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Zundel S, Conz F, Fuchs J, Blumenstock G, Guerrero-Rodrigues A, Grasshoff C, Schlisio B. Caudal Block versus Wound Infiltration for Inguinal Procedures in Young Children: A Randomized Clinical Study. Eur J Pediatr Surg 2023; 33:354-359. [PMID: 36720249 DOI: 10.1055/s-0042-1758155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Inguinal procedures in children are frequent and typically performed in an outpatient setting. We aimed to analyze whether there is a difference in postoperative pain scores and setup time (start of anesthesia management to incision time) when comparing caudal block (CB) with local wound infiltration. MATERIALS AND METHODS We enrolled pediatric outpatients scheduled for inguinal procedures. Patients were randomized to receive either preincision CBs or end-of-procedure local wound infiltration. Postoperative pain scores until 24 hours postoperatively and setup time were analyzed. RESULTS Fifty-two patients were included in the study. Thirty patients received a CB, and 22 patients received local infiltration (LI). There was no significant difference in postoperative pain scores. Setup time was significantly higher in the CB group: median 22.5 minutes IQR (16-46 minutes) compared with 17 minutes in the LI group IQR (10-35 minutes), p-value of 0.0026. CONCLUSION Both CB and LI result in good postoperative pain control after inguinal procedures in pediatric outpatients. Since LI is less time consuming and has lower risks for complications, we recommend this technique for inguinal procedures in pediatric outpatients. Our findings will need to be confirmed in larger cohorts, but we believe the evidence generated with this study has the potential to positively influence patient care, operating room efficiency, and costs.
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Affiliation(s)
- Sabine Zundel
- Department of Pediatric Surgery, Luzerner Kantonsspital, Spitalstrasse, Luzern, Switzerland
| | - Franziska Conz
- Department of Pediatric Surgery, University of Tübingen, Tübingen, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery, University of Tübingen, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Medical Biometry, University of Tübingen, Tübingen, Germany
| | - Aida Guerrero-Rodrigues
- Department of Anesthesiology and Intensive Care Medicine, Eberhard Karls Universitat Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Christian Grasshoff
- Department of Anesthesiology and Intensive Care Medicine, Eberhard Karls Universitat Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Barbara Schlisio
- Department of Anesthesiology and Intensive Care Medicine, Eberhard Karls Universitat Tübingen, Tübingen, Baden-Württemberg, Germany
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Tandra V, Koti M, Kohli S, Atta M, Khanal P, Khan O. Does local infiltration analgesia in total joint arthroplasty offer any protection from prosthetic joint infections? An invitro experimental study. J Perioper Pract 2023; 33:324-328. [PMID: 36453651 DOI: 10.1177/17504589221137981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Many local anaesthetic agents are now reported to have anti-microbial properties in various studies, and this ability to inhibit microbial growth is not uniform. As local anaesthetics are commonly infiltrated into the surgical field for perioperative pain management, it is very important to know if this practice offers any protection against surgical site infections. METHODS In this study, three of the most common prosthetic joint infection-causing organisms, namely, Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli, were chosen and tested against the commonly used local anaesthetics. The suspension of each organism was inoculated onto three different Mueller-Hinton agar plates and a drop of an undiluted solution of each local anaesthetic agent is inoculated onto one of the three culture plates; vancomycin and gentamicin discs were used as controls. RESULTS The local anaesthetic agents tested could not inhibit the growth of any of the microorganisms. As there was no inhibition of bacterial growth in the experiment with the above three agents, further experiment with a diluted mixture was not performed. CONCLUSIONS It can be concluded that local infiltration of anaesthetic agents is less likely to provide any perioperative protection against prosthetic joint infections but may interfere with some diagnostic tests for microbiology.
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Affiliation(s)
- Varun Tandra
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK
| | - Manjunath Koti
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK
| | - Sandeep Kohli
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK
| | - Mustafa Atta
- Department of Microbiology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK
| | - Prakash Khanal
- Department of Microbiology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK
| | - Osman Khan
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK
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Maniker RB, Damiano J, Ivie RMJ, Pavelic M, Woodworth GE. Perioperative Breast Analgesia: a Systematic Review of the Evidence for Perioperative Analgesic Medications. Curr Pain Headache Rep 2022; 26:299-321. [PMID: 35195851 DOI: 10.1007/s11916-022-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Breast surgery is common and may result in significant acute as well as chronic pain. A wide range of pharmacologic interventions is available including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), N-methyl-D-aspartate (NMDA) receptor antagonists, anticonvulsants, and other non-opioids with analgesic properties. We present a review of the evidence for these pharmacologic interventions. A literature search of the MEDLINE database was performed via PubMed with combined terms related to breast surgery, anesthesia, and analgesia. Articles were limited to randomized controlled trial (RCT) design, adult patients undergoing elective surgery on the breast (not including biopsy), and pharmacologic interventions only. Article titles and abstracts were screened, and risk of bias assessments were performed. RECENT FINDINGS The search strategy initially captured 7254 articles of which 60 articles met the full inclusion criteria. Articles were organized according to intervention: 6 opioid agonists, 14 NSAIDs and acetaminophen, 4 alpha-2 agonists, 7 NMDA receptor antagonists, 6 local anesthetics, 7 steroids, 15 anticonvulsants (one of which also discussed an NMDA antagonist), 1 antiarrhythmic, and 2 serotonin reuptake inhibitors (one of which also studied an anticonvulsant). A wide variety of medications is effective for perioperative breast analgesia, but results vary by agent and dose. The most efficacious are likely NSAIDs and anticonvulsants. Some agents may also decrease the incidence of chronic postoperative pain, including flurbiprofen, gabapentin, venlafaxine, and memantine. While many individual agents are well studied, optimal combinations of analgesic medications remain unclear.
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Affiliation(s)
- Robert B Maniker
- Department of Anesthesiology, Columbia University, 622 West 168th Street, PH505, NY, 10032, New York, USA.
| | | | - Ryan M J Ivie
- Oregon Health and Science University, Portland, OR, USA
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Bruenke J, Riemann T, Kessler P, Kachel N. Epidural infections, bacteriostatic drug effects and technical strategies for prevention. Reg Anesth Pain Med 2021; 47:128-130. [PMID: 34117104 PMCID: PMC8685640 DOI: 10.1136/rapm-2021-102517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 05/28/2021] [Indexed: 12/04/2022]
Affiliation(s)
| | | | - Paul Kessler
- Department of Anesthesiology, University Hospital Frankfurt, Frankfurt, Germany
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Harrison ZL, Bumgardner JD, Fujiwara T, Baker DL, Jennings JA. In vitro evaluation of loaded chitosan membranes for pain relief and infection prevention. J Biomed Mater Res B Appl Biomater 2021; 109:1735-1743. [PMID: 33871933 DOI: 10.1002/jbm.b.34831] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/01/2021] [Accepted: 02/22/2021] [Indexed: 01/28/2023]
Abstract
Wounds resulting from surgeries, implantation of medical devices, and musculoskeletal trauma result in pain and can also result in infection of damaged tissue. Up to 80% of these infections are due to biofilm formation either on the surface of implanted devices or on surrounding wounded tissue. Bacteria within a biofilm have intrinsic growth and development characteristics that allow them to withstand up to 1,000 times the minimum inhibitory concentration of antibiotics, demonstrating the need for new therapeutics to prevent and treat these infections. Cis-2-decenoic acid (C2DA) is known to disperse preformed biofilms and can prevent biofilm formation entirely for some strains of bacteria. Additionally, local anesthetics like bupivacaine have been shown to have antimicrobial effects against multiple bacterial strains. This study sought to evaluate hexanoic acid-treated electrospun chitosan membranes (HA-ESCM) as wound dressings that release C2DA and bupivacaine to simultaneously prevent infection and alleviate pain associated with musculoskeletal trauma. Release profiles of both therapeutics were evaluated, and membranes were tested in vitro against Methicillin-resistant Staphylococcus aureus (MRSA) to determine efficacy in preventing biofilm infection and bacterial growth. Results indicate that membranes release both therapeutics for 72 hr, and release profile can be tailored by loading concentration. Membranes were effective in preventing biofilm growth but were toxic to fibroblasts when loaded with 2.5 or 5 mg of bupivacaine.
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Affiliation(s)
- Zoe L Harrison
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
| | - Joel D Bumgardner
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
| | - Tomoko Fujiwara
- Department of Chemistry, University of Memphis, Memphis, Tennessee, USA
| | - Daniel L Baker
- Department of Chemistry, University of Memphis, Memphis, Tennessee, USA
| | - J Amber Jennings
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
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7
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Pospíšilová Š, Malík I, Bezouskova K, Kauerova T, Kollar P, Csöllei J, Oravec M, Cizek A, Jampilek J. Dibasic Derivatives of Phenylcarbamic Acid as Prospective Antibacterial Agents Interacting with Cytoplasmic Membrane. Antibiotics (Basel) 2020; 9:E64. [PMID: 32041117 PMCID: PMC7168207 DOI: 10.3390/antibiotics9020064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
1-[2-[({[2-/3-(Alkoxy)phenyl]amino}carbonyl)oxy]-3-(dipropylammonio)propyl]pyrrolidinium/azepan- ium oxalates or dichlorides (alkoxy = butoxy to heptyloxy) were recently described as very promising antimycobacterial agents. These compounds were tested in vitro against Staphylococcus aureus ATCC 29213, Enterococcus faecalis ATCC 29212 (reference and control strains), three methicillin-resistant isolates of S. aureus, and three isolates of vancomycin-resistant E. faecalis. 1-[3-(Dipropylammonio)-2-({[3-(pentyloxy-/hexyloxy-/heptyloxy)phenyl]carbamoyl}oxy)propyl]pyrrolidinium dichlorides showed high activity against staphylococci and enterococci comparable with or higher than that of used controls (clinically used antibiotics and antiseptics). The screening of the cytotoxicity of the compounds as well as the used controls was performed using human monocytic leukemia cells. IC50 values of the most effective compounds ranged from ca. 3.5 to 6.3 µM, thus, it can be stated that the antimicrobial effect is closely connected with their cytotoxicity. The antibacterial activity is based on the surface activity of the compounds that are influenced by the length of their alkoxy side chain, the size of the azacyclic system, and hydro-lipophilic properties, as proven by in vitro experiments and chemometric principal component analyses. Synergistic studies showed the increased activity of oxacillin, gentamicin, and vancomycin, which could be explained by the direct activity of the compounds against the bacterial cell wall. All these compounds demonstrate excellent antibiofilm activity, when they inhibit and disrupt the biofilm of S. aureus in concentrations close to minimum inhibitory concentrations against planktonic cells. Expected interactions of the compounds with the cytoplasmic membrane are proven by in vitro crystal violet uptake assays.
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Affiliation(s)
- Šárka Pospíšilová
- Regional Centre of Advanced Technologies and Materials, Faculty of Science, Palacky University, Slechtitelu 27, 783 71 Olomouc, Czech Republic;
| | - Ivan Malík
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Comenius University in Bratislava, Odbojarov 10, 832 32 Bratislava, Slovakia
| | - Kristyna Bezouskova
- Department of Infectious Diseases and Microbiology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Palackeho 1946/1, 612 42 Brno, Czech Republic; (K.B.); (A.C.)
| | - Tereza Kauerova
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic; (T.K.); (P.K.)
| | - Peter Kollar
- Department of Human Pharmacology and Toxicology, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Palackeho 1, 61242 Brno, Czech Republic; (T.K.); (P.K.)
| | - Jozef Csöllei
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences in Brno, Palackeho 1946/1, 612 42 Brno, Czech Republic;
| | - Michal Oravec
- Global Change Research Institute CAS, Belidla 986/4a, 603 00 Brno, Czech Republic;
| | - Alois Cizek
- Department of Infectious Diseases and Microbiology, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Palackeho 1946/1, 612 42 Brno, Czech Republic; (K.B.); (A.C.)
| | - Josef Jampilek
- Regional Centre of Advanced Technologies and Materials, Faculty of Science, Palacky University, Slechtitelu 27, 783 71 Olomouc, Czech Republic;
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dubravska cesta 9, 845 10 Bratislava, Slovakia
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Razavi BM, Fazly Bazzaz BS. A review and new insights to antimicrobial action of local anesthetics. Eur J Clin Microbiol Infect Dis 2019; 38:991-1002. [PMID: 30680564 DOI: 10.1007/s10096-018-03460-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022]
Abstract
Local anesthetics (LAs) are medications which can provide analgesia in distinct body regions through the blockade of voltage-gated sodium channels. Besides pain management, the supplemental role of LAs as antimicrobial agents has been documented in several studies. Different databases including PubMed, Scopus, and Web of Science with the name of different local anesthetics and related names for antimicrobial keywords were searched without time limitation. This review summarized different in vitro and in vivo studies regarding antimicrobial effects of different LAs with focuses on antimicrobial applications of most studied LAs, interaction with different agents which combined with LAs, and mechanisms of action and structural dependence of LAs antibacterial effects. Among different LAs, lidocaine is the most studied preparation. Reduction of the incidence of endophthalmitis after intravitreal injection, prophylaxis for surgical wound infections, prevention of the incidence of catheter-associated infections, oral biofilm reduction on the buccal mucosa, and prevention against bacteria that produced nosocomial infection are some examples of lidocaine antimicrobial application. Studies showed that different factors including structure, concentration, duration of exposure, type of microorganism tested, and temperature affect the degree of LA antimicrobial activity. In addition, various agents such as antibiotics, preservatives, opioids, epinephrine, and propofol can combine with LAs and affect their antimicrobial properties through synergistic or antagonistic action. Due to antibacterial activities, LAs could be applied in a clinic for prophylaxis of surgical site infection. In the application of LAs prior to diagnostic procedures caution should be needed; otherwise, when culturing the specimen, they could lead to false negative results.
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Affiliation(s)
- Bibi Marjan Razavi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bibi Sedigheh Fazly Bazzaz
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmaceutical Control Department, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kaewjiaranai T, Srisatjaluk RL, Sakdajeyont W, Pairuchvej V, Wongsirichat N. The efficiency of topical anesthetics as antimicrobial agents: A review of use in dentistry. J Dent Anesth Pain Med 2018; 18:223-233. [PMID: 30186969 PMCID: PMC6115368 DOI: 10.17245/jdapm.2018.18.4.223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/18/2018] [Accepted: 08/22/2018] [Indexed: 01/04/2023] Open
Abstract
Topical anesthetics are commonly used in oral & maxillofacial surgery to control pain in the oral cavity mucosa before local anesthetic injection. These anesthetic agents come in many forms, developed for different usages, to minimize adverse reactions, and for optimal anesthetic efficiency. Earlier studies have revealed that these agents may also limit the growth of microorganisms in the area of anesthetic application. Many topical anesthetic agents show different levels of antimicrobial activity against various bacterial strains and Candida. The dosage of local anesthetic agent used in some clinical preparations is too low to show a significant effect on microbial activity. Efficiency of antimicrobial activity depends on the local anesthetic agent's properties of diffusion within the bloodstream and binding efficiency with cytoplasmic membrane, which is followed by disruption of the bacterial cell membrane. The antimicrobial properties of these agents may extend their usage in patients to both control pain and infection. To develop the topical local anesthetic optimal usage and antimicrobial effect, a collaborating antiseptic agent may be used to benefit the local anesthetic. However, more research is required regarding minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of topical local anesthetic agents with drug interaction between anesthetics and antiseptic agents.
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Affiliation(s)
- Thanawat Kaewjiaranai
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Watus Sakdajeyont
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Local infiltration analgesia with ropivacaine in acute fracture of thoracolumbar junction surgery. Orthop Traumatol Surg Res 2017; 103:291-294. [PMID: 28038991 DOI: 10.1016/j.otsr.2016.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/11/2016] [Accepted: 11/28/2016] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Retrospective study. INTRODUCTION Local infiltration analgesia is effective in many surgeries as knee arthroplasty, but the analgesic efficacy of local infiltration analgesia with ropivacaine in trauma spine surgery in T10 to L2 has not been clarified. We conducted a trial to assess the analgesic efficacy of intraoperative local infiltration analgesia (LIA) with ropivacaine. OBJECTIVE The aim of the present study was to clarify the effect of intraoperative local infiltration analgesia with ropivacaine on postoperative pain for patients undergoing thoracolumbar junction fracture surgery. METHODS In a retrospective study, in 76 patients undergoing spine surgery for thoracolumbar junction fracture, 20ml of ropivacaine 7.5% (n R group=38) was infiltrated using a systematic technique, or no infiltration was realized (n M group=38). We assessed postoperative pain with Visual Analogue Scale (VAS) and morphine consumption in the 24 first hours. RESULTS VAS pain score upon awakening and at 2hours postoperatively were significantly lower in the ropivacaine group (P=0.01 and P=0.002). Rescue opioid requirement during the 24 first hours were about 50% lower in the ropivacaine group (P=0.01). No local or systemic side effects were observed. CONCLUSION Intraoperative LIA with ropivacaine in thoracolumbar junction fracture surgery may have an analgesic effect in postoperative pain control (24hours) with a reduction of VAS and morphine consumption.
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Tamanai-Shacoori Z, Shacoori V, Vo Van JM, Robert JC, Bonnaure-Mallet M. Sufentanil modifies the antibacterial activity of bupivacaine and ropivacaine. Can J Anaesth 2015; 51:911-4. [PMID: 15525616 DOI: 10.1007/bf03018889] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE The purpose of our study was to investigate the effect on the growth of Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), and Enterococcus faecalis (E. faecalis) of bupivacaine at a final concentration of 0.77 mg.mL(-1), ropivacaine at 1.2 mg.mL(-1), and sufentanil at 0.38 and 0.5 microg.mL(-1) (alone or in combination with bupivacaine and ropivacaine). METHODS The strains were diluted to approximately 3 x 10(4) cfu.mL(-1) in Mueller-Hinton broth. The anesthetics (0.5 mL) were incubated with the bacterial suspensions (0.5 mL) for 24 hr at 37 degrees C. RESULTS Bupivacaine inhibited the growth of E. coli (59 +/- 0.8%; P < 0.05) and S. aureus (22 +/- 3.6%; P < 0.05). Ropivacaine also inhibited the growth of E. coli (41 +/- 1.2%; P < 0.05) and S. aureus (25.5 +/- 4.1%; P < 0.05). Both anesthetics were ineffective against E. faecalis. Sufentanil only inhibited S. aureus (13.8 +/- 3.1%; P < 0.05) at a concentration of 0.5 microg.mL(-1). Sufentanil modified the antibacterial activity of bupivacaine and ropivacaine. It increased the inhibitory effect of bupivacaine on E. faecalis and S. aureus by 10 +/- 2.1% (P < 0.05) and on E. coli by 7% (P < 0.05). Sufentanil did not increase the inhibitory effect of ropivacaine on the growth of S. aureus. On the other hand, sufentanil reduced the inhibitory effect of ropivacaine on E. coli by 11% (P < 0.05). CONCLUSION Both bupivacaine and ropivacaine alone or combined with sufentanil inhibited the growth of E. coli and S. aureus. E. faecalis was partially sensitive to a bupivacaine + sufentanil mixture. Sufentanil had a partial synergistic effect on bupivacaine and a partial antagonistic effect on ropivacaine's antibacterial activity.
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Affiliation(s)
- Zohreh Tamanai-Shacoori
- Laboratoire de Micbiologie Pharmaceutique, 1254 Faculté de Pharmacie 2 Av. du Pr Léon Bernard, 35043 Rennes Cedex, France.
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Begec Z, Gulhas N, Toprak HI, Yetkin G, Kuzucu C, Ersoy MO. Comparison of the antibacterial activity of lidocaine 1% versus alkalinized lidocaine in vitro. Curr Ther Res Clin Exp 2014; 68:242-8. [PMID: 24683214 DOI: 10.1016/j.curtheres.2007.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Infections after epidural and spinal blocks are rare. The topical anesthetic liclocaine used in these procedures has been found to have antibacterial effects on various microorganisms. OBJECTIVE The aim of this study was to assess the antibacterial effects of alkalinized liclocaine on Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. METHODS Lidocaine 2%, alkalinized lidocaine, and physiologic saline (as a control solution) were added to standard bacterial preparations. The final concentration of the lidocaine was 10 mg/mL (1%). At baseline and 3 and 6 hours after incubation at 37°C, 3-mL aliquots were vortexed and pipetted into sterile polystyrene spectrophotometer cuvettes. Baseline referred to the end of the period of preparation of the solution (≤20 minutes). Growth was measured as the optical density at a wavelength of 540 nm. RESULTS Compared with the control, lidocaine significantly inhibited the growth of S aureus, E coli, and P aeruginosa at baseline and 3 and 6 hours after incubation (all, P < 0.05). Alkalinized lidocaine significantly inhibited the growth of S aureus at baseline and 3 and 6 hours (all, P < 0.05), while it significantly inhibited the growth of E coli and P aeruginosa only at 6 hours (both, P < 0.05). The growth of E coli was significantly less in lidocaine than in alkalinized lidocaine at 0 and 3 hours (both, P < 0.05). CONCLUSION The antibacterial effect of lidocaine 1% on S aureus was not changed after alkalinization. The effect of alkalinized lidocaine on E coli and P aeruginosa was significant only at 6 hours. Lidocaine significantly inhibited the growth of these 3 microorganisms at all study periods.
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Affiliation(s)
- Zekine Begec
- Department of Anesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - Nurcin Gulhas
- Department of Anesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - H Ilksen Toprak
- Department of Anesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - Gulay Yetkin
- Department of Microbiology, Inonu University, School of Medicine, Malatya, Turkey
| | - Cigdem Kuzucu
- Department of Microbiology, Inonu University, School of Medicine, Malatya, Turkey
| | - M Ozcan Ersoy
- Department of Anesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
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Pirbudak L, Karsligil T, Zer Y, Öner Ü, Balci I. Antibacterial effect of bupivacaine and ropivacaine; effect of adjuvant drugs. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/1568569053421762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Morgan G. Microbial growth in a mixture of hyperbaric bupivacaine and fentanyl prepared in a multi-dose syringe in the operating theatre environment. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Head S, Enneking FK. Infusate Contamination in Regional Anesthesia: What Every Anesthesiologist Should Know. Anesth Analg 2008; 107:1412-8. [DOI: 10.1213/01.ane.0000286228.57455.91] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Snyders SP, James MFM. Alkalinisation does not enhance the antimicrobial properties of local anaesthetic solutions. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2008. [DOI: 10.1080/22201173.2008.10872558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Johnson SM, Saint John BE, Dine AP. Local anesthetics as antimicrobial agents: a review. Surg Infect (Larchmt) 2008; 9:205-13. [PMID: 18426354 DOI: 10.1089/sur.2007.036] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Since the introduction of cocaine in 1884, local anesthetics have been used as a mainstay of pain management. However, numerous studies over the past several decades have elucidated the supplemental role of local anesthetics as antimicrobial agents. In addition to their anesthetic properties, medications such as bupivacaine and lidocaine have been shown to exhibit bacteriostatic, bactericidal, fungistatic, and fungicidal properties against a wide spectrum of microorganisms. METHODS A comprehensive literature search was conducted using MEDLINE 1950-present for in vitro and in vivo studies pertaining to the antimicrobial activity of various local anesthetics on a broad range of bacterial and fungal pathogens. Studies testing the effect on microbial growth inhibition of local anesthetics alone and in combination with other agents, such as preservatives and other medications, as well as the effect of conditions such as concentration and temperature, were included for review. Outcome measures included colony counts, area-under-the-curve and time-kill curve calculations, minimum inhibitory concentrations, and post-antibiotic effect. RESULTS Evidence suggests that local anesthetics as a class possess inherent antimicrobial properties against a wide spectrum of human pathogens. Multiple local anesthetics at concentrations typically used in the clinical setting (e.g., bupivacaine 0.125%-0.75%; lidocaine 1%-3%) inhibit the growth of numerous bacteria and fungi under various conditions. Different local anesthetics showed various degrees of antimicrobial capacity; bupivacaine and lidocaine, for example, inhibit growth to a significantly greater extent than does ropivacaine. Greater concentrations, longer exposure, and higher temperature each correlate with a proportional increase in microbial growth inhibition. Addition of other agents to the anesthetic solutions, such as preservatives, opioids, or intravenous anesthetics such as propofol, modify the antimicrobial activity via either synergistic or antagonistic action. Limited studies attribute the mechanism of action of antimicrobial activity of local anesthetics to a disruption of microbial cell membrane permeability, leading to leakage of cellular components and subsequent cell lysis. CONCLUSIONS Local anesthetics not only serve as agents for pain control, but possess antimicrobial activity as well. In such a capacity, local anesthetics can be considered as an adjunct to traditional antimicrobial use in the clinical or laboratory setting. Additionally, caution should be exercised when administering local anesthetics prior to diagnostic procedures in which culture specimens are to be obtained, as the antimicrobial activity of the local anesthetic could lead to false-negative results or suboptimal culture yields.
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Abstract
Infection is the commonest cause of serious neurologic sequelae of neuraxial anesthesia. The incidence depends on operator skill and patient population. Meningitis, a complication of dural puncture, is usually caused by viridans streptococci. The risk factors are dural puncture during labor, no mask and poor aseptic technique, vaginal infection and bacteremia. Epidural abscess is a complication of epidural catheterization, route of entry the catheter track and the organism usually the staphylococcus. Principal risk factors are prolonged catheterization, poor aseptic technique and traumatic insertion. Prevention includes wearing a mask, using a full sterile technique, avoiding prolonged catheterization and prescribing antibiotics in a high-risk situation.
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Danelli G, Berti M, Casati A, Bobbio A, Ghisi D, Mele R, Rossini E, Fanelli G. Ipsilateral shoulder pain after thoracotomy surgery: a prospective, randomized, double-blind, placebo-controlled evaluation of the efficacy of infiltrating the phrenic nerve with 0.2%wt/vol ropivacaine. Ugeskr Laeger 2007; 24:596-601. [PMID: 17437655 DOI: 10.1017/s0265021507000178] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The aim of this prospective, randomized, double-blind, placebo-controlled study was to evaluate the efficacy of phrenic nerve infiltration with ropivacaine 0.2% on the incidence and severity of ipsilateral shoulder pain after thoracotomy in patients receiving continuous thoracic epidural analgesia. METHODS Fifty ASA physical status II-III patients, receiving thoracic epidural analgesia for post-thoracotomy pain, were randomly allocated to receive infiltration of the ipsilateral phrenic nerve with either ropivacaine 0.2% 10 mL (ropivacaine, n = 25), or saline 0.9% (control, n = 25) just before lung expansion and chest closure. A blinded observer recorded the incidence and severity of ipsilateral shoulder pain 6, 12, 24, 36 and 48 h after surgery. Postoperative respiratory function was also evaluated with blood gas analyses. RESULTS The cumulative incidences of ipsilateral shoulder pain during the first 24 h after surgery were 8/25 in the ropivacaine and 16/25 in the control groups (P = 0.047), with median (range) onset times for shoulder pain of 2 (2-24) h with ropivacaine and 0.5 (0.5-24) h in controls (P = 0.005). No differences were reported on the second postoperative day. The areas under the curves of the amount of pain over time were 0 (0-2760) mm h for the ropivacaine and 350 (0-1900) mm h for the control groups (P = 0.06). Postoperatively, similar reductions in indices of oxygenation were observed in both groups. CONCLUSIONS Phrenic nerve infiltration with ropivacaine 0.2% 10 mL reduced the incidence and delayed the onset of ipsilateral shoulder pain during the first 24 h after open lung resection, with no clinically relevant effects on respiratory function.
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Affiliation(s)
- G Danelli
- University of Parma, Department of Anaesthesia and Pain Therapy, Ospedale Maggiore di Parma, Parma, Italy
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Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand 2006; 50:265-82. [PMID: 16480459 DOI: 10.1111/j.1399-6576.2006.00936.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Development of new local anesthetic agents has been focused on the potency of their nerve-blocking effects, duration of action and safety and has resulted in a substantial number of agents in clinical use. It is well established and well documented that the nerve blocking effects of local anesthetics are secondary to their interaction with the Na+ channels thereby blocking nerve membrane excitability and the generation of action potentials. Accumulating data suggest however that local anesthetics also possess a wide range of anti-inflammatory actions through their effects on cells of the immune system, as well as on other cells, e.g. microorganisms, thrombocytes and erythrocytes. The potent anti-inflammatory properties of local anesthetics, superior in several aspects to traditional anti-inflammatory agents of the NSAID and steroid groups and with fewer side-effects, has prompted clinicians to introduce them in the treatment of various inflammation-related conditions and diseases. They have proved successful in the treatment of burn injuries, interstitial cystitis, ulcerative proctitis, arthritis and herpes simplex infections. The detailed mechanisms of action are not fully understood but seem to involve a reversible interaction with membrane proteins and lipids thus regulating cell metabolic activity, migration, exocytosis and phagocytosis.
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Affiliation(s)
- J Cassuto
- Department of Anesthesiology and Intensive Care and Institution of Surgical Specialties, Sahlgrenska University Hospital, Mölndal, Sweden.
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Boselli E, Guillier M, Freney J, Mazoyer MA, Casoli E, Renaud FRN, Rimmelé T, Chassard D, Allaouchiche B. Antibacterial Activity of Clonidine and Neostigmine In Vitro. Anesth Analg 2005; 101:121-4, table of contents. [PMID: 15976217 DOI: 10.1213/01.ane.0000153500.68193.f7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted an in vitro study to investigate the antibacterial activity of clonidine and neostigmine on common microorganisms encountered during infectious complications after regional anesthesia. Standardized suspensions of Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli were incubated during 1, 3, 6, and 24 h at 37 degrees C with concentrations of 37.5, 75, and 150 microg/mL of clonidine and 125, 250, and 500 microg/mL of neostigmine. After 24 h incubation at 37 degrees C, the colony counts were compared by two-way analysis of variance. The mean colony counts for S. aureus decreased significantly from control as the exposure to clonidine increased (P < 0.05), with a approximately 100% kill at 6 h for the largest concentration (150 microg/mL) and at 24 h for the intermediate concentration (75 microg/mL). Similar results were observed for S. epidermidis, with a approximately 100% kill at 6 h for the largest concentrations (75 and 150 microg/mL). No bactericidal activity of clonidine was observed for E. coli and no bactericidal activity of neostigmine was observed for any of the tested strains. In the conditions of this experiment, clonidine, but not neostigmine, exhibited a concentration-dependent and time-dependent bactericidal activity in vitro on the microorganisms most frequently encountered in infectious complications after regional anesthesia.
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Affiliation(s)
- Emmanuel Boselli
- Service d'Anesthésie-Réanimation, Department of Anesthesiology, Hôpital Edouard Herriot, 5 place d'Arsonval, 69437 Lyon cedex 03, France.
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Hahnenkamp K, Herroeder S, Hollmann MW. Regional anaesthesia, local anaesthetics and the surgical stress response. Best Pract Res Clin Anaesthesiol 2004; 18:509-27. [PMID: 15212342 DOI: 10.1016/j.bpa.2004.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epidural anaesthesia has the potential to improve patients' outcome after major surgical procedures by reducing postoperative morbidity and duration of recovery. Possible benefits include the attenuation of cardiac complications, an earlier return of gastrointestinal function associated with an increase in patients' comfort overall, decreased incidence of pulmonary dysfunction, beneficial effects on the coagulation system and a reduction in the inflammatory response. The underlying mechanisms, however, remain unclear. Since local anaesthetics (LAs), reabsorbed from the epidural space, seem to contribute to these effects, it is not easy to differentiate between the systemic effects of LAs and the effects of neuraxial blockade by epidural anaesthesia. Thus, in patients not able or willing to receive intra- and/or postoperative epidural analgesia, systemic administration of LAs may be considered to be a new therapeutic approach for the prevention of postoperative disorders by modulation of the peri- and postoperative inflammatory.
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Affiliation(s)
- Klaus Hahnenkamp
- Department of Anaesthesiology and Intensive Care, University Hospital Muenster, 48129 Münster, Germany.
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Abstract
The following article summarizes different aspects of local anesthetic effects that cannot be explained purely by a sodium channel blockade. Particularly remarkable is hereby their antiinflammatory activity, e.g. the inhibition of pathological changes such as excessive stimulation of the inflammatory system, without compromising the host defense system. In contrast to other immunosuppressive drugs commonly used for treating such conditions, local anesthetics look promising for the future as a new therapeutic option. Besides general anesthetic activity, local anesthetics exert cerebroprotective effects and are furthermore, in consideration of their cardiovascular stability, of interest during neuroanesthetic procedures. In addition, local anesthetics are known for their potency to minimize bronchial hyperreactivity, although details of the underlying mechanisms are not yet elucidated. These effects of local anesthetics may represent interesting prospects for which their relevance has to be determined.
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Affiliation(s)
- S Pecher
- Universitätsklinik für Anaesthesiologie, Universität Heidelberg
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Kampe S, Poetter C, Buzello S, Wenchel HM, Paul M, Kiencke P, Kasper SM. Ropivacaine 0.1% with sufentanil 1 microg/mL inhibits in vitro growth of Pseudomonas aeruginosa and does not promote multiplication of Staphylococcus aureus. Anesth Analg 2003; 97:409-411. [PMID: 12873926 DOI: 10.1213/01.ane.0000067404.84486.7a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED We investigated the effect of ropivacaine combined with sufentanil, a mixture frequently used for postoperative epidural analgesia, on the growth of Staphylococcus aureus and Pseudomonas aeruginosa at room temperature. Aliquots of suspension of S. aureus and P. aeruginosa in saline were transferred into test tubes containing either a mixture of ropivacaine 0.1% and sufentanil 1 microg/mL (R+S) or saline (SA), with the latter serving as control. At 0, 3, 6, 24, and 48 h after inoculation, 1 mL of each solution was spread over standard blood agar. The plates were incubated at 22 degrees C for 48 h, and the numbers of colony-forming units (cfu) were counted. The growth ratio for both bacterial strains was calculated as cfu time (t(n))/cfu baseline (t(0)). The primary efficacy variable was the area under the curve (AUC) in (cfu t(n)/cfu t(0)) x time, based on the growth ratios. The AUC for P. aeruginosa was significantly less in R+S than in SA (P = 0.028). Multiplication of P. aeruginosa (growth ratio >1) was observed for at least 6 h after inoculation in SA. Growth of P. aeruginosa was significantly less in R+S than in SA at 3 h (P = 0.043) and 24 h (P = 0.012) after inoculation. The AUC for S. aureus did not differ significantly between R+S and SA (P = 0.74). Neither R+S nor SA promoted multiplication of S. aureus. Forty-eight hours after inoculation, growth of S. aureus was significantly less in R+S than in SA (P < 0.0001). We conclude that R+S inhibited growth of P. aeruginosa and did not promote multiplication of S. aureus when compared with SA. IMPLICATIONS This laboratory study demonstrated that compared with saline, ropivacaine 0.1% with 1 microg/mL of sufentanil inhibited growth of Pseudomonas aeruginosa and did not promote multiplication of Staphylococcus aureus at room temperature. With respect to bacterial infection with these two strains, the mixture seems to be safe for continuous epidural administration if prepared under aseptic conditions and after alcohol hand rub.
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Affiliation(s)
- Sandra Kampe
- *Department of Anesthesiology, †Infection Control Laboratory, ‡Department of Hospital Infection Control, and §Department of Medical Statistics, University of Cologne, Cologne, Germany
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Goodman EJ, Jacobs MR, Bajaksouzian S, Windau AR, Dagirmanjian JP. Clinically significant concentrations of local anesthetics inhibit Staphylococcus aureus in vitro. Int J Obstet Anesth 2002; 11:95-9. [PMID: 15321560 DOI: 10.1054/ijoa.2001.0934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study explores which concentrations of local anesthetics might be expected to inhibit the growth of Staphylococcus aureus. Serial dilutions were made of 0.5% and 0.75% bupivacaine, 2% and 5% lidocaine, 2% and 3% chloroprocaine, and 0.2% and 1% ropivacaine. To each concentration of local anesthetic solution, Mueller Hinton broth medium and Staphylococcus aureus were added. The resulting solutions were incubated and then observed for growth 24 and 48 h later. The minimum concentrations of the local anesthetics that could inhibit growth of Staphylococcus aureus were 0.25% bupivacaine, 1.25% lidocaine and 0.75% chloroprocaine. The inhibitory concentration of ropivacaine could not be determined because the more concentrated solutions precipitated in the Mueller Hinton broth. Local anesthetics may help protect against epidural abscess formation if they are used in sufficiently high concentrations. This effect may help explain the very low reported incidence of epidural abscess.
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Affiliation(s)
- E J Goodman
- Department of Anesthesiology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA.
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Abstract
IMPLICATIONS Drugs affecting bacterial growth may influence the occurrence of postoperative infections. Ropivacaine 10 mg/mL killed Staphylococcus aureus and Escherichia coli; ropivacaine 2 mg/mL supported the growth of E. coli.
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Affiliation(s)
- Istvan Bátai
- Department of Anesthesia and Intensive Care, Department of Clinical Microbiology, Department of Orthopedic Surgery, University of Pécs, Pécs, Hungary.
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Plancarte R, Mayer-Rivera F. Regional anaesthesia and medical disease. Curr Opin Anaesthesiol 2000; 13:545-8. [PMID: 17016355 DOI: 10.1097/00001503-200010000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present review addresses recent literature on advances in regional anaesthesia and medical diseases, and focuses on expert guidelines and decision-making processes. Attention is also given to risk-benefit ratios in the management of patients with chronic illnesses, difficulties in treatment of the elderly, and associated morbidity and mortality.
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Affiliation(s)
- R Plancarte
- Department of Pain Clinic and Palliative Care, Instituto Nacional de Cancerología, Mexico City, Mexico.
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