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.
Anesthetics ; Anesthetics, Local ; Anti-Infective Agents ; Candida ; Cell Membrane ; Dentistry ; Diffusion ; Drug Interactions ; Humans ; Microbial Sensitivity Tests ; Mouth ; Mucous Membrane ; Surgery, Oral

BACKGROUND: Opioids are increasingly being administered intrathecally as adjuncts to local anesthetics. They enhance spinal anesthesia without prolonging motor recovery. We evaluated the effect of 10 microgram of fentanyl to bupivacaine on sensory, motor block and side effects. METHODS: Thirty six patients undergoing urologic surgery were randomized into two groups. Control group received bupivacaine 10 mg combined with normal saline 0.2 ml, and Fentanyl group received bupivacaine 10 mg with fentanyl 10 microgram (0.2 ml). RESULTS: There were no significant differences between two groups in the peak level of sensory block, onset of peak level, duration of motor block, and side effects. However, the time of regression from peak level to T10 in Fentanyl group was longer significantly than that of Control group. CONCLUSIONS: Intrathecal small dose fentanyl (10 microgram) on bupivacaine spinal blockade prolonged duration of sensory block and did not augment side effects and provide reliable anesthesia for urologic surgery.
Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine* ; Fentanyl* ; Humans

Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. We analyze the factors that can affect drug distribution within the cerebrospinal fluid. Three categories of variables were identified: drug features, cerebrospinal fluid (CSF) dynamics and patients features. First category includes physicochemical properties and pharmacological features of intrathecal administered drugs with special attention to drug lipophilicity. In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.
Analgesics, Opioid ; Anesthetics, Local ; Baclofen ; Catheters ; Chronic Pain ; Humans ; Posture

BACKGROUND: There have been many attempts to alleviate pain after surgery, but there is no common approach to the control of postoperative pain. The use of epidural opioids, with local anesthetics, has been a widely employed formula to date. Ketamine, an N-methyl-d-aspartate receptor antagonist, has an excellent analgesic effect. Although there have been many reports on the dose and route of administrating analgesics, there have been few concerning the continuous epidural infusion of ketamine with fentanyl. We designed this study to find the effects of ketamine compared to those of epidurally injected bupivacaine and fentanyl, and used this trial to study any potential side effects. METHODS: In a double blind trial, 55 patients received either fentanyl, 0.3microgram/kg/h (Group F), or fentanyl, 0.3microgram/kg/h, and ketamine, 0.1 mg/kg/h (Group FK), added to 0.125% bupivacaine, at rates as high as 2 ml/h, for patient controlled epidural analgesia (PCEA) following a transabdominal hysterectomy. Ten minutes before the operation, patients received 10 ml of 0.125% bupivacaine, with either 0.5 mg/kg ketamine or the same amount of normal saline with 50microgram fentanyl added. The pain scores and the side effects were recorded at 1, 3, 6 and 24 hour post operation. RESULTS: There were no differences in the pain scores or side effects between the two groups. CONCLUSIONS: We failed to find any effect of the addition of epidural ketamine compared to the that of the bupivacaine and fentanyl formula. However, it is suggested that further investigations will be required on the dose and route of administration.
Analgesia, Epidural ; Analgesics ; Analgesics, Opioid ; Anesthetics, Local ; Bupivacaine* ; Fentanyl* ; Humans ; Hysterectomy* ; Ketamine* ; N-Methylaspartate ; Pain, Postoperative

Dexmedetomidine is a selective α-2 adrenoceptor agonist with anxiolytic, sedative, and analgesic properties that prolongs analgesia and decreases opioid-related side effects when used in neuraxial and perineural areas as a local anesthetics adjuvant. The current study was designed to evaluate the effects of a single perineural administration of dexmedetomidine without local anesthetics on narcotic consumption and pain intensity in patients with femoral shaft fractures undergoing surgery. This prospective randomized single-blind clinical trial was conducted in patients undergoing femoral fracture shaft surgery. Based on block permuted randomization, the patients were randomly divided into intervention and control groups. The intervention group received 100µg dexmedetomidine, for a femoral nerve block without any local anesthetics. Total intraoperative opioid consumption, postoperative opioid consumption, visual analogue score (VAS) for pain, and hemodynamic parameters were recorded and compared. Finally the data from 60 patients with a mean age of 30.4±12.3 were analyzed (90% male). There were no significant differences between the baseline characteristics of the two groups (p>0.05). The mean total consumption of narcotics was reduced during induction and maintenance of anesthesia in the intervention group (p<0.05). The amount of postoperative narcotics required showed a significant difference in the intervention group compared with the control group (p<0.05). It is likely that perineural administration of dexmedetomidine significantly not only reduced intra and postoperative narcotic requirement but also decreased postoperative pain intensity in patients undergoing femoral shaft surgery. Femoral blockade by dexmedetomidine can provide excellent analgesia while minimizing the side-effects of opioids.
Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthetics, Local ; Dexmedetomidine ; Femoral Fractures ; Femoral Nerve ; Hemodynamics ; Humans ; Narcotics ; Nerve Block ; Pain Management ; Pain, Postoperative ; Propofol ; Prospective Studies ; Random Allocation

BACKGROUND: caudal anesthesia is a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. Onset time and duration of local anesthetics had been influenced by local anesthetics with combined drugs. We wanted that the time required for the onset of local anesthesia should be short and long enough to allow time for the contemplated surgery. METHOD: To investigated the effect of lidocaine with combined drugs, 120 ASA physical status I, II patients who underwent perianal surgery with caudal anethesia. The patients were diveded into 5 groups : control group received 1.5% lidocaine 27ml, group I received lidocaine with epinephrine (1:200,000), group II received lidocaine with morphine 2mg, group III received lidocaine with fentanyl 50 g, group IV received lidocaine with clonidine 75 g. We have compared the onset time and duration of analgesia of 5 groups. RESULTS: 1. The onset time of analgesia for pin prick test were not significantly changes between groups. 2. The duration of analgesia was significantly more prolonged in group II(863.8 222.1 min) than other three group I, III, IV. 3. The most common side effect was urinary retention(20 cases, 16.7%) in all groups(n=120). 6 cases(24%) in group II(n=25), 2 cases(8%) in group III(n=25) were complained of pruritus. Bradycardia and hypotension were observed in group IV(n=20) (each 1 cases, 5%). CONCLUSIONS: It is suggested from the above results that the morhine group during caudal anesthesia can produce more prolonged duration of analgesia.
Analgesia ; Analgesics ; Anesthesia ; Anesthesia, Caudal* ; Anesthesia, Local ; Anesthetics, Local ; Bradycardia ; Clonidine ; Epinephrine ; Fentanyl ; Humans ; Hypotension ; Lidocaine* ; Morphine ; Narcotics ; Pruritus ; Umbilicus

BACKGROUND: Intrathecal opioids in combination with bupivacaine has been shown to provide adequate sensory blockade and early recovery from spinal anesthesia. This study was investigated the added effects of intrathecal fentanyl 10 microgram to bupivacaine for spinal anesthesia. METHODS: Sixty patients undergoing lower extremity surgery were into three groups. Group I received bupivacaine 10 mg (0.5%), gruop II received bupivacaine 5 mg with normal saline 1 ml, and group III received bupivacaine 5 mg with fentanyl 10 microg and normal saline 0.8 ml. RESULTS: There was no significant difference between group I and group III in the peak level and duration of sensory block. But the intensity of motor blockade was decreased in group III compared with group I and side effects of spinal anesthesia with local anesthetics was decreased in group III compared with group I. In Group II, 7 patients were complained the pain during surgery. CONCLUSIONS: Intrathecal fentanyl 10 microgram with bupivacaine 5 mg on spinal blockade provide reliable anesthesia for lower extremity surgery.
Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Lower Extremity

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Aged ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Needles ; Outpatients ; Pruritus ; Shivering

BACKGROUND: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10microgram and 20microgram when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. METHODS: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10microgram; and group 3, bupivacanie 5 mg + fentanyl 20microgram. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. RESULTS: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). CONCLUSIONS: The addition of fentanyl 10microgram and 20microgram to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10microgram is recommended as outpatient anesthesia.
Aged ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Bupivacaine ; Fentanyl ; Humans ; Needles ; Outpatients ; Pruritus ; Shivering

It is important to treat cancer-related pain in cancer patients to ensure the life quality of the patient, as well as to improve their life span. It has been estimated that at least 5% of cancer patients have pain refractory to medical treatment. Therefore, the need for epidural or intrathecal analgesia with opioids and local anesthetics is indicated if systemic treatment has failed. Intrathecal catheter placement and implantation of the injection port for administration of opioids and local anesthetics may improve pain relief in patients who are unresponsive to epidural routes. Although intrathecal implantation has several complications, similar infection rates have been reported between intrathecal and epidural administration. In addition, intrathecal administration showed better outcomes, including improved pain control, lowered daily doses, and an improvement in the level of drowsiness experienced when compared to epidural administration. We report here a case in which a terminal cancer patient was treated using an intrathecal catheter and subcutaneous port. The patient had cancer-related pain that could not be controlled by epidural opioid administration. Based on the results presented here, we suggest that intrathecal implantation is a feasible long term pain management method for intractable cancer pain patients.
Analgesia ; Analgesics, Opioid ; Anesthetics, Local ; Catheters* ; Humans ; Pain Management* ; Quality of Life ; Sleep Stages