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•The pharmacokinetics and pharmacodynamics of ropivacaine at different concentrations (Group L:0.25%, Group M:0.5%, Group H:0.75%) in SAPB were evaluated simultaneously.•The analgesic effects of Group M and Group H were better than Group L.•The Cmax and AUC increased with rising ropivacaine concentration, and both Group H and Group M had significantly higher half-life than Group L•The use of 0.5% ropivacaine is recommended for SAPB to provide satisfactory perioperative analgesia. Investigate the analgesia effects and pharmacokinetics of ropivacaine at different concentrations in Serratus Anterior Plane Block (SAPB) and assess the efficacy and safety. Thirty-six patients undergoing video-assisted thoracoscopic surgery (VATS) pulmonary resections were enrolled. Ultrasound-guided SAPB was induced with 3 mg/kg ropivacaine at different concentrations (0.25%, 0.5%, and 0.75%, referred to as Group L, Group M, and Group H, respectively). The concentration of ropivacaine in the plasma at 1, 15, 30, 45, 60 min, 2, 4, 8, 12, and 24 h after SAPB was determined by LC-MS/MS. Other evaluated measures included the Numerical Rating Scale (NRS) scores at rest and on movement, the frequency of dermatomes blocked, onset time and effective plane, Quality of Requirements(QoR)-15 scale, chronic postsurgical pain, and the level of IL-6 and IL-8. The NRS scores were significantly higher in Group L than those in other groups (P < 0.05), indicating that the analgesic effect of Group L was the worst among the three groups. Group H had a lower effective plane of anesthesia and significantly higher incidence of chronic postsurgical pain. The IL-8 level was significantly lower in Group H than in other groups at 1 min, 1 h, and 24 h after SAPB. The ropivacaine concentrations were the highest in Group H, followed by Group M and Group L. The high blood concentration of ropivacaine in Group H may increase the risk of systemic toxicity from local anesthetics. Compared to Group L and Group H, Group M had superior analgesic effects and better safety. Among the three groups, Cmax, t1/2, and AUC0-∞ differed significantly. For patients undergoing VATS, using 0.5% ropivacaine for SAPB is recommended. [Display omitted]

Venepuncture-associated pain is a major source of distress commonly experienced by adult patients in day-to-day clinical practice. Topical lignocaine application before venepuncture may address this issue, but this delivery approach may be suboptimal. Hence, we aim to investigate the safety and efficacy of a novel lignocaine-embedded transdermal microneedle array patch (LEMAP) in facilitating transcutaneous lignocaine delivery to reduce procedural-related pain in adults undergoing venepuncture in a tertiary-care outpatient clinic setting. This is an investigator-initiated, single-centre, active-controlled, double-blind, randomised superiority trial divided into two distinct stages. Twenty (single-group LEMAP recipients) and 144 adult patients (72 per group; randomised to either LEMAP (intervention) or 5% EMLA patch (control) applied on antecubital fossa, near the venepuncture site, for 30 minutes) aged 18 years and above requiring routine venepuncture will be recruited from the Ophthalmology Outpatient Clinic, Hospital Canselor Tuanku Muhriz, for stage I and II of this trial, respectively. For the stage I trial, the safety endpoints are lignocaine’s pharmacokinetic parameters and clinical adverse events. In the stage II trial, the primary endpoints are the venepuncture-associated pain experience, which will be evaluated using the Visual Analogue Scale (VAS) and the skin conductance algesimeter index (SCAI) scores at one-minute post-venepuncture. Non-linear mixed-effect model and multiple linear regression will be used to analyse the stage I and II trial outcomes, respectively. The trial protocol has been registered with the clinicaltrial.gov registry (ID: NCT05694858) and adheres to the SPIRIT 2025 reporting guideline. All trial participants will provide written informed consent, which the trial investigators will obtain before trial enrollment and randomisation. The trial findings will be disseminated via peer-reviewed publications and presentations at international conferences and shared with participants via the web-based trial notification system..

Patients with severe acute pancreatitis (SAP) often experience intense pain that significantly impacts their quality of life and may hinder recovery. Current pain management approaches have limitations. Although continuous thoracic epidural analgesia (TEA) is generally effective, some patients still need additional intermittent injections of local anesthetics for sufficient pain relief. In the ICU, nurses are the primary providers responsible for pain management. Symptom Management Theory (SMT), though used in various fields, has not yet been fully validated for nurse-led pain management employing different TEA administration methods in SAP. This protocol aims to assess the effectiveness and safety of SMT-based nurse-led TEA administration methods in patients with SAP, with the goal of optimizing pain management protocols. This single-center, randomized, controlled clinical trial will enroll 76 patients with SAP, randomized into two groups (N = 38 each). The control group will receive continuous TEA with a 50 ml mixture containing nalbuphine 40 mg, ropivacaine 225 mg, lidocaine 0.2 g, and 6 ml of 0.9% saline, administered at 3-5 ml/h. If the patient's pain score (VAS-P) exceeds 3 or becomes intolerable, the infusion rate will be increased by 1-2 ml/h. In the experimental group, under SMT-guided nurse-led TEA management, nurses will report pain scores exceeding 3 to physicians, and intermittent epidural injections of 5 ml of the same mixture will be administered according to medical prescription, at intervals of ≥2 hours. Pain responses and patient feedback will be continuously monitored to guide timely adjustments of analgesics. The primary outcome is VAS-P. Secondary outcomes include intra-abdominal pressure (IAP), total dose of combined medication, number of additional interventions, duration of epidural placement, and incidence of 16 predefined adverse events. Endpoint outcomes consist of puncture success rate, ICU length of stay, 28-day mortality, and patient satisfaction with analgesia. Data will be analyzed using SPSS. Repeated measures data (e.g., VAS-P and IAP at 0 h, 1 h, 6 h, 12 h, 24 h, 48 h, and 72 h) will be examined with a multivariate mixed-effects repeated measures model (MMRM), which appropriately handles data missing at random. Other secondary outcomes, adverse events, and endpoint measures will be analyzed with descriptive statistics, and between-group comparisons will be conducted using t-tests, Mann-Whitney U tests, χ² tests, or Fisher's exact tests, as appropriate. The experimental group is anticipated to demonstrate superior pain management outcomes compared to the control group, with no increase in adverse events. The SMT-based nurse-led TEA protocol is expected to be safe and effective in improving analgesia, reducing ICU length of stay, decreasing 28-day mortality, and enhancing patient satisfaction. This study will provide new insights and methods for pain management in SAP patients, thereby promoting optimization of clinical practice.

In this trial in patients with lumbar central stenosis and moderate-to-severe leg pain and disability, epidural injection of glucocorticoids plus lidocaine offered minimal or no short-term benefit over epidural injection with lidocaine alone with respect to disability and pain. Lumbar spinal stenosis, a common cause of spine-related disability, is the leading reason for spinal surgery in older adults. 1 , 2 Degenerative changes resulting in narrowing of the spinal canal and nerve-root compression can cause back and leg pain, lower-extremity paresthesias, and weakness. 3 , 4 The treatment of symptomatic lumbar stenosis remains controversial. Symptoms of lumbar stenosis are commonly treated with epidural glucocorticoid injections. These injections typically contain a glucocorticoid and an anesthetic, which are thought to relieve pain by reducing nerve-root inflammation and ischemia. 1 An estimated 25% of all epidural glucocorticoid injections administered in the Medicare population and 74% of those . . .

Purpose of Review. Transversus abdominis plane (TAP) block is a regional technique for analgesia of the anterolateral abdominal wall. This review highlights the nomenclature system and recent advances in TAP block techniques and proposes directions for future research. Recent Findings. Ultrasound guidance is now considered the gold standard in TAP blocks. It is easy to acquire ultrasound images; it can be used in many surgeries involving the anterolateral abdominal wall. However, the efficacy of ultrasound-guided TAP blocks is not consistent, which might be due to the use of different approaches. The choice of technique influences the involved area and block duration. To investigate the actual analgesic effects of TAP blocks, we unified the nomenclature system and clarified the definition of each technique. Although a single-shot TAP block is limited in duration, it is still the candidate of the analgesic standard for abdominal wall surgery because the use of the catheter technique and liposomal bupivacaine may overcome this limitation. Summary. Ultrasound-guided TAP blocks are commonly used. With the unified nomenclature and the development of catheter technique and/or liposomal local anesthetics, TAP blocks can be applied more appropriately to achieve better pain control.

To investigate the timing of peak blood concentrations and potential toxicity when using a combination of plain and liposomal bupivacaine for thoracic fascial plane blocks. Pharmacokinetic analysis. Operating room. Eighteen adult patients undergoing robotically-assisted mitral valve surgery. Ultrasound-guided pecto-serratus and serratus anterior plane blocks using a mixture of 0.5% bupivacaine HCl up to 2.5 mg/kg and liposomal bupivacaine up to 266 mg. Arterial plasma bupivacaine concentration. Samples from 13 participants were analyzed. There was substantial inter-patient variability in plasma concentrations. A geometric mean maximum bupivacaine concentration was 1492 ng/ml (range 660 to 4650 ng/ml) at median time of 30 min after injection. In 4/13 (31%) patients, plasma bupivacaine concentrations exceeded our predefined 2000 ng/ml toxic threshold. A second much smaller peak was observed about 32 h after the injection. No obvious signs of local anesthetic toxicity were observed. Combined injection of plain and liposomal bupivacaine for pecto-serratus/serratus anterior plane blocks produced a biphasic pattern, with the highest arterial plasma concentrations observed within 30 min. Maximum concentrations exceeded the potential toxic threshold in nearly a third of patients, but without clinical evidence of toxicity. Clinicians should not assume that routine combinations of plain and liposomal bupivacaine for thoracic fascial plane blocks are inherently safe. [Display omitted] •A combination of plain and liposomal bupivacaine is used for fascial plane blocks•Local anesthetic mixture produces a biphasic concentration pattern•Peak arterial plasma concentration is reached in 30 min•Toxic concentration is surpassed in a third of patients•No clinically obvious consequences were observed

Ropivacaine (Ropi) is a widely utilized anesthetic in cesarean sections (CS), however its optimal dosage remains controversial. To assess the efficacy and safety of varying doses (10mg, 5mg, 4mg, and 3mg) of Ropi in subarachnoid block (SA) for CS. A prospective cohort study was conducted, and a total of 74 pregnant women undergoing CS at Nantong Maternal and Child Health Care Hospital between January and June 2023 were selected as the study population. Participants were stratified into groups based on Ropivacaine dosage: Group A (10 mg, n=18), Group B (5 mg, n=26), Group C (4 mg, n=15), and Group D (3 mg, n=15). The total Ropivacaine dosage administered via SA was consistently 10 mg across all groups. We measured anesthetic efficacy, safety profiles, abdominal wall muscle relaxation, pre- and post-anesthesia stress and inflammatory responses before and after anesthesia and compared among the four groups. Group A exhibited the shortest onset time for block initiation and longest recovery duration (P < .05). Group D displayed the highest incidence of patients requiring additional anesthetics and experiencing adverse reactions, whereas the utilization rate of vasopressors was most pronounced in Group A (P < .05). Notably, Group D reported the lowest satisfaction rate regarding abdominal wall muscle relaxation (P < .05). Stress responses were significantly lower in Groups A, B, and C compared to Group D, while the levels of inflammatory factors in Groups B and C were higher than those in Group A but lower than those in Group D (P < .05). Administration of 4 mg hyperbaric Ropi in SA can achieve an optimal anesthesia effect in CS with a high level of safety, along with inducing mild abdominal wall muscle relaxation and attenuating stress and inflammatory responses pre- and post-anesthesia. Thus, it is recommended for clinical application.

Erector spinae plane (ESP) block is a novel regional anesthesia technique and gaining importance for postoperative pain management. Since it was first described, the clinicians wonder if this new simple technique can replace paravertebral block (PVB). We aimed to compare the postoperative analgesic effect of ESP block and PVB with a control group in breast surgeries. Randomized controlled trial. Operating room. Seventy-five ASA I–II patients aged 25–65, who were scheduled to go under elective unilateral breast surgery for breast cancer were included to the study. Patients were randomized into three groups as ESP, PVB, and Control group. Ultrasound (US) guided ESP block and PVB with 20 ml 0.25% bupivacaine was done preoperatively to the patients according to their groups. All patients were provided with iv patient-controlled analgesia device for postoperative analgesia. Morphine consumptions and numeric rating scale (NRS) scores for pain were recorded at 1st, 6th, 12th and 24th hours postoperatively. There was a statistically significant difference between ESP and Control groups (p < 0,001) and between PVB and Control groups (p < 0,001), while there was no difference between ESP and PVB groups (p > 0,05) for 24-hour morphine consumptions. There was a significant difference between PVB and Control groups for NRS at postoperative 1st and 6th hour (p = 0.018 and p = 0.027 respectively). This study has shown that US guided ESP block and PVB provided adequate analgesia in patients undergoing breast surgery and have an opioid sparing effect by reducing morphine consumption. Clinical Trials Registry: NCT03480958. •ESP block provides effective analgesia in breast surgery.•ESP block has lower risk of complications compared to TPV block.•Both ESP block and TPV block have a similar analgesic effect in breast surgery.

HR18034, composed of the ropivacaine encapsulated in multi-lamellar, concentric circular structure liposomes as the major component and a small amount of free ropivacaine, has performed well in animal experiments and phase I clinical trials. This trial was to investigate the efficacy, safety, pharmacokinetic profile and the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy compared with ropivacaine. A multicenter, randomized, double-blind trial. 19 medical centers in China. 85 patients undergoing hemorrhoidectomy between October 2022 to November 2022. Patients were randomly divided into HR 18034 190 mg group, 285 mg group, 380 mg group and ropivacaine 75 mg group, receiving single local anesthetic perianal injection for postoperative analgesia. The primary outcome was the area under the resting state NRS score -time curve within 72 h after injection. The second outcomes included the proportion of patients without pain, the proportion of patients not requiring rescue analgesia, cumulative morphine consumption for rescue analgesia, etc. Safety was evaluated by adverse events incidence and plasma ropivacaine concentrations were measured to explore the pharmacokinetic characteristics of HR18034. The areas under the NRS score (at rest and moving states)-time curve were significantly lower in HR 18034 380 mg group than ropivacaine 75 mg at 24 h, 48 h, and 72 h after administration. However, this superiority was not observed in HR18034 190 mg group and 285 mg group. There was no difference in cumulative morphine consumption for rescue analgesia between HR 18034 groups and ropivacaine group. HR 18034 380 mg showed superior analgesic efficacy and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose. HR 18034 380 mg showed superior analgesic efficacy (lower area under the resting and moving states NRS score-time curve, The higher proportion of patients free of pain) and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose. [Display omitted] •Few clinical studies have been conducted on liposomal ropivacaine. No randomized controlled trial of perianal injection, local infiltration anesthesia for post-hemorrhoidectomy analgesia has been reported.•Consisted of a small fraction of free ropivacaine and a predominant portion of ropivacaine encapsulated by multi-layered concentric circular liposome, HR 18034 has an innovative structure, providing rapid pain relief of operative incision through free ropivacaine and sustained analgesia via slow release of the encapsulated ropivacaine from the liposome.•In addition to evaluating the safety and efficacy of the drug, the pharmacokinetic characteristics of the HR 18034 were reported in this study to further guide the clinical applications.

AimThe aim of this study was to compare the effectiveness of 2% articaine and 2% lignocaine in achieving adequate anesthesia in children between the age group of 6–13 years using inferior alveolar nerve block.MethodsA triple blinded randomized controlled trial was conducted in 180 participants (90 patients- 2% articaine, 90 patients-2% lignocaine). Effectiveness of the anesthetic agent was determined at 3 points determined by subjective evaluation of pain using pain scales (FPS-R). Paired sample t-test and chi square test were performed for statistical significance.ResultAnesthetic success for 2% articaine were 64.4%, 42.2% and 81.8% respectively. The anesthetic success of 2% lignocaine was 66.7%, 48.9% and 85.7% at point one, point two and point three respectively (p > 0.05).ConclusionThis study concludes that 2% articaine in 1:2,00,000 did not demonstrate superior clinical effectiveness in comparison to 2% lignocaine.Clinical significanceLignocaine has always been considered the gold standard. With its unique chemical structure and increased potency, Articaine has been gaining popularity. Its efficacy in 2% concentration had not been compared to 2% lignocaine. 2% articaine did not show clinical superiority but its comparable effectiveness with lignocaine can encourage further research in using articaine in reduced concentrations to improve effectiveness.