• Journal of Yeungnam Medical Science
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• v.34 no.2
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• pp.161-168
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• 2017

Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, single-injection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.2
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• pp.63-72
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• 2020

Dental local anesthesia is performed daily on a global scale. Adverse effects are rare, but the topic of neurotoxicity of local anesthetics deserves to be explored, as publications can be controversial and confusing. Therefore, a need was felt to address and question the evidence for potential neurotoxicity of dental local anesthetics. This review aimed to assess the studies published on the neurotoxicity of dental local anesthetics. A Pubmed^Ⓡ search was conducted between January 2019 and August 2019. This revealed 2802 hits on the topic of neurotoxicity or cytotoxicity of the following anesthetics: lidocaine, prilocaine, mepivacaine, articaine, ropivacaine, and bupivacaine. Only 23 papers were deemed eligible for this review: 17 in vitro studies, 3 reviews and 3 audits of national inquiries. The heterogeneous literature on this topic showed that all dental local anesthetics are potentially neurotoxic in a concentration and/or exposure time fashion. There seems no consensus about what cell lines are to be used to investigate the neurotoxicity of local anesthetics, which makes the comparison between studies difficult and ambiguous. However, the bottom line is that all dental local anesthetics have a neurotoxic potential, but that there is no unanimity in the publications about which local anesthetic is the least or the most neurotoxic.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.237-244
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• 2016

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.2
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• pp.55-61
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• 2020

During dental treatment, a dentist usually applies the local anesthesia. Therefore, all dentists should have expertise in local anesthesia and anesthetics. Local anesthetics have a neurotoxic effect at clinically relevant concentrations. Many studies have investigated the mechanism of neurotoxicity of local anesthetics but the precise mechanism of local anesthetic-induced neurotoxicity is still unclear. In addition, it is difficult to demonstrate the direct neurotoxic effect of local anesthetics because perioperative nerve damage is influenced by various factors, such as the anesthetic, the patient, and surgical risk factors. This review summarizes knowledge about the pharmacology of local anesthetics, nerve anatomy, and the incidence, risk factors, and possible cellular mechanisms of local anesthetic-induced neurotoxicity.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.81-90
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• 2017

Pregnancy induces significant anatomical and physiological changes in the mother. Many pregnant women need dental treatment due to poor oral hygiene related to pregnancy. However, most dentists are reluctant to provide, and most pregnant women are reluctant to receive, dental treatment during pregnancy. Theoretically, maternally administered drugs are transferred to the fetus. Depending on the types of drugs and the stage of pregnancy, the effects of drugs on the mother, as well as the fetus, may vary. Local anesthetics are the most widely used in dental treatment. It is, therefore, important to understand the potential effects of local anesthetics during pregnancy. In this review, we will focus on the maternal and fetal effects of local anesthetics widely used in dental treatment with consideration of the use of local anesthetics during pregnancy.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.33 no.4
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• pp.114-125
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• 2020

Objectives : The aim of this study is to review the topical anesthetic effect of herbal medicine. Methods : Using domestic database(OASIS, RISS) and foreign database(Pubmed, Embase, Cochrane library, CNKI), clinical studies about efficacy of herbal medicine as topical anesthetics were searched. Only randomized controlled trials(RCT) were selected and analyzed. Results : Total 647 studies were searched. After screening process, 5 articles were selected. 2 were from Chinese database and 3 were from English database. Articles were about clinical use of herbal medicine as topical anesthetics and compare their efficacy with conventional topical anesthetics. Out of 5 articles, 4 articles used pain rating scales recorded by subjects as outcome measurement. All studies showed lower pain score in herbal medicine using groups. 4 studies showed that there was no statistically significant difference in pain score between herbal medicine using group and conventional topical anesthetics using group. Conclusions : The results suggest that topical anesthetics using herbal medicine is as effective as or maybe even more effective than conventional topical anesthetics. However, experimental design and composition of intervention were all different, which provides inaccuracy when comparing the experimental results. Also, sample sizes were small and the number of RCTs were insufficient to identify full list of herbs that have potentials to be used topical anesthetics. Further studies need to be conducted to find out potentials of herbal medicine as topical anesthetics.

• International Journal of Oral Biology
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• v.32 no.2
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• pp.45-49
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• 2007

In this study, the cytotoxicity of commonly used local anesthetics was evaluated on odontoblasts which are essential for pulpal homeostasis in vitro. Local anesthetics, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and procaine, were tested on the odontoblast cell line, MDPC-23. The concentration-and time-dependent cytotoxic effects of local anesthetics on odontoblasts were measured by MTT assay. Among local anesthetics treated for 18 h, only bupivacaine significantly showed cell death in a concentration-($LC_{50}=1.2mM$) and time-dependent manner. To confirm cell death induced by bupivacaine, the observation of cell morphology and FACS using Annexin V and propidium iodide (PI) staining were performed. As a result of Annexin V and PI staining, as well as the morphological change, only bupivacaine induced apoptotic cell death on odontoblasts when compared with levobupivacaine and lidocaine. These results suggest that bupivacaine might affect normal pulpal integrity even after uneventful local anesthesia.

• Journal of Life Science
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• v.2 no.2
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• pp.97-107
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• 1992

Strichartz and Richie have suggested that the mechanism of sodium donductance block of local anesthetics involves their interaction with a specific binding site within the sodium channel. However, there is evidence that local anesthetics can interact electrostatically with membrane proteins as well as membrane lipids. Whether or not all actions of local anesthetics are mediated by common site remains unclear. Thus, it can not be ruled out that local anesthetics concurrently interact with neuronal membrane lipids since sodium channels were found to be tightly associated with membrane lipids through covalent or noncovalent bonds. In summary, it is strongly postulated that local anesthetics, in addition to their direct interaction with sodium channels, concurrently interact with membrane lipids, fluidize the membrane, and thus induce conformational changes of sodium channels, which are known to be tightly associated with membrane lipids.

• The Korean Journal of Pharmacology
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• v.23 no.2
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• pp.113-121
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• 1987

Local anesthetics were investigated for their effects on mitochondrial electron transport system, production of superoxide radical from submitochondrial particles and malondialdehyde production through lipid per oxidation. Local anesthetics had various effects on activities of enzymes in electron transport chain. The activities of NADH dehydrogenase, NADH oxidase and NADH-ubiquinone oxidoreductase were effectively inhibited by lidocaine, procaine and dibucaine but slightly influenced by cocaine. The activities of succinate dehydrogenase, succinate-cytochrome c oxidoreductase and succinate-ubiquinone oxidoreductase were inhibited by lidocaine and dibucaine, but the succinate oxidase activity was stimulated by local anesthetics. Both dihydroubiquinone-cytochrome c oxidoreductase and cytochrome c oxidase activities were inhibited by local anesthetics. In these reactions, the response of Complex I segment to local anesthetics was greater than other Complex segments. Local anesthetics inhibited both the superoxide production from submitochondrial particles supplemented with succinate or NADH and the enhanced production of superoxide radicals by antimycin. The malondialdehyde production by oxygen free radicals was inhibited by local anesthetics. These results suggest that the inhibition of superoxide and malondialdehyde production caused by local anesthetics may be brought by suppression of the electron transport in mitochondria at sites in or near complex I segment.

• The Korean Journal of Pharmacology
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• v.9 no.1
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• pp.53-58
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• 1973

Author attempts to determine the absorption of the sulfanilamide by the various suppositorial bases contained the local anesthetics through the rectum of the rabbit. The types of bases examined are four of lipophillic, hydrophillic and emulsion types such as oil in water and water in oil, otherwise the local anesthetics are procaine and lidocaine each other 2 and 20 percent in a suppository. The results are as follows; 1. The absorption of sulfanilamide is higher when they are combined with the local anesthetics than when single drugs of them are used. 2. The promotion of absorption by the local anesthetics, both the procaine and lidocaine, are higher when they are used 20 percent than 2 percent as the concentration. 3. In excellency of the suppositorial base, the order of the blood level is polyethylene glycol, oil in water, water in oil as emulson type and cacao butter.