Articles: anesthetics.
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Clin. Orthop. Relat. Res. · Sep 1984
The effects of epidural injection of local anesthetics and corticosteroids on patients with lumbosciatic pain.
Although epidural cortisone injections are commonly used for treatment of lumbosciatic pain, insufficient critical analysis of the end result can be found in the literature. The present study is a retrospective critical analysis of 367 patients with leg pain who were engaged for a minimum of two weeks or an average of two months in multifaceted conservative management without relief of pain. Injections of 10 cm3 of 0.5% bupivacaine and 100 mg of methylprednisolone were given to inpatients treated by the same anesthesiologist. ⋯ The most favorable results (approaching 70% offd-excellent) were observed in patients with subacute radicular leg pain (of less than three months' duration) and chronic leg pain (of greater than three months' duration) with no prior surgery. Negative myelograms and electromyograms (EMGs), in the absence of reflex or motor deficits on physical examination, also pointed toward optimal results. Those patients with chronic pain who had had prior lumbar spine surgery had the least satisfactory results.
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The effects of the steroid anaesthetic alphaxalone on acetylcholine (ACh)-induced ionic channels were studied in voltage clamped 'myoballs' in culture. Alphaxalone produced a reversible blockade of the ACh-evoked inward current, ED50 = 6.0 microM. ⋯ In double pulse conditioning experiments, alphaxalone produced an additional inhibition with a time constant of recovery (550 ms) much longer than the time constant of recovery of the normal desensitization (250 ms). It was concluded that alphaxalone blocks active (open) ionic channels.
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Local anesthetics are the most widely used drugs in dentistry today. Knowledge of the pharmacology and toxicology of these agents will result in their intelligent and judicious use. The choice of local anesthetic should be individualized for each patient. ⋯ Occasionally, a clinician may be unsuccessful at achieving regional anesthesia despite these additional measures. Highly anxious dental patients or patients with a genuine tolerance to local anesthetics normally pose the most problems. Transitional block or threshold block phenomena should also be suspected in these situations.(ABSTRACT TRUNCATED AT 400 WORDS)
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Anesthesia progress · Jul 1984
Comparative StudyComparison of the effectiveness of etidocaine and lidocaine as local anesthetic agents during oral surgery.
In a double-blind study conducted in 112 patients undergoing removal of four impacted third molar teeth, etidocaine hydrochloride 1.5% solution with epinephrine 1:200,000 and lidocaine hydrochloride 2.0% solution with epinephrine 1:100,000 were used, one on each side of the face, to produce inferior alveolar nerve block, infiltration anesthesia of the maxillary tooth and hemostasis of the mucoperiosteum around each tooth. Surgically adequate anesthesia was rapidly produced by both agents but the duration of action of etidocaine was longer than that of lidocaine as reflected in more prolonged numbness of the lip and delayed onset of pain. Moreover, after etidocaine treatment fewer patients reported severe pain as the local anesthesia receded. No adverse local or systemic effects were observed in, or reported by, any of the patients.