine-in-simultaneous-bilateral-total-knee-arthroplasty
#4
Bryan D Springer, J Bohannon Mason, Susan M Odum
BACKGROUND: Intraoperative periarticular injections (PAIs) with local anesthetic are an important component of multimodal pain control in total joint arthroplasty. Liposomal bupivacaine is an extended-release formulation of bupivacaine designed to provide extended pain relief, approved for use in a single surgical site. The systemic safety profile for use in simultaneous bilateral TKA (bTKA) with a full dose in each knee has not been evaluated. The purpose of this study was to determine the safety and pharmacokinetics of bilateral full-dose PAI liposomal bupivacaine in the blood collected in patients undergoing simultaneous bTKA...
August 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28745230/bupivacaine-s75-r25-loaded-in-nanostructured-lipid-carriers-factorial-design-hplc-quantification-method-and-physicochemical-stability-study
#5
Gustavo Henrique Rodrigues Da Silva, Ligia Nunes de Moraes Ribeiro, Viviane Guilherme, Simone Ramos de Castro, Márcia Cristina Breitkreitz, Eneida de Paula
Bupivacaine is the most used local anesthetic in surgical procedures, producing prolonged anesthesia. The major limiting factor for the clinical use of bupivacaine comes from its systemic toxicity. Nanostructured lipid carriers (NLC) are vehicles for sustained drug delivery that are able to minimize the toxicity and to increase the action time of lipophilic drugs. This work reports a 22 factorial design, which elucidate the role of the lipids mixture in the NLC, towards an optimized formulation. It also provides a new method for Bupivacaine S75:R25 (BVCS75) quantification in NLC...
July 26, 2017: Current Drug Delivery
https://www.readbyqxmd.com/read/28727583/serum-bupivacaine-concentration-after-periarticular-injection-with-a-mixture-of-liposomal-bupivacaine-and-bupivacaine-hcl-during-total-knee-arthroplasty
#6
Michael J Buys, Marian F Murphy, Christine M Warrick, Nathan L Pace, Jeremy M Gililland, Christopher E Pelt, Byron R Bankhead, John L Patzkowsky, Ken B Johnson
BACKGROUND AND OBJECTIVES: A relatively new technique to reduce postoperative pain for total knee arthroplasty is to inject a mixture of 266 mg of liposomal bupivacaine and 125 mg of 0.25% bupivacaine HCl with epinephrine 1:300,000 around the knee joint at the time of surgery. Currently, no publications report serum bupivacaine concentrations over time after periarticular injection of liposomal mixed with free bupivacaine. This information is important to ensure safe serum bupivacaine concentrations are maintained especially when considering supplemental or rescue peripheral nerve blocks...
September 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28719457/regional-anesthesia-in-diabetic-peripheral-neuropathy
#7
Werner Ten Hoope, Marjolein Looije, Philipp Lirk
PURPOSE OF REVIEW: The aim of this review is to summarize recent relevant literature regarding regional anesthesia in the diabetic neuropathic patient and formulate recommendations for clinical practice. RECENT FINDINGS: Diabetic neuropathic nerves, but not nerves of diabetic patients per se, exhibit complex functional changes. As a result, they seem more sensitive to local anesthetics, and are more difficult to stimulate. When catheters are used postoperatively, diabetes is an independent risk factor for infection...
October 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28692439/lipid-emulsion-in-local-anesthetic-toxicity
#8
Martyn Harvey, Grant Cave
PURPOSE OF REVIEW: Enthusiasm for regional anesthesia has been driven by multimodal benefits to patient outcomes. Despite widespread awareness and improved techniques (including the increasing use of ultrasound guidance for block placement), intravascular sequestration and the attendant risk of local anesthetic systemic toxicity (LAST) remains. Intravenous lipid emulsion (ILE) for the treatment of LAST has been endorsed by anesthetic regulatory societies on the basis of animal study and human case report data...
October 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28663643/comparison-between-conventional-and-ultrasound-guided-supraclavicular-brachial-plexus-block-in-upper-limb-surgeries
#9
Kiran Abhayakumar Honnannavar, Mahantesh Shivangouda Mudakanagoudar
INTRODUCTION: Brachial plexus blockade is a time-tested technique for upper limb surgeries. The classical approach using paresthesia technique is a blind technique and may be associated with a higher failure rate and injury to the nerves and surrounding structures. To avoid some of these problems, use of peripheral nerve stimulator and ultrasound techniques were started which allowed better localization of the nerve/plexus. Ultrasound for supraclavicular brachial plexus block has improved the success rate of the block with excellent localization as well as improved safety margin...
April 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28652958/lidocaine-induced-systemic-toxicity-a-case-report-and-review-of-literature
#10
Badar Hasan, Talal Asif, Maryam Hasan
For the past 50 years, local anesthetics such as lidocaine have been commonly used in various clinical settings. Its use is not just limited to anesthesia and surgery but is also frequently utilized in internal medicine and in primary care setting for bedside procedures. Despite its widespread use, most physicians are not familiar with the life-threatening manifestations of lidocaine toxicity and its treatment. Our case demonstrates a successful resuscitation after cardiac arrest in a healthy 33-year-old female with systemic lidocaine toxicity after she received lidocaine as a local anesthetic...
May 25, 2017: Curēus
https://www.readbyqxmd.com/read/28630416/hif-1-mediated-suppression-of-mitochondria-electron-transport-chain-function-confers-resistance-to-lidocaine-induced-cell-death
#11
Akihisa Okamoto, Chisato Sumi, Hiromasa Tanaka, Munenori Kusunoki, Teppei Iwai, Kenichiro Nishi, Yoshiyuki Matsuo, Hiroshi Harada, Keizo Takenaga, Hidemasa Bono, Kiichi Hirota
The local anesthetic lidocaine induces cell death by altering reactive oxygen species (ROS) generation and mitochondrial electron transport chain function. Because hypoxia-inducible factor 1 (HIF-1) is involved in determining oxygen metabolism and mitochondria function, we investigated the involvement of HIF-1 activity in lidocaine-induced cell death. We investigated the role of HIF activation on lidocaine-induced caspase activation and cell death in renal cell-derived RCC4 cells lacking functional von Hippel-Lindau (VHL) protein...
June 19, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28617702/intraperitoneal-instillation-of-local-anesthetics-is-this-a-suitable-alternative-for-postcesarean-pain-relief-without-toxicity-profiling
#12
Nivedita Jha, Ajay Kumar Jha
No abstract text is available yet for this article.
July 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28611004/an-in-situ-forming-phospholipid-based-phase-transition-gel-prolongs-the-duration-of-local-anesthesia-for-ropivacaine-with-minimal-toxicity
#13
Hanmei Li, Tao Liu, Yuxuan Zhu, Qiang Fu, Wanxia Wu, Jie Deng, Li Lan, Sanjun Shi
An injectable, phospholipid-based phase transition gel (PPTG) has been developed for prolonging the release of ropivacaine (RO) for local anesthesia. PPTG was prepared by mixing phospholipids, medium-chain triglyceride and ethanol. Prior to injection, the PPTG is in a sol state with low viscosity. After subcutaneous injection, the PPTG rapidly forms a gel in situ, which acts as a drug release depot as verified by in vitro release profiles and in vivo pharmacokinetics. Administering RO-PPTG to rats led to a significantly smaller initial burst release than administering RO solution or RO base suspension...
June 10, 2017: Acta Biomaterialia
https://www.readbyqxmd.com/read/28562387/lipid-resuscitation-in-acute-poisoning-after-a-decade-of-publications-what-have-we-really-learned
#14
Lotte C G Hoegberg, Sophie Gosselin
PURPOSE OF REVIEW: The decision to provide intravenous lipid emulsion (ILE) therapy as a treatment modality for the reversal of various drug toxicity was discovered in the last decade. Numerous publications, in both humans and animals attest to its clinical use, but current supporting evidence is inconsistent. RECENT FINDINGS: A recent systematic review reported evidence for benefit of ILE in bupivacaine toxicity. Human randomized trials, large observational studies as well as animal models of orogastric poisoning failed to report a clear benefit of ILE for nonlocal anesthetics poisoning...
August 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28557058/thoracic-paravertebral-blockade-in-breast-surgery-is-pneumothorax-an-appreciable-concern-a-review-of-over-1000-cases
#15
Michael E Kelly, Daniel Mc Nicholas, James Killen, Joey Coyne, Karl J Sweeney, John McDonnell
There has been a substantial increase in ambulatory day-case breast surgery in recent decades. This has been largely due to improvements in anesthetic procedures and pre-emptive analgesia. Thoracic paravertebral blockade (TPVB) is increasing in popularity, though concerns over iatrogenic injury remain, especially pneumothorax. The purpose of this study was to conduct a review of the incidence of pneumothorax following TPVB prior to breast surgery. Data from of a consecutive series of patients having TPVB prior to breast surgery between 2009 and 2014 were reviewed...
May 30, 2017: Breast Journal
https://www.readbyqxmd.com/read/28550928/effectiveness-of-continuous-wound-infusion-of-local-anesthetics-after-abdominal-surgeries
#16
RANDOMIZED CONTROLLED TRIAL
Baskaran Dhanapal, Sarath Chandra Sistla, Ashok Shankar Badhe, Sheikh Manwar Ali, Niranjan T Ravichandran, Indira Galidevara
BACKGROUND: To assess the effectiveness of continuous preperitoneal wound infusion of local anesthetic drug bupivacaine in providing pain relief, reducing opioid consumption, and enhancing postoperative recovery. METHODS: Eligible patients were randomly allocated to two groups (study group: bupivacaine and control group: normal saline). There were 47 patients in each group. The patients received continuous infusion of either 0.25% bupivacaine or 0.9% normal saline at 6 mL/h, for 48 h, based on their group allocation, through a multiholed wound infiltration catheter placed preperitoneally...
May 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28540470/effects-of-remifentanil-pretreatment-on-bupivacaine-cardiotoxicity-in-rats
#17
Özcan Pişkin, Hilal Ayoğlu
Unintentional intravascular administration of bupivacaine may cause local anesthetic systemic toxicity (LAST). Although many systems are affected in LAST, the cardiovascular effects can be life-threatening. Remifentanil is a selective, ultra-short-acting, µ-opioid receptor agonist opioid. This study assessed the effects of combined pretreatment with intravenous lipid emulsion (ILE) and remifentanil on the cardiotoxicity caused by bupivacaine in an experimental model of anesthetized rats. The rats were divided into three groups...
May 24, 2017: Cardiovascular Toxicology
https://www.readbyqxmd.com/read/28538107/local-anesthetics-systemic-toxicity-association-with-exparel-bupivacaine-liposome-a-pharmacovigilance-evaluation
#18
Nitish Aggarwal
BACKGROUND: Local anesthetic systemic toxicity (last) is a rare life threatening complication usually from intra-arterial or intravenous injection leading to systemic absorption of regional anesthesia drug. the objective of this research was to statistically quantify the association between exparel (bupivacaine liposome) injectable suspension and last. METHODS: Adverse Event Reporting System database of FDA, which houses public and industry submitted adverse event case reports, was queried and analyzed to quantify the passive pharmacovigilance signal for Local Anesthetic Systemic Toxicity as associated with use of bupivacaine Liposome...
June 5, 2017: Expert Opinion on Drug Safety
https://www.readbyqxmd.com/read/28535083/reply-to-hoegberg-et-al-letter-in-response-to-lipid-emulsion-improves-survival-in-animal-models-of-local-anesthetic-toxicity-a-meta-analysis
#19
Michael R Fettiplace
No abstract text is available yet for this article.
May 23, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28529036/qx-oh-a-qx-314-derivative-agent-produces-long-acting-local-anesthesia-in-rats
#20
YuJun Zhang, Jun Yang, QinQin Yin, LingHui Yang, Jin Liu, WenSheng Zhang
QX-314 has been shown to produce long-acting local anesthesia in vivo in animals; however, translation to humans has been impeded by concerns about toxicity. We investigated whether the newly emerged QX-OH molecule could confer long-lasting anesthesia with a low local toxicity in rats. In rat sciatic nerve block model, QX-OH 25mM produced a longer sensory block than QX-314 25mM (median [25th, 75th percentiles], 5.5 [4.25, 6] h vs. 3 [3, 4] h; P=0.03). QX-OH 35mM produced a longer sensory block than QX-314 35mM (8 [6, 12] h vs...
May 18, 2017: European Journal of Pharmaceutical Sciences
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