Etidocaine hydrochloride in surgical procedures: effects on postoperative analgesia

Article Abstract:

A locally acting anesthetic known as etidocaine hydrochloride has certain properties that may make it desirable for use in dental anesthesia. One of these qualities is its prolonged duration of effectiveness. Anesthesia sufficient for surgery can be maintained for six to eight hours, followed by a considerable period of analgesia (pain relief). A discussion of the biological and pharmacological properties of this agent is provided. A study of 14 patients who required bilateral extraction of lower third molars was performed, using an intravenously injected sedative, nitrous oxide, oxygen, and local anesthesia with etidocaine hydrochloride injection on one side, and lidocaine hydrochloride (a commonly used agent) on the other. No adverse reactions were noted, and the extractions proceeded. Patients were asked to evaluate pain, numbness, number of analgesics they took following the extractions, and other aspects of their recovery. Results showed that the analgesic time for etidocaine was 7.6 hours, on the average, and an anesthetic time of 9.4 hours. Lidocaine provided an analgesic time of 1.8 hours and an anesthetic period of 2.7 hours. Numbness was never reported as disappearing first on the side injected with lidocaine. Forty-three percent of the patients reported no pain after surgery on the etidocaine side, while all lidocaine-treated extractions resulted in pain. Up until 12 hours after treatment, 92 percent of the patients had less pain on the etidocaine side. The most intense pain following tooth extraction is said to occur between three and five hours after surgery, a time when the longer-lasting analgesia of etidocaine is still in effect. In summary, etidocaine hydrochloride may be a suitable dental analgesic for procedures that often cause postoperative pain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Case studies, Anesthesia in dentistry, Dental anesthesia, Analgesia, Local anesthesia

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Interpleural analgesia

Article Abstract:

Pain relief increases patient comfort, and it also helps the patient to breathe and move about better, leading to a decrease in complications and faster recovery. Opiates are often ineffective for this purpose, however, and may cause respiratory depression. Epidurals, which are injected into the spinal column, pose some risk, and may cause severe headache. Since 1986 a new method of delivering pain relief has been available: administration of local anesthetics into the interpleural space, the area between the ribs and the lungs. Interpleural anesthetics provide rapid and long-lasting relief after gallbladder, kidney, and breast surgery, and rib fractures. It has also been used to relieve the pain of chest metastasis and pancreatic cancer, and to provide anesthesia during breast biopsy. It is not clear how the anesthetic works, but it probably works on the nerves in the intercostal space. Two studies of interpleural pleural analgesia examined its use in children, but it has been used primarily for adults. The article describes the anatomy of the pleural space and the technique of placing the catheter. The article also indicates when interpleural anesthesia should not be used, and potential complications, including pneumothorax (an air pocket in the space around the lung), catheter fracture, and inadequate anesthesia. Results obtained by other researchers are also mentioned, including several instances where interpleural anesthesia produced poor results. Nursing considerations for patients with interpleural analgesia are described in detail. (Consumer Summary produced by Reliance Medical Information, Inc.)

Anesthesia, Dosage and administration

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Epidural analgesia - a cause of transient impairment of the utero-placental circulation?

Article Abstract:

It is possible that epidural analgesia (pain-relieving drugs injected into the epidural space of the spine) given to women in labor causes the diversion of blood from internal organs, such as the uterus, as the body tries to maintain normal blood pressure. This may be the explanation for the episodes of reduced heart rate (bradycardia) in the fetus, which is often noted after epidural analgesia. To investigate this issue, 15 women were evaluated during epidural 'top-ups', periods when extra doses of analgesia were administered because of return of pain. Doppler ultrasound measurements were obtained on the uteroplacental and fetal circulation at these times, and the maternal blood pressure and pulse rate were also noted. No episodes of fetal bradycardia or changes in the fetal heart rate pattern were found. Blood flow in the umbilical artery did not change. Increases were seen in the systolic and end-diastolic peak velocities (flow rates at those points of the cardiac cycle) and in the time average of the mean velocity in the mother's femoral artery. The results indicate impairment of the uteroplacental circulation soon after a top-up, associated with increased blood flow through the femoral artery. Although transient, this could adversely affect a fetus whose oxygen levels are already insufficient due to other causes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetus, Peridural anesthesia, Epidural anesthesia, Prenatal ultrasonography

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