Local anesthetics for the Nephrologist

Uppal, Nupur N.; Jhaveri, Mital; Hong, Susana; Shore‐Lesserson, Linda; Jhaveri, Kenar D.; Izzedine, Hassan

doi:10.1093/ckj/sfab121

Cited by 9 publications

(4 citation statements)

References 49 publications

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“…Early cardiotoxicity may present as tachycardia and hypertension quickly followed by hypotension, cardiovascular collapse, and death. 15 The incidence of LAA related toxicity is estimated to be .03% for peripheral nerve blocks. However, rates are estimated to be higher with continuous flow catheter techniques and in patients with uremia.…”

Section: Discussionmentioning

confidence: 99%

“…LAA toxicity initially presents with central nervous system symptoms such as light‐headedness, dizziness, or drowsiness and may progress to seizures and coma. Early cardiotoxicity may present as tachycardia and hypertension quickly followed by hypotension, cardiovascular collapse, and death 15 . The incidence of LAA related toxicity is estimated to be .03% for peripheral nerve blocks.…”

Section: Discussionmentioning

confidence: 99%

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Continuous flow local anesthetic wound infusion for post‐operative analgesia following kidney transplantation

Thakker,

Temple,

Minnick

et al. 2024

Clinical Transplantation

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BackgroundSome patients with end stage renal disease are or will become narcotic‐dependent. Chronic narcotic use is associated with increased graft loss and mortality following kidney transplantation. We aimed to compare the efficacy of continuous flow local anesthetic wound infusion pumps (CFLAP) with patient controlled analgesia pumps (PCA) in reducing inpatient narcotic consumption in patients undergoing kidney transplantation.Materials and MethodsIn this single‐center, retrospective analysis of patients undergoing kidney transplantation, we collected demographic and operative data, peri‐operative outcomes, complications, and inpatient oral morphine milligram equivalent (OME) consumption.ResultsFour hundred and ninety‐eight patients underwent kidney transplantation from 2020 to 2022. 296 (59%) historical control patients received a PCA for postoperative pain control and the next 202 (41%) patients received a CFLAP. Median age [53.5 vs. 56.0 years, p = .08] and BMI [29.5 vs. 28.9 kg/m2, p = .17] were similar. Total OME requirement was lower in the CFLAP group [2.5 vs. 34 mg, p < .001]. Wound‐related complications were higher in the CFLAP group [5.9% vs. 2.7%, p = .03]. Two (.9%) patients in the CFLAP group experienced cardiac arrhythmia due to local anesthetic toxicity and required lipid infusion.ConclusionsCompared to PCA, CFLAP provided a 93% reduction in OME consumption with a small increase in the wound‐related complication rate. The utility of local anesthetic pumps may also be applicable to patients undergoing any unilateral abdominal or pelvic incision.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Continuous flow local anesthetic wound infusion for post‐operative analgesia following kidney transplantation

Thakker,

Temple,

Minnick

et al. 2024

Clinical Transplantation

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“…The onset time, potency, and duration of action of LA depends on factors such as pKa, lipid solubility, and protein binding [11]. LA primarily binds to two plasma proteins: α1-acid glycoprotein with high capacity and low affinity, and albumin with low affinity and high capacity.…”

Section: Discussionmentioning

confidence: 99%

Examination of the effect of bupivacaine on brain tissue in rats with induced experimental renal failure

Yılmaz,

Tepe,

Uludağ

2023

J Surg Med

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Background/Aim: Local anesthetics are frequently used and often considered harmless, but they can precipitate local anesthetic systemic toxicity (LAST) when accidentally administered intravascularly or when a toxic dose is rapidly absorbed, which can result in mortality. In cases of renal function impairment, the altered pharmacokinetics of local anesthetics lead to a lowered toxicity threshold. In this study, the aim was to histopathologically investigate the increase in neurotoxicity in the central nervous system due to bupivacaine in experimental renal failure. Methods: In the study, a total of 28 male Wistar albino rats, aged 8-10 weeks, were evenly divided into four groups: Group C (control group) received intraperitoneal 1 mL/kg saline; Group G (glycerol group) received intramuscular 10 mL/kg glycerol, Group GB (glycerol+bupivacaine group) received intramuscular 10 mL/kg glycerol followed by intraperitoneal 4 mg/kg bupivacaine; and Group B (bupivacaine group) received intraperitoneal 4 mg/kg bupivacaine. All rats were sacrificed after the experimental period. Tissue samples were preserved and stained with hematoxylin-eosin for histopathological analyses. TRPM2 and Reelin levels in brain tissue were measured using immunohistochemical methods. Results: In the histopathological examination, Group G exhibited higher Reelin and TRPM2 levels compared to all other groups (P<0.001). In Group GB, both Reelin and TRPM2 immunoreactivity were significantly higher compared to Group B (P<0.001). Conclusion: It can be concluded that renal dysfunction increases neurotoxicity in brain tissue associated with bupivacaine.

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“…As a result of the increased filtration capacity, the clearance of albumin, glucose, creatinine, and urea increased, as did the clearance of drugs. Drugs such as lidocaine, cleared by the kidneys, should have their doses adjusted to the clearance rates ( Calimag-Loyola & Lerma, 2019 ; Uppal et al, 2022 ).…”

Section: Survey Methodologymentioning

confidence: 99%

Physiology of pregnancy and oral local anesthesia considerations

Zhou

Zhong

Pan

et al. 2023

PeerJ

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Background Safe and effective local anesthesia is a prerequisite for emergency oral surgeries and most dental treatments. Pregnancy is characterized by complex physiological changes, and increased sensitivity to pain. Pregnant women are particularly vulnerable to oral diseases, such as caries, gingivitis, pyogenic granuloma and third molar pericoronitis. Maternally administered drugs can affect the fetus through the placenta. Therefore, many physicians and patients are reluctant to provide or accept necessary local anesthesia, which leads to delays in the condition and adverse consequences. This review is intended to comprehensively discuss the instructions for local anesthesia in the oral treatment of pregnant patients. Methodology An in-depth search on Medline, Embase, and the Cochrane Library was performed to review articles concerned with maternal and fetal physiology, local anesthetic pharmacology, and their applications for oral treatment. Results Standard oral local anesthesia is safe throughout the pregnancy. At present, 2% lidocaine with 1:200,000 epinephrine is considered to be the anesthetic agent that best balances safety and efficacy for pregnant women. Maternal and fetal considerations must be taken into account to accommodate the physiological and pharmacological changes in the gestation period. Semi-supine position, blood pressure monitoring, and reassurance are suggested for high-risk mothers to reduce the risk of transient changes in blood pressure, hypoxemia, and hypoglycemia. For patients with underlying diseases, such as eclampsia, hypertension, hypotension, and gestational diabetes, the physicians should use epinephrine cautiously and control the dose of anesthetic. New local anesthesia formulations and equipment, which contribute to minimizing injection pain and relieving the anxiety, have and are being developed but remain understudied. Conclusions Understanding the physiological and pharmacological changes during pregnancy is essential to ensure the safety and efficiency of local anesthesia. Optimal outcomes for the mother and fetus hinge on a robust understanding of the physiologic alterations and the appropriate selection of anesthetic drugs and approaches.

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Local anesthetics for the Nephrologist

Cited by 9 publications

References 49 publications

Continuous flow local anesthetic wound infusion for post‐operative analgesia following kidney transplantation

Continuous flow local anesthetic wound infusion for post‐operative analgesia following kidney transplantation

Examination of the effect of bupivacaine on brain tissue in rats with induced experimental renal failure

Physiology of pregnancy and oral local anesthesia considerations

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