Epinephrine concentration (1:100,000 or 1:200,000) does not affect the clinical efficacy of 4% articaine for lower third molar removal: a double-blind, randomized, crossover study.

PURPOSE: This study compared the use of 4% articaine in association with 1:100,000 (10 mug/mL; A100) or 1:200,000 (5 mug/mL; A200) epinephrine in lower third molar removal. PATIENTS AND METHODS: Fifty healthy volunteers underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia with either A100 or A200, in a double-blind, randomized, and crossed manner. Latency, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS: A100 and A200 presented very similar latency (1.64 +/- 0.08 and 1.58 +/- 0.08 minutes, respectively; P > .05). Identical volumes of both anesthetic solutions were used: 2.7 mL = 108 mg of articaine plus 27 mug (A100) or 13.5 mug (A200) of epinephrine. The 2 solutions provided similar duration of postoperative analgesia regardless of bone removal (around 200 minutes; P > .05). The 2 solutions also had a similar duration of anesthetic action on soft tissues (around 250 minutes; P > .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal. Transient changes in hemodynamic parameters were observed, but these were neither clinically significant nor attributable to the type of anesthetic used (P > .05). CONCLUSIONS: An epinephrine concentration of 1:100,000 or 1:200,000 in 4% articaine solution does not affect the clinical efficacy of this local anesthetic. It is possible to successfully use the 4% articaine formulation with a lower concentration of epinephrine (1:200,000 or 5 mug/mL) for lower third molar extraction with or without bone removal.     

Comparison of injection pain, heart rate increase, and postinjection pain of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system

The purpose of this prospective, randomized, double-blind study was to compare the pain of injection, heart rate increase, and postinjection pain of the intraligamentary injection of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine administered with a computer-controlled local anesthetic delivery system. Using a crossover design, intraligamentary injections of 1.4 mL of 4% articaine with 1:100,000 epinephrine and 1.4 mL of 2% lidocaine with 1:100,000 epinephrine were randomly administered on the mesial and distal aspects of the mandibular first molar with a computer-controlled local anesthetic delivery system in a double-blind manner at 2 separate appointments to 51 subjects. The results demonstrated the incidence of moderate pain was 14%-27% with needle insertion, with 0%-4% reporting severe pain. For solution deposition, moderate pain was reported 8%-18% of the time, with no reports of severe pain. There were no significant differences between the articaine and lidocaine solutions. Regarding heart rate changes, neither anesthetic solution resulted in a significant increase in heart rate over baseline readings. On day 1 postinjection, there was a 31% incidence of moderate/severe pain with the articaine solution and 20% incidence of moderate/severe pain with the lidocaine solution. The moderate/severe pain ratings decreased over the next 2 days. There were no significant differences between the articaine and lidocaine solutions. We concluded that the intraligamentary injection of 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine for injection pain and postinjection pain in the mandibular first molar when administered with a computer-controlled local anesthetic delivery system. For both anesthetic solutions, heart rate did not significantly increase with the intraligamentary injection using the computer-controlled local anesthetic system.     

Tramadol added to 1.5% mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently

Adjuncts to local anesthetics for peripheral plexus blockade may enhance the quality and duration of anesthesia and postoperative analgesia. The analgesic, tramadol, has a unique mechanism of action that suggests efficacy as such an adjunct. It displays a central analgesic and peripheral local anesthetic effect. We designed a prospective, randomized, controlled and double-blind clinical trial to assess the effect of tramadol added to brachial plexus anesthesia. One-hundred patients scheduled for carpal tunnel release surgery under brachial plexus anesthesia were randomized into four groups. All patients received 1.5% mepivacaine 40 mL plus a study solution containing either isotonic sodium chloride (Group P, n = 17), tramadol 40 mg (Group T(40), n = 22), tramadol 100 mg (Group T(100), n = 20) or tramadol 200 mg (Group T(200), n = 20). We evaluated the time of onset of anesthesia, duration of sensory and motor blockade, duration and quality of postoperative analgesia, and occurrence of adverse effects. Onset and duration of sensory and motor blocks were not different among groups. The number of patients requesting analgesia in the postoperative period was significantly less in the 3 tramadol groups compared with the placebo group (P = 0.02); this was also noted with the placebo and T(40) groups compared with the T(200) group. No statistical significance was demonstrated between the placebo and the T(40) group or the T(100) group and the T(200) group. Furthermore, there was a significant trend effect among groups applying the Cochran-Armitage tendency test (P = 0.003), suggesting a dose-dependent decrease for additional postoperative analgesia requirements when tramadol was added. Side effects did not differ among groups, although they were more frequently recorded in the T groups. Our study suggests that tramadol added to 1.5% mepivacaine for brachial plexus block enhances in a dose-dependent manner the duration of analgesia with acceptable side effects. However, the safety of tramadol has to be investigated before allowing its use in clinical practice. IMPLICATIONS: Tramadol's unique mechanism of action suggests efficacy as a local anesthetic adjunct for peripheral plexus blockade. Our study demonstrates that tramadol, added to mepivacaine for brachial plexus anesthesia, extends the duration and improves the quality of postoperative analgesia in a dose dependent fashion with acceptable side effects.     

Articaine and lidocaine for maxillary infiltration anesthesia.

This study was undertaken to compare the anesthetic properties of articaine hydrochloride with 1:200,000 epinephrine (Ultracain DS) and lidocaine with 1:80,000 epinephrine (Xylocain-Adrenalin) for maxillary infiltration anesthesia. Twenty healthy dental student volunteers were included in this double-blind study. Each subject received 0.6 mL of each test solution at different times. Infiltration anesthesia was performed on the upper lateral incisor. The onset and duration of anesthesia were monitored using an electric pulp tester. No statistically significant differences were seen in the onset and duration of anesthesia between the articaine and lidocaine solutions.     

The Efficacy of a Repeated Buccal Infiltration of Articaine in Prolonging Duration of Pulpal Anesthesia in the Mandibular First Molar

Previous studies have shown declining rates of pulpal anesthesia over 60 minutes when a cartridge of 4% articaine is used with 1∶100,000 epinephrine for buccal infiltration in the mandibular first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular first molar buccal infiltrations, given in 2 separate appointments, to 86 adult subjects: an initial infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine plus a repeated infiltration of the same anesthetic and dose given 25 minutes following the initial infiltration versus an initial infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine plus a mock repeated infiltration given 25 minutes following the initial infiltration. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 112 minutes after the injections. The repeated infiltration significantly improved pulpal anesthesia from 28 minutes through 109 minutes in the mandibular first molar. A repeated infiltration of a cartridge of 4% articaine with 1∶100,000 epinephrine given 25 minutes after an initial infiltration of the same type and dose of anesthetic significantly improved the duration of pulpal anesthesia, when compared with only an initial buccal infiltration, in the mandibular first molar.     

Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade

Tramadol is an analgesic drug that is antagonized by alpha2-adrenoceptor antagonists, as well as opioid antagonists. We hypothesized that tramadol might produce effects on an axillary brachial plexus blockade similar to those of clonidine. We designed a prospective, controlled, double-blinded study to assess the impact of tramadol added to mepivacaine on the duration of an axillary brachial plexus blockade. After institutional approval and informed consent, 60 patients (ASA physical status I or II) scheduled for forearm and hand surgery after trauma under brachial plexus anesthesia were included in the study. Patients were randomly assigned to receive either 40 mL of mepivacaine 1% with 2 mL of isotonic sodium chloride solution (Group A, n = 20); 40 mL of mepivacaine 1% with 100 mg of tramadol (Group B, n = 20); or 40 mL of mepivacaine 1% with 2 mL of isotonic sodium chloride solution and 100 mg of tramadol i.v. (Group C, n = 20). Sensory block, motor block, and hemodynamics were recorded before and 5, 10, 30, 60, 120, 180, and 360 min after local anesthetic injection. Duration of sensory and motor block was significantly longer (P < 0.01; P < 0.05) in Group B (299 +/- 84 and 259 +/- 76 min) than in Group A (194 +/- 35 and 181 +/- 24 min) and Group C (187 +/- 35 and 179 +/- 16 min). There was no difference in onset of sensory and motor blockade among groups. Hemodynamics remained unchanged in all patients throughout the study period. We conclude that the addition of tramadol prolongs the duration of brachial plexus block without side effects. Tramadol may be an alternative to epinephrine or clonidine as an adjuvant to local anesthesia for an axillary block. Implications: This study demonstrates that the admixture of 100 mg of tramadol with mepivacaine 1% for brachial plexus block provides a pronounced prolongation of blockade without side effects. Our data support a specific analgesic effect of tramadol on peripheral nerves.     

Articaine and mepivacaine efficacy in postoperative analgesia for lower third molar removal: a double-blind, randomized, crossover study.

OBJECTIVE: Comparison of the clinical efficacy of 4% articaine in relation to 2% mepivacaine, both with 1:100,000 epinephrine, in the prevention of postoperative pain after lower third molar removal. STUDY DESIGN: Twenty patients underwent removal of bilateral lower third molars under local anesthesia (articaine or mepivacaine) in 2 separate appointments, in a double-blind, randomized, and crossed manner. Objective and subjective parameters were recorded for paired comparison of postoperative courses. RESULTS: Duration of analgesia provided by articaine and mepivacaine was 198.00 +/- 25.86, and 125.40 +/- 13.96 min, respectively (P = .02), whereas the duration of anesthesia was 273.80 +/- 15.94 and 216.85 +/- 20.15 min, respectively (P = .06). Both solutions exerted no important effects upon arterial pressure, heart rate, or oxygen saturation (P > .05). CONCLUSIONS: Articaine provides a longer period of analgesic effect and a tendency for a longer period of anesthesia as compared to mepivacaine. The presence of a vasoconstrictor agent in local anesthetic solutions does not seem to influence hemodynamic parameters during lower third molar removal in healthy subjects.     

Comparative study on anesthetic potency of dental local anesthetics assessed by the jaw-opening reflex in rabbits

The potency of 4 local anesthetics to dental pulp was compared. Drugs were 4% articaine with 12 microgram/mL epinephrine (A12), 4% articaine with 6 microgram/mL epinephrine (A6), 2% lidocaine with 12.5 microgram/mL epinephrine (L), and 3% propitocaine with 0.03 IU/mL felypressin (P). Local anesthetics were injected into the dental root of the mandibular incisor. Electromyogram (EMG) of the digastric muscle was measured during the jaw-opening reflex induced by electrical stimulation. The disappearance of the EMG wave was judged as positive evidence of anesthesia. The determination of ED50 of the anesthetic was made by probit analysis. The ED50 of the A12 was minimal in all the tested anesthetics throughout the entire course. The potency in the A6 was 2.8 times that of the L. The potency of the A12 at the 15-minute measurement was 3.8 times that of the A6. The ED50 of the P was higher compared with those of the other 3 groups. It was concluded that articaine showed quicker onset than lidocaine and propitocaine and that there was a need to increase the dosage to attain a quick onset or to extend the duration.     

The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine.

BACKGROUND AND OBJECTIVES: Tramadol and metoclopramide have a local anesthetic effect similar to lidocaine following intradermal injection. When metoclopramide was retained in the venous system for 1 minute, it was found to be as effective as lidocaine in reducing propofol injection pain. Using this metoclopramide model, the effects of tramadol in reducing pain on propofol injection was investigated. METHODS: One hundred five patients were randomly allocated to receive 50 mg tramadol (group T), 60 mg lidocaine (group L), or normal saline (group NS) as pretreatment to reduce pain on propofol injection. Following venous occlusion with a tourniquet (70 mm Hg), one of the drugs was intravenously administered. Venous retention of the drug was maintained for 1 minute. Immediately after the tourniquet release, intravenous injection of 100 mg propofol (10 mL) at a rate of 0.5 mL/s followed. Pain assessment was made after each injection. RESULTS: Transient minor injection pain and local skin reactions were significantly greater with tramadol than with lidocaine (P < .05). Both tramadol and lidocaine significantly reduced the incidence and intensity of propofol injection pain when compared with normal saline (P < .05). CONCLUSIONS: Using -minute retention in veins, both tramadol and lidocaine significantly reduced propofol injection pain. A local anesthetic activity is postulated.     

Epidural bolus injection with alkalinized lidocaine improves blockade of the first sacral segment — a brief report

PURPOSE: It has been reported that the addition of epinephrine and/or bicarbonate to local anesthetic enhances the depth of epidural blockade and that initial partial bolus injection results in greater caudal spread. We evaluated the anesthetic effects of lidocaine with epinephrine and/or bicarbonate injected into the epidural space by bolus or catheter injection. METHODS: Forty-four patients undergoing epidural anesthesia with 17 mL of 2% lidocaine containing 1:200,000 epinephrine at L4-5 or L5-S1 were randomly divided into four groups. Lidocaine was administrated via epidural catheter [lidocaine catheter (LC) group] or Tuohy needle (lidocaine bolus group), lidocaine-bicarbonate was administrated via catheter (lidocaine-bicarbonate catheter group) or needle [lidocaine-bicarbonate bolus (LBB) group]. Pain threshold after repeated electrical stimulation was performed at L2 and S1 regions. Motor blockade was evaluated using the Bromage scale. Sympathetic blockade was assessed with plethysmographic waveforms from the toe. RESULTS: The pain threshold of the S1 dermatome in LBB group was significantly higher than in the lidocaine only groups, however, differences in the pain threshold at the L2 dermatome among the groups were insignificant. The onset of sensory blockade in the S1 dermatome in the LBB group was significantly shorter than in the LC group. Significantly greater motor blockade was achieved in the lidocaine-bicarbonate groups than in the lidocaine-only groups. The amplitude of plethysmographic waveforms significantly increased within each group. CONCLUSION: Epidural bolus injection of lidocaine-bicarbonate with epinephrine improves the pain threshold and speeds the onset of the blockade of the first sacral region.     

Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade

Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 +/- 76 versus 98 +/- 33 min) and motor (310 +/- 81 versus 130 +/- 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.     

Hemodynamic and blockade effects of high/low epinephrine doses during axillary brachial plexus blockade with lidocaine 1.5%: A randomized, double-blinded study

BACKGROUND AND OBJECTIVES: Although epinephrine commonly is added to local anesthetics for regional anesthesia, rarely it may cause undesirable hemodynamic side effects. This study compared the hemodynamic and blockade effects of 25 and 200 microg epinephrine during axillary brachial plexus blockade with lidocaine 1.5%. METHODS: Sixty American Society of Anesthesiologist classification I or II patients were divided randomly into 3 groups. Patients in group 1 received 5 mL of saline containing 25 microg epinephrine and then 35 mL of 1.5% lidocaine; patients in group 2 received 5 mL of saline alone and then 200 microg of epinephrine mixed with 35 mL of 1.5% lidocaine; patients in group 3 received 5 mL of saline alone and then 35 mL of 1.5% lidocaine. Hemodynamic data were measured for 1 to 10 minutes at 1-minute intervals after axillary injection. The duration time of motor and sensory block was recorded. RESULTS: Complete anesthesia was achieved in 85% of patients in groups 1 and 3 and 90% in group 2. Motor block duration was significantly longer in group 2 than in groups 1 and 3 (P <.05). There were no significant differences in analgesia between groups 1 and 2. Analgesia duration was significantly longer in groups 1 and 2 than in group 3 (P <.05). Heart rate from the 3rd to 6th minute was higher in group 2 than in groups 1 and 3 (P <.05). Systolic arterial pressure from the 3rd to 5th minute and diastolic arterial pressure from 2nd to 6th minute were higher in group 2 than in groups 1 and 3 (P <.05). CONCLUSIONS: Low-dose epinephrine offers more stable hemodynamics and similar blockade, and thus may be beneficial for patients undergoing forearm and hand surgery who are at risk for tachycardia and/or hypertension.     

A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal

OBJECTIVE: This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal. STUDY DESIGN: Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS: A statistically significant difference between the time to onset of A200 (1.66 +/- 0.13 minutes) and B200 (2.51 +/- 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% +/- 3.00% and 88.57% +/- 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05). CONCLUSIONS: In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.     

Is permanent maxillary tooth removal without palatal injection possible?

OBJECTIVE: The aim of the present study was to demonstrate if articaine HCl could provide palatal anesthesia in maxillary tooth removal without the need for a second palatal injection. STUDY DESIGN: Of 53 patients, 23 had bilateral and 30 had unilateral extractions. In the study group 2 mL of 4% articaine/HCl with 1:100,000 epinephrine was injected into the buccal vestibule of the tooth. After 5 min the extraction was performed. 27 subjects were controls and subjected to the same protocol with palatal injection. All patients completed a Faces Pain Scale (FPS) and a 100-mm Visual Analogue Scale (VAS) after extraction. RESULTS: According to VAS and FPS scores, when permanent maxillary tooth removal with palatal injection (97.5%) and without palatal injection (96.8%) were compared the difference was not statistically significant (P > .05) [corrected]. CONCLUSION: Permanent removal of maxillary teeth without palatal injection is possible by depositing 2 mL articaine/HCl to the buccal vestibule of the tooth.     

Effect of PaCO2 and PaO2 on Lidocaine and Articaine Toxicity

Alterations in arterial PaCO₂ can influence local anesthetic toxicity. The objective of this study was to evaluate the effect of stress-induced changes in PaCO₂ and PaO₂ on the seizure threshold of lidocaine and articaine. Lidocaine (2% with 1 ∶ 100,000 epinephrine) or articaine (4% with 1 ∶ 100,000 epinephrine) was administered intravenously under rest or stress conditions to 36 rats separated into 4 groups. Propranolol and prazosin were administered preoperatively to minimize cardiovascular effects of epinephrine. Mean arterial pressure (MAP), heart rate (HR), and arterial pH, PaCO₂, and PaO₂ were measured. Results showed no differences in MAP, HR, or pH. Stress significantly increased the latency period for the first tonic-clonic seizure induced by a toxic dose of both lidocaine and articaine (P < .05). Seizures were brought on more rapidly by articaine. No significant difference between toxic doses of lidocaine and articaine was noted. Stress raised the seizure threshold dose for both drugs and significantly (P < .01) increased arterial PaO₂ from 94.0 ± 1.90 mm Hg to 113.0 ± 2.20 mm Hg, and reduced PaCO₂ from 36.0 ± 0.77 mm Hg to 27.0 ± 0.98 mm Hg. In conclusion, reduction in PaCO₂ and/or increase in PaO₂ raised the seizure threshold of lidocaine and articaine. This study also confirmed that lidocaine and articaine have equipotent central nervous system toxicity.     

Caudal bupivacaine-tramadol combination for postoperative analgesia in pediatric herniorrhaphy

BACKGROUND: Administration of bupivacaine caudally has been used for postoperative analgesia after urogenital, rectal and lower abdominal surgery in children. Caudal opioids may offer analgesic advantages over bupivacaine alone but have been associated with side effects such as respiratory depression. Tramadol is an analgesic assumed to lack a respiratory depressant effect and has been shown to provide effective, long-lasting analgesia after epidural administration in adults and children. The aim of this study was to determine whether the addition of tramadol to bupivacaine caudally prolongs the duration of analgesia compared with bupivacaine alone, with respect to side effects, and whether caudal tramadol alone provides satisfactory analgesia. METHODS: Sixty boys, aged 12-84 months, undergoing unilateral herniorrhaphy, were allocated randomly to three groups. Children in group B received 0.25% plain bupivacaine 1 ml kg(-1), group BT received an identical local anesthetic dose mixed with tramadol 1.5 mg kg(-1) and group T received caudal tramadol 1.5 mg kg(-1) in 0.9% sodium chloride in the same total volume (1 ml kg(-1)). Pain and demeanour assessments were made 1, 2, 3, 4, 6, 12 and 24 h after recovery from anesthesia with reference to a three-point scale. RESULTS: Analgesia time (time between caudal injection and first administration of analgesic) in group BT (13.5+/-2.2 h) was significantly longer than in the other two groups (P<0.05). In group T, more patients required additional analgesia after surgery than in the other two groups (P<0.05). Pain scores in the three groups were similar up to 4 h after operation but the mean score in group T was higher than groups B and BT 4 and 6 h after operation (P<0.05). Significantly more patients who had received caudal bupivacaine alone or with tramadol had lower pain and demeanour scores during the first 24 h after operation compared with those in the tramadol group. CONCLUSION: Caudal administration of bupivacaine with the addition of tramadol resulted in superior analgesia with a longer period without demand for additional analgesics compared with caudal bupivacaine and tramadol alone without an increase of side effects.     

硬膜外注射曲马多和康尼克通合剂用于术后镇痛的观察

报道了硬膜外注射曲马多和康尼克通合剂用于术后镇痛。随机分为四组，即对照组、曲马多组、康尼克通组和曲马多与康尼克通合用组。采用双盲法观察镇痛时间、疼痛缓解率及有关并发症。结果表明，曲马多和康尼克通联合应用明显优于单一用药，表现为镇痛时间明显延长，疼痛缓解率显著提高，血浆去甲肾上腺素和肾上腺素水平下降明显。证明曲马多和康尼克通联合应用具有协同增效作用，且简单易行。     

Effect of standard diluted epinephrine infusion on epidural anesthesia in labor

BACKGROUND AND OBJECTIVES: Epinephrine is used with local anesthetics to prolong the duration of epidural analgesia and decrease the peak plasma concentrations of local anesthetics. However, the duration of labor may be prolonged because epinephrine reduces uterine activity. We designed a prospective, randomized, and doubleblind study to examine the effects of epinephrine infusion on the quality of analgesia and plasma concentration of local anesthetic, as well as the effect on the uteroplacental circulation, duration of the first or second stage of labor, and fetal outcome. METHODS: Twenty-four parturients received continuous epidural bupivacaine 0.125% (8 mL/h) combined either with epinephrine (40 microg/h) (n = 12) or without epinephrine (n = 12) for analgesia during labor. If patients requested additional analgesia, a bolus of 1% or 1.5% lidocaine (6 to 10 mL) was given. RESULTS: Only the plain bupivacaine group required additional lidocaine. However, epinephrine infusion prolonged the median (range) duration of the second stages of labor: 69 (21 to 231) minutes with epinephrine group versus 31 (8 to 99) minutes without epinephrine group (P < .05), and decreased pH in umbilical artery at the time of delivery. Epinephrine infusion did not change the uterine and umbilical blood flow, which were determined as the resistance indices. Changes in the fetal heart rate and Apgar score were also comparable. Epinephrine significantly reduced the umbilical venous to maternal arterial bupivacaine concentration (P < .05). CONCLUSIONS: A standard diluted epinephrine infusion (40 microg/h) into epidural space decreased anesthetic requirements. The possibility of the prolonged duration of labor remains a problem.     

Comparison of caudal morphine and tramadol for postoperative pain control in children undergoing inguinal herniorrhaphy

OBJECTIVES: We compared the quality and duration of analgesia, the effect on perioperative sevoflurane requirement after a single, presurgical caudal block with either tramadol or morphine in children undergoing inguinal herniorrhaphy. Our study was also designed to evaluate the preemptive analgesic efficacy of morphine administered caudally in children. METHODS: Patients were randomly divided into three groups to receive 2 mg.kg-1 tramadol (group T, preemptive group) or morphine sulphate 0.03 mg.kg-1 (group M, preemptive group). The patients in control group (group C, postincisional group) received morphine sulphate 0.03 mg.kg-1 at the end of surgery, caudally. Cardiorespiratory data, sedation and pain were recorded for 24 h following recovery from anaesthesia. RESULTS: There were no differences between the three groups in baseline blood pressure or heart rate; or duration of anaesthesia, surgery. The inhaled sevoflurane concentration was significantly lower in group M and group T than in the control group. The quality and duration of postoperative pain relief did not differ between the three groups. There were no intergroup differences in postoperative nausea, vomiting, or other complications. CONCLUSION: Caudal tramadol (2 mg.kg-1) provided reliable postoperative analgesia similar to caudal morphine (0.03 mg.kg-1) in quality and duration of pain relief in our study children who were undergoing herniorrhaphy. We also concluded that presurgical caudal morphine or tramadol reduced perioperative sevoflurane requirements and either presurgical or postsurgical caudal morphine did not make any difference to postoperative analgesia.     

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized,Double-Blind Controlled Trial

Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.