A fatal accidental subarachnoid injection of lidocaine and levobupivacaine during a lumbar paravertebral block

Spatio-Temporal Analysis of Anesthetics in Mice by Solid-Phase Microextraction: Dielectric Barrier Discharge Ionization Mass Spectrometry

Local anesthetics, drugs that only affect a restricted area of the body, are widely used in daily clinical practice. Less studied but equally important is the distribution of local anesthetics inside organisms. Here, we present a rapid in situ testing method of drug distribution in various organs. The temporal and spatial distribution of anesthetics in mice was measured by solid-phase microextraction (SPME), thermal desorption (TD), and dielectric barrier discharge ionization (DBDI) atmospheric pressure mass spectrometry. A coated SPME probe using a tungsten wire as the support covered with a carbonaceous material was prepared by a simple, low-cost flame method. An in-line structure of the inlet allows TD and DBDI to share the same capillary tube, which greatly improves the transmission efficiency. Nine kinds of anesthetics, such as lidocaine and dyclonine, were detected, and the limit of detection was determined to be as low as 13 pg/mL. In addition, the time-dependent distribution of drugs in mice organs was studied. We also found that macromolecules in organisms do not noticeably interfere with the detection. This method is convenient and efficient because it does not require tissue homogenates and allows direct in situ detection. Compared with the conventional analytical methods, this method is simple and rapid, works in situ, and allows microscale analysis of trace analytes in biological organisms with high sensitivity.

Determination of Local Anesthetic Drugs in Human Plasma Using Magnetic Solid-Phase Extraction Coupled with High-Performance Liquid Chromatography

In this work, magnetic tetraethylenepentamine (TEPA)-modified carboxyl–carbon nanotubes were synthesized, characterized, and used as adsorbents to conduct magnetic solid-phase extraction (MSPE) for the preconcentration of seven local anesthetic drugs (procaine, lidocaine, mepivacaine, oxybuprocaine, bupivacaine, tetracaine, and cinchocaine) from human plasma. The separation and determination of analytes were performed on high-performance liquid chromatography with UV detection. Several factors affected the extraction efficiency, such as the amount of adsorbents used, extraction time, sample pH, and optimization of elution conditions. Under optimal conditions, satisfactory linear relationships were obtained in the range of 0.02–5.00 mg/L, with the limits of detection (LOD) ranging from 0.003 mg/L to 0.008 mg/L. The recoveries of analytes for spiked human plasma were in the range of 82.0–108%. Moreover, the precision with intra-day and inter-day RSD values were obtained in the range of 1.5–7.7% and 1.5–8.3%. The results indicated that this method could determine the concentration of seven local anesthetic drugs in human plasma with high precision and repeatability and provide support for the clinical monitoring of the concentration of local anesthetic drugs in human plasma.

Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist

A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The article described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.