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Mary F Chisholm - One of the best experts on this subject based on the ideXlab platform.
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dose response relationships for isobaric spinal Mepivacaine using the combined spinal epidural technique
Anesthesia & Analgesia, 1999Co-Authors: Victor M Zayas, Gregory A Liguori, Mary F Chisholm, Mark H Susman, Michael A GordonAbstract:UNLABELLED: Mepivacaine, a local anesthetic with similar physiochemical properties to those of lidocaine, is an adequate alternative for patients undergoing ambulatory procedures, and is associated with a lower incidence of transient neurologic symptoms (TNS) than lidocaine. We studied the dose-response characteristics of isobaric intrathecal Mepivacaine using the combined spinal epidural technique for patients undergoing ambulatory arthroscopic surgery of the knee. Seventy-five patients were randomized prospectively to receive one of three doses of isobaric Mepivacaine for spinal anesthesia: 30 mg (2 mL 1.5%), 45 mg (3 mL 1.5%), or 60 mg (4 mL 1.5%). An observer, blinded to the dose, recorded sensory level to pinprick and motor response until resolution of the block. In addition, the incidence of TNS was determined. An initial intrathecal dose of 30 mg of isobaric Mepivacaine 1.5% produced satisfactory anesthesia in 72% of ambulatory surgical patients undergoing unilateral knee arthroscopy with a significantly shorter duration of sensory (158 +/- 32 min) and motor blockade (116 +/- 38 min) than doses of 45 and 60 mg. An intrathecal dose of 45 mg produced satisfactory anesthesia in all patients with a shorter duration of sensory (182 +/-38 min) and motor blockade (142 +/- 37 min) than 60 mg of Mepivacaine 1.5% (203 +/- 36 min and 168 +/- 36 min, respectively). The incidence of TNS was 7.4% overall (1.2%-13.6% confidence intervals), less than the rates previously reported after spinal anesthesia with lidocaine in ambulatory surgical patients undergoing knee arthroscopy. We conclude that Mepivacaine can be used as an adequate alternative to lidocaine for ambulatory procedures. IMPLICATIONS: This study evaluated the postoperative duration of spinal anesthesia after varying doses of isobaric Mepivacaine and the incidence of transient radiating back and leg pain. We found that 45 mg of Mepivacaine provided adequate anesthesia, a timely discharge, and a lower incidence of back pain than that previously reported after lidocaine spinals.
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transient neurologic symptoms after spinal anesthesia with Mepivacaine and lidocaine
Anesthesiology, 1998Co-Authors: Gregory A Liguori, Victor M Zayas, Mary F ChisholmAbstract:BACKGROUND: Spinal anesthesia with lidocaine is ideal for ambulatory surgery because of its short duration of action. However, transient neurologic symptoms (TNS) occur in 0-40% of patients. The incidence of TNS with Mepivacaine, which has a similar duration of action, is unknown. METHODS: Sixty ambulatory patients undergoing knee arthroscopy received spinal anesthesia in a randomized, double-blinded manner, with either 45 mg 1.5% Mepivacaine or 60 mg 2% lidocaine. An L3-L4 midline approach was used with a 27-gauge Whitacre needle and a 20-gauge introducer. The local anesthetic was injected over approximately 30 s with the aperture of the Whitacre needle in a cephalad direction. Two to 4 days after operation, each patient was questioned about the development of TNS. In addition, the two groups were compared for time to regression of sensory and motor blockade and time to discharge milestones. RESULTS: Three patients receiving lidocaine were lost to follow-up. None of the 30 patients in the Mepivacaine group developed TNS, whereas 6 of 27 (22%) in the lidocaine group did (P = 0.008). Time to regression to the L5 sensory level and to complete resolution of motor block were similar in both groups. The times to discharge milestones were also comparable. CONCLUSIONS: The incidence of TNS is greater with 2% lidocaine than with 1.5% Mepivacaine for patients having unilateral knee arthroscopy under spinal anesthesia. Mepivacaine seems to be a promising alternative to lidocaine for outpatient surgical procedures because of its similar duration of action. Further studies are warranted to determine the optimal dose of intrathecal Mepivacaine for ambulatory surgery and the incidence of TNS with other doses and concentrations of intrathecal Mepivacaine.
Gregory A Liguori - One of the best experts on this subject based on the ideXlab platform.
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dose response relationships for isobaric spinal Mepivacaine using the combined spinal epidural technique
Anesthesia & Analgesia, 1999Co-Authors: Victor M Zayas, Gregory A Liguori, Mary F Chisholm, Mark H Susman, Michael A GordonAbstract:UNLABELLED: Mepivacaine, a local anesthetic with similar physiochemical properties to those of lidocaine, is an adequate alternative for patients undergoing ambulatory procedures, and is associated with a lower incidence of transient neurologic symptoms (TNS) than lidocaine. We studied the dose-response characteristics of isobaric intrathecal Mepivacaine using the combined spinal epidural technique for patients undergoing ambulatory arthroscopic surgery of the knee. Seventy-five patients were randomized prospectively to receive one of three doses of isobaric Mepivacaine for spinal anesthesia: 30 mg (2 mL 1.5%), 45 mg (3 mL 1.5%), or 60 mg (4 mL 1.5%). An observer, blinded to the dose, recorded sensory level to pinprick and motor response until resolution of the block. In addition, the incidence of TNS was determined. An initial intrathecal dose of 30 mg of isobaric Mepivacaine 1.5% produced satisfactory anesthesia in 72% of ambulatory surgical patients undergoing unilateral knee arthroscopy with a significantly shorter duration of sensory (158 +/- 32 min) and motor blockade (116 +/- 38 min) than doses of 45 and 60 mg. An intrathecal dose of 45 mg produced satisfactory anesthesia in all patients with a shorter duration of sensory (182 +/-38 min) and motor blockade (142 +/- 37 min) than 60 mg of Mepivacaine 1.5% (203 +/- 36 min and 168 +/- 36 min, respectively). The incidence of TNS was 7.4% overall (1.2%-13.6% confidence intervals), less than the rates previously reported after spinal anesthesia with lidocaine in ambulatory surgical patients undergoing knee arthroscopy. We conclude that Mepivacaine can be used as an adequate alternative to lidocaine for ambulatory procedures. IMPLICATIONS: This study evaluated the postoperative duration of spinal anesthesia after varying doses of isobaric Mepivacaine and the incidence of transient radiating back and leg pain. We found that 45 mg of Mepivacaine provided adequate anesthesia, a timely discharge, and a lower incidence of back pain than that previously reported after lidocaine spinals.
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transient neurologic symptoms after spinal anesthesia with Mepivacaine and lidocaine
Anesthesiology, 1998Co-Authors: Gregory A Liguori, Victor M Zayas, Mary F ChisholmAbstract:BACKGROUND: Spinal anesthesia with lidocaine is ideal for ambulatory surgery because of its short duration of action. However, transient neurologic symptoms (TNS) occur in 0-40% of patients. The incidence of TNS with Mepivacaine, which has a similar duration of action, is unknown. METHODS: Sixty ambulatory patients undergoing knee arthroscopy received spinal anesthesia in a randomized, double-blinded manner, with either 45 mg 1.5% Mepivacaine or 60 mg 2% lidocaine. An L3-L4 midline approach was used with a 27-gauge Whitacre needle and a 20-gauge introducer. The local anesthetic was injected over approximately 30 s with the aperture of the Whitacre needle in a cephalad direction. Two to 4 days after operation, each patient was questioned about the development of TNS. In addition, the two groups were compared for time to regression of sensory and motor blockade and time to discharge milestones. RESULTS: Three patients receiving lidocaine were lost to follow-up. None of the 30 patients in the Mepivacaine group developed TNS, whereas 6 of 27 (22%) in the lidocaine group did (P = 0.008). Time to regression to the L5 sensory level and to complete resolution of motor block were similar in both groups. The times to discharge milestones were also comparable. CONCLUSIONS: The incidence of TNS is greater with 2% lidocaine than with 1.5% Mepivacaine for patients having unilateral knee arthroscopy under spinal anesthesia. Mepivacaine seems to be a promising alternative to lidocaine for outpatient surgical procedures because of its similar duration of action. Further studies are warranted to determine the optimal dose of intrathecal Mepivacaine for ambulatory surgery and the incidence of TNS with other doses and concentrations of intrathecal Mepivacaine.
Victor M Zayas - One of the best experts on this subject based on the ideXlab platform.
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dose response relationships for isobaric spinal Mepivacaine using the combined spinal epidural technique
Anesthesia & Analgesia, 1999Co-Authors: Victor M Zayas, Gregory A Liguori, Mary F Chisholm, Mark H Susman, Michael A GordonAbstract:UNLABELLED: Mepivacaine, a local anesthetic with similar physiochemical properties to those of lidocaine, is an adequate alternative for patients undergoing ambulatory procedures, and is associated with a lower incidence of transient neurologic symptoms (TNS) than lidocaine. We studied the dose-response characteristics of isobaric intrathecal Mepivacaine using the combined spinal epidural technique for patients undergoing ambulatory arthroscopic surgery of the knee. Seventy-five patients were randomized prospectively to receive one of three doses of isobaric Mepivacaine for spinal anesthesia: 30 mg (2 mL 1.5%), 45 mg (3 mL 1.5%), or 60 mg (4 mL 1.5%). An observer, blinded to the dose, recorded sensory level to pinprick and motor response until resolution of the block. In addition, the incidence of TNS was determined. An initial intrathecal dose of 30 mg of isobaric Mepivacaine 1.5% produced satisfactory anesthesia in 72% of ambulatory surgical patients undergoing unilateral knee arthroscopy with a significantly shorter duration of sensory (158 +/- 32 min) and motor blockade (116 +/- 38 min) than doses of 45 and 60 mg. An intrathecal dose of 45 mg produced satisfactory anesthesia in all patients with a shorter duration of sensory (182 +/-38 min) and motor blockade (142 +/- 37 min) than 60 mg of Mepivacaine 1.5% (203 +/- 36 min and 168 +/- 36 min, respectively). The incidence of TNS was 7.4% overall (1.2%-13.6% confidence intervals), less than the rates previously reported after spinal anesthesia with lidocaine in ambulatory surgical patients undergoing knee arthroscopy. We conclude that Mepivacaine can be used as an adequate alternative to lidocaine for ambulatory procedures. IMPLICATIONS: This study evaluated the postoperative duration of spinal anesthesia after varying doses of isobaric Mepivacaine and the incidence of transient radiating back and leg pain. We found that 45 mg of Mepivacaine provided adequate anesthesia, a timely discharge, and a lower incidence of back pain than that previously reported after lidocaine spinals.
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transient neurologic symptoms after spinal anesthesia with Mepivacaine and lidocaine
Anesthesiology, 1998Co-Authors: Gregory A Liguori, Victor M Zayas, Mary F ChisholmAbstract:BACKGROUND: Spinal anesthesia with lidocaine is ideal for ambulatory surgery because of its short duration of action. However, transient neurologic symptoms (TNS) occur in 0-40% of patients. The incidence of TNS with Mepivacaine, which has a similar duration of action, is unknown. METHODS: Sixty ambulatory patients undergoing knee arthroscopy received spinal anesthesia in a randomized, double-blinded manner, with either 45 mg 1.5% Mepivacaine or 60 mg 2% lidocaine. An L3-L4 midline approach was used with a 27-gauge Whitacre needle and a 20-gauge introducer. The local anesthetic was injected over approximately 30 s with the aperture of the Whitacre needle in a cephalad direction. Two to 4 days after operation, each patient was questioned about the development of TNS. In addition, the two groups were compared for time to regression of sensory and motor blockade and time to discharge milestones. RESULTS: Three patients receiving lidocaine were lost to follow-up. None of the 30 patients in the Mepivacaine group developed TNS, whereas 6 of 27 (22%) in the lidocaine group did (P = 0.008). Time to regression to the L5 sensory level and to complete resolution of motor block were similar in both groups. The times to discharge milestones were also comparable. CONCLUSIONS: The incidence of TNS is greater with 2% lidocaine than with 1.5% Mepivacaine for patients having unilateral knee arthroscopy under spinal anesthesia. Mepivacaine seems to be a promising alternative to lidocaine for outpatient surgical procedures because of its similar duration of action. Further studies are warranted to determine the optimal dose of intrathecal Mepivacaine for ambulatory surgery and the incidence of TNS with other doses and concentrations of intrathecal Mepivacaine.
Jhijoung Wang - One of the best experts on this subject based on the ideXlab platform.
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chlorpheniramine produces spinal motor proprioceptive and nociceptive blockades in rats
European Journal of Pharmacology, 2015Co-Authors: Jann-inn Tzeng, Ching-hsia Hung, Yu-wen Chen, Jhijoung WangAbstract:Abstract This study aimed to assess the local anesthetic effects of chlorpheniramine in spinal anesthesia and is compared with Mepivacaine, a widely-used local anesthetic. Spinal anesthesia with chlorpheniramine and Mepivacaine was constructed in a dosage-dependent fashion after the rats were injected intrathecally. The spinal block effect of chlorpheniramine in motor function, nociception, and proprioception was compared to that of Mepivacaine. We revealed that intrathecal chlorpheniramine and Mepivacaine exhibited a dose-dependent spinal block of motor function, nociception, and proprioception. On the 50% effective dose (ED50) basis, the ranks of potencies in motor function, nociception, and proprioception were chlorpheniramine>Mepivacaine (P
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isobolographic analysis of interaction between nisoxetine and Mepivacaine induced spinal blockades in rats
Fundamental & Clinical Pharmacology, 2014Co-Authors: Yuk Man Leung, Ching-hsia Hung, Yu-wen Chen, Jhijoung WangAbstract:: Although nisoxetine has been shown to elicit cutaneous (peripheral) anesthesia, spinal (central) anesthesia with nisoxetine was not exposed. The aim of this study was to examine spinal anesthesia of nisoxetine and its influence on the antinociceptive action of Mepivacaine. We compared nisoxetine with an established local anesthetic Mepivacaine for spinal anesthesia after rats were intrathecally injected with drugs. The drugs were spinally administered alone as well as in combination, and their potencies were compared via dose-response curves and isobolographic analysis. We showed that nisoxetine, as well as Mepivacaine elicited spinal anesthesia in dose-dependent manners. On a 50% effective dose (ED₅₀) basis, the spinal block effect of nisoxetine in motor function, proprioception, and nociception [0.99 (0.91-1.10), 0.85 (0.76-0.95), 0.82 (0.74-0.89)] was more potent (P < 0.05) than that of Mepivacaine [1.28 (1.21-1.34), 1.14 (1.07-1.22), 0.99 (0.93-1.05)], respectively. Furthermore, the nociceptive/sensory blockade (ED₅₀) was greater than the motor blockade in both nisoxetine and Mepivacaine groups (P < 0.05). Saline group (vehicle) produced no spinal anesthesia. Coadministration of nisoxetine with Mepivacaine displayed an additive effect. Our data reported nisoxetine produced significant anesthesia at spinal level, and additive interaction with the local anesthetic, Mepivacaine. Intrathecal nisoxetine elicited more potent spinal anesthesia than Mepivacaine.
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Isobolographic analysis of interaction between nisoxetine‐ and Mepivacaine‐induced spinal blockades in rats
Fundamental & Clinical Pharmacology, 2012Co-Authors: Yuk Man Leung, Ching-hsia Hung, Yu-wen Chen, Jhijoung WangAbstract:: Although nisoxetine has been shown to elicit cutaneous (peripheral) anesthesia, spinal (central) anesthesia with nisoxetine was not exposed. The aim of this study was to examine spinal anesthesia of nisoxetine and its influence on the antinociceptive action of Mepivacaine. We compared nisoxetine with an established local anesthetic Mepivacaine for spinal anesthesia after rats were intrathecally injected with drugs. The drugs were spinally administered alone as well as in combination, and their potencies were compared via dose-response curves and isobolographic analysis. We showed that nisoxetine, as well as Mepivacaine elicited spinal anesthesia in dose-dependent manners. On a 50% effective dose (ED₅₀) basis, the spinal block effect of nisoxetine in motor function, proprioception, and nociception [0.99 (0.91-1.10), 0.85 (0.76-0.95), 0.82 (0.74-0.89)] was more potent (P < 0.05) than that of Mepivacaine [1.28 (1.21-1.34), 1.14 (1.07-1.22), 0.99 (0.93-1.05)], respectively. Furthermore, the nociceptive/sensory blockade (ED₅₀) was greater than the motor blockade in both nisoxetine and Mepivacaine groups (P < 0.05). Saline group (vehicle) produced no spinal anesthesia. Coadministration of nisoxetine with Mepivacaine displayed an additive effect. Our data reported nisoxetine produced significant anesthesia at spinal level, and additive interaction with the local anesthetic, Mepivacaine. Intrathecal nisoxetine elicited more potent spinal anesthesia than Mepivacaine.
Richard Brull - One of the best experts on this subject based on the ideXlab platform.
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transient neurologic symptoms following spinal anesthesia with isobaric Mepivacaine a decade of experience at toronto western hospital
Anesthesiology Research and Practice, 2018Co-Authors: Ashwin Sankar, Minou Behboudi, Faraj W Abdallah, Alan J R Macfarlane, Richard BrullAbstract:Background. Transient neurologic symptoms (TNSs) can be distressing for patients and providers following uneventful spinal anesthesia. Spinal Mepivacaine may be less commonly associated with TNS than lidocaine; however, reported rates of TNS with intrathecal Mepivacaine vary considerably. Materials and Methods. We conducted a retrospective cohort study reviewing the internal medical records of surgical patients who underwent Mepivacaine spinal anesthesia at Toronto Western Hospital over the last decade to determine the rate of TNS. We defined TNS as new onset back pain that radiated to the buttocks or legs bilaterally. Results. We found one documented occurrence of TNS among a total of 679 Mepivacaine spinal anesthetics (0.14%; CI: 0.02–1.04%) that were performed in 654 patients. Conclusion. Our retrospective data suggest that the rate of TNS associated with Mepivacaine spinal anesthesia is lower than that previously reported in the literature.
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dexamethasone added to Mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade
Regional Anesthesia and Pain Medicine, 2010Co-Authors: Simon J Parrington, Dermot Odonnell, Vincent W S Chan, Danielle Brownshreves, Rajeev Subramanyam, Melody Qu, Richard BrullAbstract:Background and objectives: Corticosteroids have been used successfully to prolong the duration of local anesthetic action after peripheral nerve and epidural blockade. We hypothesized that the addition of dexamethasone to Mepivacaine would prolong the duration of analgesia after ultrasound-guided supraclavicular brachial plexus block for patients undergoing upper-limb surgery. Methods: After Federal Health Department and institutional review board approval, 45 adult patients undergoing elective hand or forearm surgery under supraclavicular brachial plexus blockade were randomized to receive either 30 mL Mepivacaine 1.5% plus dexamethasone 8 mg (4 mg/mL), or 30 mL Mepivacaine 1.5% plus 2 mL normal saline. The primary outcome measure was duration of analgesia. Secondary outcomes included onset times of sensory and motor blockade, pain and satisfaction scores, analgesic consumption, and block-related complications. Results: Patient characteristics were similar between groups. The median duration of analgesia was significantly prolonged in the Dexamethasone group (332 mins; interquartile range, 225-448 mins) compared with the Normal Saline group (228 mins; interquartile range, 207-263 mins; P = 0.008). The onset times of sensory and motor block were similar between the groups. Complications were minor and transient and did not differ between groups at 2 weeks postoperatively. Conclusions: The addition of dexamethasone to Mepivacaine prolongs the duration of analgesia but does not reduce the onset of sensory and motor blockade after ultrasound-guided supraclavicular block compared with Mepivacaine alone.