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Li Y, Li T. Enhancing patient comfort in varicose vein treatment through combined lidocaine and ropivacaine tumescent anesthesia. Front Surg 2024; 11:1359474. [PMID: 38783860 PMCID: PMC11111990 DOI: 10.3389/fsurg.2024.1359474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities. Method This study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance. Results There were no significant differences in age, body mass index, operative time, or blood loss among the three groups (P ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III (P < 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III (P < 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups (P ≥ 0.05). Conclusion The use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.
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Affiliation(s)
- Yubo Li
- Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tan Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Huang Y, Lu Y, Wang J, Lu Q, Bao HF, Liu L, Dong CS. Effect of Pericapsular Nerve Group Block with Different Concentrations and Volumes of Ropivacaine on Functional Recovery in Total Hip Arthroplasty: A Randomized, Observer-Masked, Controlled Trial. J Pain Res 2024; 17:677-685. [PMID: 38375406 PMCID: PMC10875181 DOI: 10.2147/jpr.s445000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose The pericapsular nerve group (PENG) block provides satisfactory postoperative analgesia without hampering motor function for total hip arthroplasty (THA); however, unexpected motor block has been observed clinically. It is unknown whether this motor block is related to the dose of ropivacaine. We aimed to conduct a prospective randomized trial to test whether reducing the volume or concentration of ropivacaine was better for less motor block after PENG block. Patients and Methods Ninety-nine patients with fracture or femoral head necrosis scheduled for THA were randomly allocated to receive 20 mL 0.5% ropivacaine (Group A), 20 mL 0.25% ropivacaine (Group B), and 10 mL 0.5% ropivacaine (Group C). The primary outcome was the incidence of postoperative quadriceps motor block at 6 hours. Secondary outcomes were the incidence of postoperative quadriceps motor block at 0, 12, 24 and 48 hours; pain scores on the numeric rating scale (NRS) at all postoperative time points (0, 6, 12, 24, and 48 hours); the time to first walk; the incidence of rescue analgesia; side effects such as dizziness, ache, nausea, and vomiting; and patient satisfaction. Results Compared with Group A, Group C resulted in a lower incidence of quadriceps motor block at 0 hours, 6 hours and 12 hours postoperatively (P < 0.05), while Group B only resulted in a lower incidence of motor block at 12 hours postoperatively (P < 0.05). No intergroup differences were found in terms of postoperative pain scores, the incidence of rescue analgesia, adverse events or patient satisfaction (P > 0.05). Conclusion A higher incidence of motor blockade was observed when 20 mL of 0.5% ropivacaine was administered, which was mainly caused by the excessive volume. Therefore, we recommend performing PENG block with 10 mL 0.5% ropivacaine.
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Affiliation(s)
- Ying Huang
- Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People’s Hospital), Hefei, Anhui, People’s Republic of China
| | - Yao Lu
- Department of Anaesthesiology, Anhui Medical University First Affiliated Hospital, Hefei, Anhui, People’s Republic of China
| | - Jun Wang
- Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People’s Hospital), Hefei, Anhui, People’s Republic of China
| | - Qiang Lu
- Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People’s Hospital), Hefei, Anhui, People’s Republic of China
| | - Hai-Feng Bao
- Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People’s Hospital), Hefei, Anhui, People’s Republic of China
| | - Lang Liu
- Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People’s Hospital), Hefei, Anhui, People’s Republic of China
| | - Chun-Shan Dong
- Department of Anaesthesiology, Anhui Medical University Third Affiliated Hospital (Hefei First People’s Hospital), Hefei, Anhui, People’s Republic of China
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Poorna P, Shetty P, Kalyani V, Shetty S, Upadya M, Mithra P. A comparative evaluation of the effect of addition of 8 mg dexamethasone to 2% lignocaine with adrenaline in mandibular third molar surgery: a split mouth randomised double blind study. FRONTIERS IN ORAL HEALTH 2024; 5:1349832. [PMID: 38404531 PMCID: PMC10884295 DOI: 10.3389/froh.2024.1349832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
Background Impacted lower third molar surgeries involve trauma in a highly vascularized zone with loose connective tissue leading to inflammatory sequelae including postoperative pain, swelling, trismus and generalised oral dysfunction during the post-operative phase. In minor oral surgical procedures, an all-inclusive method to protract anaesthesia and reduce the inevitable post-operative sequelae is yet to be explored substantially. Aim To evaluate the efficacy of dexamethasone added to local anaesthetics in extending the depth and duration of anaesthesia and decreasing the postoperative complications after surgical removal of impacted third molars. Methodology A controlled, randomized, split-mouth, double-blind prospective study involving lower third molar surgery was performed in 35 patients wherein the test group (Group I) received 8 mg dexamethasone added to 2 ml of 2% lignocaine with epinephrine and the control group (Group II) received 2 ml of sterile water added to 2 ml of 2% lignocaine with epinephrine. Onset and duration of anaesthesia were evaluated; followed by evaluation of pain, swelling and trismus for 7 days post-surgery, using independent t-test and ANOVA for repeated measures. Results Test group had a faster onset of anaesthesia by 69 s and a lengthier duration of 128.4 min (p < 0.001). Pain scores (Visual Analogue Scale) in the first 24 h were 4.9 and 7.5 in the test and control group respectively (p < 0.001). The average dosing of analgesics until postoperative day 7 in the test and control group were 12.6 and 18.4 respectively (p < 0.001). The swelling was significantly lesser in the test group, in addition, trismus was significantly lesser by 1 cm on postoperative days 1 and 2 and 0.2 cm on day 7. Conclusion The addition of dexamethasone to lignocaine in the nerve block reduces the time of onset and significantly prolongs the duration of anaesthesia with decreased pain, swelling and trismus. Steroids mixed directly with the local anaesthetic agent can minimise the post-operative sequelae associated with third molar surgery with a single needle prick.
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Affiliation(s)
- P. Poorna
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Premalatha Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Veerbhadra Kalyani
- Department of Oral Oncosurgery, VTSM Peripheral Cancer Centre, Kalaburagi, India
| | - Sameep Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Madhusudan Upadya
- Department of Emergency Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Miroshnychenko A, Ibrahim S, Azab M, Roldan Y, Diaz Martinez JP, Tamilselvan D, He L, Urquhart O, Tampi M, Polk DE, Moore PA, Hersh EV, Carrasco-Labra A, Brignardello-Petersen R. Injectable and topical local anesthetics for acute dental pain: 2 systematic reviews. J Am Dent Assoc 2023; 154:53-64.e14. [PMID: 36608963 PMCID: PMC10871026 DOI: 10.1016/j.adaj.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Local anesthesia is essential for pain control in dentistry. The authors assessed the comparative effect of local anesthetics on acute dental pain after tooth extraction and in patients with symptomatic irreversible pulpitis. TYPES OF STUDIES REVIEWED The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the US Clinical Trials registry through November 21, 2020. The authors included randomized controlled trials (RCTs) comparing long- vs short-acting injectable anesthetics to reduce pain after tooth extraction (systematic review 1) and evaluated the effect of topical anesthetics in patients with symptomatic pulpitis (systematic review 2). Pairs of reviewers screened articles, abstracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. The authors assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Fourteen RCTs comparing long- vs short-acting local anesthetics suggest that bupivacaine may decrease the use of rescue analgesia and may not result in additional adverse effects (low certainty evidence). Bupivacaine probably reduces the amount of analgesic consumption compared with lidocaine with epinephrine (mean difference, -1.91 doses; 95% CI, -3.35 to -0.46; moderate certainty) and mepivacaine (mean difference, -1.58 doses; 95% CI, -2.21 to -0.95; moderate certainty). Five RCTs suggest that both benzocaine 10% and 20% may increase the number of people experiencing pain reduction compared with placebo when managing acute irreversible pulpitis (low certainty). PRACTICAL IMPLICATIONS Bupivacaine may be superior to lidocaine with epinephrine and mepivacaine with regard to time to and amount of analgesic consumption. Benzocaine may be superior to placebo in reducing pain for 20 through 30 minutes after application.
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Deshpande N, Jadhav A, Bhola ND, Gupta M. The Comparative Evaluation of the Anesthetic Efficacy of 4% Articaine With 1:100,000 Adrenaline and 0.75% Ropivacaine for Inferior Alveolar Nerve Block in the Extraction of Impacted Lower Third Molar. Cureus 2022; 14:e29639. [PMID: 36321015 PMCID: PMC9612888 DOI: 10.7759/cureus.29639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Postoperative pain management is a major concern in lower third molar surgery. Various local anesthetic agents are studied for the same. Articaine and ropivacaine are recently studied for pain control intra- and postoperatively in minor oral surgical procedure. However, there is sparse literature that compares these two agents. Therefore, the present study was designed to compare 4% articaine with 1:100,000 adrenaline and 0.75% ropivacaine for inferior alveolar nerve block in lower impacted third molar surgery. Materials and method A prospective, randomized controlled, split-mouth, double-blind study was performed. A total of 60 healthy patients requiring extraction of lower impacted third molar with similar difficulty index were included in the study. Patients were administered 4% articaine with 1:100,000 adrenaline and 0.75% ropivacaine on either side by random allocation. The procedure was performed at an interval of 14 days. Parameters assessed were time of onset of anesthesia, profoundness of anesthesia, hemodynamic parameters (heart rate and blood pressure), duration of soft tissue anesthesia, duration of postoperative analgesia, and postoperative symptom severity (PoSSe) scale. Results The time of onset of articaine was faster (69.20 + 20.13 seconds) compared to ropivacaine (104.06 + 17.66 seconds). No significant difference was observed in hemodynamic parameters. There was significant difference in duration of soft tissue anesthesia, postoperative analgesia, and PoSSe scale between the two groups. Conclusion Within the limitations of the study, 0.75% ropivacaine was effective in providing prolonged soft tissue anesthesia, postoperative analgesia, and better PoSSe scale with hemodynamic stability compared to 4% articaine.
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The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4447484. [PMID: 35774754 PMCID: PMC9239787 DOI: 10.1155/2022/4447484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Abstract
Objective: To study the effects of epidural anesthesia with different doses of dexmedetomidine and ropivacaine on postoperative hemodynamics and neonatal outcome of cesarean section parturients. Methods. A total of 90 parturients who underwent cesarean section admitted to our hospital from January 2019 to January 2020 were selected as the research objects and were divided into groups A, B, and C according to different dosages of dexmedetomidine, with 30 cases in each group. Groups A, B, and C were given dexmedetomidine 0.5 μg/kg, 0.8 μg/kg, 1.0 μg/kg, respectively, combined with 0.2% ropivacaine. The anesthesia effect, traction response, hemodynamic indexes, and neonatal Apgar score of the three groups were compared; the “Numerical Rating Scale (NRS) Score” was used to assess the postoperative pain of the parturients, and the “Ramsay Sedation Scale” was used to assess the sedation state of the parturients. Results. The superior anesthesia effect of group B was obtained compared with groups A and C (P < 0.05). Group B witnessed a lower degree of grade III stretching response, as compared to group A (P < 0.05). In comparison with groups A and C, superior results of the heart rate and mean artery pressure (MAP) of group B at T1 and T2 were obtained (P < 0.05). The neonatal Apgar score in group B was lower than those in groups A and C (P < 0.05), and the NRS score of group B was also lower than that of group A (P < 0.05). Compared with groups A and C, group B yielded a more favorable outcome in terms of the Ramsay score (P < 0.05). Conclusion. The use of medium-dose dexmedetomidine in cesarean section parturients is safer and can effectively reduce the impact on maternal hemodynamics, which is worthy of promotion and application.
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Dai DM, Qu Q, Fan ZX, Hu ZQ, Miao Y. Relieving postoperative pain using tumescent solution with ropivacaine in follicular unit excision. J Cosmet Dermatol 2022; 21:4697-4702. [PMID: 35441795 DOI: 10.1111/jocd.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Local tumescent anesthesia relieves postoperative pain. OBJECTIVE To compare the effect of injecting a tumescent solution with/without ropivacaine on postoperative pain. METHODS A randomized, double-blind control study was conducted in 314 patients who underwent first follicular unit excision after obtaining informed consent and ethics committee approval. The patients were randomly divided into three groups: intra-groups (group 1, injected with tumescent solution with ropivacaine; group 2, without ropivacaine) and inter-group (group 3, right-head/left-head side with/without ropivacaine). Postoperative pain was recorded using the 5-point Wong-Baker Faces Pain Scale. No preoperative analgesic was administered to any patient. The survival rate of hair follicles was measured using dermoscopy during follow-up. Data were statistically analyzed. RESULTS Of the 314 patients included in the study, 166 were men and 148 were women with a mean age of 32.15±4.58 (range, 25-45) years. Postoperative pain with ropivacaine was significantly more relieved compared to that without ropivacaine in both groups (P<0.05). There was no significant difference between sex and survival rate of hair follicles in the intra- or inter-group. CONCLUSION A tumescent solution with ropivacaine has proven to relieve postoperative pain and is a safe and valuable form of local anesthesia in follicular unit excision.
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Affiliation(s)
- Da-Mao Dai
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Qian Qu
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Zhe-Xiang Fan
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Qi Hu
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
| | - Yong Miao
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangzhou, China
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Tian Y, Zhan Y, Liu K, Bu S, Tian Y, Xiong C, Shen J. Analgesic effects of different concentrations of ropivacaine in transversalis fascia plane block during laparotomy. BMC Anesthesiol 2022; 22:54. [PMID: 35219302 PMCID: PMC8881832 DOI: 10.1186/s12871-022-01595-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/21/2022] [Indexed: 01/10/2023] Open
Abstract
Abstract
Objective
To explore the analgesic effects of different concentrations of ropivacaine in transversalis fascia plane (TFP) block during laparotomy.
Methods
Ninety patients who underwent laparotomy admitted to our hospital from March 2019 to March 2020 were selected as the study subjects and were divided equally into a low concentration group, a medium concentration group, and a high concentration group according to the randomized grouping method. The low concentration group adopted 0.4% ropivacaine 40 ml, the medium concentration group was given 0.5% ropivacaine 40 ml, and the high concentration group was given 0.6% ropivacaine 40 ml. The hemodynamic indexes and the incidence of adverse reactions in the two groups were compared. The Numerical Rating Scale (NRS) was used to assess the postoperative pain in the three groups, the Bruggrmann comfort scale (BCS) was used to assess the comfort level in the three groups, and the Mini-mental State Examination (MMSE) was used to evaluate the postoperative cognitive function of the three groups of patients.
Results
The mean artery pressure (MAP) and heart rate (HR) levels at T1 and T2 were significantly lower in the medium concentration group than in the other two groups (P < 0.05). The low concentration group had a significantly higher NRS score at T2 than the medium concentration group and the high concentration group (P < 0.05). A significantly higher BCS score was observed in the high concentration group than the other two groups (P < 0.05). There were significantly higher Ramsay scores and MMSE scores in the medium concentration group than in the low concentration and high concentration groups (P < 0.05). The overall incidence of adverse reactions of the high concentration group was significantly higher than that of the low concentration group (P < 0.05), but showed similar results with the medium concentration group.
Conclusion
The medium concentration group exhibits a better analgesic effect than the low concentration group and higher safety than the high concentration group. Therefore, the use of medium concentration ropivacaine in TFP block may provide a referential basis for clinical treatment.
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Stojanović S, Burić N, Tijanić M, Todorović K, Burić K, Burić N, Jovanović M, Bajagić V. The Assessment of Prolonged Inferior Alveolar Nerve Blockade for Postoperative Analgesia in Mandibular Third Molar Surgery by a Perineural Addition of Dexamethasone to 0.5% Ropivacaine: A Randomized Comparison Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031324. [PMID: 35162346 PMCID: PMC8835108 DOI: 10.3390/ijerph19031324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.
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Affiliation(s)
- Simona Stojanović
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Nikola Burić
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
- Correspondence: ; Tel.: +381-63-40-63-86
| | - Milos Tijanić
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Kosta Todorović
- Department of Oral Surgery, School of Medicine and Stomatology, University of Niš, 18101 Niš, Serbia; (S.S.); (M.T.); (K.T.)
| | - Kristina Burić
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Nina Burić
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Marija Jovanović
- School of Medicine, University of Niš, 18101 Niš, Serbia; (K.B.); (N.B.); (M.J.)
| | - Vukadin Bajagić
- School of Medicine, University of Podgorica, 81110 Podgorica, Montenegro;
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Figueroa-Fernández NP, Hernández-Miramontes YA, Alonso-Castro ÁJ, Isiordia-Espinoza MA. A meta-analysis on the efficacy of the ropivacaine infiltration in comparison with other dental anesthetics. Clin Oral Investig 2021; 25:6779-6790. [PMID: 33907893 DOI: 10.1007/s00784-021-03965-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this meta-analysis was to assess the clinical efficacy and safety profile of ropivacaine in comparison with other dental anesthetics in different clinical conditions. MATERIALS AND METHODS: This meta-analysis was registered in the National Institute for Health Research PROSPERO (ID: CRD42020205580). PubMed and Scholar Google were consulted to identify clinical trials using ropivacaine in comparison with other local anesthetic drugs for any dental procedure. Articles comparing ropivacaine and other dental anesthetics were assessed with the Cochrane Collaboration's risk of bias tool. Data from reports without a high risk of bias were extracted (anesthetic and adverse effects) and analyzed using the Review Manager Software 5.3. for Windows and the Risk Reduction Calculator. RESULTS Ropivacaine produces a longer anesthetic time when compared with lidocaine/adrenaline (n = 260; p = 0.00001) and similar anesthesia than bupivacaine (n = 190). CONCLUSIONS Data of this study indicate that ropivacaine infiltration produces a longer anesthetic time when compared with lidocaine and articaine but not when compared to bupivacaine in dental procedures. CLINICAL RELEVANCE Ropivacaine was more effective than lidocaine for dental anesthesia. For this reason, the manufacture of a ropivacaine dental cartridge with a suitable concentration could be an important advancement for clinical practice.
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Affiliation(s)
| | | | - Ángel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, México
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Av. Rafael Casillas Aceves No. 1200, Tepatitlán de Morelos, Jalisco, México.
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Kakade AN, Joshi SS, Naik CS, Mhatre BV, Ansari A. Clinical efficacy of 0.75% ropivacaine vs. 2% lignocaine hydrochloride with adrenaline (1:80,000) in patients undergoing removal of bilateral maxillary third molars: a randomized controlled trial. J Dent Anesth Pain Med 2021; 21:451-459. [PMID: 34703894 PMCID: PMC8520834 DOI: 10.17245/jdapm.2021.21.5.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/25/2021] [Accepted: 08/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. METHODS This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. RESULTS The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. CONCLUSION Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.
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Affiliation(s)
- Aniket Narayan Kakade
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Sanjay S. Joshi
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Charudatta Shridhar Naik
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Bhupendra Vilas Mhatre
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, Maharashtra, India
| | - Arsalan Ansari
- Department of Oral and Maxillofacial Surgery, Terna Dental College, Navi Mumbai, Maharashtra, India
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Gaur S, Marimuthu M, Wahab A, Krishnan N, Ramasubbu S. Twin Mixed Local Anesthesia in Third Molar Surgery - Randomized Controlled Trial. J Oral Maxillofac Surg 2021; 80:63-69. [PMID: 34363764 DOI: 10.1016/j.joms.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study was to compare the clinical efficacy of injection of 2 long-acting amide local anesthetic agents - bupivacaine and ropivacaine with and without 4 mg dexamethasone in patients undergoing third molar extraction. METHODS A prospective randomized double blind controlled trial was conducted among 68 patients with impacted mandibular third molars. Group A and B were the control groups and received 1.8 mL of 0.5% bupivacaine hydrochloride and 0.75% ropivacaine hydrochloride, respectively. Group A1 and B1 were experimental groups and received modified twin mixes which were 1.8 mL of 0.5% bupivacaine hydrochloride + 1mL/4mg dexamethasone and 0.75% ropivacaine hydrochloride + 1 mL/4mg dexamethasone, respectively. Visual analog pain scale, mouth opening measurement and facial swelling were assessed at the time of injection and postoperative days 1, 3, and 7. RESULTS The mean visual analogue scale score for pain on local anesthesia injection was found to be less in both experimental groups- Group A1 (2.94) and B1 (2.41) as compared to control groups- Group A (3.59) and B (3.06). The durations of soft tissue anesthesia were higher as compared to their respective controls for both Group A1 and B1. Patients in both control groups A and B had an increased postoperative swelling, pain and trismus. CONCLUSIONS Intraoperative and postoperative comfort in both the experimental groups were higher than those for control groups, thereby establishing the clinical efficacy of both modified twin mixes for use in surgical extraction of mandibular third molars.
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Affiliation(s)
- Shivangi Gaur
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Madhulaxmi Marimuthu
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India.
| | - Abdul Wahab
- Professor, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Navaneetha Krishnan
- Professor, Department of Anesthesia, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
| | - Subhashini Ramasubbu
- Post graduate Resident, Department of Oral & Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai India
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A Nationwide Analysis of Cleft Palate Repair: Impact of Local Anesthesia on Operative Outcomes and Hospital Cost. Plast Reconstr Surg 2021; 147:978e-989e. [PMID: 34019509 DOI: 10.1097/prs.0000000000007987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigates the associations between local anesthesia practice and perioperative complication, length of stay, and hospital cost for palatoplasty in the United States. METHODS Patients undergoing cleft palate repair between 2004 and 2015 were abstracted from the Pediatric Health Information System database. Perioperative complication, length of stay, and hospital cost were compared by local anesthesia status. Multiple logistic regressions controlled for patient demographics, comorbidities, and hospital characteristics. RESULTS Of 17,888 patients from 49 institutions who met selection criteria, 8631 (48 percent), 4447 (25 percent), and 2149 (12 percent) received epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone, respectively. The use of epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with decreased perioperative complication [adjusted OR, 0.75 (95 percent CI, 0.61 to 0.91) and 0.63 (95 percent CI, 0.47 to 0.83); p = 0.004 and p = 0.001, respectively]. Only bupivacaine- or ropivacaine-alone recipients experienced a significantly reduced risk of prolonged length of stay on adjusted analysis [adjusted OR, 0.71 (95 percent CI, 0.55 to 0.90); p = 0.005]. Risk of increased cost was reduced in users of any local anesthetic (p < 0.001 for all). CONCLUSIONS Epinephrine-containing bupivacaine or bupivacaine or ropivacaine alone was associated with reduced perioperative complication following palatoplasty, while only the latter predicted a decreased postoperative length of stay. Uses of epinephrine-containing lidocaine, epinephrine-containing bupivacaine, and bupivacaine or ropivacaine alone were all associated with decreased hospital costs. Future prospective studies are warranted to further delineate the role of local anesthesia in palatal surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Rajpari KN, Andrade NN, Nikalje T. Comparison of anaesthetic efficacy of ropivacaine (0.75% & 0.5%) with 2% lignocaine with adrenaline (1:200000) in surgical extraction of bilateral mandibular 3 rd molars using IANB:a prospective, randomized, single blind study. J Oral Biol Craniofac Res 2021; 11:263-268. [PMID: 33717864 DOI: 10.1016/j.jobcr.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022] Open
Abstract
Aim To evaluate and compare the anaesthetic efficacy of 0.75% ropivacaine and 0.5% ropivacaine with 2% lignocaine with 1:200000 Adrenaline (LWA) for surgical extraction of bilateral mandibular 3rd molars using Direct inferior alveolar nerve block (IANB). Material and methods Total of 60 outpatients of both sex,age group of 18-40 included in a prospective, randomized, single blind, split mouth clinical study after satisfying inclusion and exclusion criteria. Group I includes 30 patients and 0.75% ropivacaine as test drug, Group II includes 30 patients and 0.5% ropivacaine as test drug. In both group control drug was LWA.Parameters measured were onset of action, duration of action, systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale (VAS), faces pain scale (FPS). Result Onset of action of 0.75%/0.5% ropivacaine (101.84 ± 16.92 secs/113.03 ± 12.77 sec) was faster than LWA (Group I-218 ± 21.51 secs, Group II-196.47 ± 26.27 secs). Duration of action of 0.75%/0.5% ropivacaine (343.55 ± 16.44 mins/319.03 ± 19.30 mins) was longer than 2% Lignocaine with 1:200000 adrenaline (Group I I-173 ± 16.86 mins, Group II-175.20 ± 18.02 mins). In Group I - VAS/FPS of 0.75% Ropivacaine (0.97 ± 0.54/1.32 ± 0.65) was significantly lower as compared to LWA (2.90 ± 0.83/3.29 ± 0.69). In group II-VAS/FPS of 0.5% ropivacaine (1.40 ± 0.72/1.47 ± 0.50) was lower as compared to LWA (3.40 ± 0.89/3.30 ± 0.87). Mean systolic blood pressure, diastolic blood pressure, heart rate was lower for ropivacaine (0.75%, 0.5%) than LWA except mean heart rate higher for 0.75% ropivacaine at 10 min after injection. Else mean heart rate lower in other time interval. Conclusion Ropivacaine (0.75%,0.5%) was more efficacious than 2% lignocaine with adrenaline (1:200000) it terms of all measured parameters in study.
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Affiliation(s)
- Kamil N Rajpari
- Dept of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Neelam N Andrade
- Dept of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Trupti Nikalje
- Dept of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
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Nazeer J, Kumari S, Haidry N, Kulkarni P, Aastha, Gautam A, Gupta P. Comparison of efficacy of lignocaine, ropivacaine, and bupivacaine in pain control during extraction of mandibular posterior teeth. Natl J Maxillofac Surg 2021; 12:238-243. [PMID: 34483583 PMCID: PMC8386260 DOI: 10.4103/njms.njms_14_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/15/2020] [Accepted: 12/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The management of pain during extraction of mandibular third molars is an important requisite to achieve patient comfort and to obtain desired result in an effective manner. There are various anesthetics that can be used to achieve regional or local anesthetic effect in this regard. AIM The aim of this study was to compare the efficacy of 2% lignocaine with 1:80,000 adrenaline, 0.75% ropivacaine and bupivacaine in pain control during extraction of mandibular posterior teeth. MATERIALS AND METHODS This prospective, cross-sectional study included 300 study participants indicated for mandibular third molar surgical extractions. The study subjects were categorized into three broad groups - (a) Group I (n = 100): Third molar extractions performed using 2% Lignocaine with 1: 80,000 epinephrine; (b) Group II (n = 100): This group included subjects who underwent extractions of mandibular third molars using 0.75% ropivacaine and (c) Group III (n = 100): This group included patients who underwent extractions of mandibular third molars with bupivacaine. Inclusion criteria were: (a) partially impacted mandibular third molars which were symptomatic; (b) written informed consent. Exclusion criteria were - (a) any systemic diseases and/or undergoing any medication for same; (b) subjects not willing for extraction after clinical and radiographic examination and opinion and (c) subjects undergoing orthodontic therapy. Subject response for pain was recorded using - (a) visual analog scale (VAS) and (b) Verbal Rating scale (VRS). Postoperative pain was assessed using requirement of analgesics after extraction. SPSS version 21.0 was employed as statistical software. Statistical tool used was the Analysis of Variance test which was used for determining statistical significance which was set at a P value of lesser than 0.05 (significant). RESULTS On analysis of visual analog scale (VAS), it was observed that in Group I (2% Lignocaine with 1:80,000), no pain during the extraction procedure was demonstrated in 30 study participants while minimal or less pain was present in 70 patients, while in Group II (0.75% ropivacaine), 90 patients presented with no pain while ten patients had presented with minimal amount of pain during tooth extraction. While on the other hand, Group III patients whose mandibular third molars were extracted using local anesthesia by injecting bupivacaine, lack of any pain was observed in 69 patients while minimal pain was noted in 31 individuals. While making statistical comparison between three groups, a significant P = 0.03 was observed. Also, postoperative pain was noted in 60% of cases who underwent extraction using 2% lignocaine (Group I), 10% patients who had third molar extractions under Bupivacaine anesthesia presented with pain whereas none of the patients (0%), demonstrated the presence of pain following third molar extraction. CONCLUSION 0.75% Ropivacaine is the most effective local anesthetic agent that can be used for extracting mandibular third molars due to its effective pain control both during and following the procedure when compared to 2% lignocaine and bupivacaine.
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Affiliation(s)
- Jazib Nazeer
- Department of Oral Pathology and Microbiology, Patna Dental College and Hospital, Patna, Bihar, India
| | - Soni Kumari
- Department of Orthodontics and Dentofacial Orthopedics, Hazaribag College of Dental Sciences and Hospital, Demotand, India
| | - Nazia Haidry
- Private Dental Practitioner, Patna, Bihar, India
| | | | - Aastha
- Private Practitioner, Patna, Bihar, India
| | - Ashesh Gautam
- Department of Pedodontics, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Preeti Gupta
- Private Practitioner, Chandigarh, India,Address for correspondence: Dr. Preeti Gupta, Private Practitioner, Chandigarh, India. E-mail:
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Tijanić M, Burić K, Stojanović S, Burić N. Assessment of conduction anesthesia effectiveness using the angulated needle approach for the inferior alveolar nerve block. J Craniomaxillofac Surg 2020; 48:607-615. [PMID: 32340906 DOI: 10.1016/j.jcms.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/17/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Ambulatory painless surgery is dependent on local anesthesia effectiveness. AIM Evaluating the anesthetic efficacy of the angulated needle approach (ANA) for the inferior alveolar nerve block (IANB). MATERIAL AND METHOD Group I received direct IANB; group II received indirect IANB; group III received the IANB with ANA. The quality of anesthesia score (QAS), numerical pain intensity score (NRS), onset time of full anesthesia (OT), and perianesthetic complications were measured. RESULTS Ninety patients (mean age: 37.47 ± 18.90, p = 0.027) of both sexes were split into three equal groups. Group III had the lowest QAS value with the success rate of 93.3%, compared to the statistically significantly worse QAS values of group II, with the success rate of 80% (p = 0.016). Group II had the statistically significant highest NRS values relative to group I (p = 0.002) and group III (p = 0.000001). The shortest OT occurred in group I, when compared to group II (p = 0.000484) and group III (p = 0.000498). The transient syncope and positive aspiration occurred in single cases. CONCLUSION The ANA for the IANB could successfully serve as a "first choice", or as an "addendum technique" in the cases of multiple failed attempts for direct and indirect IANB techniques.
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Affiliation(s)
- Milos Tijanić
- University of Niš, School of Medicine and Stomatology, Department of Oral Surgery, Niš, Serbia
| | | | - Simona Stojanović
- University of Niš, School of Medicine and Stomatology, Department of Oral Surgery, Niš, Serbia
| | - Nikola Burić
- University of Niš, School of Medicine and Stomatology, Department of Oral Surgery, Niš, Serbia.
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