Toxicity of Local Anesthetics

Tasch, Mark D.; Butterworth, John F.

doi:10.1097/00126869-200634010-00015

Cited by 9 publications

(5 citation statements)

References 55 publications

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“…14,27e29 Based on the evidence provided on possible chondrocyte viability and its safety and efficacy, a standard dose of bupivacaine (0.25% without epinephrine) was considered a safe method to provide postoperative pain control. 28 Our data analysis of FPS-R and opioid consumption, measured as morphine equivalents, showed that both groups used similar amounts of postoperative pain medication and does not favor the use of local hematoma to decrease the need for opioid use on postoperative day 1 in pediatric SHF after patients undergo closed reduction percutaneous pin fixation. It is unclear at this stage whether results would differ with greater power; our results should be validated in a larger sample.…”

Section: Discussionmentioning

confidence: 73%

“… 26 Furthermore, bupivacaine has a more rapid, profound, and effective (3 to 4 times) anesthetic effect on soft tissues and bones than lidocaine, as well as a longer half-life (2.7–8.1 hours vs 1.5–2 hours). 14 , 27 , 28 , 29 Based on the evidence provided on possible chondrocyte viability and its safety and efficacy, a standard dose of bupivacaine (0.25% without epinephrine) was considered a safe method to provide postoperative pain control. 28 …”

Section: Discussionmentioning

confidence: 99%

“… 14 , 27 , 28 , 29 Based on the evidence provided on possible chondrocyte viability and its safety and efficacy, a standard dose of bupivacaine (0.25% without epinephrine) was considered a safe method to provide postoperative pain control. 28 …”

Section: Discussionmentioning

confidence: 99%

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Local Hematoma Block as Postoperative Analgesia in Pediatric Supracondylar Humerus Fractures

Astacio

Echegaray

Rivera

et al. 2020

Journal of Hand Surgery Global Online

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Supracondylar humerus fracture (SHF) is the most common type of fracture in children. The aim of this study was to evaluate the efficacy of local hematoma block with 0.25% bupivacaine as postoperative pain control in patients with pediatric SHF who underwent closed reduction pin fixation. Methods: We performed an institutional review boardeapproved, prospective cohort study of 65 patients with SHF treated with closed reduction percutaneous pin fixation. For 6 months, all patients were randomly divided into 2 groups. The treatment group (35 patients) received an intraoperative local hematoma block using 0.25% bupivacaine whereas the control group (30 patients) did not receive a local hematoma block as postoperative pain management adjuvant. After surgery, all patients were prescribed opioid pain medication. To evaluate the efficacy of the hematoma block, postoperative morphine equivalent consumption and the Faces Pain ScaleeRevised (FPS-R) survey were blindly recorded during postoperative day 1. Demographic data, surgical details, clinical neurovascular examination during the hospital stay, and complications were also evaluated. Results: Comparison of the control group with the treatment group showed similar morphine equivalent consumption and Face Pain ScaleeRevised Survey results. No hematoma block-associated complications were reported. Conclusions: The result of this study do not favor the use of local hematoma block to improve pain control and decrease the need for opioid use on postoperative day 1 in pediatric SHF after patients undergo closed reduction percutaneous pin fixation. These results can lay the foundation for future studies while suggesting new, novel opioid-free pain control strategies in patients with SHF. Type of study/level of evidence: Therapeutic II.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

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Local Hematoma Block as Postoperative Analgesia in Pediatric Supracondylar Humerus Fractures

Astacio

Echegaray

Rivera

et al. 2020

Journal of Hand Surgery Global Online

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“…With the exception of bupivacaine, cardiovascular toxicity becomes evident after plasma levels have compromised the central nervous system. Cardiovascular toxicity is manifested by arrhythmias and refractory myocardial depression, especially when the agent used is bupivacaine 28 . Toxic doses are capable of inhibiting sinoatrial and atrioventricular node conduction, prolonging the PR space, widening the QRS complex, generating atrioventricular blocks of varying degrees and arrhythmias, both bradycardias and reentrant tachyarrhythmias with ventricular tachycardia or fibrillation 11 .…”

Section: Local Anesthetic Toxicitymentioning

confidence: 99%

“…Bupivacaine is bound predominantly to open and inactive Na+ channels, which may justify the severity of toxicity. Myocardial depression occurs because of several factors: inhibition of Ca++ release in the sarcoplasmic reticulum by blockade of β-adrenergic receptors, decreasing adenylate cyclase activity by reducing the synthesis of cyclic adenosine monophosphate and the conversion of ADP into ATP 28 .…”

Section: Local Anesthetic Toxicitymentioning

confidence: 99%

Lipídeos nas intoxicações por anestésicos locais

Udelsmann

Dreyer

Melo

et al. 2012

ABCD, arq. bras. cir. dig.

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-Introduction -With the advent of long-lasting local anesthetics, local and regional anesthesia gained considerable impetus and the use of these techniques has become increasingly widespread. New block techniques have been described and regional anesthesia is frequently associated with general anesthesia to provide postoperative analgesia. In contrast, large doses of local anesthetics are required with the risk of accidents due to inadvertent intravascular injection, which is a severe complication without a specific treatment until a few years ago. In 1998, the use of lipid emulsions was proposed in animals. Since 2006, many studies have demonstrated an interest in these solutions in cases of local anesthetic-induced toxicity with a decrease in morbidity and mortality. The aim of this review article was to research the methodology, reviewing mechanisms, interests, limitations and currently recommended treatment. Method -Some historical references on local anesthetics, articles published during the last 30 years in journals indexed in Medline and in two textbooks were reviewed. Articles on local anesthetic toxicity, lipid emulsion therapy, review articles on the topic and treatment adopted in diverse services and countries were selected, producing a summary. Conclusions -It is no longer necessary to show the effectiveness and interest in lipid emulsion therapy for local anesthetic toxicity. Various specialty societies have already published their guidelines and advice about stocking these products in any setting in which local and regional anesthetic techniques are practiced. ABCDDV/867RESUMO -Introdução -Com o advento dos anestésicos locais de longa duração, a anestesia locorregional ganhou grande impulso sendo cada vez mais utilizada. Novas técnicas de bloqueios foram descritas e a técnica é frequentemente associada à anestesia geral com o objetivo de proporcionar analgesia pós-operatória. A contra-partida é a necessidade da utilização de grandes doses com risco de acidentes por injeção intravascular inadvertida; trata-se de complicação grave sem tratamento específico até há alguns anos. Em 1998 foi proposta a utilização de emulsões lipídicas em animais e a partir de 2006 vários trabalhos demonstraram o interesse dessas soluções nos casos de intoxicações por anestésicos locais com diminuição da morbi-mortalidade. O objetivo desta revisão foi fazer um levantamento da metodologia, revisando os mecanismos, interesses, limites e as condutas preconizadas atualmente. Método -Foram revistas algumas referências históricas sobre anestésicos locais, artigos publicados nos últimos 30 anos em revistas indexadas no Medline e em dois livrostexto. Foram selecionados os artigos que tratavam da intoxicação por anestésicos locais, da terapia com emulsões lipídicas, os de revisão sobre o assunto e as condutas adotadas em diversos serviços e países, sendo realizada uma síntese. Conclusões -A eficiência e interesse da terapia com emulsões lipídicas nas intoxicações por anestésicos locais não é mais a demonstrar; várias soc...

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