1
|
Zhu N, Xiang B, Shi J, Yang P, Dai Y, Wang S. The effect of perineural dexamethasone on nerve injury and recovery of nerve function after surgery: A randomized controlled trial. Heliyon 2024; 10:e35612. [PMID: 39220966 PMCID: PMC11363822 DOI: 10.1016/j.heliyon.2024.e35612] [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: 07/05/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background While numerous studies have examined the influence of perineural dexamethasone on nerve block duration, its potential impact on postoperative nerve injury has not been adequately addressed. Objective This study aims to elucidate the effect of perineural dexamethasone on nerve injury and nerve function recovery after surgery. Design A prospective randomized double-blinded trial. Setting The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. The study was conducted between 14 June and 30 December 2022. Participants Patients aged 18 - 80 years, ASA I - II, scheduled for elective orthopedic or burn and plastic surgery. Interventions Patients were randomized to receive either perineural dexamethasone (D group) or no dexamethasone (ND group). Main outcome measures Primary outcomes were the incidence and recovery of nerve injury. Secondary outcomes included postoperative pain scores, analgesic consumption, and adverse events. Results Initial postoperative nerve injury rates were similar between groups (D: 30.4 %, ND: 33.3 %, P > 0.05). At 12 weeks post-discharge, significantly more patients in the ND group recovered from nerve deficits (78.8 % vs 60.3 %; OR = 2.45, 95 % CI = 1.05 - 5.72, P < 0.05). No significant differences were observed in postoperative hyperglycemia or surgical site infection rates. Conclusion Perineural dexamethasone may impede nerve function recovery, suggesting caution in its use, particularly for patients with pre-existing nerve damage or diabetes. Further research is needed to elucidate the long-term effects of dexamethasone on nerve tissue recovery. Trial registration chictr.org.cn, ChiCTR2200059424.
Collapse
Affiliation(s)
- Na Zhu
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Bingbing Xiang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinghong Shi
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Pingliang Yang
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Yunke Dai
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Shun Wang
- Department of Anesthesiology, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Rafiei MR, Khani AK, Kheradmand B, Abosaoda MK, Rasulova I, Khordad O, Moayer A, Kazemi Haki B, Namazi M. Effectiveness of Adding Dexamethasone to Lidocaine in Upper Limbs Nerve Blocks: A Systematic Review. J Perianesth Nurs 2024:S1089-9472(24)00088-1. [PMID: 39023476 DOI: 10.1016/j.jopan.2024.02.014] [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: 08/19/2023] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The use of perineural dexamethasone as an adjuvant drug to peripheral nerve block for postoperative pain is controversial. This systematic review aimed to determine the effectiveness of adding dexamethasone to lidocaine in upper limb nerve blocks. DESIGN Systematic review. METHODS This review used a comprehensive search strategy to retrieve relevant published randomized trial articles that fulfilled the inclusion and exclusion criteria, without time limits, (until December 2023) that assessed the effects of a combination of dexamethasone to lidocaine in upper limb nerve blocks. The databases used for the electronic literature search included PubMed, Embase, and Clinical Trials.gov, dbGaP, Cochrane library, and Google Scholar. There was no language, gender, or age limitation. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. FINDINGS Of 3,926 articles identified by the initial search, 8 studies that met our inclusion criteria. All articles were original research studies. All eight articles were clinical trials. The sample size in the selected studies ranged from 30 to 90 people. Studies demonstrated that combining dexamethasone with lidocaine significantly improved the quality of peripheral nerve blocks, increased the analgesia period, and decreased analgesic consumption. CONCLUSIONS This review supported that the combination of dexamethasone (dose of 4 to 10 mg) and lidocaine (concentration of 1.5% to 2%) for upper limb block was more effective and beneficial without any side effects. However, further clinical trials in this regard with more data, various regions, and larger sample sizes to support our hypothesis are recommended.
Collapse
Affiliation(s)
| | - Ali Karbalai Khani
- Fellowship of Hand Surgery, Surgical, and Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Behroz Kheradmand
- Department of Anesthesiology, AJA University of Medical Science, Tehran, Iran
| | - Munther Kadhim Abosaoda
- College of Pharmacy, The Islamic University, Najaf, Iraq; College of Pharmacy, The Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq; College of Pharmacy, The Islamic University of Babylon, Al Diwaniyah, Iraq
| | - Irodakhon Rasulova
- Central Asian Center of Development Studies, New Uzbekistan University, Tashkent, Uzbekistan; Department of Public Health, Samarkand State Medical University, Samarkand, Uzbekistan
| | - Oranous Khordad
- Department of Anesthesiology, AJA University of Medical Science, Tehran, Iran
| | - Arian Moayer
- Department of Medical Engineering, Azad Islamic University, Tehran, Iran
| | - Behzad Kazemi Haki
- Department of Anesthesiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Mehrshad Namazi
- Department of Anesthesiology, AJA University of Medical Science, Tehran, Iran.
| |
Collapse
|
3
|
Barroso FD, da Silva LJ, Sá LG, da Silva CR, Neto JB, do Nascimento FB, Queiroz HA, Leitão AC, Cabral VP, Rodrigues DS, Barbosa AD, Cavalcanti BC, Morais MO, Júnior HV. Synergistic activity of dobutamine combined with azoles and its mechanism of action against strains of Candida glabrata. Future Microbiol 2022; 17:437-448. [PMID: 35285249 DOI: 10.2217/fmb-2020-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: To evaluate the antifungal effect of dobutamine against Candida glabrata as well as its synergism with azoles and its action on biofilm. Methods: The M27-A3 protocol and flow cytometry were used for elucidation of the possible mechanism of action. Results: The tested isolates presented MICs ranging from 2 to 32 μg/ml for dobutamine, with fungistatic effect. A total of 82% of the strains showed synergism with fluconazole, with 90% showing synergism with itraconazole. The effect on biofilm formation was nonsignificant. Cytometry tests showed that dobutamine induced mitochondrial depolarization. Conclusion: Dobutamine has an antifungal effect on strains of C. glabrata and synergistic activity with azoles. This effect is probably mediated by increased oxidative damage to the membrane.
Collapse
Affiliation(s)
- Fatima Dd Barroso
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Lisandra J da Silva
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Lívia Gav Sá
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil.,Faculty of Biomedicine, Unichristus University Center, Fortaleza, Brazil
| | - Cecília R da Silva
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - João Ba Neto
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil.,Faculty of Biomedicine, Unichristus University Center, Fortaleza, Brazil
| | - Francisca Ba do Nascimento
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Helaine A Queiroz
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Amanda C Leitão
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Vitória Pf Cabral
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Daniel S Rodrigues
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Amanda D Barbosa
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| | - Bruno C Cavalcanti
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, 60430-276, Brazil
| | - Manoel O Morais
- Drug Research and Development Center, Federal University of Ceará, Fortaleza, CE, 60430-276, Brazil
| | - Hélio Vn Júnior
- Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Brazil
| |
Collapse
|
4
|
Tan ESJ, Tan YR, Liu CWY. Efficacy of perineural dexamethasone in prolonging duration of analgesia with peripheral nerve blocks compared to intravenous dexamethasone: A systematic review and meta-analysis. Korean J Anesthesiol 2021; 75:255-265. [PMID: 34963269 PMCID: PMC9171542 DOI: 10.4097/kja.21390] [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: 09/20/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Perineural dexamethasone has been regarded as a promising adjunct for prolonging the duration of nerve blocks. However, it is uncertain whether its effects are due to local effects on the nerves or from systemic absorption. This systematic review aimed to compare the duration of postoperative analgesia associated with perineural versus intravenous dexamethasone as an adjunct to peripheral nerve blocks. Methods A total of 2,216 relevant academic articles were identified after a comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from 1967 until 2020. All randomized controlled trials that compared perineural and intravenous dexamethasone as adjuncts to peripheral nerve limb blocks were included. Results Fifteen randomized controlled trials (1,467 cases; 738 perineural dexamethasone, 729 intravenous dexamethasone) were eligible. The primary outcome (duration of analgesia) was significantly longer in the perineural than in the intravenous dexamethasone group (mean difference [MD]: 2.72 h, 95% CI [1.42, 4.01], P < 0.001). Perineural dexamethasone was also found to prolong the sensory block (MD: 3.45 h, 95% CI [1.36, 5.54], P = 0.001) and lower 24 h postoperative pain scores (MD: −0.74 h, 95% CI [−1.40, −0.07], P = 0.03). Conclusions This review confirms the greater efficacy of perineural compared to intravenous dexamethasone in prolonging the analgesic duration of peripheral nerve blocks. However, the extent of prolongation was small and may not represent a clinically meaningful difference.
Collapse
Affiliation(s)
| | - Yan Ru Tan
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | | |
Collapse
|
5
|
Moreau C, Rolland AS, Pioli E, Li Q, Odou P, Barthelemy C, Lannoy D, Demailly A, Carta N, Deramecourt V, Auger F, Kuchcinski G, Laloux C, Defebvre L, Bordet R, Duce J, Devedjian JC, Bezard E, Fisichella M, Devos D. Intraventricular dopamine infusion alleviates motor symptoms in a primate model of Parkinson's disease. Neurobiol Dis 2020; 139:104846. [DOI: 10.1016/j.nbd.2020.104846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/24/2020] [Accepted: 03/18/2020] [Indexed: 12/27/2022] Open
|
6
|
Krishna Prasad GV, Khanna S, Jaishree SV. Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends. Saudi J Anaesth 2020; 14:77-84. [PMID: 31998024 PMCID: PMC6970354 DOI: 10.4103/sja.sja_423_19] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/21/2019] [Indexed: 02/07/2023] Open
Abstract
In recent anesthetic practice, peripheral nerve blocks (PNBs) are used extensively for surgical anesthesia and nonsurgical analgesia. PNBs offer many benefits over other anesthetic techniques in a certain population of patients, and in some specific clinical setting, that may contribute to faster and safer pain relief, increased patient satisfaction, reduced hospital stay, and decreased overall healthcare cost. The technique involves the injection of the anesthetic in the vicinity of a specific nerve or bundle of nerves to block the sensation of pain transmitting to a specific portion of the body. However, the length of analgesia when a single anesthetic is used for PNB may not last long. Therefore, the practice of adding an additional agent called adjuvant has been evolved to prolong the analgesic effect. There are many such adjuvants available that are clinically being used for this purpose imparting great efficacy and safety to the anesthetic process. The adjuvants molecules are generally classified as opioids, alpha-2 agonist, steroids, etc. Most of them are safe to use and show little or no adverse event related to neurotoxicity and tissue damage. Although there is extensive use of such adjuvants in the clinical field, none of the molecules is approved by the FDA and is used as an off-label drug. The risk to benefit ratio must be assessed while using such an agent. This review will try to delineate the basic need of adjuvant in peripheral nerve block and will discuss the advantages and limitations of using different adjuvants and will discuss the future prospect of such application.
Collapse
Affiliation(s)
- G V Krishna Prasad
- Department of Anaesthesiology, Military Hospital, Kirkee, Range Hills, Pune, Maharashtra, India
| | - Sangeeta Khanna
- Department of Anaesthesiology, Military Hospital, Kirkee, Range Hills, Pune, Maharashtra, India
| | - Sharma Vipin Jaishree
- Department of Anaesthesiology, Military Hospital, Kirkee, Range Hills, Pune, Maharashtra, India
| |
Collapse
|
7
|
Liaudanskaya V, Jgamadze D, Berk AN, Bischoff DJ, Gu BJ, Hawks-Mayer H, Whalen MJ, Chen HI, Kaplan DL. Engineering advanced neural tissue constructs to mitigate acute cerebral inflammation after brain transplantation in rats. Biomaterials 2018; 192:510-522. [PMID: 30529870 DOI: 10.1016/j.biomaterials.2018.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 11/15/2018] [Accepted: 11/24/2018] [Indexed: 01/22/2023]
Abstract
Stroke, traumatic brain injuries, and other similar conditions often lead to significant loss of functional brain tissue and associated disruption of neuronal signaling. A common strategy for replacing lost neurons is the injection of dissociated neural stem cells or differentiated neurons. However, this method is unlikely to be suitable for replacing large brain cavities, and the resulting distribution of neurons may lack the necessary architecture to support appropriate brain function. Engineered neural tissues may be a viable alternative. Cell death is a prominent concern in neuronal grafting studies, a problem that could be magnified with the transplantation of engineered neural tissues. Here, we examined the effect of one contributor to cell death, acute cerebral inflammation, on neuronal survival after the transplantation of bioengineered constructs based on silk scaffolds. We found evidence of a high degree of inflammation and poor neuronal survival after introducing engineered constructs into the motor cortex of rats. Integrating a corticosteroid (methylprednisolone) into the constructs resulted in significantly improved neuron survival during the acute phase of inflammation. The improved construct survival was associated with decreased markers of inflammation and an anti-inflammatory state of the immune system due to the steroid treatment.
Collapse
Affiliation(s)
- Volha Liaudanskaya
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Dennis Jgamadze
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander N Berk
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - David J Bischoff
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Ben J Gu
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Hawks-Mayer
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Michael J Whalen
- Neuroscience Center at Massachusetts General Hospital, Charlestown, MA, USA
| | - H Isaac Chen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA; Corposal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.
| |
Collapse
|
8
|
Noorafshan A, Vafabin M, Karbalay-Doust S, Asadi-Golshan R. Efficacy of Curcumin in the Modulation of Anxiety Provoked by Sulfite, a Food Preservative, in Rats. Prev Nutr Food Sci 2017; 22:144-148. [PMID: 28702432 PMCID: PMC5503424 DOI: 10.3746/pnf.2017.22.2.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/13/2017] [Indexed: 01/09/2023] Open
Abstract
Sulfites are used as food preservatives and excessive sulfite might disturb the body systems including the brain. Curcumin shows protective effects on the nervous system toxicity. The present study aimed to evaluate the protective role of curcumin in sulfite-induced anxiety in rats. Male rats were divided into five groups. The rats in groups I to V received distilled water (vehicle of sulfite, 1 mL/d), olive oil (vehicle of curcumin, 1 mL/d), curcumin (100 mg/kg/d), sulfite (25 mg/kg/d), and sulfite+curcumin, respectively, by daily gastric gavage for 8 weeks. At the end of 8 weeks the rats were tested in the elevated plus-maze for anxiety. The results showed that concomitant treatment of curcumin during sulfite consumption prevented the reduction of the time spent in the open arm and entrance to the open arm (the indexes of anxiety). Besides, an increase was found in motor activity of the rats in the sulfite+curcumin group compared to the sulfite-treated animals. Exposure of sulfite in rats can induce anxiety, and curcumin can act as an anti-anxiety agent.
Collapse
Affiliation(s)
- Ali Noorafshan
- Histomorphometry and Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran.,Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
| | - Masoud Vafabin
- Histomorphometry and Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
| | - Saied Karbalay-Doust
- Histomorphometry and Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran.,Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
| | - Reza Asadi-Golshan
- Histomorphometry and Stereology Research Centre, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran.,Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-45794, Iran
| |
Collapse
|
9
|
Scientific Opinion on the re‐evaluation of sulfur dioxide (E 220), sodium sulfite (E 221), sodium bisulfite (E 222), sodium metabisulfite (E 223), potassium metabisulfite (E 224), calcium sulfite (E 226), calcium bisulfite (E 227) and potassium bisulfite (E 228) as food additives. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
10
|
Wiesmann T, Volk T, Steinfeldt T. [Glucocorticoids as an adjunct in peripheral regional anesthesia. Move to the "Holy Grail of perineural analgesia"?!]. Anaesthesist 2016; 65:295-8. [PMID: 26952122 DOI: 10.1007/s00101-016-0143-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The role of dexamethasone as an adjunct in peripheral nerve blockades is still unclear. OBJECTIVES This article reviews the actual knowledge and scientific evidence for dexamethasone as an adjunct in peripheral regional anesthesia. Moreover, it discusses the benefits of the systemic versus the perineural mode of application. RESULTS Dexamethasone prolongs sensible as well as motor blockades in peripheral nerve blocks when applied intravenously or perineurally. Regarding potentially local neurotoxicity, published patient data are not sufficient for final conclusions. CONCLUSIONS After reviewing the actual literature, the authors prefer a systemic application mode (intravenously) over a perineural route of administration of dexamethasone as an adjunct for peripheral nerve blocks. This is due to the better understanding of potential side effects of the drug when applied intravenously. Dexamethasone might be a useful drug adjunct to prolong peripheral single shot nerve blocks.
Collapse
Affiliation(s)
- T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinik Gießen und Marburg, Baldingerstraße, 35033, Marburg, Deutschland.
| | - T Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T Steinfeldt
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinik Gießen und Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| |
Collapse
|
11
|
Postnatal glucocorticoid-induced hypomyelination, gliosis, and neurologic deficits are dose-dependent, preparation-specific, and reversible. Exp Neurol 2016; 278:1-3. [PMID: 26795086 DOI: 10.1016/j.expneurol.2016.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 12/21/2022]
|
12
|
Kirksey MA, Haskins SC, Cheng J, Liu SS. Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review. PLoS One 2015; 10:e0137312. [PMID: 26355598 PMCID: PMC4565585 DOI: 10.1371/journal.pone.0137312] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/14/2015] [Indexed: 12/13/2022] Open
Abstract
Background The use of peripheral nerve blocks for anesthesia and postoperative analgesia has increased significantly in recent years. Adjuvants are frequently added to local anesthetics to prolong analgesia following peripheral nerve blockade. Numerous randomized controlled trials and meta-analyses have examined the pros and cons of the use of various individual adjuvants. Objectives To systematically review adjuvant-related randomized controlled trials and meta-analyses and provide clinical recommendations for the use of adjuvants in peripheral nerve blocks. Methods Randomized controlled trials and meta-analyses that were published between 1990 and 2014 were included in the initial bibliographic search, which was conducted using Medline/PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Only studies that were published in English and listed block analgesic duration as an outcome were included. Trials that had already been published in the identified meta-analyses and included adjuvants not in widespread use and published without an Investigational New Drug application or equivalent status were excluded. Results Sixty one novel clinical trials and meta-analyses were identified and included in this review. The clinical trials reported analgesic duration data for the following adjuvants: buprenorphine (6), morphine (6), fentanyl (10), epinephrine (3), clonidine (7), dexmedetomidine (7), dexamethasone (7), tramadol (8), and magnesium (4). Studies of perineural buprenorphine, clonidine, dexamethasone, dexmedetomidine, and magnesium most consistently demonstrated prolongation of peripheral nerve blocks. Conclusions Buprenorphine, clonidine, dexamethasone, magnesium, and dexmedetomidine are promising agents for use in prolongation of local anesthetic peripheral nerve blocks, and further studies of safety and efficacy are merited. However, caution is recommended with use of any perineural adjuvant, as none have Food and Drug Administration approval, and concerns for side effects and potential toxicity persist.
Collapse
Affiliation(s)
- Meghan A Kirksey
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York, United States of America; Department of Anesthesiology, Weill College of Medicine at Cornell University, New York, New York, United States of America
| | - Stephen C Haskins
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York, United States of America; Department of Anesthesiology, Weill College of Medicine at Cornell University, New York, New York, United States of America
| | - Jennifer Cheng
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York, United States of America
| | - Spencer S Liu
- Department of Anesthesiology, Hospital for Special Surgery, New York, New York, United States of America; Department of Anesthesiology, Weill College of Medicine at Cornell University, New York, New York, United States of America
| |
Collapse
|
13
|
Hussin F, Eshkoor SA, Rahmat A, Othman F, Akim A, Eshak Z. Strobilanthes crispus Juice Concentrations and Anticancer Effects on DNA Damage, Apoptosis and Gene Expression in Hepatocellular Carcinoma Cells. Asian Pac J Cancer Prev 2015; 16:6047-53. [DOI: 10.7314/apjcp.2015.16.14.6047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
14
|
Turner M, Duncan J, Shah U, Metsvaht T, Varendi H, Nellis G, Lutsar I, Yakkundi S, McElnay J, Pandya H, Mulla H, Vaconsin P, Storme T, Rieutord A, Nunn A. Risk assessment of neonatal excipient exposure: lessons from food safety and other areas. Adv Drug Deliv Rev 2014; 73:89-101. [PMID: 24239480 DOI: 10.1016/j.addr.2013.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/25/2013] [Accepted: 11/06/2013] [Indexed: 11/26/2022]
Abstract
Newborn babies can require significant amounts of medication containing excipients intended to improve the drug formulation. Most medicines given to neonates have been developed for adults or older children and contain excipients thought to be safe in these age groups. Many excipients have been used widely in neonates without obvious adverse effects. Some excipients may be toxic in high amounts in which case they need careful risk assessment. Alternatively, it is conceivable that ill-founded fears about excipients mean that potentially useful medicines are not made available to newborn babies. Choices about excipient exposure can occur at several stages throughout the lifecycle of a medicine, from product development through to clinical use. Making these choices requires a scalable approach to analysing the overall risk. In this contribution we examine these issues.
Collapse
|
15
|
Chen ZC, Lee KS, Chen LJ, Wang LY, Niu HS, Cheng JT. Cardiac peroxisome proliferator-activated receptor δ (PPARδ) as a new target for increased contractility without altering heart rate. PLoS One 2013; 8:e64229. [PMID: 23724037 PMCID: PMC3665891 DOI: 10.1371/journal.pone.0064229] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/12/2013] [Indexed: 12/31/2022] Open
Abstract
Background and Aims Agents having a positive inotropic effect on the heart are widely used for the treatment of heart failure. However, these agents have the side effect of altering heart rate. It has been established that peroxisome proliferator-activated receptor δ (PPARδ) is mediated in cardiac contraction, however the effect on heart rate is unknown. Thus, we used an agonist of PPARδ, GW0742, to investigate this issue in the present study. Methods and Results We used isolated hearts in Langendorff apparatus and hemodynamic analysis in catheterized rats to measure the actions of GW0742 extra-vivo and in vivo. In diabetic rats with heart failure, GW0742 at a dose sufficient to activate PPARδ reversed cardiac contraction without changes in heart rate. In normal rats, PPARδ enhanced cardiac contractility and hemodynamic dP/dtmax significantly more than dobutamine. Both actions were diminished by GSK0660 at a dose enough to block PPARδ. However, GW0742 at the same dose failed to modify heart rate, although it did produce a mild increase in blood pressure. Detection of intracellular calcium level and Western blotting analysis showed that the intracellular calcium concentration and troponin I phosphorylation were both enhanced by GW0742. Conclusion Activation of PPARδ by GW0742 increases cardiac contractility but not heart rate. Thus, PPARδ may be a suitable target for the development of inotropic agents to treat heart failure without changing heart rate.
Collapse
Affiliation(s)
- Zhih-Cherng Chen
- Department of Cardiology, Chi-Mei Medical Center, Yong Kang, Tainan City, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Yong Kang, Tainan City, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy & Science, Jean-Tae, Tainan City, Taiwan
| | - Kung Shing Lee
- Department of Surgery, Kaohsiung Municipal Hsiao-Kang Hospital, and Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Li-Jen Chen
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Lin-Yu Wang
- Department of Pediatrics, Chi-Mei Medical Center, Yong Kang, Tainan City, Taiwan
| | - Ho-Shan Niu
- Department of Nursing, Tzu Chi College of Technology, Hualien City, Taiwan
| | - Juei-Tang Cheng
- Department of Medical Research, Chi-Mei Medical Center, Yong Kang, Tainan City, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
- * E-mail:
| |
Collapse
|
16
|
Noorafshan A, Asadi-Golshan R, Karbalay-Doust S, Abdollahifar MA, Rashidiani-Rashidabadi A. Curcumin, the main part of turmeric, prevents learning and memory changes induced by sodium metabisulfite, a preservative agent, in rats. Exp Neurobiol 2013; 22:23-30. [PMID: 23585719 PMCID: PMC3620455 DOI: 10.5607/en.2013.22.1.23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 01/07/2023] Open
Abstract
Sodium metabisulfite is used as a disinfectant, antioxidant, and preservative agent in the food, beverage, and drug industries. Neurons are highly sensitive to sulfite toxicity. Curcumin is the main part of turmeric and has neuroprotective effects on a variety of nervous system damages. The present study aimed to investigate the possible protective role of curcumin in learning and memory after exposure to sulfite in rats. The rats were divided into five groups receiving distilled water (solvent of the sulfite), olive oil (solvent of the curcumin), sodium metabisulfite (25 mg/kg/day), curcumin (100 mg/kg/day), and sulfite + curcumin. All the animals received daily gavages for 8 weeks. At the end of the 8(th) week, learning and memory were assessed in a partially-baited eight arm radial maze. The animals treated with sulfite showed fewer correct choices and more reference and working memory errors during the learning phase, at the end of the learning phase, and during the retention testing (p<0.001). The study results demonstrated that sulfite-exposure was associated with impaired learning and memory in rats. Adding curcumin to the rat nutrition plays a protective role in learning and memory after exposure to sulfite.
Collapse
Affiliation(s)
- Ali Noorafshan
- Histomorphometry and Stereology Research Centre, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. ; Anatomy Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | | |
Collapse
|
17
|
Radcliff K, Kepler C, Hilibrand A, Rihn J, Zhao W, Lurie J, Tosteson T, Vaccaro A, Albert T, Weinstein J. Epidural steroid injections are associated with less improvement in patients with lumbar spinal stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976) 2013; 38:279-91. [PMID: 23238485 PMCID: PMC3622047 DOI: 10.1097/brs.0b013e31827ec51f] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Subgroup analysis of prospective, randomized database from the Spine Patient Outcomes Research Trial (SPORT). OBJECTIVE The hypothesis of this study was that patients who received ESI during initial treatment as part of SPORT (The Spine Patient Outcomes Research Trial) would have improved clinical outcome and a lower rate of crossover to surgery than patients who did not receive ESI. SUMMARY OF BACKGROUND DATA The use of epidural steroid injection (ESI) in patients with lumbar spinal stenosis is common, although there is little evidence in the literature to demonstrate its long-term benefit in the treatment of lumbar stenosis. METHODS Patients with lumbar spinal stenosis who received ESI within the first 3 months of enrollment in SPORT (ESI) were compared with patients who did not receive epidural injections during the first 3 months of the study (no-ESI). RESULTS There were 69 ESI patients and 207 no-ESI patients. There were no significant differences in demographic factors, baseline clinical outcome scores, or operative details between the groups, although there was a significant increase in baseline preference for nonsurgical treatment among ESI patients (ESI 62% vs. no-ESI 33%, P < 0.001). There was an average 26-minute increase in operative time and an increased length of stay by 0.9 days among the ESI patients who ultimately underwent surgical treatment. Averaged over 4 years, there was significantly less improvement in 36-Item Short Form Health Survey (SF-36) Physical Function among surgically treated ESI patients (ESI 14.8 vs. no-ESI 22.5, P = 0.025). In addition, there was significantly less improvement among the nonsurgically treated patients in SF-36 Body Pain (ESI 7.3 vs. no-ESI 16.7, P = 0.007) and SF-36 Physical Function (ESI 5.5 vs. no-ESI 15.2, P = 0.009). Of the patients assigned to the surgical treatment group, there was a significantly increased crossover to nonsurgical treatment among patients who received an ESI (ESI 33% vs. no-ESI 11%, P = 0.012). Of the patients assigned to the nonoperative treatment group, there was a significantly increased crossover to surgical treatment in the ESI patients (ESI 58% vs. no-ESI 32%, P = 0.003). CONCLUSION Despite equivalent baseline status, ESIs were associated with significantly less improvement at 4 years among all patients with spinal stenosis in SPORT. Furthermore, ESIs were associated with longer duration of surgery and longer hospital stay. There was no improvement in outcome with ESI whether patients were treated surgically or nonsurgically.
Collapse
Affiliation(s)
- Kris Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Yang Z, Zhang Y, Meng Z. The vasodilator mechanisms of sodium metabisulfite on precontracted isolated aortic rings in rats: signal transduction pathways and ion channels. Food Chem Toxicol 2012; 50:3114-9. [PMID: 22727858 DOI: 10.1016/j.fct.2012.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/30/2012] [Accepted: 06/12/2012] [Indexed: 11/24/2022]
Abstract
Sodium metabisulfite (SMB) is most commonly used as a food additives, however few study was performed on the vasodilator effect of SMB. In the present paper, the vasodilator effects of SMB and roles of Ca(2+) and K(+) channels as well as the cGMP pathway on isolated rat aortic rings were studied. The results show that: (1) SMB could relax isolated aortic rings precontracted by norepinephrine in a concentration-dependent manner. The maximal endothelium-dependent vasorelaxation was approximately 20% whereas that not depending on the presence of the endothelium was more than 90%. (2) The vasorelaxant effects induced by 50 or 200 μM SMB were partially inhibited by iberiotoxin, NS-2028 or l-NNA. The vasorelaxation of 1000 μM SMB was partially inhibited by nifedipine or glibenclamide. The SMB induced vasorelaxation was partially inhibited by tetraethylammonium. These results led to the conclusions that the vasorelaxation of SMB at low concentrations (<400 μM) was endothelium-dependent and mediated by the cGMP pathway and BK(Ca) channel, but at high concentrations (>500 μM) was endothelium-independent and mediated by K(ATP) channel and L-type Ca(2+) channel. The maximal allowable concentration from China and the acceptable daily intake level from WHO of SMB as a food additive should be revised.
Collapse
Affiliation(s)
- Zhenhua Yang
- Institute of Environmental Medicine and Toxicology, Research Center of Environmental Science and Engineering, Shanxi University, Taiyuan 030006, China
| | | | | |
Collapse
|
19
|
Akdogan I, Kocamaz E, Kucukatay V, Yonguc NG, Ozdemir MB, Murk W. Hippocampal neuron number loss in rats exposed to ingested sulfite. Toxicol Ind Health 2011; 27:771-8. [DOI: 10.1177/0748233710397418] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sulfite, which is continuously formed in the body during metabolism of sulfur-containing amino acids, is commonly used in preservatives. It has been shown that there are toxic effects of sulfite on many cellular components. The aim of this study was to investigate the possible toxic effects of sulfite on pyramidal neurons by counting cell numbers in CA1 and CA2-CA3 subdivisions of the rat hippocampus. For this purpose, male albino rats were divided into a control group and a sulfite group (25 mg/kg). Sulfite was administered to the animals via drinking water for 8 weeks. At the end of the experimental period, brains were removed and neurons were estimated in total and in a known fraction of CA1 and CA2-CA3 subdivisions of the left hippocampus by using the optical fractionator method—a stereological method. Results showed that sulfite treatment caused a significant decrease in the total number of pyramidal neurons in three subdivisions of the hippocampus (CA1 and CA2-CA3) in the sulfite group compared with the control group (p < 0.05, Mann Whitney U test). It was concluded that exogenous administration of sulfite causes loss of pyramidal neurons in CA1 and CA2-CA3 subdivisions of the rat hippocampus.
Collapse
Affiliation(s)
- Ilgaz Akdogan
- Department of Anatomy, Pamukkale University, School of Medicine, Denizli, Turkey,
| | - Erdogan Kocamaz
- Department of Histology and Embryology, Pamukkale University, School of Medicine, Denizli, Turkey
| | - Vural Kucukatay
- Department of Physiology, Pamukkale University, Denizli, Turkey
| | | | | | - William Murk
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
20
|
Dragoo JL, Korotkova T, Kim HJ, Jagadish A. Chondrotoxicity of low pH, epinephrine, and preservatives found in local anesthetics containing epinephrine. Am J Sports Med 2010; 38:1154-9. [PMID: 20348285 DOI: 10.1177/0363546509359680] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent clinical and basic science investigations have revealed the chondrotoxicity of local anesthetics, especially those containing epinephrine, administered via an intra-articular pain pump. However, the exact mechanism of toxicity is unknown. This study evaluates the chondrotoxicity of low pH, epinephrine, and preservatives found in commonly used local anesthetics. HYPOTHESIS The chondrotoxicity of local anesthetics containing epinephrine is due to low pH, epinephrine, or the preservative sodium metabisulfite. STUDY DESIGN Controlled laboratory study. METHODS Human chondrocytes were harvested and cultured in a custom bioreactor designed to simulate metabolism of medication. Pain pumps were used to infuse one of the following medications into the culture system: control media; media titrated to pH 4.5, 5.0, 5.5, 6.0, 6.5; media with 1:100000 or 1:200000 epinephrine only; media with 0.5 mg/mL of sodium metabisulfite preservative; media with 0.5 mg/mL of methylparaben preservative, 0.25% bupivacaine, 0.25% bupivacaine with epinephrine, 1% lidocaine, and 1% lidocaine with epinephrine. Cultures were perfused for 24 hours and then were stained with live/dead cell viability assay. The chondrocytes were then examined by fluorescence microscopy and counted, and the percentage of cell death was calculated. RESULTS Cultures containing media titrated to pH 4.5 and 5.0 and local anesthetics containing epinephrine (pH 4.0-5.5) had high cell death rates compared with controls at all time points (P < .001), while cultures containing 1:100000 and 1:200000 epinephrine alone had no increased death rate. Also, 0.5 mg/mL sodium metabisulfite preservative had a significant effect on cell death (P < .034); however, the preservative methylparaben had no effect (P > .05). The percentage of cell death was not significant for 1% lidocaine (12.5%; P > .943) and 0.25% bupivacaine (16.5%; P > .609). CONCLUSION The marked chondrotoxicity of local anesthetics containing epinephrine appears to be a combined effect of low pH, as these medications are titrated to pH 4.0 to 5.5 for product stability, and the preservative sodium metabisulfite. Extreme caution should be exercised when using intra-articular pain pumps with local anesthetics containing epinephrine. CLINICAL RELEVANCE Understanding the causes of chondrotoxicity using local anesthetics containing epinephrine is critical to decrease complications associated with this class of medications.
Collapse
Affiliation(s)
- Jason L Dragoo
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA 94063, USA.
| | | | | | | |
Collapse
|
21
|
Diestel A, Roessler J, Pohl-Schickinger A, Koster A, Drescher C, Berger F, Schmitt KRL. Specific p38 inhibition in stimulated endothelial cells: a possible new anti-inflammatory strategy after hypothermia and rewarming. Vascul Pharmacol 2009; 51:246-52. [PMID: 19576293 DOI: 10.1016/j.vph.2009.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/17/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
Abstract
To protect immature organ systems during corrective cardiac surgery, patients are cooled to a minimal temperature of 17 degrees C during cardiopulmonary bypass (CPB). However hypothermic CPB triggers the whole body inflammatory response and results in unwanted prolonged inflammation. The present study was designed to clarify the hypothermia and rewarming induced mechanisms and examine interventional pharmacological strategies that could prevent prolonged inflammation. Stimulated primary human umbilical vein endothelial cells (HUVECs) were exposed to a dynamic temperature protocol analogous to clinical settings. Furthermore endothelial cells were pretreated with methylprednisolone and/or tacrolimus as well as with MAPK inhibitors (SB203580, U0126 and SP600125). Cell viability, expression of IL-6 and ERK 1/2, p38 and SAPK/JNK were investigated. Stimulated endothelial cells secreted significantly higher IL-6 protein 2h after rewarming in comparison to normothermic control cells. Moreover, dynamic temperature changes lead to increased MAPK phosphorylation. Only the combined pre-treatment with MP and TAC served to inhibit the IL-6 secretion. As intracellular signalling pathway we could demonstrate that SB203580 as specific p38 inhibitor most effectively down regulated the unwanted IL-6 release after cooling and rewarming. Therefore inhibition of p38 or components of the p38 pathway could be a promising and selective antiinflammatory therapeutic target after hypothermic CPB.
Collapse
Affiliation(s)
- Antje Diestel
- Department of Pediatric Cardiology, Charité Universitaetsmedizin, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
22
|
Sodium Metabisulfite Modulation of Potassium Channels in Pain-Sensing Dorsal Root Ganglion Neurons. Neurochem Res 2009; 34:2233-42. [DOI: 10.1007/s11064-009-0020-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2009] [Indexed: 11/27/2022]
|