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[PMID]: 29252407 [Au] Autor: Wu T; Smith J; Nie H; Wang Z; Erwin PJ; van Wijnen AJ; Qu W [Ad] Endereço: From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (TW, JS, WQ); Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota (HN, AJvW); Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (ZW); Medical Library, Mayo Clinic, Rochester, Minnesota (PJE); Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota (WQ); and Spine Center, Mayo Clinic, Rochester, Minnesota (WQ). [Ti] Título: Cytotoxicity of Local Anesthetics in Mesenchymal Stem Cells. [So] Source: Am J Phys Med Rehabil;97(1):50-55, 2018 Jan. [Is] ISSN: 1537-7385 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Cell therapy based on the trophic, mitogenic, and immunomodulatory capacity of mesenchymal stem cells is a promising treatment modality for degenerative musculoskeletal conditions. Local anesthetics have been commonly used in interventional procedures for alleviating pain, but local anesthetics may have negative impact on MSC dosing because of cytotoxicity or other biological effects. Because previous studies have not reached consensus yet on the potential complications of local anesthetics in cell therapy, we reviewed 11 studies that involve in vitro experimentation with MSCs using aminoamide-type anesthetics including lidocaine, ropivacaine, mepivacaine, bupivacaine, articaine, and prilocaine. Three studies that compare the effects of different types of local anesthetic agents showed that ropivacaine has the least detrimental effects on mesenchymal stem cell populations, whereas lidocaine seems to have the most significant effects on stem cell viability. Concentration- and time-dependent effects on cell viability were reported with bupivacaine, ropivacaine, lidocaine, and mepivacaine. We conclude that local anesthetic agents have time- and concentration-dependent detrimental effects on MSCs. However, in vivo studies will be required to understand the interactions of these agents with MSCs, because in vitro studies cannot replicate the pharmacokinetics of anesthetics in vivo or the recovery of MSCs in a more physiological environment. [Mh] Termos MeSH primário: Amidas/toxicidade Anestésicos Locais/toxicidade Bupivacaína/toxicidade Lidocaína/toxicidade Mepivacaína/toxicidade Células Mesenquimais Estromais/efeitos dos fármacos [Mh] Termos MeSH secundário: Anestesia Local/estatística & dados numéricos Seres Humanos [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine); 98PI200987 (Lidocaine); B6E06QE59J (Mepivacaine); Y8335394RO (Bupivacaine) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171227 [Lr] Data última revisão: 171227 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171219 [St] Status: MEDLINE [do] DOI: 10.1097/PHM.0000000000000837

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[PMID]: 27776485 [Au] Autor: Okamoto A; Tanaka M; Sumi C; Oku K; Kusunoki M; Nishi K; Matsuo Y; Takenaga K; Shingu K; Hirota K [Ad] Endereço: Department of Anesthesiology, Kansai Medical University, Hirakata, Japan. [Ti] Título: The antioxidant N-acetyl cysteine suppresses lidocaine-induced intracellular reactive oxygen species production and cell death in neuronal SH-SY5Y cells. [So] Source: BMC Anesthesiol;16(1):104, 2016 10 24. [Is] ISSN: 1471-2253 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: The local anesthetic lidocaine can affect intra- and extra-cellular signaling pathways in both neuronal and non-neuronal cells, resulting in long-term modulation of biological functions, including cell growth and death. Indeed, lidocaine was shown to induce necrosis and apoptosis in vitro. While several studies have suggested that lidocaine-induced apoptosis is mitochondrial pathway-dependent, it remains unclear whether reactive oxygen species (ROS) are involved in this process and whether the observed cell death can be prevented by antioxidant treatment. METHODS: The effects of lidocaine and antioxidants on cell viability and death were evaluated using SH-SY5Y cells, HeLa cells, and HeLa cell derivatives. Cell viability was examined via MTS/PES ([3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt]/phenazine ethosulfate) assay. Meanwhile, cell apoptosis and necrosis were evaluated using a cell death detection assay with Annexin V-FITC and PI staining, as well as by assaying for caspase-3/7 and caspase-9 activity, and by measuring the release of lactate dehydrogenase, respectively. Mitochondrial transmembrane potential (ΔΨm) was assessed using the fluorescent probe tetramethylrhodamine ethyl ester. RESULTS: Lidocaine treatment resulted in suppression of the mitochondrial electron transport chain and subsequent attenuation of mitochondrial membrane potential, as well as enhanced ROS production, activation of caspase-3/7 and caspase-9, and induction of apoptosis and necrosis in SH-SY5Y cells in a dose- and time-dependent manner. Likewise, the anesthetics mepivacaine and bupivacaine also induced apoptosis in SH-SY5Y cells. Notably, the antioxidants N-acetyl cysteine (NAC) and Trolox successfully scavenged the mitochondria-derived ROS and suppressed local lidocaine-induced cell death. CONCLUSIONS: Our findings demonstrate that the local anesthetics lidocaine, mepivacaine, and bupivacaine inhibited the activity of mitochondria and induced apoptosis and necrosis in a dose-dependent manner. Furthermore, they demonstrate that treatment with the antioxidants NAC, Trolox, and GGA resulted in preservation of mitochondrial voltage and inhibition of apoptosis via suppression of caspase activation. [Mh] Termos MeSH primário: Acetilcisteína/farmacologia Antioxidantes/farmacologia Lidocaína/farmacologia Espécies Reativas de Oxigênio/metabolismo [Mh] Termos MeSH secundário: Acetilcisteína/administração & dosagem Anestésicos Locais/farmacologia Antioxidantes/administração & dosagem Apoptose/efeitos dos fármacos Bupivacaína/farmacologia Morte Celular/efeitos dos fármacos Linhagem Celular Tumoral Sobrevivência Celular/efeitos dos fármacos Cromanos/farmacologia Relação Dose-Resposta a Droga Células HeLa Seres Humanos Potencial da Membrana Mitocondrial/efeitos dos fármacos Mepivacaína/administração & dosagem Mitocôndrias/efeitos dos fármacos Neuroblastoma/metabolismo Fatores de Tempo [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T [Nm] Nome de substância: 0 (Anesthetics, Local); 0 (Antioxidants); 0 (Chromans); 0 (Reactive Oxygen Species); 98PI200987 (Lidocaine); B6E06QE59J (Mepivacaine); S18UL9710X (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid); WYQ7N0BPYC (Acetylcysteine); Y8335394RO (Bupivacaine) [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 171204 [Lr] Data última revisão: 171204 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 161026 [St] Status: MEDLINE

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[PMID]: 28671067 [Au] Autor: Adler DMT; Damborg P; Verwilghen DR [Ad] Endereço: Department of Veterinary Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Højbakkegaard Allé 5, DK-2630 Taastrup, Denmark. Electronic address: dima@sund.ku.dk. [Ti] Título: The antimicrobial activity of bupivacaine, lidocaine and mepivacaine against equine pathogens: An investigation of 40 bacterial isolates. [So] Source: Vet J;223:27-31, 2017 May. [Is] ISSN: 1532-2971 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Lameness is the most commonly reported health problem in horses, and lameness investigations which include local anaesthetic injections are routinely performed by equine practitioners. Through this process, bacteria can enter the tissues perforated by the needle and may cause local infections at the injection site. The objective of this in vitro study was to investigate if local anaesthetics at concentrations available in commercially available solutions could inhibit growth and/or kill bacteria that could be inoculated into the synovial space or soft tissues during injection. This study evaluated the antimicrobial activity of the local anaesthetics bupivacaine, lidocaine and mepivacaine against 40 equine clinical bacterial isolates of the Actinobacillus, Corynebacterium, Enterobacter, Escherichia, Pseudomonas, Rhodococcus, Staphylococcus and Streptococcus genera. Minimum inhibitory and minimum bactericidal concentrations (MICs and MBCs) were determined by the broth microdilution method. Clinically applied concentrations of bupivacaine, lidocaine, and mepivacaine inhibited visual growth of 93%, 93%, and 80% of isolates tested, respectively. For the majority (80%) of the inhibited isolates, the concentrations were also bactericidal. The tested local anaesthetics possessed antimicrobial activity against equine pathogens at concentrations that are routinely applied in clinical cases. However, this antimicrobial activity should not discourage antiseptic preparation prior to local anaesthetic injections. [Mh] Termos MeSH primário: Anestésicos Locais Antibacterianos Bupivacaína/administração & dosagem Doenças dos Cavalos/microbiologia Lidocaína/administração & dosagem Mepivacaína/administração & dosagem [Mh] Termos MeSH secundário: Anestesia Local/efeitos adversos Animais Bactérias/efeitos dos fármacos Relação Dose-Resposta a Droga Doenças dos Cavalos/tratamento farmacológico Doenças dos Cavalos/etiologia Cavalos Coxeadura Animal/fisiopatologia Testes de Sensibilidade Microbiana/veterinária Dor/tratamento farmacológico [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anesthetics, Local); 0 (Anti-Bacterial Agents); 98PI200987 (Lidocaine); B6E06QE59J (Mepivacaine); Y8335394RO (Bupivacaine) [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171016 [Lr] Data última revisão: 171016 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170704 [St] Status: MEDLINE

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[PMID]: 28550902 [Au] Autor: Wenger A; Rothenberger J; Hakim-Meibodi LE; Notheisen T; Schaller HE [Ad] Endereço: Clinic for Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Baden-Wurttemberg, Germany. Electronic address: awenger@bgu-tuebingen.de. [Ti] Título: Quantification of the vasodilatory effect of axillary plexus block. A prospective controlled study. [So] Source: J Surg Res;212:153-158, 2017 May 15. [Is] ISSN: 1095-8673 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: Axillary plexus block is a common method for regional anesthesia, especially in hand and wrist surgery. Local anesthetics (e.g., mepivacaine) are injected around the peripheral nerves in the axilla. A vasodilatory effect due to sympathicolysis has been described, but not quantified. MATERIALS AND METHODS: In a prospective controlled study between October 2012 and July 2013, we analyzed 20 patients with saddle joint arthritis undergoing trapeziectomy under axillary plexus block. Patients received a mixture of mepivacaine 1% and ropivacaine 0.75% in a 3:1 ratio. The measurements were carried out on the plexus side and the contralateral hand, which acted as the control. Laser-Doppler spectrophotometry (oxygen to see [O2C] device) was used to measure various perfusion factors before and after the plexus block, after surgery and in 2-h intervals until 6 h postoperatively. RESULTS: Compared with the contralateral side, the plexus block produced an enhancement of tissue oxygen saturation of 117.35 ± 34.99% (cf. control SO : 92.92 ± 22.30%, P < 0.010) of the baseline value. Furthermore, blood filling of microvessels (rHb: 131.36 ± 48.64% versus 109.12 ± 33.25%, P < 0.0062), peripheral blood flow (219.85 ± 165.59% versus 129.55 ± 77.12%, P < 0.018), and velocity (163.86 ± 58.18% versus 117.16 ± 45.05%, P < 0.006) showed an increase of values. CONCLUSIONS: Axillary plexus block produces an improvement of peripheral tissue oxygen saturation of the upper extremity over the first 4 h after the inception of anesthesia. [Mh] Termos MeSH primário: Amidas/farmacologia Anestésicos Locais/farmacologia Axila/inervação Mepivacaína/farmacologia Bloqueio Nervoso Vasodilatação/efeitos dos fármacos [Mh] Termos MeSH secundário: Adulto Amidas/administração & dosagem Anestésicos Locais/administração & dosagem Axila/irrigação sanguínea Axila/diagnóstico por imagem Feminino Seres Humanos Fluxometria por Laser-Doppler Masculino Mepivacaína/administração & dosagem Microcirculação/efeitos dos fármacos Meia-Idade Avaliação de Resultados (Cuidados de Saúde) Estudos Prospectivos Pele/irrigação sanguínea Pele/diagnóstico por imagem Extremidade Superior/irrigação sanguínea Extremidade Superior/diagnóstico por imagem [Pt] Tipo de publicação: CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE [Nm] Nome de substância: 0 (Amides); 0 (Anesthetics, Local); 7IO5LYA57N (ropivacaine); B6E06QE59J (Mepivacaine) [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170913 [Lr] Data última revisão: 170913 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170529 [St] Status: MEDLINE

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[PMID]: 28489457 [Au] Autor: Corwin DJ; Topjian A; Banwell BL; Osterhoudt K [Ad] Endereço: a Division of Emergency Medicine , The Children's Hospital of Philadelphia , Philadelphia , PA , USA. [Ti] Título: Adverse events associated with a large dose of intravenous lipid emulsion for suspected local anesthetic toxicity. [So] Source: Clin Toxicol (Phila);55(6):603-607, 2017 Jul. [Is] ISSN: 1556-9519 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Intravenous lipid emulsion (ILE) has gained favor as a rescue treatment for cardiovascular collapse due to intravenous local anesthetic overdose, however, goals of ILE therapy are still being defined. We describe a case of a girl given 66 mL/kg of 20% lipid emulsion (ILE) in the treatment of presumed mepivacaine toxicity. CASE REPORT: An 11-year-old girl weighing 55.6 kg developed pallor, rolling back of the eyes, and rhythmic muscle twitching after receiving a mandibular nerve block injection with a 1.8 mL ampule of 3% mepivacaine. With concern for persistent seizures she was given three 1 mL/kg boluses of ILE, followed by an infusion of 0.25 mL/kg/min. The total dose ultimately administered was 3670 mL (66 mL/kg) over 7 h. A serum triglyceride concentration, drawn 2 h after cessation of ILE infusion, was estimated to be 16,583 mg/dL (429 mmol/L) after several dilutions; her blood was grossly lipemic. Notable signs included hypersomnolence, tachypnea, and tachycardia. Other complications included apparent metabolic acidosis (serum bicarbonate of 5 mmol/L) with hyperlactatemia (lactate 7.0 mmol/L), difficulty with serum laboratory interpretation, and a non-contrast brain magnetic resonance imaging showing high signal in the dural venous sinuses. The lipemia cleared over three days and the patient recovered uneventfully. Case discussion: This case demonstrates a unique neurologic and metabolic toxicity associated with ILE given as an antidote in a high total dose, and highlights the need for cautious antidotal application of lipid emulsion infusions. Until more data is available, clinicians are advised to take great care if considering a dose in excess of 12.5 mL/kg/day, the maximum daily dosage recommended by the U.S. Food and Drug Administration for nutritional supplementation. Careful monitoring of total doses administered across institutions and hospital wards during transfers is paramount to avoid inadvertent overdose of antidotes. [Mh] Termos MeSH primário: Anestésicos Locais/efeitos adversos Antídotos/efeitos adversos Emulsões Gordurosas Intravenosas/efeitos adversos Mepivacaína/efeitos adversos [Mh] Termos MeSH secundário: Anestésicos Locais/administração & dosagem Antídotos/administração & dosagem Criança Overdose de Drogas Emulsões Gordurosas Intravenosas/administração & dosagem Feminino Seres Humanos Mepivacaína/administração & dosagem Bloqueio Nervoso/efeitos adversos Convulsões/induzido quimicamente Convulsões/terapia [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE [Nm] Nome de substância: 0 (Anesthetics, Local); 0 (Antidotes); 0 (Fat Emulsions, Intravenous); B6E06QE59J (Mepivacaine) [Em] Mês de entrada: 1706 [Cu] Atualização por classe: 170620 [Lr] Data última revisão: 170620 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170511 [St] Status: MEDLINE [do] DOI: 10.1080/15563650.2017.1294693

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[PMID]: 28319552 [Au] Autor: Kim WJ; Park HS; Yi MS; Koo GH; Shin HY [Ad] Endereço: *From the Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University; and †Department of Anesthesiology and Pain Medicine, School of Medicine, Chung-Ang University, Seoul, Korea. [Ti] Título: Evaluation of Lung Function and Clinical Features of the Ultrasound-Guided Stellate Ganglion Block With 2 Different Concentrations of a Local Anesthetic: A Randomized Controlled Trial. [So] Source: Anesth Analg;124(4):1311-1316, 2017 Apr. [Is] ISSN: 1526-7598 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: BACKGROUND: One possible complication of stellate ganglion block (SGB) is respiratory compromise. No study has yet addressed the comparison of its effect on lung function and clinical features, including Horner's syndrome, changes in temperature, sensory and motor functions, and adverse events of lower versus higher concentrations (LC and HC, respectively) of local anesthetics in an ultrasound-guided SGB. METHODS: Fifty patients were randomized into 1 of 2 groups: the LC group (5 mL of 0.5% mepivacaine) and the HC group (5 mL of 1% mepivacaine). One anesthesiologist performed a C6- SGB under ultrasound guidance. Our primary objective was to compare LC and HC of a local anesthetic in terms of its effect on lung function, and the secondary objective was to compare the clinical features between LC and HC of a local anesthetic. Lung function was compared between the 2 groups using the Mann-Whitney U test. RESULTS: The forced vital capacity at 20 minutes post-SGB was not significantly different between the HC and the LC groups (P = .360); the median difference (95% confidence intervals [CI]) was 1 (-1 to 8). Other parameters of lung function were comparable with the forced vital capacity. Patients in the HC group had significantly greater sensory changes than those in the LC group (% decrease compared with the unblocked side); 95.4 ± 2.1 (CI: 91.11-99.73) vs 87.3 ± 3.5 (CI: 80.12-94.49). CONCLUSIONS: Lung function between the LC and HC groups after SGB did not differ significantly. Clinical features between the 2 groups also did not differ clinically, except that patients in the HC group had significantly greater sensory loss in the C6 dermatomes. [Mh] Termos MeSH primário: Anestésicos Locais/administração & dosagem Bloqueio Nervoso Autônomo/métodos Fenômenos Fisiológicos Respiratórios/efeitos dos fármacos Gânglio Estrelado/efeitos dos fármacos Gânglio Estrelado/diagnóstico por imagem Ultrassonografia de Intervenção/métodos [Mh] Termos MeSH secundário: Adulto Idoso Relação Dose-Resposta a Droga Feminino Seres Humanos Masculino Mepivacaína/administração & dosagem Meia-Idade Projetos Piloto Testes de Função Respiratória/métodos Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Local); B6E06QE59J (Mepivacaine) [Em] Mês de entrada: 1707 [Cu] Atualização por classe: 170713 [Lr] Data última revisão: 170713 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 170321 [St] Status: MEDLINE [do] DOI: 10.1213/ANE.0000000000001945

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[PMID]: 28298941 [Au] Autor: Sartoris R; Orlandi D; Corazza A; Sconfienza LM; Arcidiacono A; Bernardi SP; Schiaffino S; Turtulici G; Caruso P; Silvestri E [Ad] Endereço: Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy. [Ti] Título: In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections. [So] Source: J Ultrasound;20(1):23-31, 2017 Mar. [Is] ISSN: 1876-7931 [Cp] País de publicação: Italy [La] Idioma: eng [Ab] Resumo: OBJECTIVES: Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation. METHODS: Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients' pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks. RESULTS: All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intra-articular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed. CONCLUSIONS: Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease. [Mh] Termos MeSH primário: Injeções Intra-Articulares/métodos Imagem por Ressonância Magnética/métodos Imagem Multimodal/métodos Ultrassonografia/métodos Articulação Zigapofisária/diagnóstico por imagem [Mh] Termos MeSH secundário: Corticosteroides/administração & dosagem Idoso Idoso de 80 Anos ou mais Anestésicos Locais/administração & dosagem Anti-Inflamatórios/administração & dosagem Dor Crônica/diagnóstico por imagem Dor Crônica/tratamento farmacológico Estudos de Viabilidade Feminino Seres Humanos Injeções Intra-Articulares/efeitos adversos Injeções Intra-Articulares/instrumentação Dor Lombar/diagnóstico por imagem Dor Lombar/tratamento farmacológico Imagem por Ressonância Magnética/efeitos adversos Imagem por Ressonância Magnética/instrumentação Masculino Mepivacaína/administração & dosagem Metilprednisolona/administração & dosagem Metilprednisolona/análogos & derivados Meia-Idade Imagem Multimodal/efeitos adversos Imagem Multimodal/instrumentação Tomografia Computadorizada por Raios X/efeitos adversos Tomografia Computadorizada por Raios X/instrumentação Tomografia Computadorizada por Raios X/métodos Resultado do Tratamento Ultrassonografia/efeitos adversos Ultrassonografia/instrumentação [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Adrenal Cortex Hormones); 0 (Anesthetics, Local); 0 (Anti-Inflammatory Agents); 43502P7F0P (methylprednisolone acetate); B6E06QE59J (Mepivacaine); X4W7ZR7023 (Methylprednisolone) [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170421 [Lr] Data última revisão: 170421 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170317 [St] Status: MEDLINE [do] DOI: 10.1007/s40477-016-0233-2

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[PMID]: 28235506 [Au] Autor: López M; Calvo M; Sancho A; Brogly N; Guasch E; Gilsanz F [Ad] Endereço: Department of Anesthesia, "La Paz" University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain. Electronic address: mercelopezmartinez@yahoo.es. [Ti] Título: Effective volumes of 1.5% mepivacaine with different sodium concentration for ultrasound guided popliteal block. [So] Source: J Clin Anesth;37:139-144, 2017 Feb. [Is] ISSN: 1873-4529 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: STUDY OBJECTIVE: To determine if a solution of 1.5% mepivacaine diluted with 5% dextrose, which decreases the sodium concentration by 30%, results in reduced volume requirements for a complete sensory block, in the case of an ultrasound guided popliteal nerve block. DESIGN: A randomized controlled study. SETTING: Operating room. PATIENTS: We included seventy ASA 1-3 patients, undergoing unilateral "hallux valgus" repair under ultrasound guided popliteal nerve block. INTERVENTIONS: An ultrasound guided popliteal nerve block was performed on all patients, with 1.5% mepivacaine using the normal dilution (ND group, thirty-five patients) or the 5% dextrose dilution (D5 group, thirty-five patients). Starting with 25ml in each group, increasing or decreasing it by 1ml on subsequent patients, depending on the success or failure in the previous one (Dixon's "up-and-down" sequential allocation). MEASUREMENTS: Effective dose in 50, 90, and 95% of patients (ED50, ED90, and ED95) of 1.5% mepivacaine in both groups. Onset time and duration of the blocks, side effects, and neurological complications. MAIN RESULTS: There were no statistically significant differences between ED50 in ND group (6.2ml; 95% confidence interval, 5.2-7.5), and D5 group (5.8ml; 95% CI, 5.1-7). Also no statistically significant differences in ED90 (7.7ml, 95% CI 6.9-8.1 in the D5 group; 7.8ml, 95% CI 7-8.1 in the ND) or in ED95 (7.9ml, 95% CI 7.1-8.2 in the D5 group; 8ml, 95% CI 7.2-8.2 in the ND) were found. Onset time for a complete sensory block in D5 group was 14min (95% CI, 12-17) and 15min in ND (95% CI, 13-18), p=0.66. Neither severe side effects, nor neurological complications were reported. CONCLUSIONS: A dilution of 1.5% mepivacaine with 30% less sodium concentration does not decrease volume requirement for ultrasound guided sciatic nerve block at popliteal level. [Mh] Termos MeSH primário: Anestésicos Locais/administração & dosagem Hallux Valgus/cirurgia Mepivacaína/farmacologia Bloqueio Nervoso/métodos Nervo Isquiático/efeitos dos fármacos Sódio/farmacologia [Mh] Termos MeSH secundário: Adulto Idoso Relação Dose-Resposta a Droga Feminino Glucose/administração & dosagem Seres Humanos Masculino Mepivacaína/administração & dosagem Meia-Idade Sódio/administração & dosagem Ultrassonografia de Intervenção [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Local); 9NEZ333N27 (Sodium); B6E06QE59J (Mepivacaine); IY9XDZ35W2 (Glucose) [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170914 [Lr] Data última revisão: 170914 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170226 [St] Status: MEDLINE

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[PMID]: 28120017 [Au] Autor: Geiser T; Apel J; Vicent O; Büttner J [Ad] Endereço: Abteilung für Anästhesiologie und Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Deutschland. geiser@bgu-murnau.de. [Ti] Título: [Sciatic nerve block "out-of-plane" distal to the bifurcation: effective and safe]. [Ti] Título: Ischiadikusblockade "out-of-plane" distal der Bifurkation: effektiv und sicher.. [So] Source: Anaesthesist;66(3):177-185, 2017 Mar. [Is] ISSN: 1432-055X [Cp] País de publicação: Germany [La] Idioma: ger [Ab] Resumo: BACKGROUND: Ultrasound guided distal sciatic nerve block (DSB) at bifurcation level shows fast onset and provides excellent success rates. However, its safe performance might be difficult for the unexperienced physician. Just slightly distal to the bifurcation, the tibial nerve (TN) and common fibular nerve (CFN) can be shown clearly separated from each other. Therefore, we investigated if a block done here would provide similar quality results compared to the DSB proximally to the division, with a potentially lower risk of nerve damage. METHODS: In this randomized, prospective trial, 56 patients per group received either a DSB distal to the bifurcation "out-of-plane" (dist.) or proximally "in-plane" (prox.) with 30 ml of Mepivacaine 1% each. Success was tested by a blinded examiner after 15 and 30 min respectively (sensory and motor block of TN and CFN: 0 = none, 2 = complete, change of skin temperature). Videos of the blocks were inspected by an independent expert retrospectively with regard to the spread of the local anesthetic (LA) and accidental intraneural injection. RESULTS: Cumulative single nerve measurements and temperature changes revealed significant shorter onset and better efficacy (dist/prox: 15 min: 3.13 ± 1.86/1.82 ± 1.62; 30 min: 5.73 ± 1.92/3.21 ± 1.88; T : 30.3 ± 3.48/28.0 ± 3.67, T . 33.0 ± 2.46/30.6 ± 3.86; MV/SD; ANOVA; p < 0.01) combined with a higher rate of subparaneural spread in the dist. group (41/51 vs.12/53; χ2; p < 0,01). Procedure times were similar. There were no complications in either group. DISCUSSION: The subparaneural spread of the LA turned out to be crucial for better results in the distal group. The steep angle using the out-of-plane approach favors needle penetration through the paraneural sheath. The distance between the branches allows the safe application of the LA, so an effective block can be done with just one injection. CONCLUSION: DSB slightly distal to the bifurcation, in an out-of-plane technique between the TN and CFN, can be done fast, effectively and safe. [Mh] Termos MeSH primário: Bloqueio Nervoso/métodos Nervo Isquiático/diagnóstico por imagem [Mh] Termos MeSH secundário: Adulto Anestésicos Locais Método Duplo-Cego Feminino Seres Humanos Masculino Erros Médicos Mepivacaína Meia-Idade Nervo Fibular/diagnóstico por imagem Nervo Fibular/lesões Estudos Prospectivos Nervo Tibial/diagnóstico por imagem Nervo Tibial/lesões Ultrassonografia de Intervenção [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Anesthetics, Local); B6E06QE59J (Mepivacaine) [Em] Mês de entrada: 1703 [Cu] Atualização por classe: 170916 [Lr] Data última revisão: 170916 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170126 [St] Status: MEDLINE [do] DOI: 10.1007/s00101-017-0268-6

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[PMID]: 27160051 [Au] Autor: Edmonds RE; Garvican ER; Smith RK; Dudhia J [Ad] Endereço: Clinical Sciences and Services, The Royal Veterinary College, North Mymms, Hertfordshire, UK. [Ti] Título: Influence of commonly used pharmaceutical agents on equine bone marrow-derived mesenchymal stem cell viability. [So] Source: Equine Vet J;49(3):352-357, 2017 May. [Is] ISSN: 2042-3306 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: REASON FOR PERFORMING STUDY: To provide evidence to support recommendations regarding the co-administration of drugs with mesenchymal stem cell (MSC) therapy. OBJECTIVES: To determine the influence of sedatives, local anaesthetic and corticosteroids on MSC viability and proliferation, in comparison to somatic cells derived from tendon (TDCs). STUDY DESIGN: In vitro cell culture. MATERIALS AND METHODS: MSCs (n = 3) and TDCs (n = 2) were cultured in media containing a clinically relevant dose range of xylazine, romifidine, detomidine and butorphanol, mepivacaine, methylprednisolone, or triamcinolone acetonide. Cell viability in suspension culture was assessed at intervals up to 4 h using the trypan blue dye assay. MSCs in monolayer culture were exposed to the highest concentrations of drug and proliferation was measured using the alamarBlue fluorescence assay. RESULTS: Exposure to romifidine or mepivacaine did not significantly affect viability or proliferation rate of MSCs or TDCs at any of the dosages tested. At the highest concentration of detomidine and butorphanol, MSC viability was significantly reduced compared to controls. Although xylazine exposure caused a significant (P < 0.001), dose-dependent reduction in MSC viability compared to controls, overall population viability remained good. Conversely, both methylprednisolone and triamcinolone resulted in the rapid death of significant numbers of MSCs (P < 0.001). CONCLUSIONS: Clinicians can sedate horses and administer nerve blocks to assist in intratendinous or intrathecal injection of MSCs with confidence that these drugs will not impact the viability of implanted cells. However, the concomitant use of corticosteroids is likely to have a severely detrimental effect on cell viability and should not be performed. Similarly, steroid administration into the sheath of a damaged tendon is not recommended. [Mh] Termos MeSH primário: Anestésicos Locais/farmacologia Células da Medula Óssea/efeitos dos fármacos Sobrevivência Celular/efeitos dos fármacos Cavalos Hipnóticos e Sedativos/farmacologia Células Mesenquimais Estromais/efeitos dos fármacos [Mh] Termos MeSH secundário: Corticosteroides/farmacologia Animais Proliferação Celular Células Cultivadas Mepivacaína/farmacologia Metilprednisolona/farmacologia Triancinolona Acetonida/farmacologia [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Adrenal Cortex Hormones); 0 (Anesthetics, Local); 0 (Hypnotics and Sedatives); B6E06QE59J (Mepivacaine); F446C597KA (Triamcinolone Acetonide); X4W7ZR7023 (Methylprednisolone) [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170828 [Lr] Data última revisão: 170828 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 160511 [St] Status: MEDLINE [do] DOI: 10.1111/evj.12590

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