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Sample records for collagen bupivacaine implant

  1. A feasibility study to investigate the use of a bupivacaine-collagen implant (XaraColl for postoperative analgesia following laparoscopic surgery

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    Hemsen L

    2013-02-01

    Full Text Available Lisa Hemsen,1 Susan L Cusack,2 Harold S Minkowitz,3 Michael E Kuss41Innocoll Technologies, Athlone, Ireland; 2Cusack Pharmaceutical Consulting, Burlington, NJ, USA; 3Memorial Hermann Memorial City Medical Center, Houston, TX, USA; 4Premier Research Group, Austin, TX, USABackground: XaraColl, a collagen-based implant that delivers bupivacaine to sites of surgical trauma, has been shown to reduce postoperative pain and use of opioid analgesia in patients undergoing open surgery. We therefore designed and conducted a preliminary feasibility study to investigate its application and ease of use for laparoscopic surgery.Methods: We implanted four XaraColl implants each containing 50 mg of bupivacaine hydrochloride (200 mg total dose in ten men undergoing laparoscopic inguinal or umbilical hernioplasty. Postoperative pain intensity and use of opioid analgesia were recorded through 72 hours for comparison with previously reported data from efficacy studies performed in men undergoing open inguinal hernioplasty. Safety was assessed for 30 days.Results: XaraColl was easily and safely implanted via a laparoscope. The summed pain intensity and total use of opioid analgesia through the first 24 hours were similar to the values observed in previously reported studies for XaraColl-treated patients after open surgery, but were lower through 48 and 72 hours.Conclusion: XaraColl is suitable for use in laparoscopic surgery and may provide postoperative analgesia in laparoscopic patients who often experience considerable postoperative pain in the first 24–48 hours following hospital discharge. Randomized controlled trials specifically to evaluate its efficacy in this application are warranted.Keywords: laparoscopic, hernioplasty, hernia repair

  2. The pharmacokinetics and safety of an intraoperative bupivacaine-collagen implant (XaraColl® for postoperative analgesia in women following total abdominal hysterectomy

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    Cusack SL

    2013-03-01

    Full Text Available Susan L Cusack,1 Philip Reginald,2 Lisa Hemsen,3 Emmanuel Umerah21Cusack Pharmaceutical Consulting, Burlington, NJ, USA; 2Departments of Gynaecology and Anaesthetics, Wexham Park Hospital, Slough, SL2 4HL, UK; 3Innocoll Technologies, Athlone, IrelandBackground: XaraColl®, a collagen-based intraoperative implant that delivers bupivacaine to the site of surgical trauma, is under development for postoperative analgesia. We examined the pharmacokinetics, safety and efficacy of XaraColl following implantation in women undergoing total abdominal hysterectomy.Methods: Three XaraColl implants, each containing 50 mg bupivacaine hydrochloride, were implanted in 12 women undergoing total abdominal hysterectomy for a benign condition. Serum samples were obtained through 96 hours for pharmacokinetic analysis. Patients received acetaminophen 1000 mg every 6 hours, diclofenac 50 mg every 8 hours, and were given access to intravenous morphine for breakthrough pain via patient-controlled analgesia during the first 24 hours. Pain intensity was assessed at regular intervals using a 100 mm visual analog scale. Safety was assessed through 30 days.Results: The pharmacokinetic profile displayed a double peak in bupivacaine concentration with the second peak occurring up to 24 hours after the first and at a generally higher concentration. The time to maximum concentration (tmax varied from 0.5 to 24 hours (median 12 hours according to which peak predominated. The mean maximum concentration (Cmax was 0.22 µg/mL and the maximum individual Cmax was 0.44 µg/mL, which are well below the established systemic toxicity threshold. Morphine use was generally low (mean 16.8 mg; median 6.5 mg and compared favorably with institutional experience. At 6 hours post-surgery, 11 patients recorded pain scores ≤ 20 mm, 6 recorded ≤ 10 mm, and 2 reported no pain. Scores continued to decline throughout the study. The product was considered safe and well tolerated.Conclusion: Xara

  3. Clinical evaluation of XaraColl®, a bupivacaine-collagen implant, for postoperative analgesia in two multicenter, randomized, double-blind, placebo-controlled pilot studies

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    Cusack SL

    2012-06-01

    Full Text Available Susan L Cusack,1 Mark Jaros,2 Michael Kuss,3 Harold S Minkowitz,4 Peter Winkle,5 Lisa Hemsen61Cusack Pharmaceutical Consulting, Burlington, NJ, 2Summit Analytical, Denver, CO, USA; 3Premier Research Group, Austin, TX, USA; 4Memorial Hermann Memorial City Medical Center, Houston, TX, USA; 5Advanced Clinical Research Institute, Anaheim, CA, USA; 6Innocoll Technologies, Athlone, IrelandBackground: XaraColl®, a collagen-based implant that delivers bupivacaine to the site of surgical trauma, is under development for postoperative analgesia. Because of differing patient attitudes to postoperative pain control and the inability to assess baseline pain, standard clinical methods for evaluating analgesic efficacy are compromised and justify application of novel integrated approaches.Methods: We conducted two independent, multicenter, double-blind, placebo-controlled studies in men undergoing unilateral inguinal hernioplasty by open laparotomy to evaluate the safety and efficacy of XaraColl at different doses (100 mg and 200 mg of bupivacaine hydrochloride; study 1 and 2, respectively. Enrolled patients (50 in study 1 and 53 in study 2 were randomized to receive active or placebo implants in a 1:1 ratio. Postoperative pain intensity and use of supplementary opioid medication were recorded through 72 hours. Safety was assessed through 30 days. The principal efficacy variables were the summed pain intensity (SPI, total use of opioid analgesia (TOpA, and an integrated endpoint (I-SPI-TOpA. Each variable was analyzed at 24, 48, and 72 hours after implantation. A pooled analysis of both studies was also performed retrospectively.Results: Through 24 and 48 hours, XaraColl-treated patients experienced significantly less pain in study 1 (P < 0.001 and P = 0.012, respectively whereas they took significantly less opioid analgesia in study 2 (P = 0.004 and P = 0.042, respectively. Over the same time intervals in the pooled analysis, treated patients experienced

  4. Urinary incontinence - collagen implants

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    ... gov/ency/article/007373.htm Urinary incontinence - injectable implant To use the sharing features on this page, please enable JavaScript. Injectable implants are injections of material into the urethra to ...

  5. Peri-implant soft tissue augmentation with a porcine collagen matrix.

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    Yuri Castro

    2014-12-01

    Full Text Available A good amount and width of keratinized tissue around implants has been associated with better peri-implant health, less bone loss and improved esthetics. The purpose of this case was to evaluate a new porcine xenograft (collagen matrix used as an interpositional graft to augment thickness of the peri-implant mucosa. There are few studies using a collagen matrix as a substitute for subepithelial connective graft around implants. This case involved a clinical implant in teeth 15 in which it was made the most of it during placement of healing abutment by taking the opportunity to increase periimplant mucosa with a collagen matrix. Thickness increased 1.5mm while the amount of keratinized mucosa was kept at 4mm. It is concluded that the collagen matrix of porcine origin is a good alternative to increase thickness of the peri-implant mucosa and reduce morbidity. It is easy to handle and suture as well.

  6. TISSUE INTERACTIONS WITH DERMAL SHEEP COLLAGEN IMPLANTS - A TRANSMISSION ELECTRON-MICROSCOPIC EVALUATION

    NARCIS (Netherlands)

    VANWACHEM, PB; VANLUYN, MJA; DAMINK, LO; FEIJEN, J; NIEUWENHUIS, P

    1991-01-01

    Tissue interactions with discs of dermal sheep collagen (DSC), subcutaneously implanted in rats, were evaluated using transmission electron microscopy. DSC cross-linked with hexamethylenediisocyanate (HDSC) had already been tested previously. In the present study, we compared tissue interactions of

  7. Platelet adhesion and plasma protein adsorption control of collagen surfaces by He{sup +} ion implantation

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    Kurotobi, K. E-mail: kurotobi@postman.riken.go.jp; Suzuki, Y.; Nakajima, H.; Suzuki, H.; Iwaki, M

    2003-05-01

    He{sup +} ion implanted collagen-coated tubes with a fluence of 1 x 10{sup 14} ions/cm{sup 2} were exhibited antithrombogenicity. To investigate the mechanisms of antithrombogenicity of these samples, plasma protein adsorption assay and platelet adhesion experiments were performed. The adsorption of fibrinogen (Fg) and von Willebrand factor (vWf) was minimum on the He{sup +} ion implanted collagen with a fluence of 1 x 10{sup 14} ions/cm{sup 2}. Platelet adhesion (using platelet rich plasma) was inhibited on the He{sup +} ion implanted collagen with a fluence of 1 x 10{sup 14} ions/cm{sup 2} and was accelerated on the untreated collagen and ion implanted collagen with fluences of 1 x 10{sup 13}, 1 x 10{sup 15} and 1 x 10{sup 16} ions/cm{sup 2}. Platelet activation with washed platelets was observed on untreated collagen and He{sup +} ion implanted collagen with a fluence of 1 x 10{sup 14} ions/cm{sup 2} and was inhibited with fluences of 1 x 10{sup 13}, 1 x 10{sup 15} and 1 x 10{sup 16} ions/cm{sup 2}. Generally, platelets can react with a specific ligand inside the collagen (GFOGER sequence). The results of platelets adhesion experiments using washed platelets indicated that there were no ligands such as GFOGER on the He{sup +} ion implanted collagen over a fluence of 1 x 10{sup 13} ions/cm{sup 2}. On the 1 x 10{sup 14} ions/cm{sup 2} implanted collagen, no platelet activation was observed due to the influence of plasma proteins. >From the above, it is concluded that the decrease of adsorbed Fg and vWf caused the antithrombogenicity of He{sup +} ion implanted collagen with a fluence of 1 x 10{sup 14} ions/cm{sup 2} and that plasma protein adsorption took an important role repairing the graft surface.

  8. Comparative analysis of collagen membranes for the treatment of implant dehiscence defects.

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    Oh, Tae-Ju; Meraw, Stephen J; Lee, Eun-Ju; Giannobile, William V; Wang, Hom-Lay

    2003-02-01

    Guided bone regeneration (GBR) evolved from the concept of guided tissue regeneration (GTR) and has been used for reconstructing sites with bone deficiencies associated with dental implants. For GBR, the use of absorbable collagen membranes has been increasing, but, at present, scientific information on the use of collagen membranes for GBR is limited. This study was aimed to clinically and histomorphometrically compare two collagen membranes, Bio-Gide(R) and BioMend ExtendTM, for the treatment of implant dehiscence defects in eight mongrel dogs. Implant dehiscence defects were surgically created in edentulous ridges, followed by the placement of three endosseous implants bilaterally in the mandible. Each implant dehiscence defect was randomly assigned to one of three treatment groups: (1) control (no membrane), (2) porcine dermis collagen barrier (Bio-Gide) or (3) bovine tendon collagen barrier (BioMend Extend). Dogs were sacrificed at 4 and 16 weeks (four dogs each) after treatment. Histomorphometric analysis included percentage linear bone fill (LF), new bone-to-implant contact (BIC) and area of new bone fill (BF). The results of the study revealed no significant differences among groups for any parameter at 4 weeks. However, at 16 weeks, more LF, BIC, and BF were noted in the membrane-treated groups than controls. BioMend Extend-treated defects demonstrated significantly greater BIC than control (P Membrane exposure occurred in 9 out of 15 sites examined, resulting in significantly less LF and BIC than the sites without membrane exposure (P collagen membranes may significantly enhance bone regeneration, manifested at late stage (16 weeks) of healing; and (2) space maintenance and membrane coverage were the two most important factors affecting GBR using bioabsorbable collagen membranes.

  9. CALCIFICATION OF SUBCUTANEOUSLY IMPLANTED COLLAGENS IN RELATION TO CYTOTOXICITY, CELLULAR INTERACTIONS AND CROSS-LINKING

    NARCIS (Netherlands)

    VANLUYN, MJA; VANWACHEM, PB; DIJKSTRA, PJ; DAMINK, LHHO; FEIJEN, J

    1995-01-01

    In general, calcification of biomaterials occurs through an interaction of host and implanted material factors, but up to now the real origin of pathologic calcification is unknown. In this study we aimed to investigate incidence of calcification of (crosslinked) dermal sheep collagens (DSCs) with r

  10. Coelomic implantation of satellite transmitters in the bar-tailed godwit (Limosa lapponica) and the bristle-thighed curlew (Numenius tahitiensis) using propofol, bupivacaine, and lidocaine

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    Mulcahy, Daniel M.; Gartrell, Brett D.; Gill, Robert E.; Tibbitts, T. Lee; Ruthrauff, Daniel R.

    2011-01-01

    Intravenous propofol was used as a general anesthetic with a 2∶1 (mg∶mg) adjunctive mixture of lidocaine and bupivacaine as local anesthetics infiltrated into the surgical sites for implantation of satellite transmitters into the right abdominal air sac of 39 female and 4 male bar-tailed godwits (Limosa lapponica baueri and Limosa lapponica menzbeiri) and 11 female and 12 male bristle-thighed curlews (Numenius tahitiensis). The birds were captured on nesting grounds in Alaska, USA, and on overwintering areas in New Zealand and Australia from 2005 through 2008. As it was developed, the mass of the transmitter used changed yearly from a low of 22.4 ± 0.2 g to a high of 27.1 ± 0.2 g and weighed 25.1 ± 0.2 g in the final year. The mean load ratios ranged from 5.2% to 7.7% for godwits and from 5.7% to 7.5% for curlews and exceeded 5% for all years, locations, and genders of both species. The maximum load ratio was 8.3% for a female bar-tailed godwit implanted in Australia in 2008. Three godwits and no curlews died during surgery. Most birds were hyperthermic upon induction but improved during surgery. Two godwits (one in New Zealand and one in Australia) could not stand upon release, likely due to capture myopathy. These birds failed to respond to treatment and were euthanized. The implanted transmitters were used to follow godwits through their southern and northern migrations, and curlews were followed on their southern migration.

  11. Canine chondrocytes seeded in type I and type II collagen implants investigated in vitro.

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    Nehrer, S; Breinan, H A; Ramappa, A; Shortkroff, S; Young, G; Minas, T; Sledge, C B; Yannas, I V; Spector, M

    1997-01-01

    Synthetic and natural absorbable polymers have been used as vehicles for implantation of cells into cartilage defects to promote regeneration of the articular joint surface. Implants should provide a pore structure that allows cell adhesion and growth, and not provoke inflammation or toxicity when implanted in vivo. The scaffold should be absorbable and the degradation should match the rate of tissue regeneration. To facilitate cartilage repair the chemical structure and pore architecture of the matrix should allow the seeded cells to maintain the chondrocytic phenotype, characterized by synthesis of cartilage-specific proteins. We investigated the behavior of canine chondrocytes in two spongelike matrices in vitro: a collagen-glycosaminoglycan (GAG) copolymer produced from bovine hide consisting of type I collagen and a porous scaffold made of type II collagen by extraction of porcine cartilage. Canine chondrocytes were seeded on both types of matrices and cultured for 3 h, 7 days, and 14 days. The histology of chondrocyte-seeded implants showed a significantly higher percentage of cells with spherical morphology, consistent with chondrocytic morphology, in the type II sponge at each time point. Pericellular matrix stained for proteoglycans and for type II collagen after 14 days. Biochemical analysis of the cell seeded sponges for GAG and DNA content showed increases with time. At day 14 there was a significantly higher amount of DNA and GAG in the type II matrix. This is the first study that directly compares the behavior of chondrocytes in type I and type II collagen matrices. The type II matrix may be of value as a vehicle for chondrocyte implantation on the basis of the higher percentage of chondrocytes retaining spherical morphology and greater biosynthetic activity that was reflected in the greater increase of GAG content.

  12. Collagen implant with gentamicin sulphate reduces surgical site infection in vascular surgery: a prospective cohort study.

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    Costa Almeida, Carlos Eduardo Perdigão; Reis, Luis; Carvalho, Luis; Costa Almeida, Carlos Manuel

    2014-10-01

    Surgical site infection (SSI) is a common complication after vascular surgery. It may cause exposure of the underlying prosthesis causing graft infection, which may require the removal of the vascular graft, increasing amputation and mortality risks. Graft contamination usually occurs during operative procedure or by direct spread from an infected wound. It is therefore advisable to a strong effort in reducing SSI. Topic antibiotics have not been fully studied in vascular surgery, but collagen implant with gentamicin sulphate has shown to reduce SSI in cardiac surgery, orthopaedics, and general surgery procedures. Sixty (60) non-diabetic and non-obese patients with lower limb ischaemia with indication for femoropopliteal PTFE prosthetic bypass were allocated into 2 groups of 30 patients. A collagen implant impregnated with gentamicin sulphate (Collatamp(®)) was applied in the groin incision adjacent to the prosthesis in one group, and the other was a control group. The same surgical team operated all patients. Szilagyi classification was used. There was no SSI (0% - 0/30) in the collagen implant with gentamicin sulphate group, contrasting with 6 cases (20% - 6/30) of SSI (grade I and II) in the control group (p = 0.024). In-hospital day's data shows a significant difference between the two groups (p = 0.004) with a mean of 5.66 days for implant group and 8.10 days for control group. There was no SSI grade III. Collagen implant with gentamicin sulphate (Collatamp(®)) reduces SSI in the groin incision in ischaemic patients submitted to femoropopliteal PTFE prosthetic bypass. Days of hospitalization are also reduced. Decreasing SSI rate and in-hospital days, this implant may also reduce health care costs. Because this is a small pilot study, a multicentre RCT is necessary for validation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  13. [Implantation of collagen coated hydroxyapatite particles. A clinical-histological study in humans].

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    Sanz, M; Bascones, A; Kessler, A; García Nuñez, J; Newman, M G; Robertson, M A; Carranza, F A

    1989-05-01

    In this study, histologic behaviour of collagen coated hydroxylapatite particles implanted in human periodontal osseous defects has been analyzed. This material was surgically implanted in four patients, and reentry and block biopsies were carried out 4 and 6 months later. The histologic results demonstrate that this material is well tolerated by surrounding tissues, not eliciting an inflammatory reaction. At four months, the hydroxylapatite particles appear encapsulated by a very cellular connective tissue and at 6 months are found in direct contact with osteoid and mature bone. This material acts as a filler material, being fully biocompatible and stimulating an osseoconductive reaction of the adjacent alveolar bone.

  14. Clinical evaluation of a collagen matrix to enhance the width of keratinized gingiva around dental implants

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    Lee, Kang-Ho; Kim, Byung-Ock; Jang, Hyun-Seon

    2010-01-01

    Purpose The purpose of this study was to evaluate the effect of collagen matrix with apically positioned flap (APF) on the width of keratinized gingiva, comparing to the results of APF only and APF combined with free gingival graft (FGG) at the second implant surgery. Methods Nine patients were selected from those who had received treatments at the Department of Periodontics, Chosun University Dental Hospital, Gwangju, Korea. We performed APF, APF combined with FGG, and APF combined with coll...

  15. Oriented collagen as a potential cochlear implant electrode surface coating to achieve directed neurite outgrowth.

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    Volkenstein, Stefan; Kirkwood, John E; Lai, Edwina; Dazert, Stefan; Fuller, Gerald G; Heller, Stefan

    2012-04-01

    In patients with severe to profound hearing loss, cochlear implants (CIs) are currently the only therapeutic option when the amplification with conventional hearing aids does no longer lead to a useful hearing experience. Despite its great success, there are patients in which benefit from these devices is rather limited. One reason may be a poor neuron-device interaction, where the electric fields generated by the electrode array excite a wide range of tonotopically organized spiral ganglion neurons at the cost of spatial resolution. Coating of CI electrodes to provide a welcoming environment combined with suitable surface chemistry (e.g. with neurotrophic factors) has been suggested to create a closer bioelectrical interface between the electrode array and the target tissue, which might lead to better spatial resolution, better frequency discrimination, and ultimately may improve speech perception in patients. Here we investigate the use of a collagen surface with a cholesteric banding structure, whose orientation can be systemically controlled as a guiding structure for neurite outgrowth. We demonstrate that spiral ganglion neurons survive on collagen-coated surfaces and display a directed neurite growth influenced by the direction of collagen fibril deposition. The majority of neurites grow parallel to the orientation direction of the collagen. We suggest collagen coating as a possible future option in CI technology to direct neurite outgrowth and improve hearing results for affected patients.

  16. Quantitative Characterization of Collagen in the Fibrotic Capsule Surrounding Implanted Polymeric Microparticles through Second Harmonic Generation Imaging.

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    Dana Akilbekova

    Full Text Available The collagenous capsule formed around an implant will ultimately determine the nature of its in vivo fate. To provide a better understanding of how surface modifications can alter the collagen orientation and composition in the fibrotic capsule, we used second harmonic generation (SHG microscopy to evaluate collagen organization and structure generated in mice subcutaneously injected with chemically functionalized polystyrene particles. SHG is sensitive to the orientation of a molecule, making it a powerful tool for measuring the alignment of collagen fibers. Additionally, SHG arises from the second order susceptibility of the interrogated molecule in response to the electric field. Variation in these tensor components distinguishes different molecular sources of SHG, providing collagen type specificity. Here, we demonstrated the ability of SHG to differentiate collagen type I and type III quantitatively and used this method to examine fibrous capsules of implanted polystyrene particles. Data presented in this work shows a wide range of collagen fiber orientations and collagen compositions in response to surface functionalized polystyrene particles. Dimethylamino functionalized particles were able to form a thin collagenous matrix resembling healthy skin. These findings have the potential to improve the fundamental understanding of how material properties influence collagen organization and composition quantitatively.

  17. Actions of melatonin mixed with collagenized porcine bone versus porcine bone only on osteointegration of dental implants.

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    Calvo-Guirado, José Luis; Gómez-Moreno, Gerardo; López-Marí, Laura; Guardia, Javier; Marínez-González, José María; Barone, Antonio; Tresguerres, Isabel F; Paredes, Sergio D; Fuentes-Breto, Lorena

    2010-04-01

    This study evaluated the effect of the topical application of melatonin mixed with collagenized porcine bone on the osteointegration on the rough discrete calcium deposit (DCD) surface implants in Beagle dogs 3 months after their insertion. In preparation for subsequent insertion of dental implants, lower molars were extracted from 12 Beagle dogs. Each mandible received two parallel wall expanded platform implants with a DCD surface of 4 mm in diameter and 10 mm in length. The implants were randomly assigned to the distal sites on each mandible in the molar area and the gaps were filled with 5 mg lyophilized powdered melatonin and porcine bone and collagenized porcine bone alone. Ten histological sections per implant were obtained for histomorphometric studies. After a 4-wk treatment period, melatonin plus porcine bone significantly increased the perimeter of bone that was in direct contact with the treated implants (P < 0.0001), bone density (P < 0.0001), and new bone formation (P < 0.0001) in comparison with porcine bone alone around the implants. Melatonin plus collagenized porcine bone on DCD surface may act as a biomimetic agent in the placement of endo-osseous dental implants and enhance the osteointegration. Melatonin combined with porcine bone on DCD implants reveals more bone in implant contact at 12 wk (84.5 +/- 1.5%) compared with porcine bone alone treated area (67.17 +/- 1.2%).

  18. Implants of polyanionic collagen matrix in bone defects of ovariectomized rats.

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    Cunha, Marcelo Rodrigues; Santos, Arnaldo Rodrigues; Goissis, Gilberto; Genari, Selma C

    2008-03-01

    In recent years, there has been a great interest in the development of biomaterials that could be used in the repair of bone defects. Collagen matrix (CM) has the advantage that it can be modified chemically to improve its mechanical properties. The aim of the present study was to evaluate the effect of three-dimensional membranes of native or anionic (submitted to alkaline treatment for 48 or 96 h) collagen matrix on the consolidation of osteoporosis bone fractures resulting from the gonadal hormone alterations caused by ovariectomy in rats subjected to hormone replacement therapy. The animals received the implants 4 months after ovariectomy and were sacrificed 8 weeks after implantation of the membranes into 4-mm wide bone defects created in the distal third of the femur with a surgical bur. Macroscopic analysis revealed the absence of pathological alterations in the implanted areas, suggesting that the material was biocompatible. Microscopic analysis showed a lower amount of bone ingrowth in the areas receiving the native membrane compared to the bone defects filled with the anionic membranes. In ovariectomized animals receiving anionic membranes, a delay in bone regeneration was observed mainly in animals not subjected to hormone replacement therapy. We conclude that anionic membranes treated with alkaline solution for 48 and 96 h presented better results in terms of bone ingrowth.

  19. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints

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    Walker, J. A.; Ewald, T. J.; Lewallen, E.; Van Wijnen, A.; Hanssen, A. D.; Morrey, B. F.; Morrey, M. E.; Abdel, M. P.

    2017-01-01

    Objectives Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis. Materials and Methods A total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis. Results Animals that underwent arthrotomy had equivalent joint contractures regardless of scaffold implantation (-13.9° versus -10.9°, equivalence limit 15°). Animals that underwent surgery to induce contracture did not demonstrate equivalent joint contractures with (41.8°) or without (53.9°) collagen scaffold implantation. Chondral damage occurred in similar rates with (11 of 48) and without (nine of 48) scaffold implantation. No significant difference in synovitis was noted between groups. Absorption of the collagen scaffold occurred within eight weeks in all animals Conclusion Our data suggest that intra-articular implantation of a collagen sponge does not induce synovitis or cartilage damage. Implantation in a native joint does not seem to induce contracture. Implantation of the collagen sponge in a rabbit knee model of contracture may decrease the severity of the contracture. Cite this article: J. A. Walker, T. J. Ewald, E. Lewallen, A. Van Wijnen, A. D. Hanssen, B. F. Morrey, M. E. Morrey, M. P. Abdel, J. Sanchez-Sotelo. Intra

  20. Endometrial Collagen Fibril Hyperplasia is Associated with Implantation Failure in Women Undergoing IVF-ET

    Institute of Scientific and Technical Information of China (English)

    Min-zhi GAO; Mei-zhen XIN; Xiao-ming ZHAO; Zhong ZHENG; Yan HONG; Yun SUN; Hui-qin ZHANG

    2009-01-01

    Objective To analyse the effects of controlled ovarian hyperstimulation(COH)on the endometrial expression of collagen fibril(CF)during the peri-implantation period in patients undergoing IVF,and its relation to endometrial receptivity(ER)in repeated implantation failure(RIF).Methods Peripheral blood and endometrial biopsies were obtained from 45 infertile women on days 5,7 or 9 after oocytes retrieval or ovulation in a stimulated cycle(SC)and natural cycle(NC)respectively.CF was assayed by transmission electron microscope and quantified by modified Masson dyeing.The outcome of subsequent embryo transfer(ET)was observed.Results Levels of both E2 and progesterone were higher in the peripheral blood in SC than in NC.Also the expression of CF in the stroma in each secretory phase was increased significantly in SC(P<0.05).After embryo transferring,expression levels of CF in the pregnancy group dropped between the mid-and late-secretory phase,but no change in the non-pregnancy group.In the same term,all patients undergone endometrial curettage had higher pregnancy rate than those without.Conclusion Imbalance of production and degradation of endometrial CF in the secretory phase resulting from COH may be the cause of defective ER and implantation failure in some RIF patients.Endometrial curettage may improve implantation rate by inducing appropriate CF hyperplasia and degradation.

  1. Evaluation of a porcine collagen matrix used to augment keratinized tissue and increase soft tissue thickness around existing dental implants.

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    Schallhorn, Rachel A; McClain, Pamela K; Charles, Allan; Clem, Donald; Newman, Michael G

    2015-01-01

    Implant-supported prostheses often present with mucogingival deficiencies that may cause esthetic or hygienic issues. These issues may present as limited or no keratinized tissue, irregular soft tissue contour or concavity, and gray "showthrough" of the implant abutment and root forms. An interpositional soft tissue graft substitute that generates keratinized tissue and increases soft tissue thickness would be beneficial, as it would reduce donor site morbidity and be available in unlimited, off-the-shelf supply. Thirty patients were assessed as part of a multicenter, practice-based evaluation of the material. A xenogeneic collagen matrix was placed as an interpositional graft on the buccal aspect of implant sites; sites were reassessed at 6 months posttreatment. Results indicated that the collagen matrix increased tissue thickness and keratinized tissue around existing dental implants.

  2. Clinical safety and efficacy of implantation of octacalcium phosphate collagen composites in tooth extraction sockets and cyst holes

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    Tadashi Kawai

    2016-09-01

    Full Text Available It was demonstrated that octacalcium phosphate collagen composite achieved notable bone regeneration in bone defects in preclinical studies. On the basis of the research results, an investigator-initiated exploratory clinical trial was conducted after approval from a local Institutional Review Board. This clinical study was performed as a single-arm non-randomized intervention study. Octacalcium phosphate collagen composite was implanted into a total of 10 cases of alveolar bone defects after tooth extractions and cystectomy. Safety assessment was performed in terms of the clinical course and several consecutive laboratory examinations, and sequential radiographs were used for efficacy assessment. All participants uneventfully completed the clinical trial without major problems in their general condition. Postoperative wound swelling was observed, as also commonly seen in tooth extraction or cystectomy. Although no serious liver dysfunction, renal dysfunction, electrolyte imbalance, or abnormal urinalysis results were recognized, the number of white blood cells and C-reactive protein level temporarily increased after the operation. An increase in radiopacity in the octacalcium phosphate collagen composite–implanted site was observed in all cases. Finally, the border between the original bone and the octacalcium phosphate collagen composite–implanted site became indistinguishable. These results suggest that octacalcium phosphate collagen composite could be utilized safely in clinical situations in the future.

  3. The effects of bupivacaine and pipecoloxylidide on platelet function in vitro.

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    Odoom, J A; Sturk, A; Dokter, P W; Bovill, J G; ten Cate, J W; Oosting, J

    1989-07-01

    The influence of bupivacaine and its major metabolite, pipecoloxylidide, on human platelet function was studied in vitro. Significant inhibition of ADP and collagen-induced platelet aggregation occurred only with concentrations of bupivacaine above 10 micrograms.ml-1. This concentration (10-25 micrograms.ml-1) is much higher than would be expected in routine clinical use of bupivacaine for epidural analgesia. The inhibition of platelet aggregation was associated with a significant decrease in beta-thromboglobulin secretion. In contrast, pipecoloxylidide had no effect on platelet aggregation or the beta-thromboglobulin release. We conclude that the previously reported 30-min time-lag between the maximal plasma concentration of bupivacaine and the inhibition of platelet aggregation is unlikely to be due to a metabolism of bupivacaine to pipecoloxylidide.

  4. Altered spatiotemporal expression of collagen types I, III, IV, and VI in Lpar3-deficient peri-implantation mouse uterus.

    Science.gov (United States)

    Diao, Honglu; Aplin, John D; Xiao, Shuo; Chun, Jerold; Li, Zuguo; Chen, Shiyou; Ye, Xiaoqin

    2011-02-01

    Lpar3 is upregulated in the preimplantation uterus, and deletion of Lpar3 leads to delayed uterine receptivity in mice. Microarray analysis revealed that there was higher expression of Col3a1 and Col6a3 in the Preimplantation Day 3.5 Lpar3(-/-) uterus compared to Day 3.5 wild-type (WT) uterus. Since extracellular matrix (ECM) remodeling is indispensable during embryo implantation, and dynamic spatiotemporal alteration of specific collagen types is part of this process, this study aimed to characterize the expression of four main uterine collagen types: fibril-forming collagen (COL) I and COL III, basement membrane COL IV, and microfibrillar COL VI in the peri-implantation WT and Lpar3(-/-) uterus. An observed delay of COL III and COL VI clearance in the Lpar3(-/-) uterus may be associated with higher preimplantation expression of Col3a1 and Col6a3. There was also delayed clearance of COL I and delayed deposition of COL IV in the decidual zone in the Lpar3(-/-) uterus. These changes were different from the effects of 17beta-estradiol and progesterone on uterine collagen expression in ovariectomized WT uterus, indicating that the altered collagen expression in Lpar3(-/-) uterus is unlikely to be a result of alterations in ovarian hormones. Decreased expression of several genes encoding matrix-degrading metallo- and serine proteinases was observed in the Lpar3(-/-) uterus. These results demonstrate that pathways downstream of LPA3 are involved in the dynamic remodeling of ECM in the peri-implantation uterus.

  5. Bio-Oss collagen in the buccal gap at immediate implants: a 6-month study in the dog.

    Science.gov (United States)

    Araújo, Mauricio G; Linder, Elena; Lindhe, Jan

    2011-01-01

    following tooth extraction and immediate implant installation, the edentulous site of the alveolar process undergoes substantial bone modeling and the ridge dimensions are reduced. objective: the objective of the present experiment was to determine whether the process of bone modeling following tooth extraction and immediate implant placement was influenced by the placement of a xenogenic graft in the void that occurred between the implant and the walls of the fresh extraction socket. five beagle dogs about 1 year old were used. The 4th premolar in both quadrants of the mandible ((4) P(4) ) were selected and used as experimental sites. The premolars were hemi-sected and the distal roots removed and, subsequently, implants were inserted in the distal sockets. In one side of the jaw, the marginal buccal-approximal void that consistently occurred between the implant and the socket walls was grafted with Bio-Oss Collagen while no grafting was performed in the contra-lateral sites. After 6 months of healing, biopsies from each experimental site were obtained and prepared for histological analyses. the outline of the marginal hard tissue of the control sites was markedly different from that of the grafted sites. Thus, while the buccal bone crest in the grafted sites was comparatively thick and located at or close to the SLA border, the corresponding crest at the control sites was thinner and located a varying distance below SLA border. it was demonstrated that the placement of Bio-Oss Collagen in the void between the implant and the buccal-approximal bone walls of fresh extraction sockets modified the process of hard tissue healing, provided additional amounts of hard tissue at the entrance of the previous socket and improved the level of marginal bone-to-implant contact.

  6. Collagen type-I leads to in vivo matrix mineralization and secondary stabilization of Mg-Zr-Ca alloy implants.

    Science.gov (United States)

    Mushahary, Dolly; Wen, Cuie; Kumar, Jerald Mahesh; Lin, Jixing; Harishankar, Nemani; Hodgson, Peter; Pande, Gopal; Li, Yuncang

    2014-10-01

    Biodegradable magnesium-zirconia-calcium (Mg-Zr-Ca) alloy implants were coated with Collagen type-I (Coll-I) and assessed for their rate and efficacy of bone mineralization and implant stabilization. The phases, microstructure and mechanical properties of these alloys were analyzed using X-ray diffraction (XRD), optical microscopy and compression test, respectively, and the corrosion behavior was established by their hydrogen production rate in simulated body fluid (SBF). Coll-I extracted from rat tail, and characterized using fourier transform infrared (FT-IR) spectroscopy, was used for dip-coating the Mg-based alloys. The coated alloys were implanted into the femur bones of male New Zealand white rabbits. In vivo bone formation around the implants was quantified by measuring the bone mineral content/density (BMC/BMD) using dual-energy X-ray absorptiometry (DXA). Osseointegration of the implant and new bone mineralization was visualized by histological and immunohistochemical analysis. Upon surface coating with Coll-I, these alloys demonstrated high surface energy showing enhanced performance as an implant material that is suitable for rapid and efficient new bone tissue induction with optimal mineral content and cellular properties. The results demonstrate that Coll-I coated Mg-Zr-Ca alloys have a tendency to form superior trabecular bone structure with better osteoinduction around the implants and higher implant secondary stabilization, through the phenomenon of contact osteogenesis, compared to the control and uncoated ones in shorter periods of implantation. Hence, Coll-I surface coating of Mg-Zr-Ca alloys is a promising method for expediting new bone formation in vivo and enhancing osseointegration in load bearing implant applications. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Spatiotemporal Programing for the On-Demand Release of Bupivacaine Based on an Injectable Composite Hydrogel.

    Science.gov (United States)

    Dinh, Van Vuong; Suh, Yun-Suhk; Yang, Han-Kwang; Lim, Yong Taik

    2016-12-01

    We report a programed drug delivery system that can tailor the release of anesthetic bupivacaine in a spatiotemporally controlled manner. The drug delivery system was developed through the combination of a collagen-based injectable hydrogel and 2 types of poly(lactic-co-glycolic acid) (PLGA) particles. As a rapid-release platform (90% release after 24 h), bupivacaine hydrochloride was incorporated into collagen/poly(γ-glutamic acid) hydrogel, which exhibited gel formation at body temperature. PLGA microparticles (diameter 1-3 μm) containing bupivacaine base showed a very slow release of bupivacaine (95% after 240 h), whereas PLGA nanoparticles (124 ± 30 nm) containing bupivacaine base demonstrated an intermediate release rate (95% after 160 h). By changing the relative composition ratio between the 3 components in these injectable composite hydrogels, the release of bupivacaine could be easily controlled from very rapid (within 1 day) to very delayed (up to 9 days). The experimental results on the release data (cumulative release, time point release, average release rate) were coincident with the release profile generated by computer simulation. These injectable composite hydrogels with systematically tunable mixing ratios are expected to serve as a promising technology for the on-demand release of bupivacaine in pain management. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  8. Absence of muscle regeneration after implantation of a collagen matrix seeded with myoblasts

    NARCIS (Netherlands)

    van Wachem, PB; Brouwer, LA; van Luyn, MJA

    1999-01-01

    Collagens are widely used as biomaterials for e.g. soft tissue reconstruction. The present study was aimed at reconstruction of abdominal wall muscle using processed dermal sheep collagen (DSC) and myoblast seeding. Myoblasts were harvested from foetal quadriceps muscle of an inbred rat strain, cult

  9. The composition of engineered cartilage at the time of implantation determines the likelihood of regenerating tissue with a normal collagen architecture.

    Science.gov (United States)

    Nagel, Thomas; Kelly, Daniel J

    2013-04-01

    The biomechanical functionality of articular cartilage is derived from both its biochemical composition and the architecture of the collagen network. Failure to replicate this normal Benninghoff architecture in regenerating articular cartilage may in turn predispose the tissue to failure. In this article, the influence of the maturity (or functionality) of a tissue-engineered construct at the time of implantation into a tibial chondral defect on the likelihood of recapitulating a normal Benninghoff architecture was investigated using a computational model featuring a collagen remodeling algorithm. Such a normal tissue architecture was predicted to form in the intact tibial plateau due to the interplay between the depth-dependent extracellular matrix properties, foremost swelling pressures, and external mechanical loading. In the presence of even small empty defects in the articular surface, the collagen architecture in the surrounding cartilage was predicted to deviate significantly from the native state, indicating a possible predisposition for osteoarthritic changes. These negative alterations were alleviated by the implantation of tissue-engineered cartilage, where a mature implant was predicted to result in the formation of a more native-like collagen architecture than immature implants. The results of this study highlight the importance of cartilage graft functionality to maintain and/or re-establish joint function and suggest that engineering a tissue with a native depth-dependent composition may facilitate the establishment of a normal Benninghoff collagen architecture after implantation into load-bearing defects.

  10. Liposomal bupivacaine and clinical outcomes.

    Science.gov (United States)

    Tong, Yi Cai Isaac; Kaye, Alan David; Urman, Richard D

    2014-03-01

    In the multimodal approach to the management of postoperative pain, local infiltration and regional blocks have been increasingly utilized for pain control. One of the limitations of local anesthetics in the postoperative setting is its relatively short duration of action. Multivesicular liposomes containing bupivacaine have been increasingly utilized for their increased duration of action. Compared with bupivacaine HCl, local infiltration of liposomal bupivacaine has shown to have an increase in duration of action and causes delay in peak plasma concentration. In this article, we attempt to review the clinical literature surrounding liposomal bupivacaine and its evolving role in perioperative analgesia. This new bupivacaine formation may have promising implications in postoperative pain control, resulting in increased patient satisfaction and a decrease in both hospital stay and opioid-induced adverse events (AEs). Although more studies are needed, the preliminary clinical trials suggest that liposomal bupivacaine has predictable pharmacokinetics, a similar side effect profile compared with bupivacaine HCl, and is effective in providing increased postoperative pain control.

  11. The effect of Hydroxyapatite/collagen I composites, bone marrow aspirate and bone graft on fixation of bone implants in sheep

    DEFF Research Database (Denmark)

    Babiker, Hassan

      The effect of Hydroxyapatite/collagen I composites, bone marrow aspirate and bone graft on fixation of bone implants IN SHEEP   Ph.D. Student, Hassan Babiker; Associate Professor, Ph.D. Ming Ding; Professor, dr.med., Soren Overgaard. Department of Orthopaedic Surgery, Odense University Hospital......, Odense, Denmark   Background: Hydroxyapatite and collagen composites (HA/coll) have the potential in mimicking and replacing skeletal bones. This study attempted to determine the effect of newly developed HA/coll-composites with and without bone marrow aspirate (BMA) in order to enhance the fixation...... of bone implants.   Materials and Methods: Titanium alloy implants were inserted into bilateral femoral condyles of 8 skeletally mature sheep, four in each sheep. The implant has a circumferential gap of 2 mm. The gap was filled with: HA/coll; HA/coll-BMA; autograft or allograft. Allograft was served...

  12. Strontium content and collagen-I coating of Magnesium-Zirconia-Strontium implants influence osteogenesis and bone resorption.

    Science.gov (United States)

    Mushahary, Dolly; Wen, Cuie; Kumar, Jerald M; Sravanthi, Ragamouni; Hodgson, Peter; Pande, Gopal; Li, Yuncang

    2016-02-01

    Our objective was to study the role of Collagen type-I (Col-I) coating on Magnesium-Zirconia (Mg-Zr) alloys, containing different quantities of Strontium (Sr), in enhancing the in vitro bioactivity and in vivo bone-forming and mineralisation properties of the implants. MC3T3-E1 osteoblast cell line was used to analyse the in vitro properties of Col-I coated and uncoated alloys. Cell viability analysis was performed by MTT assay; cell attachment on alloy surfaces was studied by scanning electron microscopy (SEM); and gene profiling of bone-specific markers in cells plated on uncoated alloys was performed by Quantitative RT-PCR. In vivo studies were performed by implanting 2-mm-sized cylindrical pins of uncoated and coated alloys in male New Zealand white rabbits (n = 33). Bone formation and mineralisation was studied by Dual Energy X-ray Absorptiometry (DXA) and histological analysis at one and three months post-implantation. Our results clearly showed that Sr content and Col-I coating of Mg-Zr-Sr alloys significantly improved their bone inducing activity in vitro and in vivo. Osteoblasts on coated alloys showed better viability and surface binding than those on uncoated alloys. Sr inclusion in the alloys enhanced their bone-specific gene expression. The in vivo activity of implants with higher Sr and Col-I coating was superior to uncoated and other coated alloys as they showed faster bone induction and higher mineral content in the newly formed bone. Our results indicate that bone-forming and mineralising activity of Mg-Zr-Sr implants can be significantly improved by controlling their Sr content and coating their surface with Col-I. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Osteogenicity of titanium implants coated with calcium phosphate or collagen type-I in osteoporotic rats

    NARCIS (Netherlands)

    Alghamdi, H.S.A.; Bosco, R.; Beucken, J.J. van den; Walboomers, X.F.; Jansen, J.A.

    2013-01-01

    This study hypothesized that modification of titanium implant surface, e.g. by the deposition of inorganic/organic coatings, can significantly improve the implant-bone response compared in osteoporotic vs. healthy conditions. After osteoporosis was induced in 15 female Wistar rats by ovariectomy

  14. A long-term in vivo investigation on the effects of xenogenous based, electrospun, collagen implants on the healing of experimentally-induced large tendon defects.

    Science.gov (United States)

    Oryan, A; Moshiri, A; Parizi Meimandi, A; Silver, I A

    2013-09-01

    This study was designed to investigate the effect of novel 3-dimensional (3-D) collagen implants on the healing of large, experimentally-induced, tendon-defects in rabbits. Forty mature male white New Zealand rabbits were divided randomly into treated and control groups. Two cm of the left Achilles tendon was excised and the gap was spanned by Kessler suture. In the treated group, a novel 3-D collagen implant was inserted between the cut ends of the tendon. No implant was used in the control group. During the course of the experiment the bioelectrical characteristics of the healing and normal tendons of both groups were investigated weekly. At 120 days post injury (DPI), the tendons were dissected and inspected for gross pathology, examined by transmission and scanning electron microscopy, and their biomechanical properties, percentage dry matter and hydroxyproline concentration assessed. The collagen implant significantly improved the bioelectrical characteristics, gross appearance and tissue alignment of the healed, treated tendons, compared to the healed, control scars. It also significantly increased fibrillogenesis, diameter and density of the collagen fibrils, dry matter content, hydroxyproline concentration, maximum load, stiffness, stress and modulus of elasticity of the treated tendons, as compared to the control tendons. Treatment also significantly decreased peri-tendinous adhesions, and improved the hierarchical organization of the tendon from the collagen fibril to fibre-bundle level. 3-D xenogeneic-based collagen implants induced newly regenerated tissue that was ultrastructurally and biomechanically superior to tissue that was regenerated by natural unassisted healing. This type of bioimplant was biocompatible, biodegradable and appeared suitable for clinical use.

  15. Histological response to injected gluteraldehyde cross-linked bovine collagen based implant in a rat model

    Directory of Open Access Journals (Sweden)

    Cağlar Melda

    2006-02-01

    Full Text Available Abstract Background The aim of present study is to investigate the short and long term histopathological alterations caused by submucosal injection of gluteraldehyde cross-linked bovine collagen based on an experimental rat model. Methods Sixty Sprague-Dawley rats were assigned into two groups as group I and II each containing 30 rats. 0.1 ml of saline solution and 0.1 ml of gluteraldehyde cross-linked bovine collagen were injected into the submucosa of bladder of first (control and second groups, respectively. Both group I and II were further subdivided into 3 other groups as Group IA, IB, IC and Group IIA, IIB, IIC according to the sacrification period. Group IA and IIA, IB and IIB, IC and IIC rats (10 rats for each group were sacrificed 3, 6, and 12 months after surgical procedure, respectively. Two slides prepared from injection site of the bladder were evaluated completely for each rat by being unaware of the groups and at random by two independent senior pathologists to determine the fibroblast invasion, collagen formation, capillary ingrowth and inflammatory reaction. Additionally, randomized brain sections from each rat were also examined to detect migration of the injection material. The measurements were made using an ocular micrometer at ×10 magnification. The results were assessed using t-tests for paired and independent samples, with p Results Migration to the brain was not detected in any group. Significant histopathological changes in the gluteraldehyde cross-linked bovine collagen injected groups were fibroblast invasion in 93.3%, collagen formation in 73.3%, capillary ingrowth in 46.6%, inflamatory reaction in 20%. Conclusion We emphasize that the usage of gluteraldehyde cross-linked bovine collagen in children appears to be safe for endoscopic treatment of vesicoureteral reflux.

  16. [Effect of periodontal regeneration using collagen-coated synthetic bone implant materials. Histopathological study].

    Science.gov (United States)

    Sugaya, A

    1989-09-01

    Granulated artificial bone implant materials such as hydroxyapatite (HAP) and tricalcium phosphate (TCP) have been frequently used in attempts to restore periodontal tissue lost as a result periodontitis. However, these materials are considered insufficient for the maintenance and stability of granules at sites losing bone, for active bone formation, or for periodontal ligament regeneration. We have now developed a complex consisting of HAP or TCP coated with atelocollagen (which has recently received attention as a biomaterial) and have conducted experiments to determine the effects of this material on the reconstruction of periodontal tissue. Implantations were performed using a HAP-atelocollagen complex, TCP-atelocollagen complex, HAP and TCP at three-wall bone defect sites in experimentally-induced periodontitis in dogs. A control group without the implants was included in the study. Histopathological observations were conducted 2, 4 and 12 weeks after surgery. Compared with the control group, the groups implanted with the complex displayed enhanced maintenance and stability of granules, suppression of epithelial downgrowth, and acceleration of new bone and cementum formation. These results indicate that the implant method using an atelocollagen-coated artificial bone implant material would be useful for periodontal surgical treatment, eliminating some of the disadvantages of conventional implant methods.

  17. Collagen type I coating stimulates bone regeneration and osteointegration of titanium implants in the osteopenic rat

    National Research Council Canada - National Science Library

    Sartori, Maria; Giavaresi, Gianluca; Parrilli, Annapaola; Ferrari, Andrea; Aldini, Nicolò Nicoli; Morra, Marco; Cassinelli, Clara; Bollati, Daniele; Fini, Milena

    2015-01-01

    ...) on bone regeneration and osteointegration in a healthy and osteopenic rat animal model.TiColl screws were implanted into the femoral condyles of healthy and osteopenic rats and compared with acid-etched titanium (Ti) screws...

  18. Evaluation of a Porcine Dermal Collagen (Permacol Implant for Abdominal Wall Reconstruction in a Pediatric Multitrauma Patient

    Directory of Open Access Journals (Sweden)

    Idit Melnik

    2014-01-01

    Full Text Available The presence of a contaminated surgical field in abdominal wall defects caused by trauma presents a challenge for surgeons. Both primary suture and synthetic meshes are strongly discouraged as surgical treatments in such cases. We describe the use of a porcine dermal collagen (Permacol implant in an eight-year-old patient with multiple injuries. Three months after discharge, the child remains well with good cosmetic results. He is free of pain and has returned to full activity levels with complete wound closure and without any evidence of residual hernia. In conclusion, our experience indicates that the use of Permacol can be considered an efficient technique for reconstructing an infected abdominal wall defect of a pediatric multitrauma patient.

  19. Evaluation of 3D printed PCL/PLGA/β-TCP versus collagen membranes for guided bone regeneration in a beagle implant model.

    Science.gov (United States)

    Won, J-Y; Park, C-Y; Bae, J-H; Ahn, G; Kim, C; Lim, D-H; Cho, D-W; Yun, W-S; Shim, J-H; Huh, J-B

    2016-10-07

    Here, we compared 3D-printed polycaprolactone/poly(lactic-co-glycolic acid)/β-tricalcium phosphate (PCL/PLGA/β-TCP) membranes with the widely used collagen membranes for guided bone regeneration (GBR) in beagle implant models. For mechanical property comparison in dry and wet conditions and cytocompatibility determination, we analyzed the rate and pattern of cell proliferation of seeded fibroblasts and preosteoblasts using the cell counting kit-8 assay and scanning electron microscopy. Osteogenic differentiation was verified using alizarin red S staining. At 8 weeks following implantation in vivo using beagle dogs, computed tomography and histological analyses were performed after sacrifice. Cell proliferation rates in vitro indicated that early cell attachment was higher in collagen than in PCL/PLGA/β-TCP membranes; however, the difference subsided by day 7. Similar outcomes were found for osteogenic differentiation, with approximately 2.5 times greater staining in collagen than PCL/PLGA/β-TCP, but without significant difference by day 14. In vivo, bone regeneration in the defect area, represented by new bone formation and bone-to-implant contact, paralleled those associated with collagen membranes. However, tensile testing revealed that whereas the PCL/PLGA/β-TCP membrane mechanical properties were conserved in both wet and dry states, the tensile property of collagen was reduced by 99% under wet conditions. Our results demonstrate in vitro and in vivo that PCL/PLGA/β-TCP membranes have similar levels of biocompatibility and bone regeneration as collagen membranes. In particular, considering that GBR is always applied to a wet environment (e.g. blood, saliva), we demonstrated that PCL/PLGA/β-TCP membranes maintained their form more reliably than collagen membranes in a wet setting, confirming their appropriateness as a GBR membrane.

  20. Biodegradable PTLGA Terpolymers versus Collagen Implants Used as an Adjuvant in Trabeculectomy in Rabbit Eye

    Directory of Open Access Journals (Sweden)

    Weiran Niu

    2015-01-01

    Full Text Available Purpose. To evaluate the effectiveness and safety of three biodegradable terpolymers prepared from L-lactide, trimethylene carbonate, and glycolide (PTLGA as an aid for trabeculectomy compared with the Ologen (OLO. Methods. Trabeculectomy was carried out on rabbits with implantation made from OLO or three PTLGA terpolymers. Intraocular pressure (IOP was recorded 1, 2, 3, and 6 months postoperatively and bleb evaluations were performed using ultrasound biomicroscopy (UBM 3 months after surgery, optical coherence tomography (OCT every month, and transmission electron microscopy (TEM six months after surgery followed by histological examination 1, 2, 3, and 6 months postoperatively. Result. IOP was significantly reduced in all groups after surgery. There were no significant differences in the IOL between groups at any time after implantation. There was no significant difference between the groups examined by OCT, UBM, and TEM. Exposure of the implant was observed in one eye from the OLO group and one eye in the P1. Subconjunctiva hyperblastosis was observed in one eye from group P3 and two eyes from the OLO group. Conclusions. Subconjunctival implantation of filtering devices made from PTLGA may present a safe and effective additional surgical tool for the treatment of filtering surgery. Fewer complications were observed in the group with P2 implants compared to other groups.

  1. Biodegradable PTLGA Terpolymers versus Collagen Implants Used as an Adjuvant in Trabeculectomy in Rabbit Eye.

    Science.gov (United States)

    Niu, Weiran; Shen, Guanglin; Yuan, Yuanzhi; Ma, Xiaoping; Li, Suming; Wang, Jingzhao; Fan, Zhongyong; Liao, Lan

    2015-01-01

    Purpose. To evaluate the effectiveness and safety of three biodegradable terpolymers prepared from L-lactide, trimethylene carbonate, and glycolide (PTLGA) as an aid for trabeculectomy compared with the Ologen (OLO). Methods. Trabeculectomy was carried out on rabbits with implantation made from OLO or three PTLGA terpolymers. Intraocular pressure (IOP) was recorded 1, 2, 3, and 6 months postoperatively and bleb evaluations were performed using ultrasound biomicroscopy (UBM) 3 months after surgery, optical coherence tomography (OCT) every month, and transmission electron microscopy (TEM) six months after surgery followed by histological examination 1, 2, 3, and 6 months postoperatively. Result. IOP was significantly reduced in all groups after surgery. There were no significant differences in the IOL between groups at any time after implantation. There was no significant difference between the groups examined by OCT, UBM, and TEM. Exposure of the implant was observed in one eye from the OLO group and one eye in the P1. Subconjunctiva hyperblastosis was observed in one eye from group P3 and two eyes from the OLO group. Conclusions. Subconjunctival implantation of filtering devices made from PTLGA may present a safe and effective additional surgical tool for the treatment of filtering surgery. Fewer complications were observed in the group with P2 implants compared to other groups.

  2. Acute and chronic local inflammatory reaction after implantation of different extracellular porcine dermis collagen matrices in rats.

    Science.gov (United States)

    Lucke, Silke; Hoene, Andreas; Walschus, Uwe; Kob, Anette; Pissarek, Jens-Wolfgang; Schlosser, Michael

    2015-01-01

    Two cross-linked acellular porcine dermal collagen matrices (Permacol and NRX) were implanted into rats and the acute and chronic local inflammatory tissue reactions were investigated after 7, 14, 28, and 112 days. Both membranes were stable in vivo for up to 112 days. All investigated immune cell populations (CD68+ macrophages, CD163+ macrophages, T lymphocytes, MHC class II positive cells, mast cells, and NK cells) were present. Their amount decreased significantly over time compared to day 7 after implantation. A change from an acute to a chronic inflammation and an associated shift from proinflammatory M1-like to anti-inflammatory M2-like macrophages were observed. In the early phase there was a significant correlation of T cells to CD68+ (M1-like) macrophages, whereas in the chronic phase T lymphocytes were positively correlated with CD163+ (M2-like) macrophages. The material NRX showed an enhanced inflammatory reaction in comparison to Permacol possibly caused by material characteristics such as a twofold higher thickness of the membrane, roughness, and water absorption capacity. Nevertheless, a more pronounced regenerative process as, for example, indicated by nestin expression demonstrated its possible suitability for applications as wound repair material.

  3. Acute and Chronic Local Inflammatory Reaction after Implantation of Different Extracellular Porcine Dermis Collagen Matrices in Rats

    Directory of Open Access Journals (Sweden)

    Silke Lucke

    2015-01-01

    Full Text Available Two cross-linked acellular porcine dermal collagen matrices (Permacol and NRX were implanted into rats and the acute and chronic local inflammatory tissue reactions were investigated after 7, 14, 28, and 112 days. Both membranes were stable in vivo for up to 112 days. All investigated immune cell populations (CD68+ macrophages, CD163+ macrophages, T lymphocytes, MHC class II positive cells, mast cells, and NK cells were present. Their amount decreased significantly over time compared to day 7 after implantation. A change from an acute to a chronic inflammation and an associated shift from proinflammatory M1-like to anti-inflammatory M2-like macrophages were observed. In the early phase there was a significant correlation of T cells to CD68+ (M1-like macrophages, whereas in the chronic phase T lymphocytes were positively correlated with CD163+ (M2-like macrophages. The material NRX showed an enhanced inflammatory reaction in comparison to Permacol possibly caused by material characteristics such as a twofold higher thickness of the membrane, roughness, and water absorption capacity. Nevertheless, a more pronounced regenerative process as, for example, indicated by nestin expression demonstrated its possible suitability for applications as wound repair material.

  4. Cytokine and chemokine dynamics differ between rats and mice after collagen implantation

    NARCIS (Netherlands)

    Luttikhuizen, Daniel T.; Harmsen, Martin C.; van Luyn, Marja J. A.

    2007-01-01

    Implanted scaffold materials induce an inflammatory reaction known as the 'foreign body reaction' (FBR). We hypothesized that the observed difference in FBR between rats and mice correlate with different expression dynamics of cytokines and chemokines, which are key orchestrators of the FBR. After i

  5. Immunohistochemical studies at the bone-implant interface of collagen-coated titanium pins

    Directory of Open Access Journals (Sweden)

    Stefan Rammelt

    2006-01-01

    Full Text Available Se realizaron estudios morfológicos e inmuno histoquímicos de secciones no descalcificadas de la interfaz entre implantes de titanio recubiertos con colágeno y el hueso adyacente, embebidas en un novedoso medio de inclusi ón. Se empleó colágeno tipo I liofilizado proveniente de cuero bovino para la fibrilogénesis a 37 oC durante 4 h, se centrifugó dos veces y se adsorbió durante 15 min sobre las varillas de titanio. Se implantaron pines de titanio de 0,8 mm de diámetro en las tibias de ratas Wistar macho adultas como varillas intramedulares. Como control se usaron pines de titanio sin recubrimiento de colágeno. Se sacrificaron seis animales por grupo al cabo de 1, 2, 4, 7, 14 y 28 d de la cirugía de implantación. Después de fijar inmediatamente en paraformaldeh ído 1,6 %, estabilizar con disolución reguladora de fosfato y deshidrataci ón con etanol y xilol, los especímenes se incluyeron en resina de base metacrilato Technovit 9100N de polimerización en frío. Los bloques con los especímenes se cortaron longitudinalmente a lo largo del eje del implante con equipo de corte y pulido Exact. Los implantes se extrajeron y se hicieron cortes seriados perpendiculares de 2 mm de sección y se montaron en portaobjetos de vidrio silanizado para el análisis inmuno histoquímico. Los anticuerpos primarios se detectaron con anticuerpos secundarios tratados con biotina, y a continuaci ón con el complejo estreptavidina-biotina-peroxidasa. A lo largo del período de observación, la tinción inmuno histoquímica fue consistente dentro de los grupos de estudio y reproducible en diferentes secciones del mismo espécimen. En el primer día después de la implantación, se observó reacción inflamatoria inespecífica manifestada por la presencia de granulocitos y linfocitos. En el segundo día, se observó un gran número de células fibroblásticas con reacción positiva a la vimentina y un pequeño número de ED1 y células fagocitantes

  6. Immunohistochemical studies at the bone-implant interface of collagen-coated titanium pins

    OpenAIRE

    Stefan Rammelt; Eva Schulze; Uwe Hanisch; Achim Biewener; Rene Grass; Hartmut Worch; Hans Zwipp

    2006-01-01

    Se realizaron estudios morfológicos e inmuno histoquímicos de secciones no descalcificadas de la interfaz entre implantes de titanio recubiertos con colágeno y el hueso adyacente, embebidas en un novedoso medio de inclusi ón. Se empleó colágeno tipo I liofilizado proveniente de cuero bovino para la fibrilogénesis a 37 oC durante 4 h, se centrifugó dos veces y se adsorbió durante 15 min sobre las varillas de titanio. Se implantaron pines de titanio de 0,8 mm de diámetro en las tibias de ratas ...

  7. Morphological characteristics of tissues of anterior abdominal wall of rats after implantation of alloplastic material, processed with collagen, in the initially infected wounds

    Directory of Open Access Journals (Sweden)

    Svisenko O. V.

    2010-01-01

    Full Text Available A research purpose was to investigate the tissue reactions on implantation of polypropylene mesh, processed with collagen, after the plastic of experimental defect at rats at underaponevrotic localization of prosthesis in the initially infected wounds. Research was performed in two experimental groups. Group 1 – at 27 rats in the conditions of the infected wound the monofilamentous polypropylene mesh of size 1×1,5 sm was fixed under aponevrosis. Group 2 – at 27 rats at analogous conditions with the previously infected wound the underaponevrotic fixation of polypropylene mesh, processed with collagen, was performed. From the data of morphological analysis, use of polypropylene mesh, processed with collagen, after the plastic of experimental defect at rats at underaponevrotic localization of prosthesis in the initially infected wounds accompanied with the acceleration of reparative processes and improvement of restructuring of connective tissue, muscular and vascular components of anterior abdominal wall during 4 weeks after intervention.

  8. Healing of experimental femoral defects in rats after implantation of collagen-calcium phosphate biocomposites

    Directory of Open Access Journals (Sweden)

    O. V. Korenkov

    2017-06-01

    Full Text Available The aim of this study was to investigate the healing process of experimental defects of the femoral shaft diaphysis of rats after implantation of osteoplastic material Collapan into its cavity. In experi-mental animals, a perforated defect with diameter of 2.5 mm was created in the medullary canal of the femoral shaft and filled with osteoplastic material Collapan. In control rats, the defect was left un-filled. The bone fragments were examined on the 15th and 30th day by light microscopy morphometry and scanning electron microscopy. It was found that application of osteoplastic material Collapan in the femoral diaphysis defect optimised reparative osteogenesis, showed high biocompatibility, osteo-conductive properties, resorption ability and good integration with tissue-specific structures of the regenerate

  9. Liposomal extended-release bupivacaine for postsurgical analgesia

    National Research Council Canada - National Science Library

    Lambrechts, Mark; O'Brien, Michael J; Savoie, Felix H; You, Zongbing

    2013-01-01

    ..., inguinal hernia repair, total knee arthroplasty, and augmentation mammoplasty. However, like other bupivacaine formulations, the liposomal extended-release bupivacaine does have some side effects...

  10. The promotion of osteochondral repair by combined intra-articular injection of parathyroid hormone-related protein and implantation of a bi-layer collagen-silk scaffold.

    Science.gov (United States)

    Zhang, Wei; Chen, Jialin; Tao, Jiadong; Hu, Changchang; Chen, Longkun; Zhao, Hongshi; Xu, Guowei; Heng, Boon C; Ouyang, Hong Wei

    2013-08-01

    The repair of osteochondral defects can be enhanced with scaffolds but is often accompanied with undesirable terminal differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). Parathyroid hormone-related protein (PTHrP) has been shown to inhibit aberrant differentiation, but administration at inappropriate time points would have adverse effects on chondrogenesis. This study aims to develop an effective tissue engineering strategy by combining PTHrP and collagen-silk scaffold for osteochondral defect repair. The underlying mechanisms of the synergistic effect of combining PTHrP administration with collagen-silk scaffold implantation for rabbit knee joint osteochondral defect repair were investigated. In vitro studies showed that PTHrP treatment significantly reduced Alizarin Red staining and expression of terminal differentiation-related markers. This is achieved in part through blocking activation of the canonical Wnt/β-catenin signaling pathway. For the in vivo repair study, intra-articular injection of PTHrP was carried out at three different time windows (4-6, 7-9 and 10-12 weeks) together with implantation of a bi-layer collagen-silk scaffold. Defects treated with PTHrP at the 4-6 weeks time window exhibited better regeneration (reconstitution of cartilage and subchondral bone) with minimal terminal differentiation (hypertrophy, ossification and matrix degradation), as well as enhanced chondrogenesis (cell shape, Col2 and GAG accumulation) compared with treatment at other time windows. Furthermore, the timing of PTHrP administration also influenced PTHrP receptor expression, thus affecting the treatment outcome. Our results demonstrated that intra-articular injection of PTHrP at 4-6 weeks post-injury together with collagen-silk scaffold implantation is an effective strategy for inhibiting terminal differentiation and enhancing chondrogenesis, thus improving cartilage repair and regeneration in a rabbit model. Copyright © 2013 Elsevier Ltd. All

  11. [Study of regeneration in periodontal tissue after implantation of bone ceramic and collagen gel compound materials. Evaluation of histopathological finding and autoradiography].

    Science.gov (United States)

    Miyamoto, Y; Hayashi, H; Kamoi, K

    1989-12-01

    The aim of this study is to determine the process of periodontal tissue regeneration and the metabolic activity of osteoblasts after implantation of bone ceramic and collagen gel compound materials (BC). Bone defects were artificially prepared in the alveolar septa of the bilateral upper first and second molars of Wistar rats. Subsequently, BC were implanted into the defective sites on the left side, and the gingival flaps were closed. At the defective sites on the right side, as a control, gingival flaps were closed without implantation. Rats were sacrificed 1, 3, 5, 7 or 14 weeks after implantation, and prepared tissue sections were observed both pathologically and autoradiographically using 3H-Proline. The results obtained were as follows: Pathological Findings One week after BC implantation, inflammatory cellular infiltration of the surrounding gingival connective tissue was relatively mild. Three weeks after implantation, BC were present in fibrous connective tissues, and some directly bound to the marices of regenerated bone. Observation 5 weeks after implantation revealed that BC had become embedded in the regenerated bone matrices and that there was giant cell reaction to foreign bodies at the margin of BC located in connective tissue. BC were directly bound to the regenerated bone matrices without intermediary fibrous tissues 7 and 14 weeks after implantation. Connective tissues showed high grade regeneration of collagen fiber bundles, in an arrangement that tended to be fixed in mesial and distal directions. Autoradiographic Findings There was no uptake of 3H-Proline into the regenerated bone matrices or the gingival connective tissue surrounding BC, while uptake of 3H-Proline into the entire area around the root apex and in the vicinity of the alveolar septum was observed with time (weeks) after BC implantation. These results suggest that BC provide nuclei for bone regeneration through inclusion in newly-generated periodontal bone tissue, although it is

  12. Bupivacaine versus lidocaine analgesia for neonatal circumcision

    Directory of Open Access Journals (Sweden)

    Stolik-Dollberg Orit C

    2005-05-01

    Full Text Available Abstract Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59% were given acetaminophen following circumcision compared to only 3 (16% in the bupivacaine group (P 2 = 20.6; P = 0.006. Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.

  13. Safety and Visual Outcome of Visian Toric ICL Implantation after Corneal Collagen Cross-Linking in Keratoconus: Up to 2 Years of Follow-Up.

    Science.gov (United States)

    Antonios, Rafic; Dirani, Ali; Fadlallah, Ali; Chelala, Elias; Hamade, Adib; Cherfane, Carole; Jarade, Elias

    2015-01-01

    Purpose. To evaluate the long-term safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. Methods. This was a retrospective study of 30 eyes (19 patients), with progressive keratoconus, who underwent sequential CXL followed by Visian toric ICL implantation after 6 months. Results. At baseline, 6 eyes had stage I, 14 eyes stage II, and 10 eyes stage III keratoconus graded by Amsler-Krumeich classification. At 6 months after CXL, only K (steep) and K (max) decreased significantly from baseline, with no change in visual acuity or refraction. Flattening in keratometric readings was stable thereafter. There was significant improvement in mean uncorrected distance visual acuity (1.57 ± 0.56 to 0.17 ± 0.06 logMAR, P ICL implantation that was maintained at the 2-year follow-up. Mean cylinder power and mean spherical equivalent (SE) also decreased significantly after ICL implantation. A small hyperopic shift in SE (+0.25 D) was observed at 2 years that did not alter visual outcomes. Conclusions. Visian toric ICL implantation following CXL is an effective option for improving visual acuity in patients with keratoconus up to 2 years.

  14. The role of hyaluronidase on lidocaine and bupivacaine pharmacokinetics after peribulbar blockade.

    Science.gov (United States)

    Nathan, N; Benrhaiem, M; Lotfi, H; Debord, J; Rigaud, G; Lachatre, G; Adenis, J P; Feiss, P

    1996-05-01

    Orbital regional anesthesia is the only circumstance where hyaluronidase is routinely added to local anesthetics to accelerate the onset of the block. The aim of this study was to compare the pharmacokinetics of lidocaine and bupivacaine with or without hyaluronidase for peribulbar blockade. Twenty-one patients scheduled for cataract surgery with lens implantation were included in this prospective randomized study. Peribulbar blocks were achieved with plain bupivacaine 0.5% (5.5 mL), lidocaine 2% (5.5 mL), and hyaluronidase (100 IU = 2 mL) (n = 10) ir sterile water (2 mL) (n = 11). Plasma bupivacaine and lidocaine concentrations were measured by high-performance liquid chromatography at regular intervals from the end of the local anesthetic injection until the 360th minute. Maximum plasma concentration (Cmax) and time to reach Cmax (Tmax) were obtained for all the patients except one who needed a supplementary injection and was excluded from the study. The time to onset and duration of the analgesia and akinesia were monitored at the times of sampling. Motor blockade was incomplete in two patients in each group without affecting surgery. The Tmax and absorption half-life (t1/2a) of lidocaine and bupivacaine were not different within each group (P > 0.05). The Tmax of lidocaine was shorter in the presence of hyaluronidase (17.1 +/- 2.6 min vs 32.7 +/- 6.0 min) as well as the Tmax of bupivacaine (16.8 +/- 3.0 min vs 26.5 +/- 4.4 min). The Cmax of lidocaine and bupivacaine were not modified by the addition of hyaluronidase. The clearance, terminal half-life, and volume of distribution were not different between groups. The absorption of lidocaine and bupivacaine from the peribulbar space are hastened by the addition of hyaluronidase. The Tmax of lidocaine is not different from that of bupivacaine within each group suggesting that the absorption of local anesthetics is minimally influenced by the liposolubility of the drugs. Moreover, hyaluronidase influences the

  15. The collagen meniscus implant.

    NARCIS (Netherlands)

    Buma, P.; Tienen, T.G. van; Veth, R.P.H.

    2007-01-01

    Lesions in the meniscus occur particularly in young, active patients in the nonvascularized area which, consequently have a bad intrinsic healing capacity. This has a large impact on the mobility and function of the knee joint. Lesions, and partial lesions, lead to the progression of osteoarthritis

  16. Evaluation of analgesic efficacy of intra-articular bupivacaine, bupivacaine plus fentanyl, and bupivacaine plus tramadol after arthroscopic knee surgery.

    Science.gov (United States)

    Mitra, Sukanya; Kaushal, Harpreet; Gupta, Ravi K

    2011-12-01

    To compare the efficacy of intra-articular (IA) bupivacaine, bupivacaine-fentanyl, and bupivacaine-tramadol for relief of postoperative pain after arthroscopic knee surgery. In a randomized double-blind design, 60 adult American Society of Anesthesiologists class I or class II patients undergoing elective arthroscopic knee surgery under general anesthesia were randomized to 3 groups: all received 30 mL of 0.25% bupivacaine, plus either 1 mL of normal saline solution (group I), 1 mL (50 μg) of fentanyl (group II), or 1 mL (50 mg) of tramadol (group III). Pain was assessed by use of a 100-mm visual analog scale (VAS) at 0, 1, 2, 4, 6, and 8 hours postoperatively. Intramuscular diclofenac sodium was used as rescue analgesic. Postoperative adverse effects were noted. The mean VAS pain scores were the lowest for group II, intermediate for group III, and highest for group I. There was a significant main effect for group differences on pain scores (F = 41.138, P tramadol were better than IA bupivacaine, and bupivacaine with fentanyl was better than that with tramadol. However, both the combinations were comparable to each other with regard to the secondary outcome measure (supplementary analgesic requirement). Thus IA bupivacaine-fentanyl appears to be the best combination for relief of postoperative pain in patients undergoing arthroscopic knee surgery, followed by IA bupivacaine-tramadol. Level I, randomized controlled trial. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Plasma bupivacaine concentrations following psoas compartment block.

    Science.gov (United States)

    Odoom, J A; Zuurmond, W W; Sih, I L; Bovill, J; Osterlöf, G; Oosting, H V

    1986-02-01

    Fourteen patients undergoing hip replacement surgery under psoas compartment block combined with general anaesthesia were studied. Group 1 (n = 7) received plain and Group 2 (n = 7) received 0.25% bupivacaine with adrenaline. The mean maximum peak concentrations were 1.93 (SEM 0.46) micrograms/ml and 1.04 (SEM 0.19) micrograms/ml at 10 minutes in groups 1 and 2 respectively. Bupivacaine concentrations were higher at all times in the group which received plain than the group receiving solution containing adrenaline. These differences were statistically significant at 10, 15 (p less than 0.05) and 30 minutes (p less than 0.025). The highest recorded plasma bupivacaine concentration was 4.54 micrograms/ml in one patient receiving plain bupivacaine. No patient developed any signs of toxic symptoms. The duration of analgesia was longer (p less than 0.005) in the group receiving bupivacaine with adrenaline. Bupivacaine 0.25% with adrenaline 1:200 000 is safe for psoas compartment block, and is recommended for hip surgery.

  18. Structure of collagen adsorbed on a model implant surface resolved by polarization modulation infrared reflection-absorption spectroscopy

    Science.gov (United States)

    Brand, Izabella; Habecker, Florian; Ahlers, Michael; Klüner, Thorsten

    2015-03-01

    The polarization modulation infrared reflection-absorption spectra of collagen adsorbed on a titania surface and quantum chemical calculations are used to describe components of the amide I mode to the protein structure at a sub-molecular level. In this study, imino acid rich and poor fragments, representing the entire collagen molecule, are taken into account. The amide I mode of the collagen triple helix is composed of three absorption bands which involve: (i) (∼1690 cm-1) the Cdbnd O stretching modes at unhydrated groups, (ii) (1655-1673 cm-1) the Cdbnd O stretching at carbonyl groups at imino acids and glycine forming intramolecular hydrogen bonds with H atoms at both NH2 and, unusual for proteins, CH2 groups at glycine at a neighbouring chain and (iii) (∼1640 cm-1) the Cdbnd O stretching at carbonyl groups forming hydrogen bonds between two, often charged, amino acids as well as hydrogen bonds to water along the entire helix. The IR spectrum of films prepared from diluted solutions (c < 50 μg ml-1) corresponds to solution spectra indicating that native collagen molecules interact with water adsorbed on the titania surface. In films prepared from solutions (c ⩾ 50 μg ml-1) collagen multilayers are formed. The amide I mode is blue-shifted by 18 cm-1, indicating that intramolecular hydrogen bonds at imino acid rich fragments are weakened. Simultaneous red-shift of the amide A mode implies that the strength of hydrogen bonds at the imino acid poor fragments increases. Theoretically predicted distortion of the collagen structure upon adsorption on the titania surface is experimentally confirmed.

  19. Structure of collagen adsorbed on a model implant surface resolved by polarization modulation infrared reflection-absorption spectroscopy.

    Science.gov (United States)

    Brand, Izabella; Habecker, Florian; Ahlers, Michael; Klüner, Thorsten

    2015-03-05

    The polarization modulation infrared reflection-absorption spectra of collagen adsorbed on a titania surface and quantum chemical calculations are used to describe components of the amide I mode to the protein structure at a sub-molecular level. In this study, imino acid rich and poor fragments, representing the entire collagen molecule, are taken into account. The amide I mode of the collagen triple helix is composed of three absorption bands which involve: (i) (∼1690cm(-1)) the CO stretching modes at unhydrated groups, (ii) (1655-1673cm(-1)) the CO stretching at carbonyl groups at imino acids and glycine forming intramolecular hydrogen bonds with H atoms at both NH2 and, unusual for proteins, CH2 groups at glycine at a neighbouring chain and (iii) (∼1640cm(-1)) the CO stretching at carbonyl groups forming hydrogen bonds between two, often charged, amino acids as well as hydrogen bonds to water along the entire helix. The IR spectrum of films prepared from diluted solutions (c<50μgml(-1)) corresponds to solution spectra indicating that native collagen molecules interact with water adsorbed on the titania surface. In films prepared from solutions (c⩾50μgml(-1)) collagen multilayers are formed. The amide I mode is blue-shifted by 18cm(-1), indicating that intramolecular hydrogen bonds at imino acid rich fragments are weakened. Simultaneous red-shift of the amide A mode implies that the strength of hydrogen bonds at the imino acid poor fragments increases. Theoretically predicted distortion of the collagen structure upon adsorption on the titania surface is experimentally confirmed.

  20. Bupivacaine-loaded comatrix formed by albumin microspheres included in a poly(lactide-co-glycolide) film: in vivo biocompatibility and drug release studies.

    Science.gov (United States)

    Blanco, M D; Bernardo, M V; Gómez, C; Muñiz, E; Teijón, J M

    1999-10-01

    Bupivacaine-loaded comatrix, formed by bupivacaine-loaded microspheres included in a poly(lactide-co-glycolide) film, was assayed for the controlled release of the drug 'in vivo'. The comatrix, with 66.37 microg of bupivacaine, signifying a dose of 265.5 microg/kg, was subcutaneously implanted in the back of rats. Maximum plasma bupivacaine concentration was 147.6 +/- 5.0 ng/ml 95 h after the device implantation, and the drug was detected in plasma for 17 days. The half-life time of bupivacaine improves by more than 50 times with regard to that of the drug administered in a solution by intraperitoneal injection. After 15 days of implantation the comatrix was included in a thin fibrous capsule and degradation of the microspheres was observed. The histological studies show good biocompatibility of this comatrix. After 50 days the comatrix was degraded and its remains were almost indistinguishable from the surrounding tissue. Small number of microspheres was observed and they were surrounded by conjunctive tissue. Nerve packets and small blood vessels were also observed in the periphery of the implant.

  1. Closure of 1.5-cm alveolar oral antral fistula with intra-alveolar sinus membrane elevation and bone morphogenetic protein-2/collagen graft followed by dental implant restoration: case report.

    Science.gov (United States)

    Cottam, Jared R; Jensen, Ole T; Beatty, Lucas; Ringeman, Jason

    2013-01-01

    Closure of a 1.5-cm oral antral fistula was done in combination with sinus floor and extraction socket grafting using recombinant human bone morphogenetic protein-2 within a collagen sponge matrix. The approach to the sinus was transalveolar, with elevation of the sinus membrane done through a molar extraction socket. Following graft placement, soft tissue repair was done with a buccal advancement flap. A dental implant was subsequently placed and restored. Peri-implant bone and implant stability were well maintained at the 1-year follow up examination.

  2. The immunohistochemical and urodynamic evaluation towards the collagen-coated and non-coated polypropylene meshes implanted in the pelvic wall of the rats

    Science.gov (United States)

    Lo, Tsia-Shu; Lin, Yi-Hao; Yusoff, Faridah Mohd; Chu, Hsiao-Chien; Hsieh, Wu-Chiao; Uy-Patrimonio, Ma. Clarissa

    2016-01-01

    Our aim is to study the inflammatory response towards the collagen-coated and non-coated polypropylene meshes in rats and the urodynamic investigation post-operatively. Forty-two female Sprague Dawley were divided into 7 groups of 6 rats; Control, Day 7 and 30 for Sham, Avaulta Plus (MPC), Perigee (MP). UDS were taken at days 7 and 30. Mesh with the vagina and bladder wall was removed and sent for immunohistochemical examination. Results showed intense inflammatory reaction on day 7 in the study groups which decreased on day 30. IL-1, TNF-α, MMP-2 and CD31 were observed to decrease from day 7 to day 30. NGF was almost normal on day 30 in all groups. UDS showed no difference in voiding pressure. Both Study and Sham groups had shorter voiding interval (VI) on day 7 but significantly lower in MPC. VI had significantly increased on day 30 in all groups. Voided volume was significantly lower in the mesh groups even when an increase was seen on day 30. In conclusion, the higher levels of IL-1, TNF-α and MMP-2 in collagen-coated polypropylene mesh imply greater inflammation than the non-coated polypropylene mesh. Mesh implantation can lead to shorter voiding interval and smaller bladder capacity. PMID:27991501

  3. Treatment of Digital Ischemia with Liposomal Bupivacaine

    Directory of Open Access Journals (Sweden)

    José Raul Soberón

    2014-01-01

    Full Text Available Objective. This report describes a case in which the off-label use of liposomal bupivacaine (Exparel in a peripheral nerve block resulted in marked improvement of a patient’s vasoocclusive symptoms. The vasodilating and analgesic properties of liposomal bupivacaine in patients with ischemic symptoms are unknown, but our clinical experience suggests a role in the management of patients suffering from vasoocclusive disease. Case Report. A 45-year-old African American female was admitted to the hospital with severe digital ischemic pain. She was not a candidate for any vascular surgical or procedural interventions. Two continuous supraclavicular nerve blocks were placed with modest clinical improvement. These effects were also short-lived, with the benefits resolving after the discontinuation of the peripheral nerve blocks. She continued to report severe pain and was on multiple anticoagulant medications, so a decision was made to perform an axillary nerve block using liposomal bupivacaine (Exparel given the compressibility of the site as well as the superficial nature of the target structures. Conclusions. This case report describes the successful off-label usage of liposomal bupivacaine (Exparel in a patient with digital ischemia. Liposomal bupivacaine (Exparel is currently FDA approved only for wound infiltration use at this time.

  4. Clinical parameters of the local anesthetic effects of bupivacaine applied with and without a vasoconstrictor in oral implantology

    Directory of Open Access Journals (Sweden)

    Duka Miloš

    2007-01-01

    Full Text Available Background/Aim. Bupivacaine (Marcaine®, homologue of mepivacaine, chemically related to lidocaine, is used as a local anesthetic for local infiltration, peripheral nerve block, retrobulbar block, symphathetic block, and caudal and epidural anesthesia. The aim of this investigation was to determine and to compare clinical parameters of the local anesthetic effects of bupivacaine applied with and without a vasoconstrictor. Methods. This investigation included a total of 30 randomly selected patients, who ranged in age from 30−60 years, with partial or total anodontia in the molar region of the mandible. These patients with total or partial edentulous molar part of the mandible, scheduled for dental implantation placement, were asked to participate in the study. In the first phase of the investigation, the patients were subjected to local anesthesia with 3.5 cm3 of 0.5% bupivacaine with a vasoconstrictor (adrenalin, 1: 200 000 in the right side of the mandible. After administering local anesthesia, the placement of blade, cylindrical, transdental (B.C.T. implants was performed. In the second stage of the investigation, in 7−10 days period after the first oral surgery, the patients were subjected to local anesthesia with 3.5 cm3 of 0.5% bupivacaine, but without a vasoconstrictor, in the left side of the mandible. After administering local anesthesia, the placement of B.C.T. implants was performed. During the performance of both oral surgery procedures, the following clinical parameters of the local anesthetic effects were monitored: latent period, duration and the potency of anesthesia, and the evaluation of the postoperative pain level. Results. The latent period under local anesthesia with 3.5 cm3 of 0.5% bupivacaine and vasoconstrictor was statistically significantly shorter than without vasoconstrictor. The duration of local anesthesia was longer without vasoconstrictor. There was no difference in the potency of anesthesia with or without a

  5. Comparison of Effect of Intrathecal Sufentanil-Bupivacaine and Fentanyl-Bupivacaine Combination on Postoperative Analgesia

    Directory of Open Access Journals (Sweden)

    Ishwar Singh

    2008-01-01

    Full Text Available Fifty ASA grade I/II patients scheduled for elective lower abdominal, lower limb and urological procedures were divided into two groups of 25 each .The first group (Group S received 2.5 ml of heavy bupivacaine with 0.2. ml sufentanil made up to 3 ml with saline. The second group (Group F received 2.5 ml of heavy bupivacaine with 0.5 ml of fentanyl. From our study it can be concluded that bupivacaine sufentanil combination although had shorter onset of action, but had more side effects especially nausea, vomiting and headache. The time for rescue analgesia in both groups was however similar.

  6. Reversal of diabetes in mice with a bioengineered islet implant incorporating a type I collagen hydrogel and sustained release of vascular endothelial growth factor.

    Science.gov (United States)

    Vernon, Robert B; Preisinger, Anton; Gooden, Michel D; D'Amico, Leonard A; Yue, Betty B; Bollyky, Paul L; Kuhr, Christian S; Hefty, Thomas R; Nepom, Gerald T; Gebe, John A

    2012-01-01

    We have developed a bioengineered implant (BI) to evaluate strategies to promote graft survival and function in models of islet transplantation in mice. The BI, sized for implantation within a fold of intestinal mesentery, consists of a disk-shaped, polyvinyl alcohol sponge infused with a type I collagen hydrogel that contains dispersed donor islets. To promote islet vascularization, the BI incorporates a spherical alginate hydrogel for sustained release of vascular endothelial growth factor (VEGF). BIs that contained 450-500 islets from syngeneic (C57Bl/6) donors and 20 ng of VEGF reversed streptozotocin (STZ)-induced diabetes in 100% of mice (8/8), whereas BIs that contained an equivalent number of islets, but which lacked VEGF, reversed STZ-induced diabetes in only 62.5% of mice (5/8). Between these "+VEGF" and "-VEGF" groups, the time to achieve normoglycemia (8-18 days after implantation) did not differ statistically; however, transitory, postoperative hypoglycemia was markedly reduced in the +VEGF group relative to the -VEGF group. Notably, none of the mice that achieved normoglycemia in these two groups required exogenous insulin therapy once the BIs began to fully regulate levels of blood glucose. Moreover, the transplanted mice responded to glucose challenge in a near-normal manner, as compared to the responses of healthy, nondiabetic (control) mice that had not received STZ. In future studies, the BIs described here will serve as platforms to evaluate the capability of immunomodulatory compounds, delivered locally within the BI, to prevent or reverse diabetes in the setting of autoimmune (type 1) diabetes.

  7. Effects of intrathecal Bupivacaine with normal saline versus Bupivacaine with Fentanyl in patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Jigna R Shah

    2016-03-01

    Full Text Available Objective:To know the effects of intrathecal 0.5% Bupivacaine 2.5 cc with 0.5 cc normal saline and 0.5% Bupivacaine 2.5 cc witth 25 and #956;g fentanyl for various lower abdominal surgeries. Methods: A comparative study were conducted in 60 (ASA grade I / II patients. The onset and duration of both sensory and motor blockade was compared using relevant scales i.e. Sensory scale and Bromage Scale. - Intra-operative and post-operative hemodynamic monitoring was done. The complications which occurred were noted and studied. - The duration of analgesia after sensory wear off was compared between the 2 groups using Visual Analogue Scale. - Quality of post-operative analgesia was studied between the groups. Results: The duration of sensory and motor block as well as duration of effective analgesia was significantly longer in the bupivacaine and ndash;fantanyl group as compared with both bupivacaine and ndash;normal saline groups. Conclusion: Addition of intrathecalfantanyl to bupivacaine was more advantageous than bupivacaine with normal saline with special regard to its analgesic properties among surgical patients. [Natl J Med Res 2016; 6(1.000: 62-68

  8. The effect of bone marrow aspirate, bone graft and collagen composites on fixation of bone implants

    DEFF Research Database (Denmark)

    Babiker, Hassan; Ding, Ming; Overgaard, Søren

    2007-01-01

    or allograft (control group). The bone marrow was harvested by aspiration from the proximal part of the tibia. Autologous bone graft harvested from the four drill holes in the femoral condyles. A standardised surgical procedure was used. After surgery the sheep were observed at the outdoor facilities...... part of the implant. Specimens are preserving now at - 20°C and wait for the push-out test which is destructive and will be performed on an 858 Bionex MTS hydraulic material testing machine (MTS system cooperation, Minneapolis, Minnesota, USA). The specimens for histological analysis were taken from...

  9. Comparison of efficacy of bupivacaine and fentanyl with bupivacaine and sufentanil for epidural labor analgesia

    Directory of Open Access Journals (Sweden)

    Kalra Sumit

    2010-01-01

    Full Text Available Objectives: A study to compare the efficacy between fentanyl and sufentanil combined with low concentration (0.0625% of bupivacaine for epidural labor analgesia in laboring women. Materials and Methods: Fifty full term parturients received an initial bolus dose of a 10 ml solution containing 0.125% bupivacaine. The patients were randomly divided into two: group F received 0.0625% bupivacaine with 2.5 mcg/ml fentanyl and group S received 0.0625% bupivacaine with 0.25 mcg/ml sufentanil. Verbal analogue pain scores, need of supplementary/rescue boluses dose of bupivacaine consumed, mode of delivery, maternal satisfaction, and neonatal Apgar scores were recorded. No significant difference was observed between both groups. Results: Both the groups provided equivalent labor analgesia and maternal satisfaction. The chances of cesarean delivery were also not increased in any group. No difference in the cephalad extent of sensory analgesia, motor block or neonatal Apgar score were observed. Although mean pain scores throughout the labor and delivery were similar in both groups, more patients in fentanyl group required supplementary boluses though not statistically significant. Conclusion: We conclude that both 0.0625% bupivacaine-fentanyl (2.5 μg/ml and 0.0625% bupivacaine-sufentanil (0.25 μg/ml were equally effective by continuous epidural infusion in providing labor analgesia with hemodynamic stability achieving equivalent maternal satisfaction without serious maternal or fetal side effects. We found that sufentanil was 10 times more potent than fentanyl as an analgesic for continuous epidural labor analgesia.

  10. Combined femtosecond laser-assisted intracorneal ring segment implantation and corneal collagen cross-linking for correction of keratoconus

    Directory of Open Access Journals (Sweden)

    Ibrahim O

    2016-03-01

    Full Text Available Osama Ibrahim,1 Ahmed Elmassry,1 Amr Said,1,2 Moones Abdalla,2 Hazem El Hennawi,1 Ihab Osman1 1Department of Ophthalmology, Alexandria University, Alexandria, Egypt; 2Roayah Vision Correction Center, Alexandria, Egypt Purpose: To assess the safety, predictability, and effectiveness of Keraring intrastromal corneal ring segments (ICRS insertion assisted by femtosecond laser and corneal collagen cross-linking (CXL for keratoconus correction. Patients and methods: In this prospective, noncomparative, and interventional case series, 160 eyes of 100 adult keratoconus patients with poor best-corrected visual acuity (BCVA (less than 0.7 and intolerance to contact lens wear were included. Patients underwent femtosecond laser-assisted placement of ICRS and CXL. All patients were examined for a complete ophthalmological test: uncorrected visual acuity (UCVA, BCVA, spherical equivalent, keratometry (K1-flat and K2-steep, pachymetry, and Scheimpflug imaging with the Pentacam at 1 week and at 1, 3, and 6 months postoperatively. Results: At 6 months, a significant difference was observed (P<0.001 in mean UCVA and BCVA from 0.92±0.677 and 0.42±0.600 logMAR preoperatively to 0.20±0.568 and 0.119±0.619 logMAR, respectively. Mean spherical equivalent refractions were significantly lower (P<0.001 at 6 months. Mean keratometry (K also significantly reduced (P<0.001 from 50.93±5.53 D (K1-flat and 55.37±5.76 D (K2-steep to 47.32±4.61 and 51.08±5.38 D, respectively. In terms of pachymetry, no significant difference was observed preoperatively versus postoperatively (P=1.000. Conclusion: Keraring ICRS insertion assisted by femtosecond laser and corneal CXL provided significant improvement in visual acuity, spherical equivalent, and keratometry, which suggests that it may be effective, safe, and predictable for keratoconus correction. Keywords: keratometry, pachymetry, keratectesia, Pentacam, irregular astigmatism

  11. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

    Institute of Scientific and Technical Information of China (English)

    Mohammed Hegazy; Ayman A. Ghoneim

    2013-01-01

    Objective: Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Add-ing tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients. Methods: A prospective randomized controlled trial was conducted over 40 paediatric cancer pa-tients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol. Results: The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis. Conclusion: Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

  12. Effectiveness of xenogenous-based bovine-derived platelet gel embedded within a three-dimensional collagen implant on the healing and regeneration of the Achilles tendon defect in rabbits

    Science.gov (United States)

    Moshiri, Ali; Oryan, Ahmad; Meimandi-Parizi, Abdolhamid; Koohi-Hosseinabadi, Omid

    2014-01-01

    Background and objective: Tissue engineering is an option in reconstructing large tendon defects and managing their healing and regeneration. We designed and produced a novel xenogeneic-based bovine platelet, embedded it within a tissue-engineered collagen implant (CI) and applied it in an experimentally induced large tendon defect model in rabbits to test whether bovine platelets could stimulate tendon healing and regeneration in vivo. Methods: One hundred twenty rabbits were randomly divided into two experimental and pilot groups. In all the animals, the left Achilles tendon was surgically excised and the tendon edges were aligned by Kessler suture. Each group was then divided into three groups of control (no implant), treated with CI and treated with collagen-platelet implant. The pilot groups were euthanized at 10, 15, 30 and 40 days post-injury (DPI), and their gross and histologic characteristics were evaluated to study host–graft interaction mechanism. To study the tendon healing and its outcome, the experimental animals were tested during the experiment using hematologic, ultrasonographic and various methods of clinical examinations and then euthanized at 60 DPI and their tendons were evaluated by gross pathologic, histopathologic, scanning electron microscopic, biophysical and biochemical methods. Results: Bovine platelets embedded within a CI increased inflammation at short term while it increased the rate of implant absorption and matrix replacement compared with the controls and CI alone. Treatment also significantly increased diameter, density, amount, alignment and differentiation of the collagen fibrils and fibers and approximated the water uptake and delivery behavior of the healing tendons to normal contralaterals (p tendons and reduced peritendinous adhesion, muscle fibrosis and atrophy, and therefore, it improved the clinical scores and physical activity related to the injured limb when compared with the controls (p tendon in rabbit. This

  13. Visual rehabilitation in low-moderate keratoconus:intracorneal ring segment implantation followed by same-day topography-guided photorefractive keratectomy and collagen cross linking

    Institute of Scientific and Technical Information of China (English)

    Ferial; M.Zeraid; Asma; A; Jawkhab; Waleed; S; Al-Tuwairqi; Uchechukwu; L.Osuagwu

    2014-01-01

    AIM:To present the results of same-day topographyguided photorefractive keratectomy(TG-PRK) and corneal collagen crosslinking(CXL) after previous intrastromal corneal ring segment(ISCR) implantation for keratoconus.METHODS:An experimental clinical study on twentyone eyes of 19 patients aged 27.1±6.6y(range 19-43y),with low to moderate keratoconus who were selected to undergo customized TG-PRK immediately followed by same-day CXL, 9mo after ISCR implantation in a university ophthalmology clinic. Refraction, uncorrected distance visual acuities(UDVA) and corrected distance visual acuities(CDVA), keratometry(K) values, central corneal thickness(CCT) and coma were assessed 3mo after TG-PRK and CXL.RESULTS:After TG-PRK/CXL: the mean UDVA(logMAR) improved significantly from 0.66 ±0.41 to 0.20 ±0.25(P <0.05); Kflatvalue decreased from: 48.44±3.66 D to43.71±1.95 D; Ksteepvalue decreased from 45.61±2.40 D to41.56±2.05 D; Kaveragealso decreased from 47.00±2.66 D to42.42 ±2.07 D(P <0.05 for all). The mean sphere andcylinder decreased significantly post- surgery from,- 3. 10 ± 2. 99 D to-0.11±0.93 D and from-3.68±1.53 to-1.11 ±0.75 D respectively, while the CDVA, CCT and coma showed no significant changes. Compared to postISCR, significant reductions(P <0.05 or all) in all K values,sphere and cylinder were observed after TG-PRK/CXL.CONCLUSION:Same-day combined topography-guided PRK and corneal crosslinking following placement of ISCR is a safe and potentially effective option in treating low-moderate keratoconus. It significantly improves all visual acuity, reduced keratometry, sphere and astigmatism, but causes no change in central corneal thickness and coma.

  14. Comparison of histopathological effects of perineural administration of bupivacaine and bupivacaine-dexmedetomidine in rat sciatic nerve.

    Science.gov (United States)

    Memari, Elham; Hosseinian, Mohammad-Ali; Mirkheshti, Ali; Arhami-Dolatabadi, Ali; Mirabotalebi, Mojtaba; Khandaghy, Mohsen; Daneshbod, Yahya; Alizadeh, Leila; Shirian, Sadegh

    2016-11-01

    Injection of a variety of drugs such as local anesthetics (LAs) for peripheral nerve block has been shown to cause damage to peripheral nerves. Bupivacaine is a local anesthetic widely used in surgical procedures. The aim of this study was to evaluate the neurotoxicity of LAs including Bupivacaine and dexmedetomidine (DEX)-Bupivacaine on sciatic nerve tissue at histopathological level. In addition, we investigated whether perineural administration of DEX can attenuate Bupivacaine-induced neurotoxicity. Twenty adult Sprague Dawley rats received unilateral sciatic nerve blocks with either 0.2ml of 0.5% bupivacaine (n=8) or 0.5% bupivacaine plus 0.005% DEX (n=8) or normal saline (0.9%, as control group) (n=4) in the left hind extremity. Sciatic nerves were harvested at 14days post-injection and analyzed for nerve damage using ultrastructure and histopathologic analysis. Histopathology of sciatic nerve at day 14 post-injection showed a variable degree of neuronal injury associated with perineural inflammation in each treatment group and was classified as none or mild, intermediate or severe. Administration of both LAs resulted in a significant decrease in the total number of myelinated fibers per nerve (95% CI for group difference: Bupivacaine, P=0.001, DEX-Bupivacaine, P=0.036) compared to the saline control group. Animals that received these perineural local anesthetics (LAs) injections showed increased severity of injury compared to the control group. Animals in the DEX-Bupivacaine group had higher perineural inflammation and nerve damage than those of the saline control group and less than those of the Bupivacaine group at day 14 post-injection. Quantitatively, average total nerve fiber per nerve and average myelinated nerve fiber density in the injured region of the Bupivacaine-treated group was less than that of the DEX-Bupivacaine-treated group. LAs injection into the nerve causes peripheral nerve damage and remains an important clinical danger. Bupivacaine is

  15. Implante de tubo de silicone com e sem colágeno na regeneração de nervos em eqüinos Implant of silicone tube with or without collagen in nerve regeneration of horses

    Directory of Open Access Journals (Sweden)

    Nádia Delistoianov

    2008-09-01

    silicone conduz à regeneração de NUs e NTs de eqüinos sem formação de neuromas e que a adição de colágeno promove aumento do número de fibras mielinizadas.Surgical nerve repair in humans, dogs and laboratory animals is widely utilized for important clinical and experimental purposes. However, in horses there is scarce information. Neuroma and excessive conjunctive proliferation are reported. The aim of the present study was to add information about the repair process utilizing implant of silicone tubes with or without collagen in nerve regeneration of horses. Eight horses were allocated in two groups: GI-13 weeks and GII-26 weeks of observation. A complete section of the ulnar nerves (UNs and of the lateral cutaneous branch of the 17th thoracic nerves (TNs, bilaterally, was followed by repair with silicone tubes alternately filled with (STC or without collagen (ST, with a 5mm gap between stumps. Clinical evaluation was performed weekly, by cutaneous sensitivity testing of the region innervated by the respective operated nerves and physical examination of the thoracic limbs. No alterations were found in the locomotor apparatus. The first positive reactions to the cutaneous test occurred at the 9th week post-surgery. At the end of the observation period it was verified, grossly, that the nerves were involved by conjunctive tissue and the lumen of the tube was filled by a whitish tissue, in a cylindrical shape. The ends nerves were interconnected. Microscopically, myelinated axons and Schwann cells were present in the gap between the stumps. In the GII the number of myelinated fibers was greater. The distal nerve showed remyelination process. There was no presence of neuroma and the inflammatory process was limited to the perineural areas. It was concluded that the implant of silicone tubes results in regeneration of UNs and TNs of horses without formation of neuromas and that de addition of collagen promotes an increase in the number of myelinated fibers.

  16. Potential utility of liposome bupivacaine in orthopedic surgery.

    Science.gov (United States)

    Lonner, Jess H; Scuderi, Giles R; Lieberman, Jay R

    2015-03-01

    Management of postsurgical analgesia is an important consideration in orthopedic procedures, including joint arthroplasty. Inadequate postsurgical analgesia is associated with increased hospital length of stay, delayed ambulation, and reduced exercise capacity. In this article, we review the potential contribution of a prolonged-release liposomal formulation of bupivacaine as part of a multimodal analgesic regimen after orthopedic surgery. Controlled studies across multiple surgical settings have demonstrated that, compared with placebo and bupivacaine HCl, liposome bupivacaine in a single administration provides postsurgical analgesia for up to 72 hours, delays use of rescue medication, and reduces postsurgical opioid consumption. Liposome bupivacaine has been well tolerated in clinical studies and has had a low rate of treatment-related adverse events. To date, there has been no signal of cardiac toxicity, chondrolysis, or delayed wound healing associated with liposome bupivacaine.

  17. Collagenous gastroduodenitis.

    Science.gov (United States)

    Rustagi, Tarun; Rai, Mridula; Scholes, John V

    2011-10-01

    Collagenous gastroduodenitis is a rare histopathologic entity characterized by marked subepithelial collagen deposition with associated mucosal inflammatory infiltrate. Only 4 cases have been reported, of which 3 had associated collagenous colitis. Collagenous gastroduodenitis without colonic involvement is exceptionally rare with only 1 case reported so far in the literature. We present a case of a 68-year-old woman with dyspepsia and mild anemia, who was found to have nodular gastric and duodenal mucosa on endoscopic examination. Histopathology showed collagenous gastroduodenitis. To the best of our knowledge, this is the second (and first in English literature) reported case of isolated collagenous gastroduodenitis.

  18. Comparison of spinal block after intrathecal clonidine–bupivacaine, buprenorphine–bupivacaine and bupivacaine alone in lower limb surgeries

    Science.gov (United States)

    Arora, Major Vishal; Khan, Mohammad Zafeer; Choubey, Major Sanjay; Rasheed, Mohammad Asim; Sarkar, Arindam

    2016-01-01

    Context: Various adjuvants are being used with local anesthetics for prolongation of intraoperative and postoperative analgesia. The α2-adrenergic agonist clonidine and potent opioid buprenorphine have the ability to potentiate the effects of local anesthetics. Aims: The purpose of this prospective, double-blind study was to compare onset, duration of sensory and motor block, effect on hemodynamics, level of sedation, duration of postoperative analgesia, and any adverse effects of clonidine and buprenorphine. Settings and Design: Seventy-five American Society of Anesthesiologists Class I and II patients undergoing lower limb surgery under spinal anesthesia were randomly allocated into three Groups A, B, and C. Subjects and Methods: Control Group A received injection bupivacaine 0.5% (heavy) 2.5 ml + saline 0.5 ml whereas Group B received injection bupivacaine 0.5% (heavy) 2.5 ml + injection buprenorphine 50 μg and Group C received injection bupivacaine 0.5% (heavy) 2.5 ml + preservative free injection clonidine 50 μg intrathecally. Statistical Analysis Used: Unpaired Student's t-test and Z-test were used for comparing data. Results: Statistically highly significant differences in mean time of sensory regression to L1, mean time to attain the Bromage Score of 1, and mean time of first rescue analgesic request were observed between the three groups. The patients did not suffer any serious side effects. Conclusion: Administration of buprenorphine and clonidine intrathecally does potentiate the duration of analgesia, sensory and motor block, with buprenorphine having a long-lasting effect. PMID:27746532

  19. Clinical study of the Bicon absorbable collagen plug used for in dental immediate implantation cases%Bicon可吸收胶原塞在即拔即种牙中的临床应用

    Institute of Scientific and Technical Information of China (English)

    李可兴; 姚其卫

    2014-01-01

    Objective: To evaluate the clincal effects of using the Bicon absorbable collagen plug for immediated dental implants. Methods: 19 implants were immediately inserted into the extraction sockets in 16 patients, Bicon absorbable collagen plug were put on the top of the alveolar ridge to cover the sockets. Radiographs and clinical examination were taken at the same day, 1 week, 1 month, 3month, 6month, and every 6 months after final restoration to observe the bone regeneration of peri-imlant bone defects. Results: All patients were followed up for 6 to 24 months, all implants were inserted sucessfully and stable except one implant. There were no peri-implantitis and X-ray films indicated that no remarkable bone resorption occurred. The 3 -year survival rate was 100% . Conclusion: Bicon absorbable collagen plug show excellent biocompatibility, which can accerlate the bone repair progress, and can be successfully used for immediate implantion to obtain satisfactory clinical effects.%目的:观察Bicon可吸收胶原塞在即拔即种牙术中的临床疗效。方法:将16例患者19颗牙齿即刻拔除,即刻植入种植体,同时应用Bicon可吸收胶原塞覆盖于牙槽嵴顶封闭创口。术后当天、1周、1月、3月、6月及修复后每6个月行X线曲面断层片和临床检查,评价Bicon可吸收胶原塞在种植体周围引导骨组织再生修复的效果。结果:随访6~24个月,16例19枚即刻植入种植体除1枚1周后伤口裂开外,其余均稳固无松动,种植体周围无炎症及明显骨吸收,未出现X线透射影,临床修复效果好,种植体存活率达100%。结论: Bicon可吸收胶原塞生物相容性好,能促进骨缺损的再生修复,可成功地应用于即刻种植修复中。

  20. COMPARATIVE EVALUATION OF INTRATHECAL BUPIVACAINE-FENTANYL AND BUPIVACAINE-SUFENTANIL FOR CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Pooja

    2014-06-01

    Full Text Available BACKGROUND: Addition of lipophilic opioids like Fentanyl and Sufentanil to local anaesthetic for spinal anaesthesia has shown to prolong the duration of analgesia. This study was carried out to study (a Comparison of effect of Fentanyl and Sufentanil added to Bupivacaine on onset and duration of anaesthesia in Cesarean Section. (b To compare the quality and duration of analgesia between the two opioids and (c To compare the effect on neonatal outcome. METHODS: 50 parturients of ASA grade 1 and 2 undergoing Cesarean Section were randomized into two groups of 25 each. Group F received 2.5 ml 0.5% Bupivacaine heavy + inj. Fentanyl 0.25 ml (12.5 mcg and Group S received 2.5 ml 0.5% Bupivacaine heavy + inj. Sufentanil 0.1 ml (5 mcg intrathecally. Onset of sensory and motor blockade was noted in all the patients. Haemodynamic parameters were recorded every 5 minutes for first 30 minutes and then every 15 minutes till the completion of surgery. Duration of sensory and motor sensory blockade was observed post operatively. RESULT: Both the groups were stable haemodynamically. Both the groups were comparable regarding the duration of sensory and motor block, but the total duration of effective analgesia was significantly longer in Sufentanil group. Pruritus was significant side effect in Sufentanil group. Neither the mother nor the neonate had respiratory depression. CONCLUSION: Addition of Sufentanyl to intrathecal bupivacaine provides longer duration of analgesia as compared to intrathecal fentanyl-bupivacaine. However, the incidence of pruritus was greater in Sufentanyl group.

  1. PROSPECTIVE RANDOMISED CONTROL STUDY OF POST OP EPIDURAL ANALGESIA WITH BUPIVACAINE AND FENTANYL VS. BUPIVACAINE AND CLONIDINE

    Directory of Open Access Journals (Sweden)

    Rachana

    2014-07-01

    Full Text Available The aim of the study was to compare the relative potencies and clinical characteristics of epidural Clonidine and Fentanyl with Bupivacaine in lower limb and lower abdominal surgeries using patient-controlled analgesia. In a randomised double-blinded study, 60 ASA I or II patients requiring epidural analgesia for post- operative pain relief were allocated to receive either 0.125% Bupivacaine with Clonidine 1µg/kg or 0.125% Bupivacaine with Fentanyl 1µg/kg via a sterile syringe by trained anaesthesiologists. Analgesia was established with 10-15 ml bolus of study solution. There were significant differences in onset time, duration and quality of analgesia, local anaesthetic consumption, between the two groups. We conclude that 0.125% Bupivacaine with Clonidine 1µg/kg group of patients clinically had better quality of analgesia and for a longer duration in comparison with patients receiving 0.125% Bupivacaine with Fentanyl 1µg/kg.

  2. Collagenous sprue

    DEFF Research Database (Denmark)

    Soendergaard, Christoffer; Riis, Lene Buhl; Nielsen, Ole Haagen

    2014-01-01

    Collagenous sprue is a rare clinicopathological condition of the small bowel. It is characterised by abnormal subepithelial collagen deposition and is typically associated with malabsorption, diarrhoea and weight loss. The clinical features of collagenous sprue often resemble those of coeliac dis...... disease and together with frequent histological findings like mucosal thinning and intraepithelial lymphocytosis the diagnosis may be hard to reach without awareness of this condition. While coeliac disease is treated using gluten restriction, collagenous sprue is, however, not improved...

  3. Effects of levobupivacaine and bupivacaine on rat myometrium

    Institute of Scientific and Technical Information of China (English)

    LI Zi-gang; ZHOU Liang; TANG Hui-fang

    2006-01-01

    Objective: To study the effect of levobupivacaine and bupivacaine on the contractility of isolated uterine muscle strips from pregnant and non-pregnant female rats. Methods: Full-thick myometrial strips were prepared from 18- to 21-day pregnant (n=g) and non-pregnant rats (n=7). After contractions became regular, strips were exposed to cumulative concentrations of the two drugs from 10-8 to 10-4 mol/L, amplitude and frequency of the uterine contraction was recorded. Results: Two local anesthetics caused a concentration dependent inhibition on contractility of myometrial strips from pregnant and non-pregnant rats. In the myometrium from non-pregnant rats, -logIC50 of levobupivacaine and bupivacaine were 4.85 and 4.25 respectively. In the myometrium from pregnant rats, similar concentrations of levobupivacaine and bupivacaine were observed, -logIC50 were 2.7 and 2.9respectively. Levobupivacaine produced an increase in amplitude of contractions, while bupivacaine showed an increased trend in frequency. Conclusion: These results demonstrate that levobupivacaine and bupivacaine may inhibit myometrium contractility.The inhibitory effect of levobupivacaine or bupivacaine is not enhanced by gestation in rat. Levobupivacaine may have more positive influence than bupivacaine in pregnant myometrium.

  4. Bupivacaine and botulinum toxin to treat comitant strabismus

    Directory of Open Access Journals (Sweden)

    Luisa Moreira Hopker

    2012-04-01

    Full Text Available PURPOSE: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. METHODS: Eight patients (five female were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique. RESULTS: Mean change in alignment was 10 prism diopters after 180 days (n=6. An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. CONCLUSION: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.

  5. Pharmacokinetics of bupivacaine after intraperitoneal administration to cats undergoing ovariohysterectomy.

    Science.gov (United States)

    Benito, Javier; Monteiro, Beatriz P; Beaudry, Francis; Lavoie, Anne-Marie; Lascelles, B Duncan X; Steagall, Paulo V

    2016-06-01

    OBJECTIVE To evaluate pharmacokinetics of bupivacaine after IP administration to cats undergoing ovariohysterectomy. ANIMALS 8 healthy cats. PROCEDURES Anesthesia was induced with propofol and maintained with isoflurane. Buprenorphine (0.02 mg/kg, IV) and meloxicam (0.2 mg/kg, SC) were administered. A 20-gauge catheter was inserted into a jugular vein for blood sample collection. A ventral midline incision was made, and a solution of 0.5% bupivacaine (2 mg/kg) diluted with an equal volume of saline (0.9% NaCl) solution (final concentration, 0.25% bupivacaine) was injected into the peritoneal space over the right and left ovarian pedicles and caudal aspect of the uterus before ovariohysterectomy. Cats were monitored for signs of bupivacaine toxicosis. Venous blood samples (2 mL) were collected before (time 0) and 2, 5, 10, 15, 20, 30, 60, 120, and 240 minutes after bupivacaine administration. Plasma bupivacaine concentrations were determined with a liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters were determined by data plotting followed by analysis with a noncompartmental model. RESULTS No signs of bupivacaine toxicosis were observed. Maximum bupivacaine plasma concentration was 1,030 ± 497.5 ng/mL at a mean ± SD value of 30 ± 24 minutes after administration. Mean elimination half-life was 4.79 ± 2.7 hours. Mean clearance indexed by bioavailability and volume of distribution indexed by bioavailability were 0.35 ± 0.18 L•h/kg and 2.10 ± 0.84 L/kg, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Intraperitoneal administration of bupivacaine resulted in concentrations that did not cause observable toxicosis. Studies to investigate analgesic effects for this technique in cats are warranted.

  6. 胶原蛋白类植入性医疗器械及其安全性评价探讨%Development and safety evaluation of implantable medical device of collagen

    Institute of Scientific and Technical Information of China (English)

    刘文博

    2015-01-01

    This paper categorizes implantable medical device of collagen on Chinese market according to manufacturing technique and performance.Combining with supervision requirements from China Food and Drug Administration (CFDA), this paper discusses safety evaluation in following aspects, such as immunogenicity risk,virus and infectious pathogen risk, and product technical requirements.Finally, the paper looks into the future of collagen implants considering technology progress in biomedical engineering, tissue engineering, and genetic engineering fields.%对已在中国上市的胶原蛋白类植入性医疗器械按生产工艺及性能特征进行了分类,并结合国家食品药品监督管理总局(CFDA)对该类产品的监管要求,从免疫原性风险、病毒及传染性病原体风险、产品技术要求项目等方面探讨了该类医疗器械安全性评价的要点;最后结合生物医学工程、组织工程、基因工程等领域的技术进步对该类医疗器械未来的发展方向进行展望.

  7. Effect of intraoperatory peritoneal bupivacaine irrigation on inmediate, 24 hour

    OpenAIRE

    2004-01-01

    Objective: To compare the response on inmediate, 24 hour abdominal pain and referred shoulder pain (omalgia), when an intraperitoneal irrigation of bupivacaine was used as opposed to saline irrigation, in a group of patients who has laparoscopy done in a medical center in Cali, between April and June of 2000. Material and methods: After previous authorization and consentment by all 100 patients, a placebo was applied to 50 patients and bupivacaine to the other 50 patients, without randomizat...

  8. The Role of Liposomal Bupivacaine in Value-Based Care.

    Science.gov (United States)

    Iorio, Richard

    Multimodal pain control strategies are crucial in reducing opioid use and delivering effective pain management to facilitate improved surgical outcomes. The utility of liposomal bupivacaine in enabling effective pain control in multimodal strategies has been demonstrated in several studies, but others have found the value of liposomal bupivacaine in such approaches to be insignificant. At New York University Langone Medical Center, liposomal bupivacaine injection and femoral nerve block were compared in their delivery of efficacious and cost-effective multimodal analgesia among patients undergoing total joint arthroplasty (TJA). Retrospective analysis revealed that including liposomal bupivacaine in a multimodal pain control protocol for TJA resulted in improved quality and efficiency metrics, decreased narcotic use, and faster mobilization, all relative to femoral nerve block, and without a significant increase in admission costs. In addition, liposomal bupivacaine use was associated with elimination of the need for patient-controlled analgesia in TJA. Thus, at Langone Medical Center, the introduction of liposomal bupivacaine to TJA has been instrumental in achieving adequate pain control, delivering high-level quality of care, and controlling costs.

  9. Plasma bupivacaine levels following single dose intraarticular instillation for arthroscopy.

    Science.gov (United States)

    Meinig, R P; Holtgrewe, J L; Wiedel, J D; Christie, D B; Kestin, K J

    1988-01-01

    Arthroscopy of the knee was performed using 30 ml single dose intraarticular instillations of 0.5% or 0.25% solutions of bupivacaine (Marcaine). A total of 18 patients (mean age, 34 years), divided into two groups, participated in this study. Venous plasma levels were measured at 0, 10, 20, 30, 45, 60, 90, 120, and 240 minute intervals following a single instillation into the knee joint. All patients had suspected traumatic internal derangement of the knee. Electrocardiogram tracings, blood pressure, and neurologic assessment were monitored at each venous sampling interval or more often if clinically indicated. The type and amount of supplemental anesthesia were also recorded. None of our 18 patients required a general anesthetic because of pain although the following procedures were performed: meniscectomy, plica release, abrasion chondroplasty, loose body retrieval, and limited meniscal repair. A new methodology for the measurement of plasma bupivacaine using the gas chromatograph mass spectrometer is described. Monitoring specific molecular mass fragments allows the measurement of picogram per milliliter levels of bupivacaine. The highest peak plasma concentration occurred 20 minutes after instillation of 30 ml of 0.5% bupivacaine. The 625 +/- 225 ng/ml level was well below the 2,500 to 4,000 ng/ml reported to elicit early subjective CNS symptoms of bupivacaine toxicity. Thus, a single dose intraarticular instillation of 30 ml 0.5% or 0.25% bupivacaine is convenient, efficacious, and pharmacologically safe for routine clinical arthroscopy.

  10. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section

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    Hala Mostafa Gomaa

    2014-10-01

    Conclusion: Either intrathecal nalbuphine 0.8 mg or intrathecal fentanyl 25 μg combined with 10 mg bupivacaine provides good intra-operative and early post-operative analgesia in cesarean section.

  11. COMPARATIVE STUDY OF BUPIVACAINE V/S BUPIVACAINE WITH CLONIDINE FOR BRACHIAL PLUXUS BLOCK

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    Praveen Kumar

    2015-10-01

    Full Text Available BACKGROUND : The prime duty of any anesthesiologist is to relive pain in the perioperative period. Today regional anesthesia is well established as equal to general anesthesia in effectiveness and patient acceptability. Regional anesthesia is blocking of peripheral ne rve conduction in a reversible way using local anesthetic agents. For surgeries on upper extremities, particularly in emergency surgeries, regional anesthesia has many advantages over general anesthesia. The brachial plexus is approached at the level of tr unks and the compact arrangement of trunks at the supraclavicular level gives a high success rate with minimum local anesthetic drug volume and a dense and fast onset of the block. To prolong the duration of analgesia various drugs have been studied as adj uvants to the local anesthetics. This study is intended to determine the effects of adding Clonidine to Bupivacaine in brachial plexus blockade by Nerve locator assisted supraclavicular approach, with regard to the onset, intensity and duration of blockade along with its analgesic efficacy. METHODS : Forty adult patients of both sexes in the age group of 20 - 60 years of weight ranging from 50 - 70kg belonging to ASA I/II category posted for various types of upper limb surgeries the patients were randomly alloca ted into two groups,. Supraclavicular brachial plexus block was performed via peripheral nerve locator assisted subclavian perivascular technique. Group – B ( B upivacaine alone – 20 patients received 30 ml of 0.375%Bupivacaine with 2ml of 0.9% sodium chloride solution. Group – BC ( B upivacaine + C lonidine – 20 patients received 30ml of 0.375%Bupivacaine with Clonidine hydrochloride 100μg (1ml of 150μg diluted with 2ml 0.9% Na C l solution. From that 2ml used fo r study. ( T he following parameters are assessed Onset of blockade, Duration of blockade, Intensity of blockade, Sedation, Quality of analgesia, Haemodynamic changes & Complications if any RESULTS

  12. Bioengineered collagens

    Science.gov (United States)

    Ramshaw, John AM; Werkmeister, Jerome A; Dumsday, Geoff J

    2014-01-01

    Mammalian collagen has been widely used as a biomedical material. Nevertheless, there are still concerns about the variability between preparations, particularly with the possibility that the products may transmit animal-based diseases. Many groups have examined the possible application of bioengineered mammalian collagens. However, translating laboratory studies into large-scale manufacturing has often proved difficult, although certain yeast and plant systems seem effective. Production of full-length mammalian collagens, with the required secondary modification to give proline hydroxylation, has proved difficult in E. coli. However, recently, a new group of collagens, which have the characteristic triple helical structure of collagen, has been identified in bacteria. These proteins are stable without the need for hydroxyproline and are able to be produced and purified from E. coli in high yield. Initial studies indicate that they would be suitable for biomedical applications. PMID:24717980

  13. Collagen for bone tissue regeneration.

    Science.gov (United States)

    Ferreira, Ana Marina; Gentile, Piergiorgio; Chiono, Valeria; Ciardelli, Gianluca

    2012-09-01

    In the last decades, increased knowledge about the organization, structure and properties of collagen (particularly concerning interactions between cells and collagen-based materials) has inspired scientists and engineers to design innovative collagen-based biomaterials and to develop novel tissue-engineering products. The design of resorbable collagen-based medical implants requires understanding the tissue/organ anatomy and biological function as well as the role of collagen's physicochemical properties and structure in tissue/organ regeneration. Bone is a complex tissue that plays a critical role in diverse metabolic processes mediated by calcium delivery as well as in hematopoiesis whilst maintaining skeleton strength. A wide variety of collagen-based scaffolds have been proposed for different tissue engineering applications. These scaffolds are designed to promote a biological response, such as cell interaction, and to work as artificial biomimetic extracellular matrices that guide tissue regeneration. This paper critically reviews the current understanding of the complex hierarchical structure and properties of native collagen molecules, and describes the scientific challenge of manufacturing collagen-based materials with suitable properties and shapes for specific biomedical applications, with special emphasis on bone tissue engineering. The analysis of the state of the art in the field reveals the presence of innovative techniques for scaffold and material manufacturing that are currently opening the way to the preparation of biomimetic substrates that modulate cell interaction for improved substitution, restoration, retention or enhancement of bone tissue function.

  14. Absorption of Bupivacaine after Administration of a Lozenge as Topical Treatment for Pain from Oral Mucositis

    DEFF Research Database (Denmark)

    Mogensen, Stine; Sverrisdóttir, Eva; Sveinsdóttir, Kolbrún;

    2017-01-01

    , respectively, after administration. The plasma concentration-time profiles of bupivacaine were fitted to pharmacokinetic models using nonlinear mixed-effects modelling, evaluating demographics and health status as covariates. The population pharmacokinetics (PK) of bupivacaine lozenge was best described...

  15. Acetylcholinesterase assay for cerebrospinal fluid using bupivacaine to inhibit butyrylcholinesterase

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    Anders Jens

    2001-12-01

    Full Text Available Abstract Background Most test systems for acetylcholinesterase activity (E.C.3.1.1.7. are using toxic inhibitors (BW284c51 and iso-OMPA to distinguish the enzyme from butyrylcholinesterase (E.C.3.1.1.8. which occurs simultaneously in the cerebrospinal fluid. Applying Ellman's colorimetric method, we were looking for a non-toxic inhibitor to restrain butyrylcholinesterase activity. Based on results of previous in vitro studies bupivacaine emerged to be a suitable inhibitor. Results Pharmacokinetic investigations with purified cholinesterases have shown maximum inhibition of butyrylcholinesterase activity and minimal interference with acetylcholinesterase activity at bupivacaine final concentrations between 0.1 and 0.5 mmol/l. Based on detailed analysis of pharmacokinetic data we developed three equations representing enzyme inhibition at bupivacaine concentrations of 0.1, 0.2 and 0.5 mmol/l. These equations allow us to calculate the acetylcholinesterase activity in solutions containing both cholinesterases utilizing the extinction differences measured spectrophotometrically in samples with and without bupivacaine. The accuracy of the bupivacaine-inhibition test could be confirmed by investigations on solutions of both purified cholinesterases and on samples of human cerebrospinal fluid. If butyrylcholinesterase activity has to be assessed simultaneously an independent test using butyrylthiocholine iodide as substrate (final concentration 5 mmol/l has to be conducted. Conclusions The bupivacaine-inhibition test is a reliable method using spectrophotometrical techniques to measure acetylcholinesterase activity in cerebrospinal fluid. It avoids the use of toxic inhibitors for differentiation of acetylcholinesterase from butyrylcholinesterase in fluids containing both enzymes. Our investigations suggest that bupivacaine concentrations of 0.1, 0.2 or 0.5 mmol/l can be applied with the same effect using 1 mmol/l acetylthiocholine iodide as substrate.

  16. Tetrodotoxin-Bupivacaine-Epinephrine Combinations for Prolonged Local Anesthesia

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    Christina Bognet

    2011-12-01

    Full Text Available Currently available local anesthetics have analgesic durations in humans generally less than 12 hours. Prolonged-duration local anesthetics will be useful for postoperative analgesia. Previous studies showed that in rats, combinations of tetrodotoxin (TTX with bupivacaine had supra-additive effects on sciatic block durations. In those studies, epinephrine combined with TTX prolonged blocks more than 10-fold, while reducing systemic toxicity. TTX, formulated as Tectin, is in phase III clinical trials as an injectable systemic analgesic for chronic cancer pain. Here, we examine dose-duration relationships and sciatic nerve histology following local nerve blocks with combinations of Tectin with bupivacaine 0.25% (2.5 mg/mL solutions, with or without epinephrine 5 µg/mL (1:200,000 in rats. Percutaneous sciatic blockade was performed in Sprague-Dawley rats, and intensity and duration of sensory blockade was tested blindly with different Tectin-bupivacaine-epinephrine combinations. Between-group comparisons were analyzed using ANOVA and post-hoc Sidak tests. Nerves were examined blindly for signs of injury. Blocks containing bupivacaine 0.25% with Tectin 10 µM and epinephrine 5 µg/mL were prolonged by roughly 3-fold compared to blocks with bupivacaine 0.25% plain (P < 0.001 or bupivacaine 0.25% with epinephrine 5 µg/mL (P < 0.001. Nerve histology was benign for all groups. Combinations of Tectin in bupivacaine 0.25% with epinephrine 5 µg/mL appear promising for prolonged duration of local anesthesia.

  17. Shenfu injection reduces toxicity of bupivacaine in rats

    Institute of Scientific and Technical Information of China (English)

    王强; 刘艳红; 雷毅; 杨静; 陈绍洋; 陈敏; 熊利泽

    2003-01-01

    Objective To investigate the effects of injecting Shenfu, an extract of traditional Chinese herbal medicines, on the central nervous system (CNS) and the cardiac toxicity of bupivacaine in rats. Methods Sixteen male Sprague-Dawley rats, weighing form 280 to 320 g, were randomly assigned to two groups (n=8 in each group). Animals in the control group received a saline injection 10 ml/kg while animals in the Shenfu group received an injection of Shenfu 10 ml/kg intraperitoneally 30 minutes before intravenous infusion of bupivacaine. Lead Ⅱ of an electrocardiogram (EEG) was continuously monitored after 3 needles were inserted into the skin of both forelimbs and the left hind-leg of each rat. The femoral artery was cannulated for measurement of arterial blood pressure and blood sampling. The femoral vein was cannulated for the infusion of bupivacaine. After baseline measurement (arterial blood pressure, heart rate and arterial blood gas), 0.5% bupivacaine was infused intravenously at a rate of 2 mg*kg-1*min-1 to all animals until asystole occurred. The time of bupivacaine-induced convulsions, arrhythmia and asystole were determined. The dose of bupivacaine was then calculated at the corresponding time point. Results The doses of bupivacaine that induced convulsions, arrhythmia and cardiac arrest were remarkably larger in Shenfu injection-treated animals than in saline-treated rats [convulsions, (10.5±1.9) mg/kg vs (7.2±1.5) mg/kg; arrhythmia (10.5±2.0) mg/kg vs (7.2±1.9) mg/kg; asystole, (32.8±8.5) mg/kg vs (25.0±5.0) mg/kg; P=0.006, 0.009 and 0.044, respectively]. Conclusion The Shenfu injection is able to reduce the toxicity of bupiralaine to CNS and cardiac system in rats.

  18. 可吸收胶原膜在即刻种植中引导骨组织再生作用的研究%Guided Bone Regeneration of Bioabsorbable Collagen Membrane in Immediate Dental Implants

    Institute of Scientific and Technical Information of China (English)

    刘向辉; 张磊; 孙卫革; 杨建; 黄辉; 张林

    2012-01-01

    Objective: This study was proposed to evaluate the effect of bioabsorbable collagen membrane in guided bone regeneration in cases of bone defects with immediate dental implants. Methods: 8 beagle dogs were sedated with ketamine and 2, 3, and 4 premolars in both sides of mandible were extracted. Immediate implants was inserted into the extraction wounds. Each extraction socket was made one implantation. A half circumferential bone defect measured 3 mmx4 mm was prepared around the neck of implant. 6 bone defects in one dog were randomly divided into 3 groups. Group A, coralline hydroxyapatite (CHA) covered with bioabsorbable collagen membrane were used as restorative material in the defects. Group B, CHA only. Group C, blank control. All the dogs were sacrificed at the end of 3 months. The bone specimens including the single implant were collected, which were removed and studied by Gross examination, histological observation, and biomechanical tests. Result: New bone formation in bone defects were observed in all 3 groups. Group A: great amount of matured new bone with no soft tissue growth. Group B: there was scanty new bone and some soft tissue formation. Group C was the worst of three groups. Conclusion: Bioabsorbable collagen membrane with CHA might act as a autograft and stimulate peri-implant bone healing.%目的;通过动物实验研究可吸收胶原膜在即刻种植骨缺损区引导骨组织再生的作用.方法:8只实验用犬,拔除双侧下颌第二、三、四前磨牙,每个拔牙窝植入1枚种植体,并在种植体颈部对应牙槽骨上制备半环状骨缺损,将每只实验犬口内的6处骨缺损随机分为3组,每组两处,并给予不同处理.A组:骨缺损中植入珊瑚羟基磷灰石,并用可吸收胶原膜覆盖;B组:骨缺损中单纯植入珊瑚羟基磷灰石;C组:骨缺损中不植入任何材料,作为空白对照组.3个月后处死所有实验动物,制作含单个种植体的骨标本,进行大体观察、生物力学测

  19. Comparison of Local Anesthetic Effect of Bupivacaine versus Bupivacaine plus Dexamethasone in Nasal Surgery

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    Abdolhosein Ma’somi

    2012-12-01

    Full Text Available   Introduction: Adequate pain control is an important consideration in the post-surgical management of patients. Local nerve blockade added to general anesthesia can provide excellent pain control during and after most nasal surgical procedures. The aim of this study was to determine the combined effect of local anesthetic drugs with corticosteroids in nasal surgery. Materials and Methods: In this double-blind clinical study, 60 patients who underwent different nasal surgical procedures were matched and divided into two equal groups. Bilateral local nerve blockade was used in both groups. Bupivacaine or bupivacaine plus dexamethasone was administered by injection (groups B and B+D, respectively. Postoperative visual analog scale (VAS pain values and the need for oral/intramuscular analgesic treatment in the first 24 h were recorded in all patients. Results: Thirty-eight male (63.3% and 22 female (36.7% patients were included in this study, with a mean age of 28.3 ± 8.2 years. At 1, 2, 4, 6, and 12 h post surgery, VAS pain values were significantly lower in the B+D group than in the B group. The analgesic requirement was significantly lower in the B+D group compared with the B group. No relevant complications were seen during surgery or postoperative hospitalization. Conclusion: This study demonstrates the positive effect of a combination of a dexamethasone with a bupivacaine in reducing pain and the need for analgesic drugs after different nasal surgeries. No acute or short-term post-surgical complications were observed in this study.   

  20. Post operative analgesia after incisional infiltration of bupivacaine v/s bupivacaine with buprenorphine

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    Tanu R Mehta

    2011-01-01

    Full Text Available Introduction: Opioid receptors have been demonstrated in the peripheral nerve endings of afferent neurons. Blockade of these receptors with peripherally administered opioid is believed to result in analgesia. Aim: To evaluate whether buprenorphine added to bupivacaine for wound infiltration can enhance post-operative analgesia via peripheral mechanisms. Materials and Methods: Forty ASA I and II adult patients scheduled for open donor nephrectomy were enrolled in this randomized double blind prospective study. In group A ( n=20 patients, the wound was infiltrated with bupivacaine 0.5% (2 mg/kg and in group B ( n=20 with bupivacaine 0.5% (2 mg/kg and buprenorphine (2 μg/kg. All patients were given diclofenac 75 mg IM at 8 h interval. Post-operative quality of analgesia was assessed by VAS (0-10 for 24 h and when VAS > 4 rescue analgesic was administered. Total dose of rescue analgesic and side effects were noted. Results: The time of administration of first rescue analgesic was significantly higher in group B (10.52±5.54 h as compared to group A (3.275±1.8 h. Mean VAS was significantly lower in group B as compared to group A. The total dosage of rescue analgesic was more in group A as compared to group B patients. Conclusion: Addition of buprenorphine to the local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 h, thus providing evidence in support of the existence of peripheral opioid receptors.

  1. [Collagenous colitis].

    Science.gov (United States)

    Lindström, C G

    1991-05-01

    Collagenous colitis is now regarded by an overwhelming majority of authors as a clinicopathological entity and has been taken up as a such in many text-books and diagnostic atlases (Morson & Dawson, 1990, Fenoglio-Preiser et al., 1989, Whitehead 1985, Whitehead 1989). A good, detailed review of cases of collagenous colitis published up to 1988 was performed by Perri et al. Collagenous colitis was also presented to a wider medical public through a clinicopathological conference case at Massachusetts General Hospital (Case 29-1988). Finally it may be added that collagenous colitis has been included in the new fourth edition of Robbins Pathologic Basis of Disease (Cotran, Kumar, Robbins, 1989), where the possibility of an autoimmune disease is stressed.

  2. Evaluation of intrathecal bupivacaine alone, bupivacaine with butorphanol and bupivacaine with dexmedetomidine for lower segment caesarean section: a randomized control trial

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    Ashem Jack Meitei

    2016-12-01

    Conclusions: Addition of dexmedetomidine to spinal bupivacaine block in caesarean section increase the duration of analgesia and motor block with minimal side effect and no adverse effects on the babies. [Int J Basic Clin Pharmacol 2016; 5(6.000: 2675-2682

  3. Postoperative Analgesia in Children- Comparative Study between Caudal Bupivacaine and Bupivacaine plus Tramadol

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    Meena Doda

    2009-01-01

    Full Text Available Thirty children, ASAI-II, aged between 2yrs-5yrs, undergoing sub umbilical operation (inguinal and penile surgery were selected for this double blind study. They were randomly divided in two groups, group Aand group B. Group A(n15 received 0.25%bupivacaine 0.5ml.kg -1 and Group B (n=15 received 0.25% bupivaeaine 0.5ml.kg -1 and tramadol 2mg.kg -1 as single shot caudal block. Postoperative pain was assessed by a modified TPPPS (Toddler-Preschool Postoperative Pain Scale and analgesic given only when the score was more than 3. In the first 24 hrs it was observed that the mean duration of time interval between the caudal block and first dose of analgesic was significantly long(9. lhrs in Group B as compared to Group A (6.3hrs which was much shorter(p< 0.01.There was no significant haemodynamie changes, motor weakness or respiratory depression in both groups. This study con-cluded that addition of tramadol 2mg.kg -1 to caudal 0.25% bupivacaine 0.5ml.kg -1 significantly prolong the duration of postoperative analgesia in children withoutprodueing much adverse effects.

  4. A COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE WITH CLONIDINE AND EPIDURAL BUPIVACAINE FOR POST OPERATIVE ANALGESIA

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    Durga Prasad

    2015-10-01

    Full Text Available BACKGROUND: Clonidine, an α 2 - adrenoreceptor agonist, administered epidurally, is gaining popularity for its analgesic, sympatholytic, hemodynamic stabilizing and sedative properties without significant side effects. METHODS: This present study “ A Comparative Study o f Epidural Bupivac aine w ith Clonidine a nd Epidural Bupivacaine f or Post - o perative Analgesia ” was conducted in 70 cases of ASA grade I and II, between the age groups of 30 - 75yrs undergoing abdominal, gynecological and orthopedic surgeries under epidural anaesthesia. At the e nd of surgery, patients were shifted to recovery room. When patients complained of pain with VAS > 4/10, they were allocated to receive either of B: Plain Bupivacaine 0.125% 10ml (n = 35. B+C: Clonidine 150 mcg (1ml + 0.125% Bupivacaine 9ml (n = 35. The following parameters were monitored: A. Onset of analgesia . B. Duration of analgesia . C. VAS and Quality of analgesia . D. ardio - respiratory effects: Pulse rate, blood pressure, respiratory rate. E. Side effects like: nausea, vomiting, pruritus, hypotensio n, sedation and respiratory depression were studied. ONSET OF ANALGESIA: The time of onset of analgesia in group (B+C was significantly less (12.7 ± 0.87 (S.D min when compared to g roup (B (16 ± 3.34 (S.D min. DURATION OF ANALGESIA: The duration of a nalgesia in group (B+C (225.2 ± 45.74 (SD min was significantly more when compared to group (B (119 ± 29.29 (SD min. VISUAL ANALOGUE SCORE: In comparison of group B and group B+C, highly significant difference in VAS was seen from 15min till 3.5hrs in between the groups. The quality of analgesia in Group B+C was VAS 3 - 4 (good to excellent pain relief, as compared to Group B, where VAS was 2 - 3 (fair to good pain relief. SEDATION: In Group B+C from 30min till 2hrs, 100% of patients were asleep (sedat ion score 3. Even in patients with sedation score 3, patients were calm, quiet and asleep but when questions were asked, they answered with

  5. COMPARATIVE STUDY OF EPIDURAL BUPIVACAINE AND BUPIVACINE WITH NEOSTIGMINE

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    Pavani

    2015-05-01

    Full Text Available BACKGROUND: Many drugs have been used to prolong analgesic effects of epidural local anesthetics. These are called adjuvants. We studied the epidural effect of Neostigmine when adminstered with Bupivacaine in comparison with Bupivacaine . OBJECTIVE: The objective for the study was to find a drug which enhances the onset of action, increases the duration of action of the local anesthetic with minimal or no side effects, instead of increasing the dose of local anaesthetic. MATERIALS AND METHODS: A prospecti ve study was conducted on 100 adult patients, selected at random of either sex, of age between 20 - 65 years and belonging to ASA grade I or II. The study was designed to compare the effects of epidural Neostigmine with Bupivacaine and epidural Bupivacaine u sed alone with regard to onset, duration of analgesia, hemodynamic stability and level of anaesthesia. Patients were divided into two groups of 50 each. Group I received 19ml of 0.5% Bupivacaine+1ml of normal saline. Group II received 19ml of 0.5% Bupivaca ine+100μg of Neostigmine in 1ml of normal saline. In the operating room the patients were assessed for time of onset of analgesia, duration of anaesthesia, level of analgesia and complications. RESULTS : The addition of Neostigmine resulted in significant r apid onset of action, longer duration of analgesia and motor blockade. There was no incidence of respiratory depression, pruritus, fluctuations in blood pressure, or change in pulse rate, except one patient who developed bradycardia. CONCLUSION : Co adminis tration of epidural Neostigmine and Bupivacaine appears to be a useful technique for epidural anaesthesia as it provides faster onset, longer duration of action and haemodynamic stability.

  6. A COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA BY CAUDAL EPIDURAL ROUTE USING BUPIVACAINE WITH TRAMADOL AND BUPIVACAINE WITH FENTANYL IN PAEDIATRIC BELOW UMBILICAL SURGERIES

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    Meera

    2015-05-01

    Full Text Available The aim of this study was to compare the effectiveness of Bupivacaine (0.25% 0.5 ml/kg with Fentanyl 1μg/kg and Bupivacaine (0.25% 0.5 ml/kg with Tramadol 2 mg/kg in caudal block for postoperative analgesia. In the present study, 60 children of ASA I and II, aged between 5-12 years who were scheduled for below umbilical surgical procedures were randomly allotted into 2 groups (30 each to receive either bupivacaine with fentanyl or bupivacaine with tramadol. Caudal block was performed after induction of general anesthesia, no analgesics were given intra-operatively. Postoperative analgesia was evaluated by Numerical Rating Scale and sedation was assessed by five point sedation score. Postoperative analgesia was supplemented with Syrup Paracetamol (10mg/kg when Numerical Rating Scale was 4. Any adverse effect like respiratory depression, urinary retention, nausea and vomiting were recorded in all patients. Caudal tramadol with bupivacaine produced significant increased postoperative analgesia. The duration of analgesia was 861±23 minutes in tramadol with bupivacaine group, as compared to 353.46±31.79 minutes in fentanyl with bupivacaine group. No significant difference found in sedation score in both groups in first hour postoperatively. Two cases in fentanyl with bupivacaine and three cases in tramadol with bupivacaine group developed urinary retention in postoperative period. Four cases in fentanyl with bupivacaine and three cases in tramadol with bupivacaine group developed nausea and vomiting. Our study showed that caudal tramadol with bupivacaine provided longer duration of postoperative analgesia without having significant side effects.

  7. Modulation of the tissue reaction to biomaterials. II. The function of T cells in the inflammatory reaction to crosslinked collagen implanted in T-cell-deficient rats

    NARCIS (Netherlands)

    van Luyn, MJA; Khouw, IMSL; van Wachem, PB; Blaauw, EH; Werkmeister, JA

    1998-01-01

    Unwanted tissue reactions are often observed resulting in events such as early resorption of the biomaterial, loosening of the implant, or a chronic (immunologic) response. From immunologic studies it is known that inflammatory reactions can be modulated by use of (anti)-growth factors or anti-infla

  8. Octacalcium phosphate combined with collagen orthotopically enhances bone regeneration.

    Science.gov (United States)

    Kamakura, Shinji; Sasaki, Kazuo; Honda, Yoshitomo; Anada, Takahisa; Suzuki, Osamu

    2006-11-01

    Octacalcium phosphate (OCP) is resorbable bone regenerative material, but its brittleness makes it difficult to maintain its shape without restraint. We have engineered a scaffold constructed of synthetic OCP and porcine collagen sponge (OCP/Collagen) and investigated whether OCP/Collagen composite could improve bone regeneration. To examine this hypothesis, bone regeneration by the implantation of OCP/Collagen was compared with those by OCP and collagen. Radiographic and histological examination was performed and the percentage of newly formed bone (n-Bone%) in the defect was determined by a histomorphometrical analysis. OCP/Collagen, OCP, or collagen was implanted into the critical-sized defects in rat crania and fixed at 2, 4, or 8 weeks after implantation. OCP/Collagen improved the handling performance than the granules of OCP, and synergistically enhanced the bone regeneration beyond expectation, which were composed of bone nucleation by OCP and cell infiltration by collagen. Histomorphometrical analysis showed that n-Bone% +/- standard error treated with OCP/Collagen (48.4 +/- 5.14) was significantly higher than those with OCP (27.6 +/- 4.04) or collagen (27.4 +/- 5.69) in week 8. The present study suggests that the combination OCP with collagen elicited the synergistic effect for bone regeneration.

  9. Comparative study of epidural bupivacaine with butorphanol and bupivacaine with tramadol for postoperative pain relief in abdominal surgeries

    Science.gov (United States)

    Swathi, N.; Ashwini, N.; Shukla, Mukesh I.

    2016-01-01

    Introduction: To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries. Aims: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. Materials and Methods: A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's t-test using IBM SPSS software version 20. P ≤0.05 was considered to be statistically significant. P ≤ 0.001 was considered to be statistically highly significant. Results: Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group. Conclusions: Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients. PMID:27746533

  10. A COMPARATIVE STUDY OF ANALGESIC EFFICACY OF INTRATHECAL CLONIDINE WITH BUPIVACAINE & BUPIVACAINE ALONE IN ELECTIVE CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Chethanananda

    2014-03-01

    Full Text Available : Spinal anaesthesia in caesarean section has many advantages in that it is simpler to perform, provides a more certain endpoint& has a higher degree of success than epidural anaesthesia as it provides more profound block than epidural anaesthesia. As the dose of local anaesthetics used with spinal anaesthesia is small, there is little chance of maternal toxicity & placental transfer of drugs. Bupivacaine 0.5% is the most popular drug used for spinal anaesthesia in caesarean section. Many adjuvant drugs are added intrathecally along with Bupivacaine to increase the duration and intensity of analgesia. Intrathecal Clonidine (an α2 agonist is being extensively evaluated as an alternative to neuraxial opioid along with local anaesthetic agents. We evaluated the efficacy of clonidine added to 0.5% bupivacaine in prolonging the analgesia produced by intrathecal bupivacaine in parturients undergoing elective lower segment caesarean section (LSCS. 60 parturients between 20-30 years of age weighing 50-70 Kgs belonging to ASA (American Society of Anaesthesiologists grading I & II were prospectively randomised to two groups. 30 parturients of Group B (control group received 2.0 ml of 0.5% hyperbaric bupivacaine intrathecally alone and 30 parturients of Group BC received 1.75 ml of 0.5% hyperbaric bupivacaine +0.25 ml (37.5mcg of preservative free clonidine. The time taken for onset of sensory and motor blockade duration of postoperative analgesia and the duration of motor blockade were noted. The mean time of onset of sensory blockade in Group B was 57.16±9.9 seconds and Group BC was 62.8±6.80 seconds (p < 0.05. The meantime taken for onset motor block was 66.00±5.15 seconds in Group B and 81.33±8.89 seconds in Group BC (p = 0.000 with the grade of motor blockade was similar in both groups. The mean duration of analgesia was 152.77±11.79 minutes in B group and 288.16±16.73 in BC group (p = 0.000. The mean duration of motor blockade was 93.33±8

  11. Biocompatibility research of the collagen-polymer as human implants%胶原聚合物人体植入材料的生物相容性研究

    Institute of Scientific and Technical Information of China (English)

    辜臻晟; 盛耀华; 王丽天; 祝肇荣; 李增琦; 高金榜

    2005-01-01

    lens(ICL). There is no similar material in our country.OBJECTIVE: To evaluate the biocompatibility of ICL made mainly by collagen-polymer in animals.DESIGN: A randomized controlled trial.SETTING: Testing Center of Shanghai Institute of Biomaterial.MATERIALS: Our study was conducted in the Testing Center of Shanghai Institute of Biomaterial from January 2000 to April 2000. Cell strain: hearty L-929 cells(fibroblast of mouse) after 48-72 hours of passage; Twenty white guinea pig of either gender aged between 1 month and 3 months with a body mass between 300 g and 500 g; Seven healthy adult New Zealand rabbit of either gender(female rabbits were not required pregnant for pyrogenic reaction test) with a body mass between 1.7 kg and 3.0 kg or between 2.5 kg and 3.5 kg(experimental animals were obtained from Shanghai experimental animal center, ordinary grade).INTERVENTIONS: Collagen was used to perform the following biological tests: ① cytotoxicity test (cell growth rate); ② anaphylaxis test; ③ pyrogenic reactions test; ④ subcutaneous implant test. The data were analyzed and evaluated according to criteria.MAIN OUTCOME MEASURES: ① Growth and proliferation of fibroblast in mice; ② Reactions of erythema and edema of every provocation site and every observatory time after the induction of intradermal injection and local patch test; ③ Increase of body temperature of the rabbit after the injection of the extraction of the material into auricle marginal vein; ④ Reactions around the materials after 4 weeks of collagen implantation in rabbits subcutaneously.RESULTS: ① Cytotoxicity test: relative growth rate of collagen group was 99% to 106%, and the toxicity grade was level 0 - 1. ② Anaphylaxis test:there was no erythema or edema reaction at every provocation site at each time point of collagen group. The skin reaction to collagen-polymer was level 0. ③ Pyrogenic reactions test: the temperature increased in rabbit was below 0.6 ℃ and the total increase of

  12. EPIDURAL ANESTHESIA BUPIVACAINE 0.5%+ KCL 5 MEQ/L VS BUPIVACAINE 0.5%

    Directory of Open Access Journals (Sweden)

    F ALAVI

    2000-03-01

    Full Text Available Background. Although epidural anesthesia is a Successful method for most surgical procedures on lower extremities and lower abdomen. It is not so favorable because of it's slow onset and differential sensory and motor block. In order to solve this problem effects of additive KCl (5 meq/L into Bupivacaine 0.5 percent according to onset, intensity, duration of block and homodynamic changes during epidural anesthesia will be investigated through the present study. Methods. All the ASA I or II patients at medical centers of Isfahan university of medical sciences throughout 1378, candidate for elective Surgical procedures on lower extremities and lower abdomen with no contraindication for epidural anesthesia were Subdivided into Case (35 patients and Control (35 patients groups in a random manner to perform a double blind clinical trial. Epidural anesthesia applied to cases (by Bupivacaine 0.5 percent+ KCl 5meq/L and controls (by Bupivacaine 0.5 percent. Under identical conditions, data indicating basic MAP, basic heart rate and their changes as well as the onset, duration and intensity of motor and sensory block, were obtained and recorded by the anesthesiologist. Quantitative & qualitative variables were examined by T.test and X2 test respectively. Findings. Sensory onset for cases (8.22±1.43Min was faster than controls (11.56±1.45Min (P<0.005. Motor onset for cases (12.77 ± 1.83Min was faster than controls (20.24±1.71Min (P < 0.005. Sensory duration for cases (l86.34±8.37 Min was longer than controls (162.17±7.47Min (P<0.005. Motor duration for cases (106.25±13.50 Min was longer than controls (77.60 ± 9.94Min (P < 0.005.Intensity of sensory block for cases was greater than controls (P < 0.01. Intensity of motor block for cases was greater than controls (P < 0.001. Mean heart rate changes for cases (7.28±9.37 percent and controls (7 ± 8 percent were not different (P < 0.8. Mean decrease in MAP for cases (20.17 ± 2.10n percent was

  13. Tratamento aditivo do ceratocone por 'crosslinking' do colágeno após implante de anel de Ferrara Addictive treatment of keratoconus with collagen crosslinking after Ferrara ring implant

    Directory of Open Access Journals (Sweden)

    Edna Almodin

    2009-06-01

    Full Text Available OBJETIVO: Este trabalho tem como objetivo relatar experiência com utilização do crosslinking após implante de anel intracorneano de Ferrara (Ferrara Ophtalmic visando a melhora refrativa e estabilização corneana. MÉTODOS: Seis pacientes com idade entre 26 e 38 anos foram submetidos ao tratamento com crosslinking após implante de anel de Ferrara. Cinco pacientes receberam 2 segmentos de anel e um paciente recebeu um segmento. Depois de 4 a 55 meses os pacientes foram submetidos a aplicação do "crosslinking" com ultra-violeta de acordo com o protocolo estabelecido por Seiler & cols. RESULTADOS: Quatro olhos apresentaram alteração progressiva da refração e 2 apresentaram refração sem alteração progressiva. A topografia mostrou queda acentuada da curvatura e o estudo da lâmpada de fenda mostrou anel em boa profundidade durante um ano de pós-operatório em 100% dos olhos. A microscopia especular não mostrou alteração significativa e a acuidade visual se mostrou semelhante ao pré-operatório. CONCLUSÃO: O crosslinking poderá ajudar a manter ceratocones estáveis, não-somente nos casos de progressão, mas também nos cones evolutivos com implante de anel.PURPOSE: To describe our experience with crosslinking after Ferrara ring implant for better vision and corneal stabilization. METHODS: six patients with age of 26 - 38 years old had treatment with crosslinking after Ferrara ring implant. Five patients had 2 ring segments implanted and one patient had one segment implanted. After 4 to 55 months the patients were submitted to crosslinking with UVA light according to Seiler et al protocol. RESULTS: Four eyes had progressive alteration of refraction and 2 patients had no alteration of refraction. The topography showed flattener curvature and at the slip lamp 100% of the eyes had good depth after one year post operatively. The specular microscopy didn't show any significant alteration and the visual acuity was similar before the

  14. Collagenous gastritis.

    Science.gov (United States)

    Jin, Xiaoyi; Koike, Tomoyuki; Chiba, Takashi; Kondo, Yutaka; Ara, Nobuyuki; Uno, Kaname; Asano, Naoki; Iijima, Katsunori; Imatani, Akira; Watanabe, Mika; Shirane, Akio; Shimosegawa, Tooru

    2013-09-01

    In the present paper, we report a case of rare collagenous gastritis. The patient was a 25-year-old man who had experienced nausea, abdominal distention and epigastralgia since 2005. Esophagogastroduodenoscopy (EGD) carried out at initial examination by the patient's local doctor revealed an extensively discolored depression from the upper gastric body to the lower gastric body, mainly including the greater curvature, accompanied by residual mucosa with multiple islands and nodularity with a cobblestone appearance. Initial biopsies sampled from the nodules and accompanying atrophic mucosa were diagnosed as chronic gastritis. In August, 2011, the patient was referred to Tohoku University Hospital for observation and treatment. EGD at our hospital showed the same findings as those by the patient's local doctor. Pathological findings included a membranous collagen band in the superficial layer area of the gastric mucosa, which led to a diagnosis of collagenous gastritis. Collagenous gastritis is an extremely rare disease, but it is important to recognize its characteristic endoscopic findings to make a diagnosis. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.

  15. Comparison of the maternal and neonatal effects of bupivacaine ...

    African Journals Online (AJOL)

    2012-02-20

    Feb 20, 2012 ... bupivacaine + 25 μg (0.5 ml) fentanyl in elective cesarean delivery. Materials and ... Drager, Lubeck, Germany) monitoring were carried out. Before the ..... have a significant incidence of visceral pain when using lower doses ...

  16. The safety of liposome bupivacaine following various routes of administration in animals

    Directory of Open Access Journals (Sweden)

    Joshi GP

    2015-10-01

    Full Text Available Girish P Joshi,1 Gary Patou,2 Vladimir Kharitonov21Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, TX, 2Pacira Pharmaceuticals, Inc., Parsippany, NJ, USABackground: This report presents results from four preclinical studies evaluating safety and pharmacokinetics (PKs of liposome bupivacaine following intravascular (intravenous [IV], intra-arterial [IA], epidural, and intrathecal administration in dogs.Methods: Intravascular administration was initially tested in a pilot study to determine maximum tolerated doses, and then in an expanded study of systemic adverse effects and PKs. An epidural study compared properties of liposome bupivacaine alone and in combination with lidocaine/epinephrine vs bupivacaine HCl. Another study assessed effects after intrathecal administration.Results: In the initial intravascular studies, maximum doses at which no meaningful adverse events were observed with liposome bupivacaine were higher than for bupivacaine HCl (4.5 mg/kg IV vs 0.75 mg/kg IV, and 1.5 mg/kg IA vs 0.1 mg/kg IA, respectively. In the expanded intravascular study, there was no mortality or changes in pathology; adverse clinical signs included convulsions, lying on side, and decreased muscle tone (all were transient. In the epidural study, liposome bupivacaine was well tolerated at doses up to the highest dose tested (40 mg, with no evidence of spinal cord damage and with less motor blockade than bupivacaine HCl 15 mg. Intrathecal administration of liposome bupivacaine 40 mg was not associated with meaningful safety concerns and resulted in less motor blockade than bupivacaine HCl 15 mg. PK analyses showed that maximum plasma bupivacaine levels following administration of liposome bupivacaine (4.5 mg/kg IV and 40 mg epidural were similar to maximum plasma bupivacaine levels following a threefold lower dose of bupivacaine HCl (1.5 mg/kg IV and 15 mg epidural.Conclusion: Liposome bupivacaine

  17. [Comparison of ropivacaine and bupivacaine for epidural analgesia during labor].

    Science.gov (United States)

    Sánchez-Conde, P; Nicolás, J; Rodríguez, J; García-Castaño, M; del Barrio, E; Muriel, C

    2001-05-01

    To compare the analgesic efficacy and level of motor block using two local anesthetics, ropivacaine and bupivacaine, during labor. Sixty nulliparous women were enrolled during labor after full-term pregnancies. They were randomly assigned to receive epidural analgesia with ropivacaine (group R) or bupivacaine (group B). Group R patients received 10 ml of 0.18% ropivacaine with 5 microgram/ml of fentanyl followed by continuous epidural infusion of 0.1% ropivacaine with 2 microgram/ml of fentanyl at a rate of 10 ml/h. Group B patients received 10 ml of 0.15% bupivacaine with 5 microgram/ml of fentanyl followed by continuous epidural perfusion of 0.0625% bupivacaine with 2 microgram/ml of fentanyl at the same rate. Pain intensity was assessed on a visual analog scale, motor blockade on a Bromage scale, and level of sensory block at different moments. We also recorded total doses of local anesthetic employed during continuous epidural infusion, manner of final delivery, Apgar score, degree of maternal satisfaction and side effects. The demographic and delivery characteristics were similar in both groups. We found no statistically significant differences between the two groups for level of motor blockade, which was nil for 29 patients (96.66%) in group R and 28 patients (93.33%) in group B. No differences in degree of pain or level of sensory block (T8-T10 in both groups) were observed. The total doses of local anesthetic used were similar at 23.7 +/- 11.6 mg in group R and 16.5 +/- 7.3 mg in group B (non-significant difference). Nor did we find differences in manner of delivery, neonatal Apgar scores, degree of maternal satisfaction or side effects. Ropivacaine and bupivacaine are equally effective for epidural analgesia during labor at the doses used and they do not cause a relevant level of motor blockade.

  18. Does Extended-Release Liposomal Bupivacaine Better Control Pain Than Bupivacaine After Total Knee Arthroplasty (TKA)? A Prospective, Randomized Clinical Trial.

    Science.gov (United States)

    Schroer, William C; Diesfeld, Paul G; LeMarr, Angela R; Morton, Diane J; Reedy, Mary E

    2015-09-01

    Liposomal bupivacaine periarticular injection (PAI) offers sustained bupivacaine release after TKA, but few prospective independent studies exist. In this prospective, blinded study, liposomal bupivacaine was randomized against bupivacaine and incorporated into a comprehensive multimodal pain management protocol. 111 primary TKAs were randomized to receive PAI: 58 patients received 266 mg (20cc) liposomal bupivacaine mixed with 75 mg (30cc) 0.25% bupivacaine, and 53 patients received 150 mg (60cc) 0.25% bupivacaine. Visual analog pain scores and narcotic use were determined. No pain score differences occurred between study and control patients: Day 1: 4.5/4.6 (P=0.73); Day 2: 4.4/4.8 (P=0.27); or Day 3: 3.5/3.7 (P=0.58). Narcotic use was similar during hospitalization, 51.8/54.2 (P=0.34). The study medication costs $285, and the control medication costs $2.80. This finding does not justify the routine use of liposomal bupivacaine.

  19. Effects of thoracic paravertebral block with bupivacaine versus combined thoracic epidural block with bupivacaine and morphine on pain and pulmonary function after cholecystectomy

    DEFF Research Database (Denmark)

    Bigler, D; Dirkes, W; Hansen, R;

    1989-01-01

    Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml...

  20. COMPARATIVE EVALUATION OF INTRATHECAL BUPIVACAINE-FENTANYL AND BUPIVACAINE - CLONIDINE FOR CAESAREAN SECTION IN PREGNANCY INDUCED HYPERTENSION

    Directory of Open Access Journals (Sweden)

    Tripti

    2014-09-01

    Full Text Available BACKGROUND: Pain free postoperative period and early ambulation are the need of the day for mothers and their neonates for early initiation of breast feeding. It is moral responsibility of Anaesthesiologist to provide a safe and pain free postoperative period with use of various techniques and drug combinations. Spinal anaesthesia has been widely used for caesarean section in normalas well as preeclamptic parturients and has been found to be efficaciousand safe. The present study aimed to compare the analgesic efficacy and side effect profile of intrathecal Bupivacaine with Fentanyl and Bupivacaine with Clonidine in cesarean section of parturients with pregnancy induced hypertension (PIH. METHODS: 50 full term parturients with pregnancy induced hypertension scheduled for cesarean section were randomized into 2 groups of 25 each. GROUP BF (Bupivacaine with Fentanyl received 7.5mg of 0.5% hyperbaric Bupivacaine and 20µg Fentanyl intrathecally. GROUP BC (Bupivacaine with Clonidine received 7.5mg of 0.5% hyperbaric Bupivacaine and 60µg clonidine intrathecally. RESULTS: Patients in group BC showed long lasting analgesia compared to group BF (p value<0.05. Both the groups had satisfactory analgesia with hemodynamic stability, however the incidence of hypotension and vasopressor requirement was more in group BC compared to BF. Incidence of pruritus was exceptionally seen in group BF, however more patients were sedated and complained of dry mouth in group BC. Both the groups had comparable APGAR scores with no adverse neonatal effects. CONCLUSION: We conclude use of intrathecal clonidine 60µg and Fentanyl 20µg both provide excellent sensory and motor blockage with lower dose of bupivacaine. Both drugs improved intraoperative analgesia and prolonged the duration of effective analgesia without any adverse effect on neonate neurobehaviour. Fairly good analgesia with less sedation and better haemodynamic stability is observed with 20μg fentanyl

  1. 胶原性眼内接触镜兔眼植入术后的生物相容性研究%Study of biocompatibility on implantation of collagen intraocular contact lens in rabbit eyes

    Institute of Scientific and Technical Information of China (English)

    辜臻晟; 盛耀华; 祝肇荣; 高金榜

    2004-01-01

    BACKGROUND:Implantation of intraocular contact lens(ICL) in crystal eyes is a kind of new operation which can correct high myopia. As a kind of new material, collagen has been applied abroad to research and manufacture of ICL, while there is no similar domestic products. OBJECTIVE:To observe the cellular response after implantation of collagen ICL in rabbit eyes and evaluate biocompatibility of collagen by animal experiments. DESIGN:A randomized and control grouping experiment was designed. SETTING and PARTICIPANTS: The exporment was carried out in Department of Ophthalmology in the Affiliated Xinhua Hospital of Shanghai second Medical University.Twenty adult New Zealand white rabbits weighing from 2.0 kg to 2.5 kg,were selected without distinction of sex. MAIN OUTCOME MEASURE:The morphological changes of histocytes on the surface of ICL and ocular anterror tissue were observed. RESULTS: In ICL implantation group, the infiltration of plenty of phagocytes was major in ocular anterior segment tissues in the earlier period after operation,and the phagocytes were functionally active.There were only a few fibroblasts.The number of macrophages decreased in the later period,while the number of fibroblasts increased. In surgical control group many macrophages existed in ocular anterior tissue in the earlier period after operation and the number of fibroblasts increased significantly accompanied with fibrous tissue formation in the later period. CONCLUSION:Changes of inflammatory cells after ICL implantation showed a progress of classic foreign-body granulomatous inflammation.There was excellent ocular biocompatibility in collagen ICL.%背景:有晶体眼眼内接触镜植入术是一种矫治高度近视的新型手术,胶原作为一种新型材料已在国外应用于眼内接触镜(ICL)的研制,国内尚无同类产品.目的:通过兔眼的动物实验,观察胶原性眼内接触镜植入眼内后的组织细胞学反应,评定胶原的生物相容性.设计:随机

  2. Spatio-Temporal Modification of Collagen Scaffolds Mediated by Triple Helical Propensity

    OpenAIRE

    Wang, Allen Y.; Foss, Catherine A.; Leong, Shirley; Mo, Xiao; Pomper, Martin G.; Yu, Seungju M.

    2008-01-01

    Functionalized collagen that incorporates exogenous compounds may offer new and improved biomaterials applications, especially in drug-delivery, multifunctional implants, and tissue engineering. To that end, we developed a specific and reversible collagen modification technique utilizing associative chain interactions between synthetic collagen mimetic peptide (CMP) [(ProHypGly)x; Hyp = hydroxyproline] and type I collagen. Here we show temperature-dependent collagen binding and subsequent rel...

  3. Bupivacaine hydrochloride complexation with some alpha- and beta-cyclodextrins studied by potentiometry with membrane electrodes.

    Science.gov (United States)

    Kopecký, Frantisek; Vojteková, Mária; Kaclík, Pavol; Demko, Marek; Bieliková, Zuzana

    2004-05-01

    Membrane electrodes selective to bupivacaine cations were developed and those with PVC-dibutylphthalate membrane containing sparingly soluble bupivacaine phosphotungstate appeared to be the most suitable. Inclusion complexation of bupivacaine cations with cyclodextrins was studied by potentiometric measurements of the free bupivacaine cation concentration in aqueous solutions of bupivacaine hydrochloride with cyclodextrin using the prepared electrodes. Native alpha-cyclodextrin (alpha-CD) and beta-cyclodextrin (beta-CD), as well as their random-substituted derivatives hydroxypropyl-alpha-cyclodextrin (HP-alpha-CD), hydroxypropyl-beta-cyclodextrin (HP-beta-CD) and methyl-beta-cyclodextrin (M-beta-CD), were chosen for the study. The measured potentiometric data processed both by a linear and nonlinear regression corroborated the formation of weak 1:1 bupivacaine cation-cyclodextrin complexes and the corresponding complexation constants K(11) approximately 50-155 M(-1) were evaluated by the non-linear least-squares method. The mutual order of K(11) values, especially alpha-CD > beta-CD, suggested that the bupivacaine butyl group was mainly responsible for the inclusion complexation; the highest K(11) was exhibited by M-beta-CD followed by alpha-CD. The observed complexation may substantially modify properties of bupivacaine hydrochloride dosage forms with sufficient concentration of cyclodextrin but bupivacaine cations are readily released from the weak cyclodextrin complexes by dilution.

  4. Type XI Collagen

    DEFF Research Database (Denmark)

    Luo, Yunyun

    2016-01-01

    Type XI collagen is a fibrillary collagen. Type XI collagen is broadly distributed in articular cartilage, testis, trachea, tendons, trabecular bone, skeletal muscle, placenta, lung, and the neoepithelium of the brain. Type XI collagen is able to regulate fibrillogenesis by maintaining the spacing...... and diameter of type II collagen fibrils, and a nucleator for the fibrillogenesis of collagen types I and II. Mutations in type XI collagen are associated with Stickler syndrome, Marshall syndrome, fibrochondrogenesis, otospondylomegaepiphyseal dysplasia deafness, and Weissenbacher–Zweymüller syndrome. Type XI...... collagen binds heparin, heparan sulfate, and dermatan sulfate. Currently there are no biomarkers for type XI collagen....

  5. A CLINICAL COMPARISON OF COMPOUNDED SOLUTION (2% XYLOCAINE & 0.5% BUPIVACAINE WITH 0.5% BUPIVACAINE IN EPIDURAL ANALGESIA

    Directory of Open Access Journals (Sweden)

    Sathesha

    2014-09-01

    Full Text Available Epidural Analgesia is used for relief of pain during and following surgical operations, for relief of chronic pain, for relief of pain in labour, reduction of bleeding by producing sympathetic blockade and hypotension during surgery or to supplement light general anaesthesia, thereby suppressing the transmission of afferent impulses and autonomic and hormonal response to surgery. The commonly used drugs for epidural analgesia are 2% xylocaine and 0.5% bupivacaine. Mixing of the local anaesthetics and altering the pH have been found to be safe and cost effective.1,2 our study was a prospective randomized controlled double blind study to investigate effect of the benefits of usage of a compounded solution (2% xylocaine and 0.5% bupivacaine in a 1:1 ratio over a single drug (0.5% bupivacaine and ascertain whether it can be recommended for routine use in epidural analgesia in regular anaesthetic practice.3,4,5 The following parameters are Studied 1 The time of onset of analgesia. 2 The quality of analgesia. 3 The degree of motor blockade. 4 Duration of analgesia. 5 Safety of compounding local anaesthetics. METHODS AND MATERIAL: One Hundred Adult Patients of either sex ranging between 20-60 years of age belonging to ASA grade 1 and II were studied. All patients were at random divided into 2 groups fifty in each group. Group A received 0.5% bupivacaine 15cc. Group B received a mixture of 0.5% bupivacine and 2% xylocaine (7.5cc + 7.5cc RESULTS: Mean time of onset of analgesia in group B was lower (11.50 + 2.05 as compared to group A (22.24 + 2.18 and this difference was statistically highly significant (P<0.001. 16% of group A and 6% of group B required to be changed over to general anaesthesia. Grade IV motor blockade was seen only in 24% of group A and 30% of the group B which is significant. Mean duration of action in group A was higher (128.90 + 6.70 than in group B (98.30 + 5.29 and this difference was statistically significant. CONCLUSIONS: The

  6. A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery

    Directory of Open Access Journals (Sweden)

    Manpreet Kaur

    2011-01-01

    Full Text Available Background: The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries. Methods: In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthesia, were allocated into three groups of 30 each. Patients received either 2.5 ml of 0.5% hyperbaric buypivacaine 12.5 mg (Group A, 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 10 μg sufentanil (Group B or 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 25 μg butorphanol (Group C. Vital parameters, level, duration and regression of sensory block and motor block and side-effects were recorded and compared. Statistical Analysis Analysis of variance (ANOVA, post hoc test and Chi-square test were used. Results: Intrathecal addition of sufentanil/butorphanol prolonged the duration of sensory block (DOSB compared with bupivacaine alone (DOSB being 156.83±23.83 min, 170.87 ± 22.21 min and 171.17 ± 23.99 min in groups A, B and C, respectively without altering the duration of motor blockade. Bromage score 3 was achieved in 100%, 90% and 54.4% patients in groups A, B and C, respectively. The time to first request for analgesia was 112 ± 46.3 min, 323 ± 65.0 min and 299 ± 73.9 min in groups A, B and C, respectively. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus (60%. Conclusions: The analgesia was significantly prolonged in groups B and C; group C had a less-intense motor block. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus. Thus, this combination of butorphanol with low-dose bupivacaine is especially beneficial in the geriatric group

  7. A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery

    Science.gov (United States)

    Kaur, Manpreet; Katyal, Sunil; Kathuria, Suneet; Singh, Prabhjot

    2011-01-01

    Background: The objective of the present study was to compare the onset, degree and recovery time of sensory and motor block and hemodynamic effects of intrathecal bupivacaine alone and bupivacaine with sufentanil or butorphanol in endoscopic urological surgeries. Methods: In a randomized, double-blind study, 90 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective endoscopic urological surgeries under spinal anesthesia, were allocated into three groups of 30 each. Patients received either 2.5 ml of 0.5% hyperbaric buypivacaine 12.5 mg (Group A), 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 10 μg sufentanil (Group B) or 1.5 ml of 0.5% hyperbaric bupivacaine 7.5 mg with 25 μg butorphanol (Group C). Vital parameters, level, duration and regression of sensory block and motor block and side-effects were recorded and compared. Statistical Analysis: Analysis of variance (ANOVA), post hoc test and Chi-square test were used. Results: Intrathecal addition of sufentanil/butorphanol prolonged the duration of sensory block (DOSB) compared with bupivacaine alone (DOSB being 156.83±23.83 min, 170.87 ± 22.21 min and 171.17 ± 23.99 min in groups A, B and C, respectively) without altering the duration of motor blockade. Bromage score 3 was achieved in 100%, 90% and 54.4% patients in groups A, B and C, respectively. The time to first request for analgesia was 112 ± 46.3 min, 323 ± 65.0 min and 299 ± 73.9 min in groups A, B and C, respectively. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus (60%). Conclusions: The analgesia was significantly prolonged in groups B and C; group C had a less-intense motor block. Complications were reduced by the addition of butorphanol, which also has a lower tendency than sufentanil to produce pruritus. Thus, this combination of butorphanol with low-dose bupivacaine is especially beneficial in the geriatric group of patients

  8. COMPARATIVE STUDY BETWEEN EPIDURAL BUPIVACAINE WITH BUPRENORPHINE AND EPIDURAL BUPIVACAINE FOR POST - OPERATIVE ANALGESIA IN ABDOMINAL AND LOWER LIMB SURGERY

    Directory of Open Access Journals (Sweden)

    Nagesh

    2015-02-01

    Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the

  9. A COMPARATIVE STUDY OF BUPIVACAINE AND BUPIVACAINE WITH CLONIDINE UNDER SPINAL ANESTHESIA IN PATIENT FOR TOTAL ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Manuraj

    2015-02-01

    Full Text Available BACKGROUND: Bupivacaine is the most commonly used drug for spinal anesthesia . To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenoreceptor agonist with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Low doses of clonidine and buprenorphine have shown effectiveness in i ntensifying spinal anesthesia. AIM: This study is designed to evaluate the effectiveness of spinal blockade by adding 50μgm clonidine to bupivacaine. SET TINGS AND DESIGN: This a prospective, randomized , comparative clinical study involved 60 ASA grade Ι/ΙΙ patients aged 18 - 55 years undergoing elective hysterectomy under spinal anesthesia after approval from hospital ethics committee with written an d inform ed consent of patients. MATERIALS AND METHODS: 60 ASA grade Ι/ΙΙ patients aged 18 - 55 years selected for the study are divided in two groups of 30 each. Group B (Bupivacaine group patients will receive intrathecally 0.5% hyperbaric bupivacaine 4 ml (Total 4 ml whereas Group C (Clonidine group patient will receive intrathecally 0.5% hyperbaric bupivacaine 3. 5 ml + 50μg (Total 4 ml. The onset time to reach peak sensory and motor level, post - operative analgesia , hem odynamic changes, and side effects were recorded. RESULTS: The onset of sensory and motor blockade was faster in the group C compared to group B [137.60 seconds and 112.22 seconds] (p<0.001, [231.80 seconds and 165.1 seconds] (p<0.001. Duration of sensor y block, motor block and postoperative analgesia [221.4 minutes in group B vs. 362.84 minutes in group C] (P<0.001, was significantly prolonged in group C. There were no significant hemodynamic changes in both the groups. CONCLUSION: Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without significant hemodynamic side

  10. Effect of Silicone on the Collagen Fibrillogenesis and Stability

    OpenAIRE

    Kadziński, Leszek; Prokopowicz, Magdalena; Jakóbkiewicz-Banecka, Joanna; Gabig-Cimińska, Magdalena; Łukasiak, Jerzy; Banecki, Bogdan

    2015-01-01

    Collagen, the most abundant protein in mammals, is able to form fibrils, which have central role in tissue repair, fibrosis, and tumor invasion. As a component of skin, tendons, and cartilages, this protein contacts with any implanted materials. An inherent problem associated with implanted prostheses is their propensity to be coated with host proteins shortly after implantation. Also, silicone implants undergoing relatively long periods of contact with blood can lead to formation of thrombi ...

  11. Alleviating Thoracotomy Pain With Intercostal Liposomal Bupivacaine: A Case Report.

    Science.gov (United States)

    Saby, Adam; Swaminathan, Kavitha; Pangarkar, Sanjog; Tribuzio, Bianca

    2016-11-01

    Thoracotomy pain is common after chest surgery and may result from injury to the lung pleura, intercostal muscles, costovertebral joint, or intercostal nerves. Inappropriately controlled postoperative pain can hinder recovery and increase the risk of complications such as infection, atelectasis, blood clots, and development of post-thoracotomy pain syndrome. A number of treatment options for acute pain are available, most of which require systemic medications or indwelling catheters that may be contraindicated in patients on anticoagulants. We present the case of a patient with post-thoracotomy pain that effectively was treated with an ultrasound-guided nerve block with liposomal bupivacaine. The patient experienced pain relief without adverse event. Liposomal bupivacaine may be considered a potential treatment option for patients with severe acute post-thoracotomy pain in whom other modalities have not worked or are contraindicated. N/A. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  12. Effects of extradural bupivacaine on the haemostatic system.

    Science.gov (United States)

    Henny, C P; Odoom, J A; ten Cate, H; ten Cate, J W; Oosterhoff, R J; Dabhoiwala, N F; Sih, I L

    1986-03-01

    Twenty consecutive patients undergoing elective transurethral resection of the prostate were allocated randomly to one of two groups. Group I (n = 10) received lumbar extradural analgesia with 0.5% bupivacaine. Group II (n = 10) received general anaesthesia with spontaneous respiration, using 60% nitrous oxide and 1-2% halothane in oxygen. There was a significant inhibitory effect on platelet aggregation in the extradural group. No such effect was observed in the general anaesthesia group. Measured indices of coagulation and fibrinolysis showed no abnormalities compared with control in either group except for a significant decrease in alpha 2-antiplasmin during surgery in group II. These results suggest that the possible thromboprophylatic effect of extradural analgesia with bupivacaine may result from an inhibitory effect on platelet aggregation which is in addition to the increase in lower limb blood flow.

  13. Delayed postoperative gastric emptying following intrathecal morphine and intrathecal bupivacaine.

    LENUS (Irish Health Repository)

    Lydon, A M

    2012-02-03

    PURPOSE: A decrease in the rate of gastric emptying can delay resumption of enteral feeding, alter bioavailability of orally administered drugs, and result in larger residual gastric volumes, increasing the risk of nausea and vomiting. We compared the effects of 1) intrathecal bupivacaine (17.5 mg) and 2) the combination of intrathecal morphine (0.6 mg) and intrathecal bupivacaine (17.5 mg) on the rate of gastric emptying in patients undergoing elective hip arthroplasty. METHODS: Twenty four fasting ASA 1-3 patients were randomly assigned, in a double blind manner, to receive intrathecal hyperbaric bupivacaine (17.5 mg), either alone (group 1), or followed by intrathecal morphine (0.6 mg) (group 2). Gastric emptying was measured (using an acetaminophen absorption technique), twice in each patient; preoperatively, and approximately one hour postoperatively. Gastric emptying parameters are: AUC (area under the plasma acetaminophen concentration time curve), maximum plasma acetaminophen concentration (Cmax), and time to Cmax (tCmax), analyzed using paired Student\\'s t tests. RESULTS: Gastric emptying rates were reduced in both group 1 (AUC = 14.98 (3.8) and 11.05 (4.6) pre- and postoperatively, respectively) and group 2 (AUC = 13.93 (3.59) and 6.4 (3.42) pre- and postoperatively, respectively); the magnitude of the reduction was greater in group 2 [AUC (P = 0.04), Cmax (P = 0.05), tCmax (P = 0.13)]. CONCLUSION: The combination of intrathecal morphine (0.6 mg) and intrathecal bupivacaine (17.5 mg) delays gastric emptying postoperatively.

  14. 胶原性眼内接触镜眼内植入后的生物相容性评价%Biocompatibility of collagen intraocular contact lens after implantation in eyes

    Institute of Scientific and Technical Information of China (English)

    辜臻晟; 盛耀华; 祝肇荣; 高金榜

    2006-01-01

    术对照组术后各时间点眼压均无明显变化(P>0.05).②术后角膜损伤和前房渗出情况:眼内接触镜植入组:5只兔眼术后第1天出现不同程度的前房变浅,1周内均恢复正常;2只兔眼出现少量前房出血,2周后吸收;2只兔眼分别出现虹膜前粘连和后粘连,瞳孔轻度变形;2只兔眼出现不同程度眼内接触镜偏位;1只兔眼术后1个月出现晶体前囊膜下点状混浊.手术对照组:6只兔眼术后第1天前房出现1~2级渗出,1周后均吸收;各兔眼角膜透明,无前房出血、前房变浅、虹膜后粘、晶体混浊等变化.③术后各组房水中炎症递质前列腺素E2浓度检测结果:眼内接触镜植入组术后1~4 d房水中前列腺素E2含量最高,以后含量逐步递减.术后14 d和1个月,各组均基本相似(P>0.05).结论:眼内接触镜植入术后前房无明显慢性葡萄膜炎发生.房水中前列腺素E2浓度逐步降低,表现了眼内接触镜植入后典型的异物肉芽肿炎症过程,反映其良好的眼内耐受性.%BACKGROUND: Intraocular contract lens (ICL) implantation emerges as a crystal refrangibilit operation to rectify and cure high myopia in recent years. Collagen, a new material, is consisted of collagen Ⅳ and aquagel in Starr Company. It is an ideal material for ICL; however, high price is restricted to its development at a certain degree.OBJECTIVE: To find out ideal method of collagen ICL implantation through animal experiment in rabbit eyes and evaluate intraocular biocompatibility by observing inflammatory reaction and variation of inflammatory mediators.DESIGN: Single exponent and opening study.SETTING: Department of Ophthalmology, Xinhua Hospital affiliated to Medical College of Shanghai Jiaotong University.MATERIALS: The experiment was carried out in Xinhua Hospital affiliated to Medical College of Shanghai Jiaotong University and Shanghai Nanyang Radio-immunity Testing Center from August 1999 to March 2000.Twenty New Zealand rabbits were divided

  15. USE OF DEXMEDETOMIDINE ALONG WITH BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Rachana Gandhi

    2012-02-01

    Full Text Available Introduction: Supraclavicular brachial plexus block provides safe, effective, low cost anaesthesia with good postoperative analgesia. This study was conducted to compare the postoperative analgesic efficacy and safety of dexmedetomidine for brachial plexus blockade along with bupivacaine. Methodology: This prospective double blind study was conducted on 70 patients of age 18 to 60 years posted for various upper limb surgeries and randomly allocated into two equal groups of 35 each. Control group-C received injection bupivacaine (0.25% 38 milliliter plus 2 milliliter normal saline, dexmedetomidine group-D received injection bupivacaine (0.25% 38 milliliter plus dexmedetomidine 30 microgram (2 milliliter. Assessment of motor and sensory blockade, pulse, systolic blood pressure, respiration and side effects were noted every 5 minutes for first 30 minute and every 10 minute till end of surgery. Duration of analgesia and incidence of various complications following the procedure were observed. Results: It was observed that in control group onset of motor and sensory blockade was faster. Where as, dexmedetomidine group have better hemodynamic stability and greater postoperative analgesia. Only two cases of bradycardia and two cases of hypotension were noticed in dexmedetomidine group-D. [National J of Med Res 2012; 2(1.000: 67-69

  16. Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on postoperative pain, pulmonary, and endocrine-metabolic function after minilaparotomy cholecystectomy

    DEFF Research Database (Denmark)

    Dahl, J B; Hjortsø, N C; Stage, J G

    1994-01-01

    cholecystectomy improves pain relief in the immediate postoperative period, compared to intramuscular morphine. Pulmonary and endocrine-metabolic function is not changed to such degree after minicholecystectomy that epidural analgesia can be demonstrated to have beneficial effects.......BACKGROUND AND OBJECTIVES. The study investigates the effects of combined perioperative continuous epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine, compared with intermittent systemic morphine, ibuprofen, and incisional bupivacaine, on postoperative pain, respiratory...... function, and endocrine-metabolic alterations associated with minilaparotomy cholecystectomy. METHODS. Thirty-two patients scheduled for cholecystectomy, performed through a minilaparotomy, were randomized to receive general anesthesia with pre- and postoperative thoracic (T7-9) epidural analgesia...

  17. The Effects of Intrathecal Bupivacaine-Fentanyl and Bupivacaine-Morphine on Ephedrine Requirements and Health Status of Fetus in Elective Cesarean Section.

    OpenAIRE

    But, A.Kadir; Öztürk, Erdoğan; Gülhaş, Nurçin; Durmuş, Mahmut; Doğan, Zafer; Ersoy, M. Özcan

    2005-01-01

    Objectives: In this study, we aimed to compare the effects of intrathecal bupivacaine-fentanyl and bupivacainemorphine on ephedrine requirements and on health status of fetus. Methods: We enrolled 54 cases undergoing elective cesarean section in this study. Ringer's lactate was infused to all patients at a rate of 10-12 mL kg-1 preoperatively and 8-10 mL kg hr-1 during operation. Spinal anesthesia was achieved with 2 mL of bupivacaine %0.5 in Group I (n=18), with 1.5 mL of bupivacaine...

  18. A comparison of epidural anaesthesia with lignocaine, bupivacaine and a lignocaine-bupivacaine mixture in cats

    Directory of Open Access Journals (Sweden)

    F.M. Lawal

    2009-05-01

    Full Text Available A mixture of 2% lignocaine (LIG and 0.5% bupivacaine (BUP, at respective dose rates of 2 mg/kg and 0.5 mg/kg (LIG-BUP, was compared to LIG (4 mg/kg and BUP (1 mg/kg for lumbosacral epidural anaesthesia in 5 sedated cats. Each cat received all 3 treatment regimens at 1-week intervals. The cats were premedicated with an intramuscular injection of atropine sulphate (0.04 mg/kg and ketamine hydrochloride (10 mg/kg. Onset and duration of analgesia, and time to walking were determined. Associated changes in heart rate (HR, respiratory frequency (ƒR and rectal temperature (RT were recorded. Onset of analgesia with epidurally administered LIG-BUP (4.5 ± 0.7 min, LIG (3.9 ± 1.0 min and BUP (5.0 ± 1.0 min was similar. Duration of analgesia with LIG-BUP (49.4 ± 4.5 min was significantly (P < 0.05 longer than with LIG (40.2 ± 1.0 min but shorter than with BUP (79.4 ± 6.3 min. There were no significant differences in times to standing with LIG-BUP (26.3 ± 6.4 min, LIG (20.4 ± 4.7 min and BUP (22.6 ± 10.3 min. Minimal changes were observed in HR, ƒR and RT. In conclusion, duration of analgesia produced by LIG-BUP was shorter compared with BUP but longer compared with LIG. Neither LIG nor LIG-BUP has any advantage over epidural BUP in terms of onset of analgesia, time to standing and physiological responses. Therefore, lumbosacral epidural administration of BUP appears to be the best choice for a long surgical procedure lasting more than 1 hour when compared with either LIG or LIG-BUP.

  19. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    1996-01-01

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine 0.

  20. The addition of lidocaine to bupivacaine does not shorten the duration of spinal anesthesia

    DEFF Research Database (Denmark)

    Jacobsen, Jon; Husum, Bent; Staffeldt, Henrik

    2011-01-01

    The duration of spinal anesthesia with bupivacaine is often too long for day surgery. A recent study of patients presenting for transurethral surgery suggested that the addition of a small amount of lidocaine to intrathecal hyperbaric bupivacaine could shorten the duration of the sensory and motor...

  1. Postoperative analgesia with continuous epidural sufentanil and bupivacaine : A prospective study in 614 patients

    NARCIS (Netherlands)

    Broekema, AA; Gielen, MJM; Hennis, PJ

    To assess the efficacy and safety of postoperative analgesia with continuous epidural sufentanil and bupivacaine, we performed a prospective study in 614 patients undergoing major surgery. Before surgical incision, all patients received an initial dose of 50 mu g sufentanil in 6-10 mL bupivacaine

  2. Liposomal bupivacaine versus traditional periarticular injection for pain control after total knee arthroplasty.

    Science.gov (United States)

    Bagsby, Deren T; Ireland, Phillip H; Meneghini, R Michael

    2014-08-01

    The purpose of this study was to compare a novel liposomal bupivacaine to traditional peri-articular injection (PAI) in a multi-modal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared 85 consecutive patients undergoing TKA with a traditional PAI of ropivacaine, epinephrine and morphine to 65 patients with a liposomal bupivacaine PAI. After the initial 24h, inpatient self-reported pain scores were higher in the liposomal bupivacaine group compared to the traditional PAI group (P = 0.04) and a smaller percentage (16.9%) of patients in the liposomal bupivacaine group rated their pain as "mild" compared to the traditional group (47.6%). Liposomal bupivacaine PAI provided inferior pain control compared to the less expensive traditional PAI in a multi-modal pain control program in patients undergoing TKA.

  3. Bupivacaine drug-induced liver injury: a case series and brief review of the literature.

    Science.gov (United States)

    Chintamaneni, Preethi; Stevenson, Heather L; Malik, Shahid M

    2016-08-01

    Bupivacaine is an established and efficacious anesthetic that has become increasingly popular in postoperative pain management. However, there is limited literature regarding the potential for bupivacaine-induced delayed liver toxicity. Describe cholestasis as a potential adverse reaction of bupivacaine infusion into a surgical wound. Retrospective review of patients' medical records. We report the cases of 3 patients with new onset of cholestatic injury after receiving bupivacaine infusion for postoperative herniorrhaphy pain management. All patients had negative serologic workups for other causes of liver injury. All patients achieved eventual resolution of their liver injury. Bupivacaine-induced liver injury should be on the differential of individuals presenting with jaundice and cholestasis within a month of infusion via a surgically placed catheter of this commonly used anesthetic.

  4. Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy

    DEFF Research Database (Denmark)

    Rasmussen, Sten; Lorentzen, Jan S; Larsen, Allan S

    2002-01-01

    We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups...... receiving intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. All patients were instructed to resume normal activities immediately after...... the procedure. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. A combination of bupivacaine and morphine reduced pain, duration of immobilization and of convalescence. The addition of methylprednisolone further reduced pain, use...

  5. (Electron) microscopic observations on tissue integration of collagen-immobilized polyurethane

    NARCIS (Netherlands)

    van Wachem, PB; Hendricks, M; Blaauw, EH; Dijk, F; Verhoeven, MLPM; Cahalan, PT; van Luyn, MJA

    2002-01-01

    The foreign body reactions to collagen-immobilized polyurethane (PU-CI) films during subcutaneous implantation in rats were characterized. The underlying concept is that collagen-immobilization will improve the tissue integration. Since the method of collagen-immobilization involves the covalent cou

  6. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section

    Directory of Open Access Journals (Sweden)

    Srivastava Pratima

    2005-05-01

    Full Text Available Abstract Background Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. Methods Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. Results Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. Conclusion Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod on bupivacaine (a local anesthetic in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

  7. Thoracic epidural catheter for postoperative pain control following an ineffective transversus abdominis plane block using liposome bupivacaine

    Science.gov (United States)

    Terrien, Brian D; Espinoza, David; Stehman, Charles C; Rodriguez, Gabriel A; Connolly, Nicholas C

    2017-01-01

    A 24-year-old female with a history of ulcerative colitis underwent colectomy. The patient received an ineffective transversus abdominis plane (TAP) block with liposome bupivacaine (Exparel) intraoperatively and was started on a hydromorphone patient-controlled analgesia 5 hours after the TAP block, which did not relieve her pain. A continuous thoracic epidural (CTE) was then placed after blood levels of bupivacaine were drawn, and the patient immediately experienced significant pain relief. The combined use of liposome bupivacaine and bupivacaine CTE infusion in the postoperative management of this patient demonstrated no safety concerns, provided excellent analgesia and plasma concentrations of bupivacaine remained far below toxic levels. PMID:28144162

  8. A COMPARATIVE STUDY BETWEEN 0.5% HYPERBARIC BUPIVACAINE AND 0.5% HYPERBARIC BUPIVACAINE WITH 25 mcg FENTANYL IN SPINAL ANAESTHESIA IN OBSTETRIC PATIENTS UNDERGOING ELECTIVE LSCS

    Directory of Open Access Journals (Sweden)

    Abhinav

    2015-03-01

    Full Text Available Neuraxial administration of opioids along with local anesthetics improve the quality of intraoperative analgesia and also provides postoperative pain relief for longer duration . The present study was conducted to study and compare the effects of bupivacaine alone and its combination with fentanyl used intrathecallyin o bstetric patients posted for elective LSCS . 50 ASA grade I and II patients were selected and divided into 2 groups as Group ( I : Bupivacaine and Group ( II: Bupivacaine - Fentanyl group . Haemodynamic variables like systolic and diastolic blood pressure , heart rate were recorded every 3 minutes up to delivery of baby and then every 5 minutes until end of surgery . Sensory block and motor block along with side effects were recorded . Pain was evaluated using visual analogue scale and neonatal outcome assessed using APGAR scoring . The highest sensory level achieved in bupivacaine - fentanyl group was higher than in the group receiving plain bupivacaine . The time taken for sensory regression to T12 and duration of analgesia was longer in the Bupivacaine - Fentanyl g roup . We conclude the combination group prolongs the duration of sensory spinal block , increases the duration of analgesia without increasing the duration of motor block , does not cause any significant side effects and provides stable haemodynamic conditio ns without fetal or maternal compromise .

  9. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

    Directory of Open Access Journals (Sweden)

    Varaprasad

    2015-07-01

    Full Text Available BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of sedation were studied. RESULTS: There was no significant differ ence between the two groups in maternal satisfaction, analgesia and neonatal outcome .

  10. Effect of intraoperatory peritoneal bupivacaine irrigation on inmediate, 24 hour

    Directory of Open Access Journals (Sweden)

    Navarro Hernando

    2004-09-01

    Full Text Available Objective: To compare the response on inmediate, 24 hour abdominal pain and referred shoulder pain (omalgia, when an intraperitoneal irrigation of bupivacaine was used as opposed to saline irrigation, in a group of patients who has laparoscopy done in a medical center in Cali, between April and June of 2000. Material and methods: After previous authorization and consentment by all 100 patients, a placebo was applied to 50 patients and bupivacaine to the other 50 patients, without randomization. The drug came in unmarked bottles, some of which had the medication and some had only saline and nobody knew beforehand which one was given to the patient. Its effect on post surgical pain was evaluated throught the cromatic visual analog scale, which subjectively determines the intensity of the pain according to colors which range from white to dark red, with a numerical equivalent from 0 to 10, in the following manner: zero (0 no pain , 2 mild, 4 moderate, 6 strong, 8 sevre and 10 intolerable pain. The scale was measured in the postoperative room two hours after procedure. A telephonic follow up was done at 24 hours after surgery, applying the visual analog scale on abdominal and shoulder pain. The information was processed using Epi Info 2000. An univariante and bivariante analysis was done. A comparasion was established using the differences in averages with inmediate abdominal pain and omalgia, and at 24 hours according to the use or not bupivacaine. Results: The variable are described in a univariante manner in relation to the distribution of pain at 2 and 24 hours, as well as the shoulder pain, where the mean score of pain decreases from 3.8, to 2.1 to 1.1 respectively. The variables were also described in a bivariant way comparing the drug and its effect on the intensity of pain at 2 and 24 hours, and the omalgia, where no statistically significant difference was found between the drug, the saline and the scales of pain. The relationship between

  11. A Content Incontinent: Report of Liposomal Bupivacaine Induced Fecal Incontinence

    Directory of Open Access Journals (Sweden)

    Emanuel A. Shapera

    2016-01-01

    Full Text Available Proper surgical management of anal fistula demands sound clinical judgment and extraordinary care to prevent incontinence and adequate postoperative pain control and provide satisfactory resolution to optimize quality of life. Fecal incontinence can be a devastating complication of procedures performed for fistula in ano. We report a unique case in which temporary incontinence (for less than 4 days followed injection of liposomal bupivacaine for postoperative pain control after draining seton placement for fistula in ano. Patients and physicians should be aware as it may be mistaken for a more serious anatomical and permanent cause of fecal incontinence.

  12. A COMPARATIVE STUDY OF HEAMOD Y NAMIC PARAMETERS IN LSCS WITH INTRATHECAL FENTANYL - BUPIVACAINE COMBINATION AND BUPIVACAINE ALONE

    Directory of Open Access Journals (Sweden)

    Ramana Prasad

    2015-10-01

    Full Text Available BACKGROUND: Caesarean section is considered as a major abdominal surgery, which requires profound blockade of spinal segments. Spinal anaesthesia is the most elegant approach providing profound anaesthesia and excellent operative conditions. Hypotension, the most clinically significant effect of spinal anaesthesia can occur rapidly and have a significant impact on neonatal outcome. There has been interest in using analgesic additives to local anaesthetics to decrease the dose of local anaesthetics and reduce in incidence of hypotension without compromising intra - operative analgesia, enabling faster motor recovery and providing efficient post - operative analgesia. This study was conducted t o compare the incidence of hypotension between intrathecal fentanyl - bupivacaine combinations with bupivacaine alone in patients undergoing elective LSCS. INTRODUCTION: In Caesarean section, the surgery is major and profound blockade of many spinal segments is required. Strong visceral stimulation is present, sudden cardiovascular changes is compounded by posture and fetal wellbeing may be influenced by several physiologic variables and drugs. Spinal anaesthesia is perhaps the most efficient and elegant appr oach to this challenge. With a small needle and little amount of drug, profound anaesthesia and excellent operating conditions can be readily provided for this major intrabdominal surgery. Spinal hypotension, the most clinically significant aspect of spina l anaesthesia can occur rapidly and may have a significant impact on the neonatal outcome. Recently, there has been an interest in using analgesic additives to subarachnoid local anaesthetic dose so as to reduce the incidence and degree of hypotension but at the same time without compromising intraoperative analgesia and also to enable faster recovery and providing efficient post - operative analgesia. Opioids were the first clinically used selective spinal analgesics after the discovery of opioids

  13. Growth Inhibition by Bupivacaine Is Associated with Inactivation of Ribosomal Protein S6 Kinase 1

    Directory of Open Access Journals (Sweden)

    Mushtaq Ahmad Beigh

    2014-01-01

    Full Text Available Bupivacaine is an amide type long acting local anesthetic used for epidural anesthesia and nerve blockade in patients. Use of bupivacaine is associated with severe cytotoxicity and apoptosis along with inhibition of cell growth and proliferation. Although inhibition of Erk, Akt, and AMPK seemingly appears to mediate some of the bupivacaine effects, potential downstream targets that mediate its effect remain unknown. S6 kinase 1 is a common downstream effector of several growth regulatory pathways involved in cell growth and proliferation known to be affected by bupivacaine. We have accordingly attempted to relate the growth inhibitory effects of bupivacaine with the status of S6K1 activity and we present evidence that decrease in cell growth and proliferation by bupivacaine is mediated through inactivation of S6 kinase 1 in a concentration and time dependent manner. We also show that ectopic expression of constitutively active S6 kinase 1 imparts substantial protection from bupivacaine induced cytotoxicity. Inactivation of S6K1 though associated with loss of putative mTOR mediated phosphorylation did not correspond with loss of similar phosphorylations in 4EBP1 indicating that S6K1 inhibition was not mediated through inactivation of mTORC1 signaling pathway or its down regulation.

  14. Spinal blockades of class I antiarrythmic drugs with bupivacaine by isobolographic analysis in rats.

    Science.gov (United States)

    Chen, Yu-Wen; Chu, Chin-Chen; Chen, Yu-Chung; Leung, Yuk-Man; Wang, Jhi-Joung

    2012-10-18

    Flecainide, quinidine, and mexiletine have been shown to be sodium channel blockers and local anesthetics. The purpose of this study was to examine the interaction of the traditional local anesthetic bupivacaine with flecainide, quinidine, or mexiletine on spinal blockades. To obtain the 50% effective dose (ED(50)) of drugs, dose-dependent responses of spinal blockades of motor and sensory functions with intrathecal flecainide, quinidine, mexiletine, and bupivacaine in rats were constructed. Using a continuum of different fixed drug dose ratios, the interactions of bupivacaine with drugs (flecainide, quinidine, or mexiletine) were evaluated by an isobolographic analysis. Our resulting data showed that flecainide, quinidine, and mexiletine, as well as local anesthetic bupivacaine produced dose-dependent spinal blockades in motor function and nociception. Flecainide had the most potent spinal antinociceptive effect (P<0.01) among these three class I antiarrhythmic drugs. Co-administration of bupivacaine with flecainide, quinidine, or mexiletine displayed an additive effect on spinal blockades of motor function and nociception. We concluded that bupivacaine combined with flecainide, quinidine, or mexiletine exhibited an additive effect on spinal blockades of motor function and nociception. Using such a combination strategy to produce antinociception may potentially provide an improved therapeutic separation from myocardial toxicity occurred after spinal bupivacaine.

  15. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  16. COMPARATIVE STUDY OF INTRAVENOUS DEXMEDETOMIDINE PLUS INTRATHECAL BUPIVACAINE VS INTRATHECAL BUPIVACAINE ALONE FOR PROLONGATION OF SPINAL ANALGESIA

    Directory of Open Access Journals (Sweden)

    Rani

    2015-11-01

    Full Text Available : BACKGROUND: The prolongation of spinal anaesthesia by using clonidine through the oral, intravenous and spinal route has been known. The new alpha-2 agonist, dexmedetomidine has been proved to prolong the spinal anaesthesia through the intrathecal route. We hypothesized that dexmedetomidine when administered intravenously following spinal block also prolongs spinal analgesia. A placebo controlled randomized controlled trial study was done. METHODOLOGY: 50 Patients were randomly allocated into two equal groups group D and group C. Both group received spinal hyperbaric bupivacaine 15mg intrathecally. Patients in group D received intravenously a loading dose of 1mcg/kg dexmedetomidine over 10 min followed by C maintenance dose of 0.5mcg/kg/hr till the end of surgery. Patients in group C (The control group received normal saline. The regression times to reach S1 sensory level and bromage 0 motor scale, hemodynamic changes and the level of sedation were recorded. RESULTS: The duration of sensory block was longer in intravenous dexmedetomidine group compared with control group (264.32+15.3 min vs 164.2+13.12 min, p 0.001. The duration of motor block was longer in dexmedetomidine group than control group (198.8+16.9 min vs 135.8+12.38 min, p 0.001 CONCLUSION: Intravenous dexmedetomidine administration prolonged the sensory and motor blocks of bupivacaine spinal analgesia with good sedation effect and hemodynamic stability. The incidence of bradycardia is significantly high when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anaesthesia. Dexmedetomidine induced bradycardia and hypotension can be easily managed with atropine and mephentermine respectively. Dexmedetomidine provides excellent sedation and postoperative analgesia.

  17. Comparison of efficacy of intraarticular application of tenoxicam, bupivacaine and tenoxicam: bupivacaine combination in arthroscopic knee surgery.

    Science.gov (United States)

    Talu, Gül K; Ozyalçin, Süleyman; Koltka, Kemallettin; Ertürk, Engin; Akinci, Ozkan; Aşik, Mehmet; Pembeci, Kamil

    2002-11-01

    Arthroscopic knee surgery is one of the most common surgeries done in outpatient settings; however, postoperative pain is believed to be the major barrier for discharge and early rehabilitation. In this study we evaluated and compared the efficacy of intraarticular application of long-lasting non-steroidal analgesic drug tenoxicam, a long-lasting local anaesthetic bupivacaine and combination of the two on postoperative pain after arthroscopic knee surgery. With the approval of the local ethics committee and signed informed consent of the patients, 75 American Society of Anesthesiologists I-II patients aged between 18 and 65 years going under elective arthroscopic meniscectomy were included in this randomized, blind, prospective study. The patients were divided into three groups: group-T (GT) patients ( n=25) had intraarticular 20 mg of tenoxicam in 20 ml normal saline; group-B (GB) patients ( n=25) had 50 mg bupivacaine in 20 ml normal saline (0.25%); group-BT (GBT) patients ( n=25) had intraarticular 20 mg of tenoxicam and 50 mg bupivacaine (0.25%) in 20 ml normal saline after completion of the surgery and before deflation of the tourniquet. Postoperative analgesia was maintained by intravenous tramadol hydrochloride 50 mg/s at the first 4 h and paracetamol 500 mg and codeine 7.5 mg preparation (Pacofen) as needed (maximum six per day) during the study period. The numeric rating scale (NRS) values were at rest and at active-passive motion at 4, 12, 24 and 48 h, total analgesic consumption, at 4 h for tramadol and at the end of 48 h for oral medication; and patient satisfaction at the end of 48 h was evaluated and recorded. The demographic features of the patients, and tourniquet times, were found to be similar between the groups. Group BT had significantly lower NRS values than GB at 12 h at rest. Group BT was found to have significantly lower NRS values at 4 h compared with GT, and significantly lower NRS values at 12 h compared with GB. Group BT was found to

  18. Absorption of Bupivacaine after Administration of a Lozenge as Topical Treatment for Pain from Oral Mucositis.

    Science.gov (United States)

    Mogensen, Stine; Sverrisdóttir, Eva; Sveinsdóttir, Kolbrún; Treldal, Charlotte; Jensen, Kenneth; Jensen, Anders Bonde; Kristensen, Claus Andrup; Jacobsen, Jette; Kreilgaard, Mads; Petersen, Janne; Andersen, Ove

    2017-01-01

    The aim was to investigate systemic exposure after administration of a novel bupivacaine lozenge in healthy individuals with normal mucosa and in head and neck cancer (HNC) patients with oral mucositis. A lozenge containing 5, 10, 25 and 50 mg bupivacaine, respectively, was administered as single dose to 10 healthy individuals, and a lozenge containing 25 mg bupivacaine was administered as single dose to 10 HNC patients with oral mucositis and as multiple doses to five patients with HNC. Blood samples were collected for 6 hr from the healthy individuals and 3 hr from the patients with HNC, respectively, after administration. The plasma concentration-time profiles of bupivacaine were fitted to pharmacokinetic models using nonlinear mixed-effects modelling, evaluating demographics and health status as covariates. The population pharmacokinetics (PK) of bupivacaine lozenge was best described by a two-compartment distribution model with absorption transit compartments. All the observed plasma concentrations were well below the bupivacaine concentrations (2000-2250 ng/ml) which have caused toxic symptoms. The PK model suggested that relative bioavailability was two times higher in HNC patients with oral mucositis grade 1-2 and three times higher in HNC patients with oral mucositis grade 3-4 than in the healthy individuals. Simulations showed that the plasma concentrations would be below the toxic limit after repeated dosing every second hour with 25 mg bupivacaine for five days. The 25-mg bupivacaine lozenges were safe without systemic toxic levels of bupivacaine or risk of side effects. Based on PK simulations of repeated doses of 25 mg every two hours for 16 hr a day, the lozenges can be administered with minimum risk of exceeding the toxic limit.

  19. Liposomal bupivacaine: an innovative nonopioid local analgesic for the management of postsurgical pain.

    Science.gov (United States)

    Candiotti, Keith

    2012-09-01

    Local anesthetics are a cornerstone of multimodal pain control strategies in the surgical setting as they have a long history of use and an established safety profile. Although effective, their duration of action is relatively short, which usually leads to the use of other agents, such as opioids, for effective postsurgical pain control in most patients. A medical need exists to extend the duration of analgesia with local anesthetics to help reduce the reliance on opioids in the postsurgical setting. Liposomal bupivacaine uses a product delivery platform to release bupivacaine slowly over 96 hours after infiltration at the surgical site. Liposomal bupivacaine was compared with placebo in two pivotal, multicenter, randomized, double-blind, parallel-group trials in 189 adults undergoing soft-tissue surgery (hemorrhoidectomy) and 193 adults undergoing orthopedic surgery (bunionectomy). Among patients undergoing hemorrhoidectomy, liposomal bupivacaine significantly reduced cumulative pain scores for up to 72 hours (primary end point) as measured by the area under the curve of pain scores on the numeric rating scale (pliposomal bupivacaine significantly reduced total consumption of rescue opioids (p=0.0077) and cumulative pain scores as measured by the area under the curve of pain scores on the numeric rating scale (p=0.0005) during the first 24 postsurgical hours (primary end point) relative to placebo. Furthermore, liposomal bupivacaine also significantly delayed the time to first use of opioid rescue (pliposomal bupivacaine were nausea, vomiting, and constipation. No adverse effects on the QTc interval or cardiac safety signal have been detected in the clinical trial development program (823 patients) when liposomal bupivacaine was infiltrated into the surgical site. The beneficial effects of liposomal bupivacaine on postsurgical pain management and opioid use, significantly reducing both, are likely to translate into improved clinical and economic outcomes.

  20. Hexamethonium and midazolam terminate dysrhythmias and hypertension caused by intracerebroventricular bupivacaine in rabbits.

    Science.gov (United States)

    Bernards, C M; Artu, A A

    1991-01-01

    Previous studies have demonstrated that bupivacaine administered directly into the central nervous system (CNS) is capable of producing signs of bupivacaine cardiovascular toxicity. To investigate the mechanisms by which bupivacaine may act within the CNS to produce cardiovascular toxicity, we studied four groups of halothane-anesthetized rabbits in which infusion of intracerebroventricular (icv) bupivacaine or intravenous (iv) phenylephrine resulted in dysrhythmias and hypertension. In group 1 (n = 5), icv bupivacaine (500 +/- 79 micrograms [mean +/- SEM]) produced dysrhythmias lasting 73 +/- 13 min, whereas icv saline caused no dysrhythmias or hypertension. In group 2 (n = 9), icv bupivacaine-induced hypertension and dysrhythmias were abolished by icv midazolam in 4.4 +/- 0.6 min, and when dysrhythmias and hypertension recurred (22 +/- 0.9 min), hexamethonium (10 mg/kg iv) promptly terminated dysrhythmias and hypertension (14 +/- 1 s). In group 3 (n = 10), icv bupivacaine-induced dysrhythmias and hypertension were not affected by increasing the inspired halothane concentration from 0.8 to 1.6%. In group 4 (n = 6), iv phenylephrine-induced dysrhythmias and hypertension were not affected by icv midazolam. These results suggest that icv bupivacaine produces dysrhythmias and hypertension by increasing autonomic nervous system (ANS) outflow from the brain stem. The finding that peripheral autonomic blockade by hexamethonium rapidly terminated dysrhythmias and hypertension supports this mechanism. We speculate that icv bupivacaine produces an increase in autonomic outflow by blockade of the inhibitory gamma-aminobutyric acid (GABA) neurons that are known to be the principal tonic inhibitors of the ANS.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Systemic Safety of Liposomal Bupivacaine in Simultaneous Bilateral Total Knee Arthroplasty.

    Science.gov (United States)

    Springer, Bryan D; Mason, J Bohannon; Odum, Susan M

    2017-08-01

    Intraoperative periarticular injections (PAIs) with local anesthetic are an important component of multimodal pain control in total joint arthroplasty. Liposomal bupivacaine is an extended-release formulation of bupivacaine designed to provide extended pain relief, approved for use in a single surgical site. The systemic safety profile for use in simultaneous bilateral TKA (bTKA) with a full dose in each knee has not been evaluated. The purpose of this study was to determine the safety and pharmacokinetics of bilateral full-dose PAI liposomal bupivacaine in the blood collected in patients undergoing simultaneous bTKA. In this prospective study, patients had an identical PAI consisting of 20 cc of liposomal bupivacaine (266 mg), 30 cc of 0.25% bupivacaine (75 mg) with epinephrine, and 10 cc of normal saline injected into each knee during bTKA. Blood samples were collected at predefined intervals until patient discharge. No exogenous bupivacaine was administered. Pharmacokinetic evaluations were subsequently performed and compared to bupivacaine toxicity levels. Patients were monitored for adverse events related to anesthetic toxicity (cardiac and neurologic). Fifteen patients (mean age, 60.7 years; range, 57-64 years) were enrolled in the study. The mean peak level (Cmax) was 0.8 μg/mL (range, 0.4-1.2 μg/mL). All patients were well below the reported systemic cardiac and toxicity levels reported as 2-4 μg/mL. There were no reported cardiac and neurotoxic events in any patients. The use of full-dose PAI with liposomal bupivacaine placed into each knee during simultaneous bTKA is safe with systemic bupivacaine levels well below reported cardiac and neurotoxic levels. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. 不同pH与蛋白含量的胶原海绵植入缺损骨组织部位的疗效及安全性考察%The Curative Effect and Safety of Collagen Sponge with Different pH and Content of Protein Implanted into Orthopedic Bone Defect

    Institute of Scientific and Technical Information of China (English)

    佟刚; 雷静; 钟翠红; 蔡伟信; 林雪微

    2012-01-01

    This paper presents a 3mm fracture model of radial bone of rabbits using operation method. The bone defect was treated with collagen sponge with different pH and different content. After the operation, the body temperature, blood routine measurement, serum antibody, X-ray examination and histological observation in each group were examined to evaluate and study the curative effect and safety of collagen sponge. Collagen sponge had a good result of safety, but there was slightly change in blood routine, serum antibody, and histological observation, etc, with the pH changing and different content of collagen. The results showed that there was no obvious influence of safety to tissues after treatment of the collagen sponge at different pH implanted into bone defect. Collagen sponge at lower pH could promote the healing of bone defect partly, while the safety of collagen sponge with lower content was better.%手术构建家兔桡骨3 mm完全缺损的骨折模型,在骨缺损部位植入不同pH及蛋白含量的胶原海绵,各组动物于术后进行体温测量、血常规、血清抗体、X光片及组织病理检查,考察胶原海绵的疗效和安全性.结果发现胶原海绵具有良好的安全性,但在血常规、血清抗体水平、病理等方面,随着pH及胶原含量变化会呈现轻微的改变,表明不同pH胶原海绵对组织无明显的安全性影响,低pH条件在一定程度上可促进缺损组织愈合,但会影响血常规及血清抗体水平;而低含量组海绵的安全性更佳.

  3. THE EFFICACY OF CLONIDINE ADDED TO BUPIVACAINE AS COMPARED WITH BUPIVACAINE ALONE USED IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK FOR UPPER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Suchismita

    2014-09-01

    Full Text Available : INTRODUCTION: Clonidine when added to local anesthetic solutions improved peripheral nerve blocks by reducing the onset time, improving the efficacy of the block during surgery and extending postoperative analgesia. MATERIALS AND METHODS: Sixty patients aged 18 to 60 years, scheduled for elective orthopedic operations in the upper limb, of ASA Grade I or II were included in the study. We conducted the study with 2 groups consisting of 30 patients each to compare the effects of Clonidine added to Bupivacaine with Bupivacaine alone in supraclavicular brachial plexus block. First group received 40 ml of Bupivacaine 0.25% plus 0.15mg (1ml of Clonidine, second group had 40 ml of Bupivacaine 0.25% plus 1 ml 0.9% Saline respectively. The onset as well as duration of sensory and motor block along with monitoring of heart rate, NIBP, oxygen saturation were recorded. The level of sedation and side effects were also noted. RESULTS: In this study the addition of Clonidine to Bupivacaine resulted in faster onset (study group 15.2±1.44, control group 20.4±1.12, p˂0.001 and longer duration of sensory block (study group 544±31.2, control group 302±34.4, p=0.0363 as well as analgesia (study group 561.2±30.96, control group 324.4±34.08, p=0.0001 without any adverse hemodynamic changes.

  4. Breast Implants

    Science.gov (United States)

    ... Medical Procedures Implants and Prosthetics Breast Implants Breast Implants Share Tweet Linkedin Pin it More sharing options Linkedin Pin it Email Print Breast implants are medical devices that are implanted under the ...

  5. Biomedical applications of collagens.

    Science.gov (United States)

    Ramshaw, John A M

    2016-05-01

    Collagen-based biomedical materials have developed into important, clinically effective materials used in a range of devices that have gained wide acceptance. These devices come with collagen in various formats, including those based on stabilized natural tissues, those that are based on extracted and purified collagens, and designed composite, biosynthetic materials. Further knowledge on the structure and function of collagens has led to on-going developments and improvements. Among these developments has been the production of recombinant collagen materials that are well defined and are disease free. Most recently, a group of bacterial, non-animal collagens has emerged that may provide an excellent, novel source of collagen for use in biomaterials and other applications. These newer collagens are discussed in detail. They can be modified to direct their function, and they can be fabricated into various formats, including films and sponges, while solutions can also be adapted for use in surface coating technologies.

  6. Collagen vascular disease

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/001223.htm Collagen vascular disease To use the sharing features on this ... previously said to have "connective tissue" or "collagen vascular" disease. We now have names for many specific ...

  7. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy

    Directory of Open Access Journals (Sweden)

    Hala Saad Abdel-Ghaffar

    2017-01-01

    Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

  8. Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2012-02-01

    The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. Preoperative, day 1 and 6 weeks pain score, 24-h postoperative opiate requirements and duration of inpatient stay were recorded. Data was analysed using Mann-Whitney test for statistical significance. 100 patients were recruited. A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.

  9. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  10. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G;

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were...... randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first week and at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence...

  11. The primacy of octacalcium phosphate collagen composites in bone regeneration.

    Science.gov (United States)

    Kamakura, Shinji; Sasaki, Kazuo; Homma, Takahiro; Honda, Yoshitomo; Anada, Takahisa; Echigo, Seishi; Suzuki, Osamu

    2007-12-01

    We have engineered a scaffold constructed of synthetic octacalcium phosphate (OCP) and porcine collagen sponge (OCP/Col), and reported that OCP/Col drastically enhanced bone regeneration. In this study, we investigated whether OCP/Col would enhance bone regeneration more than beta-tricalcium phosphate (beta-TCP) collagen composite (beta-TCP/Col) or hydroxyapatite (HA) collagen composite (HA/Col). Discs of OCP/Col, beta-TCP/Col, or HA/Col were implanted into critical-sized defects in rat crania and fixed at 4 or 12 weeks after implantation. The newly formed bone and the remaining granules of implants in the defect were determined by histomorphometrical analysis, and radiographic and histological examinations were performed. Statistical analysis showed that the newly formed bone by the implantation of OCP/Col was significantly more than that of beta-TCP/Col or HA/Col. In contrast, the remaining granules in OCP/Col were significantly lower than those in beta-TCP/Col or HA/Col. Bone regeneration by OCP/Col was based on secured calcified collagen and bone nucleation by OCP, whereas bone regeneration by beta-TCP/Col or HA/Col was initiated by poorly calcified collagen and osteoconductivity by beta-TCP or HA. This study showed that the implantation of OCP/Col in a rat cranial defect enhanced more bone regeneration than beta-TCP/Col and HA/Col.

  12. Differential mortality of male spectacled eiders (Somateria fischeri) and king eiders (Somateria spectabilis) subsequent to anesthesia with propofol, bupivacaine, and ketoprofen

    Science.gov (United States)

    Mulcahy, Daniel M.; Tuomi, Pamela A.; Larsen, R.S.

    2003-01-01

    Twenty free-ranging spectacled eiders (Somateria fischeri; 10 male, 10 female), 11 free-ranging king eiders (Somateria spectabilis; 6 male, 5 female), and 20 female common eiders (Somateria mollissima) were anesthetized with propofol, bupivacaine, and ketoprofen for the surgical implantation of satellite transmitters. Propofol was given to induce and maintain anesthesia (mean total dose, 26.2-45.6 mg/kg IV), bupivacaine (2-10 mg/kg SC) was infused into the incision site for local analgesia, and ketoprofen (2-5 mg/kg IM) was given at the time of surgery for postoperative analgesia. Four of 10 male spectacled eiders and 5 of 6 male king eiders died within 1-4 days after surgery. None of the female spectacled or common eiders and only 1 of the 5 female king eiders died during the same postoperative period. Histopathologic findings in 2 dead male king eiders were severe renal tubular necrosis, acute rhabdomyolysis, and mild visceral gout. Necropsy findings in 3 other dead male king eiders were consistent with visceral gout. We suspect that the perioperative use of ketoprofen caused lethal renal damage in the male eiders. Male eiders may be more susceptible to renal damage than females because of behavioral differences during their short stay on land in mating season. The combination of propofol, bupivacaine, and ketoprofen should not be used to anesthetize free-ranging male eiders, and nonsteroidal anti-inflammatory drugs should not be used perioperatively in any bird that may be predisposed to renal insufficiency.

  13. [Prolongation of Bupivacaine spinal anaesthesia by oral and intramuscular Clonidine].

    Science.gov (United States)

    Dziubdziela, Włodzimierz; Jałowiecki, Przemysław; Kawecki, Piotr

    2003-01-01

    The effect of oral and intramuscular clonidine premedication on the duration of sensory and motor blockade and postoperative analgesia during bupivacaine spinal anaesthesia was studied in 102 ASA physical status I-II patients scheduled for lower limbs orthopaedic surgery. In all cases one hour before anaesthesia midazolam (0.1-0.15 mg/kg) was applied orally and isotonic saline solution (10 ml/kg) was infused intravenously. The patients were randomly allocated into one of the following groups: oral (A) or intramuscular (B) clonidine premedication (0.15 mg) (n = 33) and oral or intramuscular premedication by placebo (C) (n = 36). All patients received 10-20 mg of 0.5% hyperbaric bupivacaine intrathecally. Sensory blockade (SB) was evaluated by pinprick and motor blockade (MB) according to Bromage's scale. The following parameters were measured: duration of motor and sensory block, requirement for postoperative analgesia (buprenorfine); systolic, diastolic and mean blood pressures; heart rate; oxyhemoglobin saturation (SpO2) and adverse events. As far as sex, body weight, age, height, ASA grade, dose of midazolam and bupivacaine, the onset of sensory and motor blockade, level of sensory analgesia, type of surgery and its average duration between groups were concerned, no differences were observed (p > 0.05). Both oral and intramuscular premedication with clonidine increased significantly the duration of motor (A--185.9 +/- 59.3; B--190.9 +/- 66.3 min) and sensory (A--216.2 +/- 69.4; B--254.2 +/- 76.8 min) blockade in comparison with placebo (MB--141.9 +/- 56.6; SB--156.7 +/- 62.9 min) (p premedication with clonidine intensified the sedative effect of midazolam (p clonidine (A--0.6 +/- 0.2; B--0.5 +/- 0.2 mg) nearly twice as small as than in a control group (1.1 +/- 0.2 mg) (p premedication with 0.15 mg of oral and intramuscular clonidine. The application of clonidine reduces the early postoperative analgesic requirements. The side effects are more pronounced with the

  14. Investigating the Effects of Adding Fentanyl to Bupivacaine in Spinal Anesthesia of Opium-addicted Patients

    Directory of Open Access Journals (Sweden)

    H Satari

    2014-10-01

    Full Text Available Introduction: Spinal anesthesia in opium-addicted patients can be associated with many complications. Hence, this study aimed to investigate sensory and motor block characteristics, duration of postoperative analgesia, hemodynamic and side effects by adding Fentanyl to bupivacaine in spinal Anesthesia of opium-addicted patients. Methods: In a double-blind randomized clinical trial, 60 American society of Anesthesiology (ASA class I and II opium-addicted patients under spinal anesthesia in lower abdominal and lower limb operations were randomly classified into two groups of spinal anesthesia with bupivacaine and bupivacaine-fentanyl. Clinical symptoms, side effects, the duration of sensory and motor block, initiation of analgesia requirement and sensory block were assessed. Results: The study results indicated no significant difference between bupivacaine and bupivacaine-fentanyl groups in regard with demographic, side effects, blood pressure and heart rate, though a significant difference was observed in respiratory rate 5min, 10min, 45min, 75min and 90 min after block. Duration of sensory (100.33 to 138.83 and motor block (93.43 to 107.66 and , initiation of analgesia requirement (165.33 to 187.76 was significantly longer in bupivacaine-fentanyl, though initiation of sensory block (8.83 to 4.93 was significantly longer in bupivacaine. Conclusion: Addition of fentanyl to bupivacaine in spinal anesthesia increases the duration of sensory and motor block and initiation of analgesia requirement in opium-addicted patients and also decreases initiation of sensory block in these patients.

  15. In vivo release of bupivacaine from subcutaneously administered oily solution. Comparison with in vitro release

    DEFF Research Database (Denmark)

    Larsen, Dorrit Bjerg; Joergensen, Stig; Olsen, Niels Vidiendal;

    2002-01-01

    A non-randomized cross-over study was performed with bupivacaine HCl (5 mg x ml(-1)) aqueous solution and bupivacaine free base (4.44 mg x ml(-1)) in Viscoleo/castor oil 2:1 (v/v) administered s.c. to male Wistar rats. Plasma levels were analyzed by LC-MS. Plasma profiles obtained after administr....... This led to establishment of an in vitro/in vivo correlation for this particular formulation....

  16. Impact of volume expansion on the efficacy and pharmacokinetics of liposome bupivacaine

    Directory of Open Access Journals (Sweden)

    Hadzic A

    2015-12-01

    Full Text Available Admir Hadzic,1,2 John A Abikhaled,3 William J Harmon4 1Department of Anesthesiology, The New York School of Regional Anesthesia (NYSORA, New York, NY, USA; 2Department of Anesthesiology, Ziekenhouse Oost Limburgh, Genk, Belgium; 3Austin Surgeons, Austin, TX, 4Urology San Antonio, San Antonio, TX, USA Abstract: Liposome bupivacaine is a prolonged-release liposomal formulation of bupivacaine indicated for single-dose infiltration into the surgical site to produce postsurgical analgesia of longer duration than traditional local anesthetics. This review summarizes the available data on how volume expansion may impact the analgesic efficacy of liposome bupivacaine. The Phase II and III clinical studies that involved surgical site administration of liposome bupivacaine at various concentrations in different surgical settings revealed no apparent concentration–efficacy relationship. A single-center, prospective study comparing the efficacy of transversus abdominis plane infiltration with liposome bupivacaine administered in a lower (266 mg/40 mL vs a higher (266 mg/20 mL dose concentration in subjects undergoing robotic-assisted laparoscopic prostatectomy also reported similar postsurgical pain intensity scores and opioid usage in both treatment groups. The pharmacokinetic profile of liposome bupivacaine following subcutaneous injections in rats was unaltered by differences in drug concentration, dose, or injection volume within the ranges tested. Volume expansion of liposome bupivacaine to a total volume of 300 mL or less does not appear to impact its clinical efficacy or pharmacokinetic profile, thus allowing flexibility to administer the formulation across a wide range of diluent volumes. Keywords: pain, analgesia, liposome bupivacaine, dose, concentration, dilution 

  17. Plasma concentrations and pharmacokinetics of bupivacaine with and without adrenaline following caudal anaesthesia in infants

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Morton, N S; Cullen, P M

    2001-01-01

    The aim of this study was to determine whether the use of adrenaline 1/400000 added to 0.25% bupivacaine significantly delays the systemic absorption of the drug from the caudal epidural space in young infants.......The aim of this study was to determine whether the use of adrenaline 1/400000 added to 0.25% bupivacaine significantly delays the systemic absorption of the drug from the caudal epidural space in young infants....

  18. Bupivacaine in microcapsules prolongs analgesia after subcutaneous infiltration in humans: a dose-finding study

    DEFF Research Database (Denmark)

    Pedersen, Juri L; Lillesø, Jesper; Hammer, Niels A;

    2004-01-01

    In this study, we examined the onset and duration of local analgesic effects of bupivacaine incorporated into biodegradable microcapsules (extended-duration local anesthetic; EDLA) administered as subcutaneous infiltrations in different doses in humans. In 18 volunteers, the skin on the medial calf...... concentrations were evaluated. No serious side effects were observed for up to 6 mo after administration. In conclusion, bupivacaine incorporated in microcapsules provided analgesia for 96 h after subcutaneous infiltration....

  19. Population pharmacokinetics of bupivacaine in combined lumbar and sciatic nerve block

    Directory of Open Access Journals (Sweden)

    Hanene Eljebari

    2014-01-01

    Full Text Available Objectives: The primary aim of this study was to establish the population pharmacokinetic (PPK model of bupivacaine after combined lumbar plexus and sciatic nerve blocks and secondary aim is to assess the effect of patient′s characteristics including age, body weight and sex on pharmacokinetic parameters. Materials and Methods: A total of 31 patients scheduled for elective lower extremity surgery with combined lumbar and sciatic nerve block using plain bupivacaine 0.5% were included. The total bupivacaine plasma concentrations were measured before injection and after two blocks placement and at selected time points. Monitoring of bupivacaine was made by high performance liquid chromatography (HPLC with ultraviolet detection. Non-linear mixed effects modeling was used to analyze the PPK of bupivacaine. Results: One compartment model with first order absorption, two input compartments and a central elimination was selected. The Shapiro-Wilks test of normality for normalized prediction distribution errors for this model (P = 0.156 showed this as a valid model. The selected model predicts a population clearance of 930 ml/min (residual standard error [RSE] = 15.48%, IC 95% = 930 ± 282.24 with inter individual variability of 75.29%. The central volume of distribution was 134 l (RSE = 12.76%, IC = 134 ± 33.51 L with inter individual variability of 63.40%. The absorption of bupivacaine in two sites Ka1 and Ka2 were 0.00462/min for the lumbar site and 0.292/min for the sciatic site. Age, body weight and sex have no effect on the bupivacaine pharmacokinetics in this studied population. Conclusion: The developed model helps us to assess the systemic absorption of bupivacaine at two injections sites.

  20. Collagen biomineralization In Vivo by sustained release of inorganic phosphate ions

    NARCIS (Netherlands)

    Habibovic, Pamela; Bassett, David C.; Doillon, Charles J.; Gerard, Catherine; McKee, Marc D.; Barralet, Jake E.

    2010-01-01

    A new strategy for mineralized tissue formation in vivo is presented based on localized sustained delivery of inorganic orthophosphate (Pi) sufficient to supersaturate tissue surrounding an implant and induce mineralization of collagen. After 15 days implantation mineral formation around the implant

  1. COMPARATIVE STUDY OF 0.5% BUPIVACAINE AND 0.5% BUPIVACAINE WITH CLONIDINE (30μg FOR SPINAL ANAESTHESIA

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    Shilpashri

    2015-09-01

    Full Text Available In the present day practice of Anesthesiology, bupivacaine is the most commonly used drug for spinal anesthesia. To improve upon the quality of analgesia and prolong the duration of its action, many adjuvants have been tried. Intrathecal clonidine an α2 adrenceptor agonist has potent central antinoceptive properties with analgesic effect at spinal level mediated by postsynaptically situated adrenoreceptor in dorsal horn of spinal cord. Lo w doses of clonidine have shown effectiveness in intensifying spinal anesthesia. Hence this study was done in our institute to evaluate the efficacy of spinal anesthesia with clonidine added to hyperbaric bupivacaine in elective lower limb, lower abdominal, gynaecological and urological surgeries under spinal anaesthesia. This prospective, single center parallel group, double blind study conducted over a span of 1 year with 100 patients, was effective in proving that Clonidine potentiates bupivacaine spinal anesthesia by increasing the duration and improving the quality of analgesia without producing significant hemodynamic side effects and with mild sedation.

  2. Bupivacaine induces apoptosis through caspase-dependent and -independent pathways in canine mammary tumor cells.

    Science.gov (United States)

    Chiu, Yi-Shu; Cheng, Yeong-Hsiang; Lin, Sui-Wen; Chang, Te-Sheng; Liou, Chian-Jiun; Lai, Yu-Shen

    2015-06-01

    Local anesthetics have been reported to induce apoptosis in various cell lines. In this study, we showed that bupivacaine also induced apoptosis in DTK-SME cells, a vimentin(+)/AE1(+)/CK7(+)/HSP27(+), tumorigenic, immortalized, canine mammary tumor cell line. Bupivacaine induced apoptosis in DTK-SME cells in a time- and concentration-dependent manner. Apoptosis-associated morphological changes, including cell shrinkage and rounding, chromatin condensation, and formation of apoptotic bodies, were observed in the bupivacaine-treated DTK-SME cells. Apoptosis was further confirmed with annexin V staining, TUNEL staining, and DNA laddering assays. At the molecular level, the activation of caspases-3, -8, and -9 corresponded well to the degree of DNA fragmentation triggered by bupivacaine. We also demonstrated that the pan-caspase inhibitor, z-VAD-fmk, only partially inhibited the apoptosis induced by bupivacaine. Moreover, treated cells increased expression of endonuclease G, a death effector that acts independently of caspases. Our data suggested that bupivacaine-induced apoptosis occurs through both caspase-dependent and caspase-independent apoptotic pathways.

  3. Liposomal Bupivacaine vs Interscalene Nerve Block for Pain Control After Shoulder Arthroplasty: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Hannan, Casey V; Albrecht, Matthew J; Petersen, Steve A; Srikumaran, Uma

    The aim of this study was to compare liposomal bupivacaine and interscalene nerve block (ISNB) for analgesia after shoulder arthroplasty. We compared 37 patients who received liposomal bupivacaine vs 21 who received ISNB after shoulder arthroplasty by length of hospital stay (LOS), opioid consumption, and postoperative pain. Pain was the same in both groups for time intervals of 1 hour and 8 to 14 hours postoperatively. Compared with ISNB patients, liposomal bupivacaine patients reported less pain at 18 to 24 hours (P = .001) and 27 to 36 hours (P = .029) and had lower opioid consumption on postoperative days 2 (P = .001) and 3 (P = .002). Mean LOS for liposomal bupivacaine patients was 46 ± 20 hours vs 57 ± 14 hours for ISNB patients (P = .012). Sixteen of 37 liposomal bupivacaine patients vs 2 of 21 ISNB patients were discharged on the first postoperative day (P = .010). Liposomal bupivacaine was associated with less pain, less opioid consumption, and shorter hospital stays after shoulder arthroplasty compared with ISNB.

  4. [Clinical research of hyperbaric, isobaric, and hypobaric solutions of bupivacaine in continuous spinal anesthesia].

    Science.gov (United States)

    Yang, Hong-wei; Bai, Nian-yue; Guo, Qu-lian

    2005-02-01

    To compare the anesthesia properities of hyperbaric bupivacaine with those of isobaric and hypobaric solutions when administered in the supine position undergoing hip surgery or lower limb surgery using continuous spinal anesthesia. Sixty patients( ASA I approximately III ) scheduled for hip or lower limb surgery were randomly divided into 3 groups with 20 patients in each group: Group A: 0. 375% hyperbaric bupivacaine solutions; Group B :0.375% isobaric bupivacaine solutions; and Group C: 0. 375% hypobaric bupivacaine solutions. The following variables were measured every 2 minutes during the first 30 minutes after the intrathecal injection : the onset time of sensation block, the highest plane of analgesia, the time to reach complete motor blockade, and the plane of analgesia and the extent of lower extremities' movement (modified bromage score, BMS) at different time after the administration. Meanwhile the changes of hemodynamics were recorded. There was no statistical difference among the basic conditions ( P > 0.05). The onset time of sensation block, and the time to reach complete motor blockade, and the time receiving the highest sharp pain sensory block in Group A were significantly shorter than those in Group B and Group C ( P anesthesic conditions with moderate hemodynamic changes and satisfying analgesia effects. Under similar conditions, 0. 375% hyperbaric bupivacaine produces major hemodynamic consequences with high cephalad spread and 0. 375% hypobaric bupivacaine has a too long onset time.

  5. Tissue reactions to collagen scaffolds in the oral mucosa and skin of rats: environmental and mechanical factors.

    NARCIS (Netherlands)

    Jansen, R.G.; Kuppevelt, A.H.M.S.M. van; Daamen, W.F.; Kuijpers-Jagtman, A.M.; Hoff, J.W. Von den

    2008-01-01

    OBJECTIVE: To compare the tissue reactions to implanted collagen scaffolds in the palate and the skin of rats. DESIGN: Crosslinked collagen scaffolds were implanted submucoperiosteally in the palate, and subcutaneously on the skull and on the back of 25 rats and evaluated after up to 16 weeks. On H&

  6. Spatio-temporal modification of collagen scaffolds mediated by triple helical propensity.

    Science.gov (United States)

    Wang, Allen Y; Foss, Catherine A; Leong, Shirley; Mo, Xiao; Pomper, Martin G; Yu, Seungju M

    2008-07-01

    Functionalized collagen that incorporates exogenous compounds may offer new and improved biomaterials applications, especially in drug-delivery, multifunctional implants, and tissue engineering. To that end, we developed a specific and reversible collagen modification technique utilizing associative chain interactions between synthetic collagen mimetic peptide (CMP) [(ProHypGly) chi; Hyp = hydroxyproline] and type I collagen. Here we show temperature-dependent collagen binding and subsequent release of a series of CMPs with varying chain lengths indicating a triple helical propensity driven binding mechanism. The binding took place when melted, single-strand CMPs were allowed to fold while in contact with reconstituted type I collagens. The binding affinity is highly specific to collagen as labeled CMP bound to nanometer scale periodic positions on type I collagen fibers and could be used to selectively image collagens in ex vivo human liver tissue. When heated to physiological temperature, bound CMPs discharged from the collagen at a sustained rate that correlated with CMP's triple helical propensity, suggesting that sustainability is mediated by dynamic collagen-CMP interactions. We also report on the spatially defined modification of collagen film with linear and multi-arm poly(ethylene glycol)-CMP conjugates; at 37 degrees C, these PEG-CMP conjugates exhibited temporary cell repelling activity lasting up to 9 days. These results demonstrate new opportunities for targeting pathologic collagens for diagnostic or therapeutic applications and for fabricating multifunctional collagen coatings and scaffolds that can temporally and spatially control the behavior of cells associated with the collagen matrices.

  7. Analgesic Efficacy of Transverse Abdominal Plane Block after Elective Cesarean Delivery – Bupivacaine with Fentanyl versus Bupivacaine Alone: A Randomized, Double-blind Controlled Clinical Trial

    Science.gov (United States)

    John, Roshan; Ranjan, R. V.; Ramachandran, T. R.; George, Sagiev Koshy

    2017-01-01

    Background: The analgesic benefit of transversus abdominis plane (TAP) blocks for cesarean delivery remains controversial. In our study, we compared the analgesic efficacy of TAP block using local anesthetic bupivacaine and adjunct fentanyl with bupivacaine alone in patients undergoing elective cesarean section. Methods: Our study was a randomized, double-blind, controlled clinical trial where sixty patients undergoing elective cesarean delivery under subarachanoid block (2 ml of 0.5% bupivacaine) were randomized into two groups, A and B. At the end of the surgical procedure, bilateral TAP block was performed guided by the ultrasound. Group A received 38 ml of 0.25% bupivacaine and 2 ml of 50 μg of fentanyl, whereas Group B received 38 ml of 0.25% bupivacaine + 2 ml of normal saline. The total volume was divided equally and administered bilaterally. Each patient was assessed for 24 h after TAP block, for time to rescue analgesia, pain using visual analog scale (VAS) score at rest and on movement, hemodynamic parameters (heart rate and blood pressure), nausea, vomiting, and sedation. Diclofenac 75 mg was given as rescue analgesia when the patient complained of pain or when VAS score >4. Results: Prolonged postoperative analgesia was noticed with both the groups, with a mean time to rescue analgesia of approximately 6.5 h. There was no significant difference in time to rescue analgesia (6.49 ± 0.477 vs. 6.5 ± 0.480) when both the groups were compared among themselves. The pain scores among the two groups when compared did not show any added benefit. Incidence of nausea, vomiting, and sedation when compared between both the groups showed no difference. Conclusion: The TAP block as a part of a multimodal analgesic regimen definitely has a role in providing superior analgesia in the postoperative period. However, adjunct fentanyl to local anesthetic bupivacaine was found to have no added advantage when quality and duration of analgesia was compared.

  8. EFFICACY OF CLONIDINE AS AN ADJUVANT TO BUPIVACAINE FOR CAUDAL BLOCK IN CHILDREN UNDERGOING INFRA - UMBILICAL SURGERY

    Directory of Open Access Journals (Sweden)

    Dilip Kumar

    2015-10-01

    Full Text Available Caudal epidural analgesia with bupivacaine is common in paediatric anaesthesia for providing intra and postoperative analgesia. But duration of analgesia even with bupivacaine; long acting anaesthetic is short only 4-6hrs. Hence, several adjuvants have been tried to prolong the duration of action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesic effect provided by caudal bupivacaine in children undergoing infra-umbilical surgery. Forty children, aged one to seven years, American Society of Anaesthesiologists (ASA Grade I/II, undergoing infra-umbilical surgery, were included in prospective randomized double blind study to one of two groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the Objective Pain Scale (OPS. The mean duration of analgesia was significantly longer in Group B (10.2 Hrs. than in Group A (4.2 1Hrs; P0.05. The requirement of rescue medicine was lesser in Group B. Clonidine as an adjunct to bupivacaine prolongs the post-operative pain relief in children and is safe compared to bupivacaine alone in paediatric infra umbilical surgeries.

  9. High-performance liquid chromatography using UV detection for the simultaneous quantification of ropivacaine and bupivacaine in human plasma.

    Science.gov (United States)

    Gaudreault, François; Drolet, Pierre; Varin, France

    2009-12-01

    A specific high-performance liquid chromatography assay coupled with UV detection has been developed and validated for the simultaneous determination of ropivacaine and bupivacaine in human plasma. A liquid-liquid back extraction procedure was used to increase specificity, and very good and consistent recoveries were obtained: 93%-95% for ropivacaine and 90%-96% for bupivacaine. The lowest limit of quantification was 4 and 8 ng/mL for ropivacaine and bupivacaine, respectively. The method was sensitive, reproducible (coefficient of variation bupivacaine in a perioperative context.

  10. Endocytic collagen degradation

    DEFF Research Database (Denmark)

    Madsen, Daniel H.; Jürgensen, Henrik J.; Ingvarsen, Signe;

    2012-01-01

    it crucially important to understand both the collagen synthesis and turnover mechanisms in this condition. Here we show that the endocytic collagen receptor, uPARAP/Endo180, is a major determinant in governing the balance between collagen deposition and degradation. Cirrhotic human livers displayed a marked......Fibrosis of the liver and its end-stage, cirrhosis, represent major health problems worldwide. In these fibrotic conditions, activated fibroblasts and hepatic stellate cells display a net deposition of collagen. This collagen deposition is a major factor leading to liver dysfunction, thus making...... up-regulation of uPARAP/Endo180 in activated fibroblasts and hepatic stellate cells located close to the collagen deposits. In a hepatic stellate cell line, uPARAP/Endo180 was shown to be active in, and required for, the uptake and intracellular degradation of collagen. To evaluate the functional...

  11. Complications of collagenous colitis

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman

    2008-01-01

    Microscopic forms of colitis have been described, including collagenous colitis. This disorder generally has an apparently benign clinical course. However, a number of gastric and intestinal complications, possibly coincidental, may develop with collagenous colitis. Distinctive inflammatory disorders of the gastric mucosa have been described, including lymphocytic gastritis and collagenous gastritis. Celiac disease and collagenous sprue (or collagenous enteritis) may occur. Colonic ulceration has been associated with use of nonsteroidal anti-inflammatory drugs, while other forms of inflammatory bowel disease, including ulcerative colitis and Crohn's disease, may evolve from collagenous colitis. Submucosal "dissection", colonic fractures or mucosal tears and perforation from air insufflation during colonoscopy may occur and has been hypothesized to be due to compromise of the colonic wall from submucosal collagen deposition. Similar changes may result from increased intraluminal pressure during barium enema contrast studies. Finally, malignant disorders have also been reported, including carcinoma and lymphoproliferative disease.

  12. Computed tomography-guided bupivacaine and corticosteroid injection for the treatment of symptomatic calcification in the great toe tendon

    Directory of Open Access Journals (Sweden)

    Karatoprak O

    2014-04-01

    Full Text Available Omer Karatoprak,1 Sinan Karaca,2 Mehmet Nuri Erdem,3 Ozgur Karaman,2 Azmi Hamzaoglu41Department of Orthopedic Surgery, Kadikoy Florence Nightingale Hospital, Istanbul, Turkey; 2Department of Orthopedic Surgery, Fatih Sultan Mehmet Training and Research Hospital Atasehir, Istanbul, Turkey; 3Department of Orthopedics and Traumatology, Kolan International Hospital Sisli, Istanbul, Turkey; 4Department of Orthopedic Surgery, Istanbul Florence Nightingale Hospital, Istanbul TurkeyBackground: Calcification in the great toe tendon is a rare disorder that is characterized by the deposition of calcium on degenerative collagen fibrils.Case presentations: In this report, we present two cases of calcific tendonitis: one in the adductor hallucis and the other in the flexor hallucis longus tendon. We preferred computed tomography-guided steroid injection in our cases because of pain unresponsive to conservative treatment. Patients were free of symptoms at the follow-up visit, 4 weeks after injection.Conclusion: Calcification of the hallux tendons is a rare disorder. Treatment of tendonitis consists of nonsteroidal anti-inflammatory drugs. Local anesthetic and steroid injection may be considered in cases unresponsive to conservative treatment. Because of the anatomic location of tendons, injection could be difficult. Computed tomography guidance may improve the success rate of injections.Keywords: bupivacaine, calcification, great toe tendons, corticosteroid injection

  13. Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    H.A. El Gendy

    2014-07-01

    Conclusion: Adding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.

  14. Use of liposomal bupivacaine in the postoperative management of posterior spinal decompression.

    Science.gov (United States)

    Grieff, Anthony N; Ghobrial, George M; Jallo, Jack

    2016-07-01

    OBJECTIVE The aim in this paper was to evaluate the efficacy of long-acting liposomal bupivacaine in comparison with bupivacaine hydrochloride for lowering postoperative analgesic usage in the management of posterior cervical and lumbar decompression and fusion. METHODS A retrospective cohort-matched chart review of 531 consecutive cases over 17 months (October 2013 to February 2015) for posterior cervical and lumbar spinal surgery procedures performed by a single surgeon (J.J.) was performed. Inclusion criteria for the analysis were limited to those patients who received posterior approach decompression and fusion for cervical or lumbar spondylolisthesis and/or stenosis. Patients from October 1, 2013, through December 31, 2013, received periincisional injections of bupivacaine hydrochloride, whereas after January 1, 2014, liposomal bupivacaine was solely administered to all patients undergoing posterior approach cervical and lumbar spinal surgery through the duration of treatment. Patients were separated into 2 groups for further analysis: posterior cervical and posterior lumbar spinal surgery. RESULTS One hundred sixteen patients were identified: 52 in the cervical cohort and 64 in the lumbar cohort. For both cervical and lumbar cases, patients who received bupivacaine hydrochloride required approximately twice the adjusted morphine milligram equivalent (MME) per day in comparison with the liposomal bupivacaine groups (5.7 vs 2.7 MME, p = 0.27 [cervical] and 17.3 vs 7.1 MME, p = 0.30 [lumbar]). The amounts of intravenous rescue analgesic requirements were greater for bupivacaine hydrochloride in comparison with liposomal bupivacaine in both the cervical (1.0 vs 0.39 MME, p = 0.31) and lumbar (1.0 vs 0.37 MME, p = 0.08) cohorts as well. None of these differences was found to be statistically significant. There were also no significant differences in lengths of stay, complication rates, or infection rates. A subgroup analysis of both cohorts of opiate-naive versus

  15. Shenfu injection attenuates neurotoxicity of bupivacaine in cultured mouse spinal cord neurons

    Institute of Scientific and Technical Information of China (English)

    XIONG Li-ze; WANG Qiang; LIU Mu-yun; PENG Ye; LI Qing-bo; LU Zhi-hong; LEI Chong

    2007-01-01

    Background Our previous in vivo study in the rat demonstrates that Shenfu injection, a clinically used extract preparation from Chinese herbs, attenuates neural and cardiac toxicity induced by intravenous infusion of bupivacaine, a local anesthetic. This study was designed to investigate whether bupivacaine could induce a toxic effect in primary cultured mouse spinal cord neuron and if so, whether the Shenfu injection had a similar neuroprotective effect in the cell model. Methods The spinal cords from 11- to 14-day-old fetal mice were minced and incubated. Cytarabine was added into the medium to inhibit the proliferation of non-neuronal cells. The immunocytochemical staining of β-tubulin was used to determine the identity of cultured cells. The cultured neurons were randomly assigned into three sets treated with various doses of bupivacaine, Shenfu and bupivacaine+Shenfu, for 48 hours respectively. Cell viability in each group was analyzed by methyl thiazoleterazolium (MTT) assay. Results The viability of the cultured neurons treated with bupivacaine at concentrations of 0.01%, 0.02%, 0.04% and 0.08% was decreased in a dose-dependent manner. Although the Shenfu injection at concentrations ranging from 1/50 to 1/12.5 (V/V) had no significant influence on the viability of cultured neurons (P<0.05 vs control), the injection significantly increased the cellular viability of cultured neurons pretreated with 0.03% bupivacaine (P<0.05). Conclusion Although Shenfu injection itself has no effect on spinal neurons, it was able to reduce the bupivacaine induced neurotoxicity in vitro.

  16. Isobolographic analysis of the interaction between epidural sufentanil and bupivacaine in rats.

    Science.gov (United States)

    Vercauteren, M; Meert, T F

    1997-09-01

    The present study was performed to evaluate the nature of the interaction between epidurally administered sufentanil and bupivacaine in producing antinociception in rats. Rats in which epidural catheters had been inserted received epidural injections with bupivacaine and sufentanil. Nociception was tested by use of the tail-withdrawal reaction (TWR) test and the hot-plate test. Isobolographic analyses were performed with fixed and variable dose ratio treatment schedules based on the ED50s and the highest inactive concentrations of the compounds in both tests. In the TWR test, a synergistic interaction was obtained between the two compounds independent of whether a variable dose ratio regimen (with either 0.08 microgram/rat sufentanil or 80 micrograms/rat bupivacaine as the preset component) or a fixed dose ratio of 1/1,000 sufentanil/bupivacaine (based on the individual ED50s) was used. In the hot-plate test, a synergistic interaction was observed only in the variable dose ratio regimen with 0.08 microgram/rat sufentanil as the preset component and in the fixed dose ratio regimen of 1/1,000 sufentanil/bupivacaine (a ratio based on the ED50 values of the TWR test) but not with a ratio of 1/200, as demonstrated by the ED50s of both drugs in the hot-plate test. The interaction between epidurally administered bupivacaine and sufentanil seems to be synergistic for both tests when variable and fixed dose ratios are used. The synergism could be more easily demonstrated in the TWR test. For drugs with a segmental action, the hot-plate test seems to be less optimal. The necessity of a minimal critical amount of bupivacaine to obtain synergism may have clinical implications.

  17. Minimum effective local anesthetic dose of intrathecal hyperbaric ropivacaine and bupivacaine for cesarean section

    Institute of Scientific and Technical Information of China (English)

    GENG Zhi-yu; WANG Dong-xin; WU Xin-min

    2011-01-01

    Background Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose (MLAD) of intrathecal ropivacaine for nonobstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio.Methods We enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine.The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection.Results The intrathecal MLAD was 9.45 mg (95%confidence interval (CI), 8.45-10.56 mg) for ropivacaine and 7.53 mg (95%CI, 7.00-8.10 mg) for bupivacaine. The relative potency ratio was 0.80 (95% Cl, 0.74-0.85) for ropivacaine/bupivacaine when given intrathecally in cesarean section.Conclusion Ropivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.

  18. Magnesium Versus Bupivacaine Infiltration in Controlling Postoperative Pain in Inguinal Hernia Repair

    Science.gov (United States)

    Razavi, Seyed Sajad; Peyvandi, Hasan; Badrkhani Jam, Ali Reza; Safari, Farhad; Teymourian, Houman; Mohajerani, Seyed Amir

    2015-01-01

    Background: Postoperative pain is one of the most common problems after hernia repair. Decrease in postoperative pain accelerates functional recovery, decreases duration of hospital stay and postoperative morbidity. Objectives: To compare postoperative analgesic effect of infiltration of magnesium versus bupivacaine into incision of inguinal hernia repair. Patients and Methods: In a double blind clinical trial, 80 patients’ candidates for elective inguinal hernia repair were enrolled. Right before closure of incision, in Bupivacaine group 5 mL Bupivacaine 0.5% added to 5 mL normal saline and in Magnesium group, 10 mL Magnesium sulfate 20% was infused subcutaneously. Pain score was measured using numeric rating score (NRS) at 1, 3, 6, 12 and 24 hours postoperatively. If NRS was above 3, 1 mg morphine was administered as rescue analgesic until patient felt comfortable or NRS < 3. Results: Postoperative pain scores at 1 and 3 hours were not significantly different between bupivacaine and magnesium groups (P = 0.21, 0.224; respectively). However, at 6 (P = 0.003), 12 (P = 0.028) and 24 (P = 0.022) hours postoperative, pain score (NRS) was significantly lower in bupivacaine group. Number of patients needed at least 1 dose of rescue morphine (P = 0.001), mean number of episodes asked for morphine during next 24 hours (P = 0.001) and total dose of morphine requirement (P = 0.01) were significantly lower in bupivacaine group. Conclusions: Magnesium infiltration did not decrease total dose and number of episodes needed for morphine rescue analgesic. Bupivacaine infiltration into surgical site was more effective than magnesium sulfate infiltration in postoperative pain control. PMID:26705525

  19. Comparison of the cytotoxic effects of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes.

    Science.gov (United States)

    Park, Jinuk; Sutradhar, Bibek C; Hong, Gyeongmi; Choi, Seok H; Kim, Gonhyung

    2011-03-01

    To compare the chondrotoxicity of bupivacaine, lidocaine, and mepivacaine in equine articular chondrocytes in vitro. Prospective, experimental study. Equine articular chondrocytes. Primary cultured equine chondrocytes were exposed to 0.5% bupivacaine, 2% lidocaine, or 2% mepivacaine for 30 or 60 minutes. After treatment, cell viability was evaluated by trypan blue exclusion and the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay in a dose dependent manner. Apoptosis and necrosis of chondrocytes were analyzed with the double staining of Hoechst 33258 and propidium iodide using fluorescence microscopy, and the results were confirmed using flow cytometry. After 30-minute exposure, trypan blue exclusion assay revealed that cell viability of 0.5% bupivacaine group was 28.73±8.44%, and those of 2% lidocaine and 2% mepivacaine were 66.85±6.03% and 86.27±2.00%, respectively. The viability of chondrocytes after saline treatment was 95.95±2.75%. The results of MTT assay and fluorescence microscopy had similar tendency with trypan blue assay. Each result showed that bupivacaine was the most toxic of the three local anaesthetics. Mepivacaine was less toxic than lidocaine. The results of the viability test suggest that bupivacaine and lidocaine exhibit a marked chondrotoxicity, and that this is mainly due to necrosis rather than apoptosis. Bupivacaine may induce detrimental chondrotoxicity when administered intra-articularly, especially in patients with joint disease, and we suggest that it should be used cautiously in equine practice. Mepivacaine may be an alternative to both bupivacaine and lidocaine. © 2011 The Authors. Veterinary Anaesthesia and Analgesia © 2011 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.

  20. The cytotoxicity of bupivacaine, ropivacaine, and mepivacaine on human chondrocytes and cartilage.

    Science.gov (United States)

    Breu, Anita; Rosenmeier, Katharina; Kujat, Richard; Angele, Peter; Zink, Wolfgang

    2013-08-01

    Intraarticular injections of local anesthetics are frequently used as part of multimodal pain regimens. However, recent data suggest that local anesthetics affect chondrocyte viability. In this study, we assessed the chondrotoxic effects of mepivacaine, ropivacaine, and bupivacaine. We hypothesized that specific cytotoxic potencies directly correlate with analgesic potencies, and that cytotoxic effects in intact cartilage are different than in osteoarthritic tissue. Human articular chondrocytes were exposed to equal and equipotent concentrations of bupivacaine, ropivacaine, and mepivacaine for 1 hour. Cell viability, apoptosis, and necrosis were determined at predefined time points using flow cytometry, live-dead staining, and caspase detection. Intact and osteoarthritic human cartilage explants were treated with equipotent concentrations of named drugs to determine cell viability applying fluorescence microscopy. Chondrotoxic effects increased from ropivacaine to mepivacaine to bupivacaine in a time-dependent and concentration-dependent manner. Compared with control, bupivacaine 0.5% decreased chondrocyte viability to 78% ± 9% (P = 0.0183) 1 hour and 16% ± 10% (P mepivacaine 2%, viable cells were scored 36% ± 6% (P mepivacaine exposure (P = 0.0059). Exposure to concentrations up to 0.25% of bupivacaine, 0.5% of ropivacaine, and 0.5% of mepivacaine did not reveal significant chondrotoxicity in flow cytometry. However, chondrotoxicity did not correlate with potency of local anesthetics. Immediate cell death was mainly due to necrosis followed by apoptosis. Cellular death rates were clearly higher in osteoarthritic compared with intact cartilage after bupivacaine, mepivacaine, and ropivacaine treatment in a decreasing order. Bupivacaine, ropivacaine, and mepivacaine are chondrotoxic in a time-dependent, concentration-dependent, and drug-dependent manner. Chondrotoxic and analgesic potencies do not directly correlate. Cellular death rates were higher in

  1. Effect of long-chain triglyceride lipid emulsion on bupivacaine-induced changes in electrophysiological parameters of rabbit Purkinje cells.

    Science.gov (United States)

    Lemoine, Sandrine; Rouet, René; Manrique, Alain; Hanouz, Jean-Luc

    2014-10-01

    Lipid emulsions are used in the reversal of local anesthetic toxicity. The aim of this study was to investigate the cellular electrophysiological effects of long-chain triglyceride lipid emulsion (LCTE) on cardiac action potential characteristics and conduction disturbances induced by bupivacaine. Purkinje fibers were dissected from the left ventricle of New Zealand white rabbit hearts and superfused with either Tyrode's solution during 30 min (control group), with bupivacaine 10(-6) M, 10(-5) M, and 5.10(-5) M alone, or in the presence of LCTE 0.5%, in addition, LCTE at 0.1%, 0.5%, and 1% was perfused alone. Electrophysiological parameters were recorded using the conventional microelectrode technique (37 °C, 1 Hz frequency). Bupivacaine 5.10(-5) M-induced conduction blocks (8/8 preparations): LCTE 0.5% suppressed the bupivacaine 5.10(-5) M-induced conduction blocks (1/8 preparations). Exposure to bupivacaine 10(-6) M, 10(-5) M, and 5.10(-5) M resulted in a significant decrease in the maximal rate of depolarization (Vmax) (respectively, 25%, 55%, 75%; P bupivacaine 10(-6) M did not significantly decreased Vmax (13%; P = 0.10 vs. control group). The decrease in Vmax resulting from bupivacaine 10(-5) M alone was significantly less in the presence of LCTE 0.5% (P bupivacaine 10(-5) M alone). Exposure to bupivacaine 10(-6) M, 10(-5) M, and 5.10(-5) M alone or in the presence of LCTE 0.5% resulted in a significant decrease in action potential duration measured at 50% and 90% repolarization (APD50 and APD90; P bupivacaine. Moreover, LCTE 0.5% attenuates the decrease in Vmax induced by bupivacaine 10(-6) M and 10(-5) M.

  2. Penile Implants

    Science.gov (United States)

    ... the discussion with your doctor. Types of penile implants There are two main types of penile implants: ... might help reduce the risk of infection. Comparing implant types When choosing which type of penile implant ...

  3. Pseudomembranous collagenous colitis.

    Science.gov (United States)

    Yuan, Shan; Reyes, Victoria; Bronner, Mary P

    2003-10-01

    The classic clinical and histologic features of collagenous colitis are well characterized; however, the acute or neutrophilic inflammatory changes that may accompany this entity are less well established. In this report of 10 patients, we describe the first series of pseudomembranous collagenous colitis. Because superimposed Clostridium difficile infection was only demonstrated in one patient and no other causes of pseudomembranous colitis were evident in the remaining nine patients, we conclude that pseudomembranes are part of the spectrum of collagenous colitis itself. This case series illustrates the importance of searching for collagenous colitis in the evaluation of pseudomembranous colitis. At the same time, superimposed infectious or ischemic etiologies need to be excluded clinically in any patient with superimposed pseudomembranes. The existence of pseudomembranes in collagenous colitis also lends support to the hypothesis that toxin- and/or ischemia-mediated injury may be involved in the pathogenesis of collagenous colitis.

  4. Periodontal regeneration with stem cells-seeded collagen-hydroxyapatite scaffold.

    Science.gov (United States)

    Liu, Zeping; Yin, Xing; Ye, Qingsong; He, Wulin; Ge, Mengke; Zhou, Xiaofu; Hu, Jing; Zou, Shujuan

    2016-07-01

    Re-establishing compromised periodontium to its original structure, properties and function is demanding, but also challenging, for successful orthodontic treatment. In this study, the periodontal regeneration capability of collagen-hydroxyapatite scaffolds, seeded with bone marrow stem cells, was investigated in a canine labial alveolar bone defect model. Bone marrow stem cells were isolated, expanded and characterized. Porous collagen-hydroxyapatite scaffold and cross-linked collagen-hydroxyapatite scaffold were prepared. Attachment, migration, proliferation and morphology of bone marrow stem cells, co-cultured with porous collagen-hydroxyapatite or cross-linked collagen-hydroxyapatite, were evaluated in vitro. The periodontal regeneration capability of collagen-hydroxyapatite scaffold with or without bone marrow stem cells was tested in six beagle dogs, with each dog carrying one sham-operated site as healthy control, and three labial alveolar bone defects untreated to allow natural healing, treated with bone marrow stem cells - collagen-hydroxyapatite scaffold implant or collagen-hydroxyapatite scaffold implant, respectively. Animals were euthanized at 3 and 6 months (3 animals per group) after implantation and the resected maxillary and mandibular segments were examined using micro-computed tomography scan, H&E staining, Masson's staining and histometric evaluation. Bone marrow stem cells were successfully isolated and demonstrated self-renewal and multi-potency in vitro. The porous collagen-hydroxyapatite and cross-linked collagen-hydroxyapatite had average pore sizes of 415 ± 20 µm and 203 ± 18 µm and porosity of 69 ± 0.5% and 50 ± 0.2%, respectively. The attachment, proliferation and migration of bone marrow stem cells were satisfactory on both porous collagen-hydroxyapatite and cross-linked collagen-hydroxyapatite scaffolds. Implantation of bone marrow stem cells - collagen-hydroxyapatite or collagen-hydroxyapatite scaffold in

  5. Covalent Immobilization of Collagen on Titanium through Polydopamine Coating to Improve Cellular Performances of MC3T3-E1 Cells

    Science.gov (United States)

    Yu, Xiaohua; Walsh, John; Wei, Mei

    2014-01-01

    Surface modification of orthopedic implants is critical for improving the clinical performance of these medical devices. Herein, collagen was covalently immobilized onto a titanium implant surface via a novel adherent polydopamine coating inspired by mussel adhesive proteins. The formation and composition of the collagen coating was characterized using X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). Fluorescent labeled collagen was also used to examine the formation and uniformity of the collagen coating. The resultant collagen coating with a polydopamine supporting substrate demonstrated better uniformity and distribution on the titanium surface compared to a physical adsorption of collagen. The covalent immobilized collagen coating is biologically active, as evidenced by its ability to enhance MC3T3-E1 cell adhesion, support cell proliferation and promote early stage osteogenic differentiation of pre-osteoblasts. Our study suggests covalent immobilization of collagen through the polydopamine coating might be an efficient way to improve the cellular performance of implant surfaces. PMID:24932406

  6. Covalent Immobilization of Collagen on Titanium through Polydopamine Coating to Improve Cellular Performances of MC3T3-E1 Cells.

    Science.gov (United States)

    Yu, Xiaohua; Walsh, John; Wei, Mei

    2013-11-21

    Surface modification of orthopedic implants is critical for improving the clinical performance of these medical devices. Herein, collagen was covalently immobilized onto a titanium implant surface via a novel adherent polydopamine coating inspired by mussel adhesive proteins. The formation and composition of the collagen coating was characterized using X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). Fluorescent labeled collagen was also used to examine the formation and uniformity of the collagen coating. The resultant collagen coating with a polydopamine supporting substrate demonstrated better uniformity and distribution on the titanium surface compared to a physical adsorption of collagen. The covalent immobilized collagen coating is biologically active, as evidenced by its ability to enhance MC3T3-E1 cell adhesion, support cell proliferation and promote early stage osteogenic differentiation of pre-osteoblasts. Our study suggests covalent immobilization of collagen through the polydopamine coating might be an efficient way to improve the cellular performance of implant surfaces.

  7. Enigmatic insight into collagen

    Directory of Open Access Journals (Sweden)

    Shrutal Narendra Deshmukh

    2016-01-01

    Full Text Available Collagen is a unique, triple helical molecule which forms the major part of extracellular matrix. It is the most abundant protein in the human body, representing 30% of its dry weight. It is the fibrous structural protein that makes up the white fibers (collagen fibers of skin, tendons, bones, cartilage and all other connective tissues. Collagens are not only essential for the mechanical resistance and resilience of multicellular organisms, but are also signaling molecules defining cellular shape and behavior. The human body has at least 16 types of collagen, but the most prominent types are I, II and III. Collagens are produced by several cell types and are distinguishable by their molecular compositions, morphologic characteristics, distribution, functions and pathogenesis. This is the major fibrous glycoprotein present in the extracellular matrix and in connective tissue and helps in maintaining the structural integrity of these tissues. It has a triple helical structure. Various studies have proved that mutations that modify folding of the triple helix result in identifiable genetic disorders. Collagen diseases share certain similarities with autoimmune diseases, because autoantibodies specific to each collagen disease are produced. Therefore, this review highlights the role of collagen in normal health and also the disorders associated with structural and functional defects in collagen.

  8. Efficiency of levobupivacaine and bupivacaine for supraclavicular block: a randomized double-blind comparative study

    Directory of Open Access Journals (Sweden)

    Cenk Ilham

    2014-06-01

    Full Text Available Background and objectives: Success rate of catheter applications is low in supraclavicular block. Thus, bupivacaine and levobupivacaine become important with their long effect time in single injection practices. In this study, we aimed to compare the effectiveness, side effects and complications of bupivacaine and levobupivacaine in supraclavicular block. Methods: Sixty patients aged between 20 and 65, with body weight between 50 and 100 kg, in the ASA I-II-III group who were scheduled for hand, forearm and arm surgery using supraclavicular block were randomized into two groups of 30. The patients received 30 ml 0.5% bupivacaine (Group B or 30 ml 0.5% levobupivacaine (Group L. Motor and sensory blocks were evaluated. Motor and sensory block onset times, total block durations, postoperative pain, amount of postoperative analgesic used and patient satisfaction were recorded. Results: Demographic data, distribution of surgical area and hemodynamic data were similar between the two groups. Surgery, motor and sensory block durations of Group B and L patients did not vary statistically significantly. However, motor and sensory block onset times in Group B were significantly shorter than Group L (p 0.05. Conclusion: 30 ml 0.5% bupivacaine and levobupivacaine provide similar block characteristics for supraclavicular block. Bupivacaine leads to faster motor and sensory block onset compared to levobupivacaine however similar duration of postoperative analgesia.

  9. Effects of Ropivacaine and Bupivacaine on Rabbit Myocardial Energetic Metabolism and Mitochondria Oxidation

    Institute of Scientific and Technical Information of China (English)

    张诗海; 姚尚龙; 李晴

    2003-01-01

    Summary: To compare the cardiotoxicity induced by ropivacaine and bupivacaine and to investigatethe mechanism of cardiotoxicity, 24 mature New Zealand rabbits were divided randomly into controlgroup (group C), ropivacaine group (group R) and bupivacaine group (group B). Hearts were drawnout rapidly from the anesthetized animals and cardiac perfusion was performed immediately. Ropiva-caine 500 ng/ml (group R) or bupivacaine 500 ng/ml (group B) was added to the perfusion solution.Ventricular myocardial ATP, ADP and AMP were measured with high performance liquid chro-matogram. The ability of myocardial mitochondria oxidation to pyruvate or palmitoylcarnitine wasdetected with Clark electrode. Our results showed that myocardial ATP and ADP decreased signifi-cantly (P<0. 05) in group R and most significantly (P<0. 01) in group B as compared with groupC. Myocardial ATP and ADP decreased most significantly (P<0. 01) in group B as compared withgroup R. The changes of myocardial AMP revealed significant difference among three groups. Thechanges of pyruvate oxidation exibited no significant difference among the three groups. Palmitoyl-carnitine oxidation decreased markedly (P<0. 05) in group R and most significantly (P<0. 01) ingroup B as compared with group C. The present study indicated that the inhibition of lipid substrateoxidation may be responsible for the cardiotoxicity induced by bupivacaine and ropivacaine. The car-diotoxicity induced by ropivacaine is far more less than bupivacaine.

  10. Successful resuscitation of serious bupivacaine intoxication in a patient with pre-existing heart failure.

    Science.gov (United States)

    Favier, Jean-Christophe; Da Conceiçao, Manuel; Fassassi, Mikaïla; Allanic, Laurent; Steiner, Thierry; Pitti, Raphaël

    2003-01-01

    In dogs intoxicated with bupivacaine, clonidine is effective to treat conduction disturbances and dobutamine corrects myocardial depression. We report the case of a patient who experienced severe bupivacaine cardiotoxicity and who was treated successfully using these medications. In a patient with pre-existing heart failure a surgical procedure to fix a humeral fracture was necessary. Preoperatively, heart failure was controlled with transcutaneous nitroglycerin and iv deslanoside. A bupivacaine bolus was administered iv accidentally (a mixture of bupivacaine 75 mg, 15 micro g clonidine). The patient developed nodal rhythm with extreme bradycardia, severe shock and convulsions. Seizures were controlled with thiopentone/succinylcholine. Epinephrine iv boluses (0.1 mg x 3) restored blood pressure (BP) to 50/30 mmHg and heart rate (HR) to 60 (nodal rhythm). Following 75 micro g clonidine iv, BP rose to 90/70 and HR to 90 min. Cardiac rhythm reverted to sinus rhythm with first degree atrio-ventricular block. Echocardiography showed hyperkinesia and relative hypovolemia that was controlled with iv administration of terlipressin and glucagon. Subsequent dobutamine infusion stabilized hemodynamic conditions. It was decided to proceed with surgery using a midazolam/sufentanil based general anesthetic. In the intensive care unit, recovery, extubation and weaning from the dobutamine infusion were realized within 16 hr of the event. In this patient with preoperative heart failure, clonidine was effective to treat bupivacaine induced conduction disturbances. Epinephrine and dobutamine were effective to treat myocardial depression and terlipressin effectively controlled vasodilatation.

  11. The influence of epidural analgesia on platelet function and correlation with plasma bupivacaine concentrations.

    Science.gov (United States)

    Odoom, J A; Dokter, P W; Sturk, A; Ten Cate, J W; Sih, I L; Bovill, J G

    1988-09-01

    The effect of epidural anaesthesia with bupivacaine 0.5% on platelet aggregation was studied in seven patients undergoing transurethral resection of the prostate. Peak plasma concentrations of bupivacaine 470 +/- 270 ng ml-1 occurred at 30 min after administration. At that time there were no significant changes in platelet aggregation. However, the maximum rate of the primary- and secondary-aggregation velocities induced by 1.0 microM ADP were significantly decreased at 1 h and 3 h after bupivacaine administration. The maximum percentage ADP-induced platelet aggregation was also decreased significantly at 1 h and 3 h. The minimum concentration of ADP required to induce secondary-phase platelet aggregation was significantly increased at 1 h but not at 3 h. There was a significant correlation between bupivacaine concentrations and all platelet aggregation parameters except the maximum ADP-induced aggregation. Platelet inhibition occurred at plasma bupivacaine concentrations that were considerably lower than those needed to produce similar inhibition in vitro.

  12. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...

  13. Efficacy of clonidine as an adjuvant to bupivacaine for caudal analgesia in children undergoing sub-umbilical surgery

    Directory of Open Access Journals (Sweden)

    Aruna Parameswari

    2010-01-01

    Full Text Available Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. We evaluated the efficacy of clonidine added to bupivacaine in prolonging the analgesia produced by caudal bupivacaine in children undergoing sub-umbilical surgery. One hundred children, age one to three years, undergoing sub-umbilical surgery, were prospectively randomized to one of two groups: caudal analgesia with 1 ml/kg of 0.25% bupivacaine in normal saline (Group A or caudal analgesia with 1 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group B. Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group B (593.4 ± 423.3 min than in Group A (288.7 ± 259.1 min; P < 0.05. The pain score assessed using FLACC scale was compared between the two groups, and children in Group B had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group B. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects.

  14. iTRAQ proteomics analysis reveals that PI3K is highly associated with bupivacaine-induced neurotoxicity pathways.

    Science.gov (United States)

    Zhao, Wei; Liu, Zhongjie; Yu, Xujiao; Lai, Luying; Li, Haobo; Liu, Zipeng; Li, Le; Jiang, Shan; Xia, Zhengyuan; Xu, Shi-yuan

    2016-02-01

    Bupivacaine, a commonly used local anesthetic, has potential neurotoxicity through diverse signaling pathways. However, the key mechanism of bupivacaine-induced neurotoxicity remains unclear. Cultured human SH-SY5Y neuroblastoma cells were treated (bupivacaine) or untreated (control) with bupivacaine for 24 h. Compared to the control group, bupivacaine significantly increased cyto-inhibition, cellular reactive oxygen species, DNA damage, mitochondrial injury, apoptosis (increased TUNEL-positive cells, cleaved caspase 3, and Bcl-2/Bax), and activated autophagy (enhanced LC3II/LC3I ratio). To explore changes in protein expression and intercommunication among the pathways involved in bupivacaine-induced neurotoxicity, an 8-plex iTRAQ proteomic technique and bioinformatics analysis were performed. Compared to the control group, 241 differentially expressed proteins were identified, of which, 145 were up-regulated and 96 were down-regulated. Bioinformatics analysis of the cross-talk between the significant proteins with altered expression in bupivacaine-induced neurotoxicity indicated that phosphatidyl-3-kinase (PI3K) was the most frequently targeted protein in each of the interactions. We further confirmed these results by determining the downstream targets of the identified signaling pathways (PI3K, Akt, FoxO1, Erk, and JNK). In conclusion, our study demonstrated that PI3K may play a central role in contacting and regulating the signaling pathways that contribute to bupivacaine-induced neurotoxicity.

  15. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus

    1988-01-01

    -point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given...

  16. The roles of acute and chronic pain in regression of sensory analgesia during continuous epidural bupivacaine infusion

    DEFF Research Database (Denmark)

    Mogensen, T; Scott, N B; Lund, Claus;

    1988-01-01

    -point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane--N2O general anesthesia. No opiates were given...

  17. Extracts from rabbit skin inflamed by the vaccinia virus attenuate bupivacaine-induced spinal neurotoxicity in pregnant rats

    Institute of Scientific and Technical Information of China (English)

    Rui Cui; Shiyuan Xu; Liang Wang; Hongyi Lei; Qingxiang Cai; Hongfei Zhang; Dongmei Wang

    2013-01-01

    Extracts from rabbit skin inflamed by the vaccinia virus can relieve pain and promote repair of nerve injury. The present study intraperitoneally injected extracts from rabbit skin inflamed by the vaccinia virus for 3 and 4 days prior to and following intrathecal injection of bupivacaine into pregnant rats. The pain threshold test after bupivacaine injection showed that the maximum possible effect of tail-flick latency peaked 1 day after intrathecal injection of bupivacaine in the extract-pretreatment group, and gradually decreased, while the maximum possible effect in the bupivacaine group continued to increase after intrathecal injection of bupivacaine. Histological observation showed that after 4 days of intrathecal injection of bupivacaine, the number of shrunken, vacuolated, apoptotic and caspase-9-positive cells in the dorsal root ganglion in the extract-pretreatment group was significantly reduced compared with the bupivacaine group. These findings indicate that extracts from rabbit skin inflamed by the vaccinia virus can attenuate neurotoxicity induced by intrathecal injection of bupivacaine in pregnant rats, possibly by inhibiting caspase-9 protein expression and suppressing nerve cell apoptosis.

  18. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G

    2002-01-01

    randomized to receive simultaneous subcutaneous injections of bupivacaine microcapsules with dexamethasone and bupivacaine microcapsules without dexamethasone in each calf. Local analgesia was assessed with a validated human pain model; main parameters evaluated were thermal, mechanical, and pain detection...... thresholds and suprathreshold responses to heat and mechanical stimulation. Measurements were performed every 2 h for the first 8 h and daily for the week after injection. Primary endpoints were evaluation of maximal analgesic effect, time of onset, and duration of analgesia. Summary measures (area under...... curve [AUC]) were considered best estimate of analgesia. Safety evaluations were performed daily for the first week and at 2 weeks, 6 weeks, and 6 months after injection. RESULTS: The addition of dexamethasone significantly prolonged local analgesia of bupivacaine microcapsules without influence...

  19. COMPARISON OF EFFICACY OF BUTORPHANOL AND FENTANYL AS INTRATHECAL ADJUVANT TO BUPIVACAINE

    Directory of Open Access Journals (Sweden)

    Gopal Reddy

    2015-04-01

    Full Text Available OBJECTIVE: The objective of the study was to compare the efficacy of butorphanol and Fentanyl as an adjuvant to local anaesthetics in relation to onset, degree and recovery time of sensory and motor blockade in orthopaedi c procedures done under spinal anaesthesia. METHODS: In a Randomized double blind study, 90 cases of ASA grade 1 & 2 between the ages of 18 - 60yrs of either sex undergoing elective lower limb orthopaedic procedures were allocated into three groups of 30 each. Group A received intrathecal 0.5% hyperbaric bupivacaine 3ml with 0.2 ml of normal saline (n=30. Group B received intrathecal 0.5% hyperbaric bupivacaine 3ml with Butorphanol 200microgram. (n=30 Group C received intrathecal 0.5% hyperbaric bupivaca ine 3ml with fentanyl 20microgram. (n=30.Vital parameters, onset, level, duration and regression of sensory & motor block, duration of effective analgesia were recorded and compared. Analysis was done by of variance (ANOVA test. RESULTS: Intrathecal admi nistration of Bupivacaine + Butorphanol (141.6±7.2 min Bupivacaine + Fentanyl (124.5±7.1min prolongs 2 segment regression times compared to Bupivacaine with Normal saline (118.3±12.5min without altering the duration of motor blockade. Duration of effect ive analgesia was 191.8±19,272.8±17.2 min and 270.0±27.4 min in Group A, Group B and Group C respectively. Post - operative side effects were comparable in all the three groups. CONCLUSION: Both fentanyl and butorphanol given intrathecally along with hyperba ric Bupivacaine prolong the d uration of effective analgesia.

  20. Downregulation of miR-210 protected bupivacaine-induced neurotoxicity in dorsal root ganglion.

    Science.gov (United States)

    Wang, Yiheng; Ni, Hongxia; Zhang, Wenrui; Wang, Xiu; Zhang, Haishan

    2016-04-01

    Local anesthetic may cause neurotoxicity in developing neurons. In this study, we examined the molecular mechanisms of microRNA-210 (miR-210) in regulating bupivacaine-induced dorsal root ganglia (DRG) neurotoxicity in vitro. Young mouse (P30) DRG explants were cultured in vitro and treated with 5 mM bupivacaine to induce neurotoxicity. QRT-PCR was used to evaluate the expression profiles of miRNAs within 24 h after bupivacaine treatment. MiR-210 was downregulated in DRG, and its effects on bupivacaine-induced neurotoxicity were evaluated by apoptosis and neurite growth assays, respectively. Putative downstream target of miR-210 in DRG, BDNF, was evaluated by dual-luciferase assay, qRT-PCR, and western blot, respectively. BDNF was then knocked down by siRNA to assess its associated effects in regulating DRG neurotoxicity. Within the initial 24 h after bupivacaine treatment, various patterns of miRNA expression were observed, whereas miR-210 was constantly upregulated. Application of miR-210 inhibitor efficiently downregulated endogenous miR-210, protected apoptosis and neurite retraction in bupivacaine damaged DRG neurons. Using dual-luciferase assay, qRT-PCR, and western blot, BDNF was confirmed to the downstream target of miR-210 in DRG. SiRNA-mediated BDNF downregulation reversed the effect of miR-210 downregulation in DRG neurotoxicity. MiR-210, through the regulation of BDNF, plays important role in anesthetics-induced DRG neurotoxicity.

  1. The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration

    Energy Technology Data Exchange (ETDEWEB)

    Veering, B.T.; Burm, A.G.; Vletter, A.A.; van den Hoeven, R.A.; Spierdijk, J. (Leiden Univ. Hospital (Netherlands))

    1991-02-01

    In order to evaluate the role of the pharmacokinetics of the age-related changes in the clinical profile of spinal anesthesia with bupivacaine, we studied the influence of age on the systemic absorption and systemic disposition of bupivacaine after subarachnoid administration in 20 male patients (22-81 yr), ASA Physical Status 1 or 2, by a stable isotope method. After subarachnoid administration of 3 ml 0.5% bupivacaine in 8% glucose, a deuterium-labeled analog (13.4 mg) was administered intravenously. Blood samples were collected for 24 h. Plasma concentrations of unlabeled and deuterium-labeled bupivacaine were determined with a combination of gas chromatography and mass fragmentography. Biexponential functions were fitted to the plasma concentration-time data of the deuterium-labeled bupivacaine. The systemic absorption was evaluated by means of deconvolution. Mono- and biexponential functions were fitted to the data of fraction absorbed versus time. The maximal height of analgesia and the duration of analgesia at T12 increased with age (r = 0.715, P less than 0.001; r = 0.640, P less than 0.01, respectively). In 18 patients the systemic absorption of bupivacaine was best described by a biexponential equation. The half-life of the slow systemic absorption process (r = -0.478; P less than 0.05) and the mean absorption time (r = -0.551; P less than 0.02) decreased with age. The total plasma clearance decreased with age (r = -0.650, P less than 0.002), whereas the mean residence time and terminal half-life increased with age (r = 0.597, P less than 0.01; r = 0.503, P less than 0.05).

  2. Neostigmine Decreases Bupivacaine Use by Patient-Controlled Epidural Analgesia During Labor: A Randomized Controlled Study

    Science.gov (United States)

    Ross, Vernon H.; Pan, Peter H.; Owen, Medge D; Seid, Melvin H.; Harris, Lynne; Clyne, Brittany; Voltaire, Misa; Eisenach, James C.

    2009-01-01

    Background Intrathecal neostigmine produces analgesia, but also severe nausea. In contrast, epidural neostigmine enhances opioid and local anesthetic analgesia without causing nausea. Previous studies examined only single epidural neostigmine bolus administration and did not assess the efficacy of continuous epidural infusion or several aspects of maternal and fetal safety. We therefore tested the hypothesis that epidural neostigmine in combination with bupivacaine by continuous infusion during labor would reduce the amount of bupivacaine required. Methods Twelve healthy women scheduled for elective cesarean delivery were assigned to receive epidural neostigmine, 40 μg (first 6 subjects) or 80 μg (second 6 subjects) as a single bolus, with fetal heart rate and uterine contractions monitored for 20 minutes. In a subsequent experiment, 40 healthy laboring women were randomized to receive bupivacaine 1.25 mg/mL alone or with neostigmine 4 μg/mL by patient-controlled epidural analgesia. The primary outcome measure was hourly bupivacaine use. Results Epidural neostigmine bolus did not alter baseline fetal heart rate, induce contractions or produce nausea. Epidural neostigmine infusion reduced bupivacaine requirement by 19% in all patients and 25% in those with > 4 hours of treatment (P<0.05 for both), but might have contributed to the incidence of mild sedation. Mode of delivery, incidence of maternal nausea and fetal heart rate abnormality were similar between groups. Conclusions These data show that adding epidural neostigmine 4 μg/mL reduces the hourly bupivacaine requirement by 19% to 25% with patient-controlled epidural analgesia during labor. Administered as a bolus and by continuous infusion at the studied doses, epidural neostigmine does not cause nausea and does not induce uterine contractions or fetal heart rate abnormalities, but mild sedation can occur. PMID:19377050

  3. Local injection of bupivacaine after rubber band ligation of hemorrhoids: prospective, randomized study.

    Science.gov (United States)

    Hooker, G D; Plewes, E A; Rajgopal, C; Taylor, B M

    1999-02-01

    The aim of this study was to determine if local injection of bupivacaine after hemorrhoidal banding causes a decrease in pain and in the incidence of associated symptoms. After hemorrhoidal banding, patients were randomly assigned to receive a local injection of bupivacaine with 1:200,000 epinephrine, an injection of normal saline, or no injection, just superior to each band. Pain was graded by the patient and by the study nurse within 30 minutes, and any associated symptoms were recorded. At intervals 6, 24, and 48 hours postbanding, the patient recorded pain, limitation of activities, and analgesic requirements. Associated symptoms while at home were recorded. Of 115 patients studied, 42 received bupivacaine injection, 42 received normal saline injection, and 31 received no injection. In patients receiving bupivacaine compared with no injection, within 30 minutes postbanding there was a significant reduction in pain graded by the patient (P = 0.000002) and by the nurse (P = 0.000005) and a significant reduction in incidence of nausea (P = 0.01) and shaking (P = 0.008). However, in the bupivacaine group compared with the other two groups, at the intervals of 6, 24, and 48 hours postbanding there was no sustained reduction in the severity of pain and no reduction in analgesic requirements or limitation of normal activities. In the week after banding, there was no difference between groups in symptoms of nausea, shaking, lightheadedness, urinary retention, or bleeding. Bupivacaine injection may be useful for reducing pain and associated symptoms long enough to tolerate a trip home from the outpatient department but does not show a sustained effect.

  4. Changes in myocardial collagen content before and after left ventricular assist device application in dilated cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    LIANG Hong 梁红; Roland Hetzer; Johannes Müller; WENG Yu-guo 翁渝国; Gerd Wallukat; FU Ping 付平; LIN Han-sheng 林汉生; Sabina Bartel; Christoph Knosalla; Reinhard Pregla

    2004-01-01

    Background The purposes of this study were to confirm the changes in myocardial collagen level after left ventricular assist device (LVAD) support in dilated cardiomyopathy (DCM), find the relation between these changes and prognosis, and test a practical method to assess the level of myocardial collagen.Methods Left ventricular samples were collected from DCM patients with different prognosis (transplanted group n=8, weaning group n=10) at the time when the LVADs were implanted and again during cardiac transplantation (n=8). The level of neutral salt soluble collagen (NSC) and acid soluble collagen (ASC) was measured by Sircol collagen assay, and that of total collagen and insoluble collagen (ISC) by quantification of hydroxyproline (Hyp). Serum samples were collected from a portion of these patients (transplanted group, n=6; weaning group n=7) at the time the LVADs were implanted, 1 month after implantation and on explantation. Circulating concentration of carboxy-terminal propeptide of type Ⅰ procollagen (PⅠCP), amino-terminal propeptide of type Ⅰ procollagen (PⅠNP), amino-terminal propeptide of type Ⅲ procollagen (PⅢNP) and type Ⅰ collagen telopeptide (ⅠCTP) were measured by the equilibrium type radioimmunoassay. Results Before LVAD implantation the level of NSC and ISC in the weaning group was higher but ASC in the transplanted group was lower than in the controls (P<0.05). After LVAD support, the level of total collagen was higher, but ASC was also lower in the transplanted group than in the controls (P<0.05). In comparison of the pre- and post-LVAD subgroups of the transplanted and weaning groups, all collagen fraction levels before LVAD implantation were lower in the transplanted group than in the weaning group (P<0.05); but this difference disappeared after LVAD support. Comparison of the pre- and post-LVAD subgroups of the transplanted group showed increased level of NSC and total collagen after LVAD support. The changes of serum peptide

  5. Ropivacaine plus lidocaine versus Bupivacaine plus lidocaine for peribulbar double injection regional anesthesia

    OpenAIRE

    Omar Elsafty MD, Ahmed M.S. Hamed MD, Sherif Wadie MD

    2003-01-01

    Our study was designed to evaluate the efficacy of Ropivacaine 0.75% plus Lidocaine 2% versus Bupivacaine 0.5 % plus lidocaine 2 % to provide peribulbar anaesthesia for cataract surgery .Time to adequate block for surgery, ocular eyelid movement scores at 8 min after block and quality for postoperative analgesia were recorded. Sixty patients are randomly divided into two groups of 30, to receive a peribulbar block with 8 ­ 10 ml of either Ropivacaine ­ Lidocaine or Bupivacaine ­ lidocaine,and...

  6. Proximal collagenous gastroenteritides:

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Riis, Lene Buhl; Danese, Silvio

    2014-01-01

    a systematic review of collagenous gastritis, collagenous sprue, and a combination thereof. METHOD: The search yielded 117 studies which were suitable for inclusion in the systematic review. Excluding repeated cases, 89 case reports and 28 case series were reported, whereas no prospective studies...... of these disorders is presented. The prognosis of both collagenous gastritis and sprue seems not to be as dismal as considered previously. Data point to involvement of immune or autoimmune mechanisms potentially driven by luminal antigens initiating the fibroinflammatory condition. CONCLUSIONS: To reach...

  7. "COMPARATIVE STUDY OF ONSET AND DURATION OF ACTION OF 0.5% BUPIVACAINE AND A MIXTURE OF 0.5% BUPIVACAINE AND 2% LIDOCAINE FOR EPIDURAL ANESTHESIA"

    Directory of Open Access Journals (Sweden)

    F. Z

    2004-09-01

    Full Text Available Local anesthetic solutions are frequently mixed to take advantage of the useful properties of each drug but the medical literature is surprisingly deficient in well controlled studies about the onset and duration of action of these mixtures for epidural anesthesia. A total of 32 patients scheduled for elective operation were enrolled in this prospective randomized controlled study; in group I, 16 patients received 15 ml solution containing bupivacaine 0.5% and lidocaine 2% as a single injection epidural anesthesia after 3 ml test dose containing 15 mcg epinephrine; in group II, 16 patients received 15 ml bupivacaine 0.5% with the same technique. The times from injection of the test dose to the onset of sensory anesthesia at inguinal ligament and umbilicus and the time of termination of anesthesia at the maximum sensory level and two levels regression of anesthesia level were checked with pinprick test. The results were compared with two sample t test. Times to onset of sensory block in L1 and T10 levels (mean±SD were 14.87±3.1 min and 21±3.37 min in group I and 17.12±2.18 min and 24.9±2.54 min in group II, respectively (P< 0.025 and P< 0.001, respectively. Times to termination of sensory anesthesia at the maximum level of anesthesia and two dermatomes regression were 75.12±8.26 min and 87.8±7.01 min in group I and 116.37±22.4 min and 134.87±21.64 min in group II, respectively ( P= 0 and P=0,respectively. Mixing lidocaine 2% with bupivacaine 0.5% in a 1:1 ratio compared to 0.5% bupivacaine solution results in significantly more rapid initiation and termination of sensory block.

  8. The Effect of Local Injections of Bupivacaine Plus Ketamine, Bupivacaine Alone, and Placebo on Reducing Postoperative Anal Fistula Pain: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Alireza Kazemeini

    2014-01-01

    Full Text Available Background and Objective. This study aimed to compare the effects of different local anesthetic solutions on postoperative pain of anal surgery in adult patients. Method. In this randomized double-blind prospective clinical trial, 60 adult patients (18 to 60 years old with physical status class I and class II that had been brought to a university hospital operating room for fistula anal surgery with spinal anesthesia were selected. Patients were randomly divided into 4 equal groups according to table of random numbers (created by Random Allocation Software 1. Group 1 received 3 mL of normal saline, group 2, 1 mL of normal saline plus 2 mL of bupivacaine 0.5%, group 3, 1 mL of ketamine plus 2 mL of bupivacaine 0.5%, and group 4, no infiltration. Intensity of pain in patients was measured using visual analogue scale (VAS at 0 (transfer to ward, 2, 6, 12, and 24 hours after surgery. Time interval to administration of drugs and overall dose of drugs were measured in 4 groups. Results. Mean level of pain was the lowest in group 3 at all occasions with a significant difference, followed by groups 2, 4, and lastly 1 (P<0.001. Furthermore, groups 2 and 3 compared to groups 1 and 4 had the least overall dose of analgesics and requested them the latest, with a significant difference (P<0.05. Conclusion. Local anesthesia (1 mL of ketamine plus 2 mL of bupivacaine 0.5% or 1 mL of normal saline plus 2 mL of bupivacaine 0.5% combined with spinal anesthesia reduces postoperative pain and leads to greater comfort in recovering patients.

  9. Dental Implants.

    Science.gov (United States)

    Griggs, Jason A

    2017-10-01

    Systematic reviews of literature over the period between 2008 and 2017 are discussed regarding clinical evidence for the factors affecting survival and failure of dental implants. The factors addressed include publication bias, tooth location, insertion torque, collar design, implant-abutment connection design, implant length, implant width, bone augmentation, platform switching, surface roughness, implant coatings, and the use of ceramic materials in the implant body and abutment. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Comparison of the Maternal and Neonatal Effects of Intratechal Bupivacaine Plus Fentanyl or Morphine During Cesarean Delivery

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    Ahmet Yıldırım

    2016-09-01

    Full Text Available Aim: To evaluate the effects of morphine and fentanyl added to bupivacaine and intrathecal bupivacaine to combine spinal-epidural anaesthesia during caesarean. Methods: Forty subjects with American Society of Anesthesiologists I-II status who would have caesarean were included in the study. The subjects were divided into two groups. Group bupivacaine-fentanyl (BF were given 0.5% bupivacaine 7.5 mg + 25 µg fentanyl and group bupivacaine-morphine (BM received 0.5% bupivacaine 7.5 mg + 0.1 mg morphine intrathecal total 2 mL. Periods for access to T4 block, two dermatome regression of sensory block, time elapsed between the administration of the local anaesthetic and reaching Bromage scale 1, reaching the highest level of motor block, first analgesic necessity, umbilical cord clamping time, and when the operation ends were recorded. One-minute and five-minute Apgar scores, umbilical blood gas values of the newborns and the adverse effects were recorded. Results: Comparisons between the two groups show that group BM has longer periods for motor block start time, two dermatome regression time, and first anaesthetic necessity time and group BF had higher levels for motor block level at the 1st minute and visual analog scale scores at postop 60th minute. There was no significant difference between the groups for the adverse effects. Conclusion: Fentanyl and morphine added to intrathecal bupivacaine show similar effects in intraoperative analgesia. We have deduced that although low doses of hyperbaric bupivacaine is effective during caesarean section, fentanyl and morphine added to bupivacaine can also be used safely and effectively.

  11. Covalent Immobilization of Collagen on Titanium through Polydopamine Coating to Improve Cellular Performances of MC3T3-E1 Cells

    OpenAIRE

    Yu, Xiaohua; Walsh, John; Wei, Mei

    2013-01-01

    Surface modification of orthopedic implants is critical for improving the clinical performance of these medical devices. Herein, collagen was covalently immobilized onto a titanium implant surface via a novel adherent polydopamine coating inspired by mussel adhesive proteins. The formation and composition of the collagen coating was characterized using X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy (SEM). Fluorescent labeled collagen was also used to examine the forma...

  12. [Maternal hypotension with low doses of spinal bupivacaine or levobupivacaine and epidural volume expansion with saline for cesarean section].

    Science.gov (United States)

    Guasch, E; Gilsanz, F; Díez, J; Alsina, E

    2010-05-01

    Epidural volume extension (EVE) with saline solution can contribute to greater cephalad spread of drugs injected into the subarachnoid space during cesarean section. We studied the incidence of material hypotension with spinal bupivacaine or levobupivacaine (L-bupivacaine) and the spread after epidural saline injection. After ethics committee approval, we randomized women scheduled for cesarean section to 4 groups to receive 5 mg of 0.25% bupivacaine with (n=51) or without (n=6) saline EVE; 5 mg of 025% L-bupivacaine (n=50); or 6 mg of 03% L-bupivacaine (n=50). All patients also received 25 microg of fentanyl per 2 mL of local hyperbaric spinal anesthetic. In all except the non-EVE group, 10 mL of saline was infused through an epidural catheter 5 minutes after anesthetic infusion. We recorded patient demographic data, procedural and anesthetic times, incision-clamping times, occurrence of hypotension, ephedrine dose required, motor and sensory blockade, requirement for rescue analgesics, and neonatal outcome. After 6 patients had been randomized to the non-EVE group, no further patients were assigned because all the women required rescue analgesics. Demographic data, duration of procedure, time between. incision and delivery, and Apgar scores were similar in all the groups. The incidence of hypotension was lower in the group receiving 5 mg of L-bupivacaine (26% vs. 52.9% in the bupivacaine 5-mg group, and 56% in the 6-mg L-bupivacaine group, P = .04). More women given 5 mg of L-bupivacaine required rescue analgesia (46%) than did those receiving 5 mg of bupivacaine (235%) or 6 mg of L-bupivacaine (28%) (P = .039). Hypotension was associated with a lower umbilical cord pH (P = .001). Ephedrine doses over 20 mg were also associated with a lower umbilical cord pH (P = .031). The incidence of hypotension was lowest in the group anesthetized with 5 mg of L-bupivacaine, but the need for rescue analgesia was greater in this group. Doses of 5 mg and 6 mg may be sufficient

  13. Collagenous gastritis: Review

    Institute of Scientific and Technical Information of China (English)

    Kenya Kamimura; Masaaki Kobayashi; Yuichi Sato; Yutaka Aoyagi; Shuji Terai

    2015-01-01

    Collagenous gastritis is a rare disease characterizedby the subepithelial deposition of collagen bandsthicker than 10 μm and the infiltration of inflammatorymononuclear cells in the lamina propria. Collagenouscolitis and collagenous sprue have similar histologicalcharacteristics to collagenous gastritis and are thoughtto be part of the same disease entity. However, whilecollagenous colitis has become more common inthe field of gastroenterology, presenting with clinicalsymptoms of chronic diarrhea in older patients,collagenous gastritis is rare. Since the disease was firstreported in 1989, only 60 cases have been documentedin the English literature. No safe and effective treatmentshave been identified from randomized, controlled trials.Therefore, better understanding of the disease and thereporting of more cases will help to establish diagnosticcriteria and to develop therapeutic strategies. Therefore,here we review the clinical characteristics, endoscopicand histological findings, treatment, and clinical outcomesfrom case reports and case series published to date,and provide a summary of the latest information on thedisease. This information will contribute to improvedknowledge of collagenous gastritis so physicians canrecognize and correctly diagnose the disease, and willhelp to develop a standard therapeutic strategy forfuture clinical trials.

  14. A STUDY OF HYPERBARIC BUPIVACAINE VERSUS ISOBARIC ROPIVACAINE FOR ELECTIVE CAESAREAN DELIVERIES

    Directory of Open Access Journals (Sweden)

    Radha Ramana

    2016-05-01

    Full Text Available OBJECTIVE Is to compare the anaesthetic effects of intrathecal administration of hyperbaric Bupivacaine 10 mg with isobaric Ropivacaine 15 mg for elective caesarean delivery. METHOD 100 parturients of ASA 1 and II posted for elective caesarean delivery were randomly divided into 2 groups of 50 each: Group A received intrathecal 0.5% Hyperbaric Bupivacaine 10 mg and Group B received intrathecal 0.75% isobaric Ropivacaine 15 mg. Time of onset and regression of sensory and motor blocks, haemodynamics, time of first complaint of pain, neonatal APGAR and side-effects were evaluated. RESULTS Ropivacaine group has significantly slower onset of sensory analgesia at T6 (4.45±0.03 in Ropivacaine group as against 2.38±0.36 in Bupivacaine group, p 0.05. There was no difference in the haemodynamics and neonatal APGAR. Neither of the groups had any significant intraoperative or postoperative complications. CONCLUSION Intrathecal Isobaric Ropivacaine 15 mg provides effective spinal anaesthesia for caesarean delivery. It has slower onset, shorter motor block, early sensory regression and similar postoperative analgesia and APGAR scores as compared to 10 mg of 0.5% hyperbaric bupivacaine. The shorter duration of motor block can facilitate early ambulation and makes Ropivacaine a good alternative for elective caesarean deliveries.

  15. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne;

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...

  16. Hyperbaric spinal ropivacaine in lower limb and hip surgery: A comparison with hyperbaric bupivacaine

    Directory of Open Access Journals (Sweden)

    Feroz Ahmad Dar

    2015-01-01

    Conclusion: We conclude that hyperbaric bupivacaine used intrathecally has a faster onset of sensory block and prolonged duration of analgesia compared to hyperbaric ropivacaine group. A more rapid postoperative recovery of sensory and motor function was seen in Group R compared with Group B. However, side effects observed were more in Group B.

  17. Minidose Bupivacaine – Fentanyl Spinal Anesthesia for Cesarean Section In Preeclamptic Parturients

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    N. Fatholahzadeh

    2006-07-01

    Full Text Available Background:Spinal anesthesia for cesarean section is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods: Forty-four preeclamptic parturients undergoing cesarean section were randomized in two groups of 22 patients. Group A received a spinal anesthetic of bupivacaine 6 mg plus fentanyl 20 µg , and group B received 12 mg bupivacaine. Hypotension was defined as a 30% decrease in systolic and diastolic pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 2.5-5 mg up to maximum 50 mg. Results: All patients had satisfactory anesthesia. Five of 22 patients in group A required ephedrine, a single dose of 5 mg. Seventeen of 22 patients in group B required vasopressor support of blood pressure.The lowest recorded systolic,diastolic and mean blood pressures as fractions of the baseline pressures were 71.2%, 64.5% and 70.3% versus 59.9%, 53.5% and 60.2% respectively for group A versus group B. Conclusion: A “minidose” of 6 mg bupivacaine in combination with 20 µg fentanyl may provide satisfactory spinal anesthesia for cesarean section in the preeclamptic patient. The minidose combination caused dramatically less hypotension than 12 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure. 

  18. Effect of epidural 0.25% bupivacaine on somatosensory evoked potentials to dermatomal stimulation

    DEFF Research Database (Denmark)

    Lund, C; Hansen, O B; Kehlet, H

    1989-01-01

    The effect of lumbar epidural analgesia with similar volumes (about 25 ml) of 0.25% and 0.5% bupivacaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients. Level of sensory...

  19. Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy

    DEFF Research Database (Denmark)

    Salale, Nesrin; Treldal, Charlotte; Mogensen, Stine;

    2014-01-01

    Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult...... with a lidocaine spray proved to be a superior option as topical pharyngeal anesthetic before an UGE....

  20. Post-operative pain relief in children following caudal bupivacaine and buprenorphine--a comparative study.

    Directory of Open Access Journals (Sweden)

    Anilkumar T

    1994-04-01

    Full Text Available Eighty-five paediatric patients (age range: 6 mths-12yrs undergoing lower abdominal surgery were studied for post-operative pain relief following either caudal bupivacaine (GpI: n = 43 or buprenorphine (GpII: n = 42. Bupivacaine was administered as 0.5ml/kg body weight of 0.25% solution and buprenorphine as 4 micrograms/ml and volume of 0.5 ml/Kg body weight in normal saline. Post-operatively pain was graded on a 4-point scale and behaviour on a 5-point scale. Any post-operative complications and need for additional analgesia were also noted. Bupivacaine provided good pain relief in the early post-operative hours but buprenorphine provided pain relief lasting for 24 hrs or more post-operatively. Post-operative behaviour of 10 patients receiving buprenorphine was graded as cheerful as compared to 2 from bupivacaine group. Till the end of observation period (i.e. 8 hr post-operatively, majority of patients receiving buprenorphine remained cheerful.

  1. Wound infiltration with ropivacaine and bupivacaine for pain after inguinal herniotomy

    DEFF Research Database (Denmark)

    Erichsen, C J; Vibits, H; Dahl, J B;

    1995-01-01

    and movement on a visual analogue scale (VAS) and by means of pressure algometry. No differences between pain intensities or wound tenderness were found between the groups. The demand for analgesics was similar in the two groups. We conclude that incisional ropivacaine is as effective as bupivacaine...

  2. Evaluation of the effect of magnesium sulphate vs. clonidine as adjunct to epidural bupivacaine

    Directory of Open Access Journals (Sweden)

    Tanmoy Ghatak

    2010-01-01

    Full Text Available For treatment of intra and postoperative pain, no drug has yet been identified that specifically inhibits nociception without associated side effects. Magnesium has antinociceptive effects in animal and human models of pain. The current prospective randomised double-blind study was undertaken to establish the effect of addition of magnesium or clonidine, as adjuvant, to epidural bupivacaine in lower abdominal and lower limb surgeries. A total of 90 American Society of Anesthesiology (ASA grade I and II patients undergoing lower abdominal and lower limb surgeries were enrolled to receive either magnesium sulphate (Group B or clonidine (Group C along with epidural bupivacaine for surgical anaesthesia. All patients received 19 ml of epidural bupivacaine 0.5% along with 50 mg magnesium in group B, 150 mcg clonidine in Group C, whereas in control group (Group A, patients received same volume of normal saline. Onset time, heart rate, blood pressure, duration of analgesia, pain assessment by visual analogue score (VAS and adverse effects were recorded. Onset of anaesthesia was rapid in magnesium group (Group B. In group C there was prolongation of duration of anaesthesia and sedation with lower VAS score, but the incidence of shivering was higher. The groups were similar with respect to haemodynamic variables, nausea and vomiting. The current study establishes magnesium sulphate as a predictable and safe adjunct to epidural bupivacaine for rapid onset of anaesthesia and clonidine for prolonged duration of anaesthesia with sedation.

  3. Dexamethasone prolongs local analgesia after subcutaneous infiltration of bupivacaine microcapsules in human volunteers

    DEFF Research Database (Denmark)

    Holte, Kathrine; Werner, Mads U; Lacouture, Peter G;

    2002-01-01

    BACKGROUND: The addition of small amounts of dexamethasone to extended-release formulations of bupivacaine in microcapsules has been found to prolong local analgesia in experimental studies, but no clinical data are available. METHODS: In a double-blinded study, 12 healthy male volunteers were ra...

  4. BUPIVACAINE INFILTRATION VERSUS DICLOFENAC SUPPOSITORY FOR POST-TONSILLECTOMY PAIN RELIEF IN PAEDIATRIC PATIENTS

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    Nayna S Solanki

    2012-02-01

    Full Text Available Background: Pain management after tonsillectomy in children remains a dilemma for anaesthesiologist. The study was designed to compare the effect of pre-incisional infiltration of Bupivacaine (0.25% versus Diclofenac suppository on postoperative pain relief in children. Methodology: Fifty patients of American Society of Anaesthesiology grade – I, aged between 1 and 15 years undergoing elective tonsillectomy were selected. They were randomly divided equally into group A and B. Five minutes before incision, peritonsillar fossa were infiltrated with 5 ml Bupivacaine(0.25% in group A patients. Group B received Diclofenac suppository 2mg/kg after induction. Intra operatively all patients were observed for vital parameters. Post-operatively all the patients were observed for 24 hours for analgesia using observer pain scale, analgesic requirement, vital data and other complications. Result: Diclofenac suppository is a better option for post-operative analgesia in paediatric patients undergoing tonsillectomy as compared to bupivacaine infiltration as there were significant difference in pain score (P<0.05 after two hours onwards post operatively. Complications like bradycardia, hypotension, allergic reaction and convulsion were not found in either group. Conclusion: Diclofenac suppository is a better option as compared to pre-incisional bupivacaine infiltration because of its convenience and duration of analgesia. [National J of Med Res 2012; 2(1.000: 5-7

  5. A comparative study of magnesium sulfate vs dexmedetomidine as an adjunct to epidural bupivacaine

    Science.gov (United States)

    Shahi, Vaibhav; Verma, Anil Kumar; Agarwal, Apurva; Singh, Chandra Shekhar

    2014-01-01

    Background and Aims: This prospective, randomized, double-blind study was undertaken to establish the effect of addition of magnesium or dexmedetomidine, as an adjuvant, to epidural bupivacaine in lower limb surgeries. Materials and Methods: One hundred and twenty ASA (American Society of Anesthesiologists) class I and II patients undergoing lower limb surgeries were enrolled to receive either magnesium sulfate (Group M) or dexmedetomidine (Group D) along with epidural bupivacaine for surgical anesthesia. All the study subjects received an epidural anesthesia with 14 ml of 0.5% bupivacaine along with either MgSO4 50 mg (Group M) or dexmedetomidine 0.5 μg/kg (Group D) or saline (Group C). The onset of motor and sensory block, duration of block, hemodynamic parameters, and any adverse events were monitored. Results: Analgesia in the postoperative period was better in Group D, duration of sensory and motor blockade was significantly prolonged in Group D and incidence of sedation was more in Group D. Conclusion: Hence, addition of dexemedetomidine to epidural bupivacaine can be advantageous with respect to increased duration of motor and sensory blockade and arousable sedation. PMID:25425781

  6. Unpredictability of regression of analgesia during the continuous postoperative extradural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C; Bigler, D;

    1988-01-01

    Twenty-four otherwise healthy patients scheduled for elective major abdominal surgery received general anaesthesia plus lumbar extradural analgesia. A loading dose of 0.5% plain bupivacaine was given to produce sensory analgesia (pin prick) from T4 to S5 and followed by a continuous infusion of 0...

  7. NERVE BLOCKING (PAIN CONTROL AFTER THORACOTOMY WITH BUPIVACAINE:EPIDURAL VS INTERCOSTAL

    Directory of Open Access Journals (Sweden)

    A GHAFOURI

    2001-09-01

    Full Text Available Introduction. Use of analgesics is an evitable and necessary part of thoracic surgery. This study was designed to compare analgesic effects of persistent thoracic epidural anesthesia versus persistent intercostal nerve block and determine their role in opioid need after thoracotomy. Methods. 116 patients above 20 years old who were candidate for thoracotomy through either posterolateral or thoracoabdominal incision were situatedin one of three group for pain relief. For the first group, pain relieved by petidine and pentazosin. In 2nd group, pain relived by thoracic epidural anesthesia with bupivacaine catheters which were inserted between costal and plural space. In 3rd group, bupivacaine was introduced through 3rd and 4th intercostal space by catheter (2 mg/kg in devided doses. Pain was meseared by visual analogue scale and quantified by surgical residents through a method bupivacaine was injected. If Bupivacaine did not relieve pain, then opioid was used as adjuvant. Results. The study showed that epidural group needed less opioids and had more cooperation in comparison with two other group. The intercostal group complained of pain at chest tube site. Discussion. In thoracotomized patients, pain control is more effective via epidural anesthesia in turns of opioid side effects, expenses and patient comfort.

  8. Lack of postoperative pain relief after hysterectomy using preperitoneally administered bupivacaine

    DEFF Research Database (Denmark)

    Kristensen, Billy Bjarne; Christensen, D S; Østergaard, Mette

    1999-01-01

    bupivacaine (15 mL 2.5 mg/mL) every 4 hours for 48 hours via each catheter starting in the operating room. The placebo group (n = 19) received saline in a like manner. Postoperative pain was evaluated using a visual analog scale (VAS) and verbal rating scale (VRS) twice a day for 2 days at rest...

  9. Comparison of Hyperbaric Levobupivacaine with Hyperbaric Bupivacaine in Unilateral Inguinal Hernia Operations Performed Under Spinal Anesthesia

    Directory of Open Access Journals (Sweden)

    Orhan Gozaydin

    2014-02-01

    Conclusions: Hyperbaric levobupivacaine was found to have similar effects to hyperbaric bupivakain for anesthetic effects, hemodynamic parameters, postoperative analgesic necessity time, and the first 24-hour side effects and complications. Levobupivacaine, having a lesser cardiovascular and central nervous system, was suggested as an alternative to bupivacaine. [Arch Clin Exp Surg 2014; 3(1.000: 1-9

  10. Incorporation of Collagen in Calcium Phosphate Cements for Controlling Osseointegration

    Directory of Open Access Journals (Sweden)

    Ming-Hsien Hu

    2017-08-01

    Full Text Available In this study, we investigated the effect of supplementing a non-dispersive dicalcium phosphate-rich calcium phosphate bone cement (DCP-rich CPC with type I collagen on in vitro cellular activities and its performance as a bone graft material. Varying amounts of type I collagen were added during the preparation of the DCP-rich CPC. In vitro cell adhesion, morphology, viability, and alkaline phosphatase (ALP activity were evaluated using progenitor bone cells. Bone graft performance was evaluated via a rat posterolateral lumbar fusion model and osteointegration of the implant. New bone formations in the restorative sites were assessed by micro-computed tomography (micro-CT and histological analysis. We found that the incorporation of collagen into the DCP-rich CPC was associated with increased cell adhesion, cell viability, and ALP activity in vitro. The spinal fusion model revealed a significant increase in bone regeneration. Additionally, better osseointegration was observed between the host bone and graft with the DCP-rich CPC supplemented with collagen than with the collagen-free DCP-rich CPC control graft. Furthermore, compared to the control graft, the results of micro-CT showed that a smaller amount of residual material was observed with the collagen-containing DCP-rich CPC graft compared with the control graft, which suggests the collagen supplement enhanced new bone formation. Of the different mixtures evaluated in this study (0.8 g DCP-rich CPC supplemented with 0.1, 0.2, and 0.4 mL type I collagen, respectively, DCP-rich CPC supplemented with 0.4 mL collagen led to the highest level of osteogenesis. Our results suggest that the DCP-rich CPC supplemented with collagen has potential to be used as an effective bone graft material in spinal surgery.

  11. Mechanical properties of collagen fibrils

    OpenAIRE

    Wenger, M. P. E.; Bozec, L.; Horton, M. A.; Mesquida, P

    2007-01-01

    The formation of collagen fibers from staggered subfibrils still lacks a universally accepted model. Determining the mechanical properties of single collagen fibrils ( diameter 50 - 200 nm) provides new insights into collagen structure. In this work, the reduced modulus of collagen was measured by nanoindentation using atomic force microscopy. For individual type 1 collagen fibrils from rat tail, the modulus was found to be in the range from 5 GPa to 11.5 GPa ( in air and at room temperature)...

  12. RELATIVE POTENCIES OF MOTOR BLOCKADE AFTER INTRATHECAL ROPIVACAINE, LEVOBUPIVACAINE AND BUPIVACAINE

    Directory of Open Access Journals (Sweden)

    Udayagiri Ravisankar

    2015-12-01

    Full Text Available AIM Ever since the times spinal anaesthesia has been introduced by August Bier, multiple drugs at different dosages, concentrations and differing baricities have been studied. This study was conducted to compare the anaesthetic efficacy of intrathecal isobaric 0.5% ropivacaine, isobaric 0.5% bupivacaine and isobaric levobupivacaine in lower abdominal and lower limb surgeries, in 150 ASA grade I and II patients of both sexes in the age group of 19-65 years undergoing elective surgery under spinal anaesthesia. MATERIALS & METHODS After getting ethical committee approval and informed written consent from the patients, 150 patients were allocated into three groups of 50 patients each. The baseline pulse rate and mean arterial pressure were recorded. The first group A received 3ml of isobaric 0.5% ropivacaine (5mg/ml, the second group received 3ml of isobaric 0.5% bupivacaine and the third group C received 3ml of isobaric levobupivacaine intrathecally. The onset of sensory and motor blocks, duration of sensory and motor blocks was recorded in three groups. RESULTS The results were analyzed statistically using epidemiologically information package. On comparison of data we have found that the intrathecal isobaric 0.5% ropivacaine produces delayed onset of both sensory and motor block but of shorter duration which is statistically significant when compared with that of isobaric 0.5% bupivacaine and levobupivacaine. There is no significant inter-group difference between bupivacaine and levobupivacaine except for the mean duration of sensory block, which is more in levobupivacaine group. The quality of motor block which was assessed by Bromage scale, shows relatively lesser degree of motor block for ropivacaine group, when compared with that of bupivacaine and levobupivacaine groups. The haemodynamics were also recorded. The incidence of hypotension and Bradycardia is more in bupivacaine group. The height of block (peak sensory level is higher for

  13. Melatonin plus porcine bone on discrete calcium deposit implant surface stimulates osteointegration in dental implants.

    Science.gov (United States)

    Calvo-Guirado, José Luis; Gómez-Moreno, Gerardo; Barone, Antonio; Cutando, Antonio; Alcaraz-Baños, Miguel; Chiva, Fernando; López-Marí, Laura; Guardia, Javier

    2009-09-01

    The aim of this study was to evaluate the effect of the topical application of melatonin mixed with collagenized porcine bone to accelerate the osteointegration on the rough discrete calcium deposit (DCD) surface implants in Beagle dogs 3 months after their insertion. In preparation for subsequent insertion of dental implants, lower premolars and molars were extracted from 12 Beagle dogs. Each mandible received three parallel wall implants with discrete calcium deposit (DCD) surface of 4 mm in diameter and 10 mm in length. The implants were randomly assigned to the distal sites on each side of the mandible in three groups: group I implants alone, group II implants with melatonin and group III implants with melatonin and porcine bone. Prior to implanting, 5 mg lyophylized powdered melatonin was applied to one bone hole at each side of the mandible. None was applied at the control sites. Ten histological sections per implant were obtained for histomorphometric studies. After a 4-wk treatment period, melatonin significantly increased the perimeter of bone that was in direct contact with the treated implants (P implants. Topical application of melatonin on DCD surface may act as a biomimetic agent in the placement of endo-osseous dental implants and enhance the osteointegration. Melatonin combined with porcine bone on DCD implants reveals more bone to implant contact at 12 wk (84.5 +/- 1.5%) compared with melatonin treated (75.1 +/- 1.4%) and nonmelatonin treated surface implants (64 +/- 1.4%).

  14. Impact of dental implant insertion method on the peri-implant bone tissue: Experimental study

    Directory of Open Access Journals (Sweden)

    Stamatović Novak

    2013-01-01

    Full Text Available Background/Aim. The function of dental implants depends on their stability in bone tissue over extended period of time, i.e. on osseointegration. The process through which osseointegration is achieved depends on several factors, surgical insertion method being one of them. The aim of this study was to histopathologically compare the impact of the surgical method of implant insertion on the peri-implant bone tissue. Methods. The experiment was performed on 9 dogs. Eight weeks following the extraction of lower premolars implants were inserted using the one-stage method on the right mandibular side and two-stage method on the left side. Three months after implantation the animals were sacrificed. Three distinct regions of bone tissue were histopathologically analyzed, the results were scored and compared. Results. In the specimens of one-stage implants increased amount of collagen fibers was found in 5 specimens where tissue necrosis was also observed. Only moderate osteoblastic activity was found in 3 sections. The analysis of bone-to-implant contact region revealed statistically significantly better results regarding the amount of collagen tissue fibers for the implants inserted in the two-stage method (Wa = 59 105, α = 0.05. No necrosis and osteoblastic activity were observed. Conclusion. Better results were achieved by the two-stage method in bone-to-implant contact region regarding the amount of collagen tissue, while the results were identical regarding the osteoblastic activity and bone tissue necrosis. There was no difference between the methods in the bone-implant interface region. In the bone tissue adjacent to the implant the results were identical regarding the amount of collagen tissue, osteoblastic reaction and bone tissue necrosis, while better results were achieved by the two-stage method regarding the number of osteocytes.

  15. Comparative study on the clinical effects of two collagen barrier membranes in guided bone regeneration in dental implant%两种胶原膜在牙种植中引导骨再生的对照研究

    Institute of Scientific and Technical Information of China (English)

    石艳; 严宁; 何维兴

    2016-01-01

    目的:比较在牙种植引导骨再生术中,海奥口腔修复膜和Bio-Gide胶原膜的临床修复效果。方法:选取单颗牙缺失的患者82例,行引导骨再生手术修复种植区骨缺损并同期植入种植体82枚,随机分为实验组和对照组,每组41例。两组患者均采用天博骨粉作骨移植物,实验组采用海奥口腔修复膜行引导骨再生;对照组采用Bio-Gide胶原膜行引导骨再生。观察二期手术时植骨区外形及牙龈状况,比较两组的骨再生效果及不良反应发生率;修复后随访观察1年,比较两组的修复成功率。结果:82枚种植体均与骨组织形成良好的骨结合,骨再生效果及不良反应发生率实验组与对照组相当,差异无统计学意义(P>0.05),种植修复成功率均为100%。修复后随访1年,种植体均成功负载。结论:采用海奥口腔修复膜和Bio-Gide胶原膜均能取得满意的骨再生效果,但采用海奥口腔修复膜更为经济,值得临床推广。%ObjectiveThe aim of this study was to compare clinical effects of Heal-all oral bioiflm and Bio-Gide membrane on guided bone regeneration in dental implant.Methods Eighty-two implants were placed in Eighty-two single tooth missing patients with bone defects in the implantation area and simultaneous guided bone regeneration. All the subjects were randomly divided into experimental group and the control group (n = 41). Bone defects around implants were repaired by guided bone regeneration technique with Heal-all oral bioiflm and Bio-Gide membrane respectively. To observe the shape and gingival status of bone defects when stage II operation was performed,the amount of new-formed bone tissue and adverse reaction rate of the two groups was compared. After 1 year follow-up, the success rate of the two groups was compared. Results Osseointegration was formed well between implants and bone tissue in all Eighty-two patients. The difference of bone

  16. COMPARISON OF DEXMEDETOMIDINE, BUPRENORPHINE AND FENTANYL AS AN ADJUVANT TO BUPIVACAINE DURING SPINAL ANAESTHESIA FOR HEMIARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Pradeep R

    2016-10-01

    Full Text Available BACKGROUND Opioids such as fentanyl or buprenorphine are being added as adjuvant to local anaesthetic for spinal anaesthesia. Dexmedetomidine, a new α2 agonist is being tried as an adjuvant in the recent times. MATERIALS AND METHODS The patients were randomised into three Groups (n=30 each by closed envelope technique. Patients in Group 1 received 10 µg fentanyl with 15 mg of 0.5% hyperbaric bupivacaine, Group 2 received 15 mg of 0.5% hyperbaric bupivacaine supplemented with 30 µg of buprenorphine and Group 3 received 15 mg of 0.5% hyperbaric bupivacaine plus 5 µg dexmedetomidine intrathecally. The time to reach maximum sensory and motor level, the regression time of the same, any adverse effects were recorded. Data were analysed using chi-square test or Fisher’s exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was accepted as statistically significant. Settings and Design- The study was conducted in a prospective, randomised and double-blind manner. It included ninety American Society of Anaesthesiologists class I and II patients undergoing hemiarthroplasty under spinal anaesthesia. RESULTS In this study, the patients in dexmedetomidine group showed significantly longer duration of motor block (240±20 mins. and sensory blockade (180±22.2 mins. compared to other groups, which is statistically significant (P=0.0001 and P=0.006, respectively. The time to first request of analgesic postoperatively was also longer (260±30.2 in dexmedetomidine group when compared with other groups (P=0.0001. Haemodynamic parameters were stable and there were no complications in any group. CONCLUSIONS We concluded that intrathecal dexmedetomidine (5 µg with bupivacaine provides significantly longer duration of sensory and motor blockade and longer duration for first request of analgesia in the recovery than intrathecal buprenorphine (30 µg or fentanyl (10 µg with bupivacaine for spinal anaesthesia for

  17. The analgesic efficacy of continuous presternal bupivacaine infusion through a single catheter after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Dalia Abdelhamid Nasr

    2015-01-01

    Full Text Available Background: Median sternotomy, sternal spreading, and sternal wiring are the main causes of pain during the early recovery phase following cardiac surgery. Aim: This study was designed to evaluate the analgesic efficacy of continuous presternal bupivacaine infusion through a single catheter after parasternal block following cardiac surgery. Materials and Methods: The total of 40 patients (American Society of Anesthesiologist status II, III, 45-60 years old, undergoing coronary - artery bypass grafting were enrolled in this prospective, randomized, double-blind study. A presternal catheter was inserted with continuous infusion of 5 mL/h bupivacaine 0.25% (Group B or normal saline (Group C during the first 48 postoperative hrs. Primary outcomes were postoperative morphine requirements and pain scores, secondary outcomes were extubation time, postoperative respiratory parameters, incidence of wound infection, Intensive Care Unit (ICU and hospital stay duration, and bupivacaine level in blood. Statistical Methods: Student′s t-test was used to analyze the parametric data and Chi-square test for categorical variables. Results: During the postoperative 48 h, there was marked reduction in morphine requirements in Group B compared to Group C, (8.6 ± 0.94 mg vs. 18.83 ± 3.4 mg respectively, P = 0.2, lower postoperative pain scores, shorter extubation time (117 ± 10 min vs. 195 ± 19 min, respectively, P = 0.03, better respiratory parameters (PaO 2 /FiO 2, PaCO 2 and pH, with no incidence of wound infection, no differences in ICU or hospital stay duration. The plasma concentration of bupivacaine remained below the toxic threshold (at T24, 1.2 ug/ml ± 0.3 and T48 h 1.7 ± 0.3 ug/ml. Conclusion: Continuous presternal bupivacaine infusion has resulted in better postoperative analgesia, reduction in morphine requirements, shorter time to extubation, and better postoperative respiratory parameters than the control group.

  18. Cold bupivacaine versus magnesium sulfate added to room temperature bupivacaine in sonar-guided femoral and sciatic nerve block in arthroscopic anterior cruciate ligament reconstruction surgery

    Science.gov (United States)

    Alzeftawy, Ashraf Elsayed; El-Daba, Ahmad Ali

    2016-01-01

    Background: Cooling of local anesthetic potentiates its action and increases its duration. Magnesium sulfate (MgSo4) added to local anesthetic prolongs the duration of anesthesia and postoperative analgesia with minimal side effects. Aim: The aim of this prospective, randomized, double-blind study was to compare the effect of cold to 4°C bupivacaine 0.5% and Mg added to normal temperature (20–25°C) bupivacaine 0.5% during sonar-guided combined femoral and sciatic nerve blocks on the onset of sensory and motor block, intraoperative anesthesia, duration of sensory and motor block, and postoperative analgesia in arthroscopic anterior cruciate ligament (ACL) reconstruction surgery. Patients and Methods: A total of 90 American Society of Anesthesiologists classes I and II patients who were scheduled to undergo elective ACL reconstruction were enrolled in the study. The patients were randomly allocated to 3 equal groups to receive sonar-guided femoral and sciatic nerve blocks. In Group I, 17 ml of room temperature (20–25°C) 0.5% bupivacaine and 3 ml of room temperature saline were injected for each nerve block whereas in Group II, 17 ml of cold (4°C) 0.5% bupivacaine and 3 ml of cold saline were injected for each nerve block. In Group III, 17 ml of room temperature 0.5% bupivacaine and 3 ml of MgSo4 5% were injected for each nerve block. The onset of sensory and motor block was evaluated every 3 min for 30 min. Surgery was started after complete sensory and motor block were achieved. Intraoperatively, the patients were evaluated for heart rate and mean arterial pressure, rescue analgesic and sedative requirements plus patient and surgeon satisfaction. Postoperatively, hemodynamics, duration of analgesia, resolution of motor block, time to first analgesic, total analgesic consumption, and the incidence of side effects were recorded. Results: There was no statistically significant difference in demographic data, mean arterial pressure, heart rate, and duration of

  19. The Effects of Bupivacaine and Ropivacaine on Baroreflex Sensitivity With or Without Respiratory Acidosis and Alkalosis in Rats

    National Research Council Canada - National Science Library

    Watanabe, Yukinaga; Dohi, Shuji; Iida, Hiroki; Ishiyama, Tadahiko

    1997-01-01

    ...) depression that could be enhanced in the presence of respiratory acidosis.We examined a potential suppression of baroreflex function with bupivacaine and ropivacaine during hypercapnic acidosis or hypocapnic alkalosis...

  20. Intraarticular glucocorticoid, morphine and bupivacaine reduces pain and convalescence after arthroscopic ankle surgery: a randomized study of 36 patients

    DEFF Research Database (Denmark)

    Rasmussen, S; Kehlet, H

    2000-01-01

    In a double-blind randomized study, 36 patients undergoing arthroscopic removal of bony spurs and synovitis causing impingement of the ankle were allocated to intraarticular saline or bupivacaine 15 mg + morphine 5 mg + intraarticular methylprednisolone 40 mg. Combined methylprednisolone...

  1. The effect of sub-Tenon's bupivacaine on oculocardiac reflex during strabismus surgery and postoperative pain: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Talebnejad

    2017-01-01

    Conclusions: Sub-Tenon injection of bupivacaine as a local anesthetic can significantly prevent OCR and decrease the severity of bradycardia. This technique can also diminish postoperative pain in patients who underwent strabismus surgery.

  2. A randomized controlled double-blinded prospective study of the efficacy of clonidine added to bupivacaine as compared with bupivacaine alone used in supraclavicular brachial plexus block for upper limb surgeries

    Directory of Open Access Journals (Sweden)

    Shivinder Singh

    2010-01-01

    Full Text Available We compared the effects of clonidine added to bupivacaine with bupivacaine alone on supraclavicular brachial plexus block and observed the side-effects of both the groups. In this prospective, randomized,double-blinded, controlled trial, two groups of 25 patients each were investigated using (i 40 ml of bupivacaine 0.25% plus 0.150 mg of clonidine and (ii 40 ml of bupivacaine 0.25% plus 1 ml of NaCl 0.9, respectively. The onset of motor and sensory block and duration of sensory block were recorded along with monitoring of heart rate, non-invasive blood pressure, oxygen saturation and sedation. It was observed that addition of clonidine to bupivacaine resulted in faster onset of sensory block, longer duration of analgesia (as assessed by visual analogue score, prolongation of the motor block (as assessed by modified Lovett Rating Scale, prolongation of the duration of recovery of sensation and no association with any haemodynamic changes (heart rate and blood pressure, sedation or any other adverse effects. These findings suggest that clonidine added to bupivacaine is an attractive option for improving the quality and duration of supraclavicular brachial plexus block in upper limb surgeries.

  3. Onset Time of 2% Lidocaine and 0.5% Bupivacaine Mixture versus 0.5% Bupivacaine Alone using Ultrasound and Double Nerve Stimulation for Infraclavicular Brachial Plexus Anesthesia in ESRD Patients Undergoing Arteriovenous Fistula Creation.

    Science.gov (United States)

    Pongraweewan, Orawan; Inchua, Nipa; Kitsiripant, Chanatthee; Kongmuang, Benchawan; Tiwirach, Wannapa

    2016-05-01

    To reduce the onset of 0.5% bupivacaine by adding 2% lidocaine with 0.5% bupivacaine for ultrasound-guided and double stimulation technique at musculocutaneous and radial nerve for infraclavicular brachial plexus block. Prospective randomized double-blinded, controlled trial study. 90 patients undergoing creation of arteriovenous fistula under ultrasound-guided infraclavicular brachial plexus block were randomized into 2 groups. Gr B (46 patients) received 0.5% bupivacaine 30 mL and Gr BL (44 patients) received mixture of 0.5% bupivacaine 20 mL and 2% lidocaine 10 mL. The onset of sensory block were assessed by response to pinprick (grading: 0 = no sensation, 1 = hypoesthesia, and 2 = normal sensation). Rescue analgesia during the operation, duration of sensory and motor blockade were recorded. Surgeon and patient satisfactions are also evaluated using 6-point scale (0 = dissatisfied to 5 = very satisfied). There were no significant difference in the onset time of either group. Duration of sensory and motor block was not different. Surgeons' and patients' satisfaction were also not significantly different between the groups. Mixing 2% lidocaine with 0.5% bupivacaine to the final concentration of 0.67%for lidocaine and 0.33% for bupivacaine does not reduce the onset of ultrasound-guided infraclavicular brachial plexus block.

  4. Effects of labor analgesia on maternal and neonatal outcome by epidural low concentration of bupivacaine combined with anisodamine

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To observe the effects of labor analgesia on maternal and neonatal outcome by epidural application of 0.125% bupivacaine combined with anisodamine on the labor stage, and modes of delivery and neonatal Apgar's score. Methods A total of 220 primiparaes with full-term pregnancy, monocyesis and fetal head presentation without any obstetrical or systematic complications were chosen and divided into analgesic group and control group (110 in each group). The mixture of bupivacaine and anisodamine was in...

  5. Mass transfer of large molecules through collagen and collagen-silica hybrid membranes

    Science.gov (United States)

    Jofre-Lora, Pedro

    Diabetes is a growing concern in the United States and around the world that must be addressed through new treatment options. Current standard treatment options of diabetes are limiting and have tremendous impacts on patient's lives. Emerging therapies, such as the implantation of encapsulated islets, are promising treatment options, but have not yet materialized due to unsolved problems with material properties. Hybrid silica-collagen membranes address some of these unsolved problems and are a promising material for cell encapsulation. However, the mass transfer properties of large molecules, such as insulin, TNF-alpha, IL1beta, and other important proteins in the etiology of diabetes, through these hybrid membranes are poorly characterized. In order to begin characterizing these properties, a device was constructed to accurately and efficiently measure the mass transfer of other similar large molecules, fluorescein isothiocyanate dextrans (FITC-dextran), through collagen-silica hybrid membranes. The device was used to measure diffusion coefficients of 4, 20, 40, and 150 kDa FITC-dextrans through non-silicified and silicified samples of 200 and 1000 Pa porcine skin collagen. Diffusion coefficients were found to be in the 10-7-10-6 cm2s -1 range, which is in agreement with previously published data for similar molecules through similar hydrogels. The effects of collagen stiffness, FITC-dextran molecular weight, and silicification treatment on diffusion were investigated. It was found that collagen stiffness and FITC-dextran molecular weight had a negative correlation with diffusion, whereas silicification treatment had no global impact on diffusion. The device created, and the results of this preliminary investigation, can be used to develop collagen-silica hybrid membranes as an alternative material for cell encapsulation in a forward-design manner.

  6. Corneal collagen crosslinking for keratoconus. A review

    Directory of Open Access Journals (Sweden)

    M. M. Bikbov

    2014-10-01

    C, and collagen fiber diameter increase by 12.2 % (anterior stroma and 4.6 % (posterior stroma. In mild bullous keratopathy, corneal crosslinking provides antimicrobial effect. In moderate and severe keratopathy, crosslinking reduces pain and corneal edema and improves visual acuity immediately after the procedure. A case of HSV keratitis exacerbation was described. Amongst the complications, infection, halos, and posterior segment damage should be mentioned. Poor refractive results can be improved by the implantation of intrastromal corneal ring segments.

  7. Corneal collagen crosslinking for keratoconus. A review

    Directory of Open Access Journals (Sweden)

    M. M. Bikbov

    2014-01-01

    C, and collagen fiber diameter increase by 12.2 % (anterior stroma and 4.6 % (posterior stroma. In mild bullous keratopathy, corneal crosslinking provides antimicrobial effect. In moderate and severe keratopathy, crosslinking reduces pain and corneal edema and improves visual acuity immediately after the procedure. A case of HSV keratitis exacerbation was described. Amongst the complications, infection, halos, and posterior segment damage should be mentioned. Poor refractive results can be improved by the implantation of intrastromal corneal ring segments.

  8. Collagen metabolism in obesity

    DEFF Research Database (Denmark)

    Rasmussen, M H; Jensen, L T; Andersen, T

    1995-01-01

    OBJECTIVE: To investigate the impact of obesity, fat distribution and weight loss on collagen turnover using serum concentrations of the carboxyterminal propeptide of type I procollagen (S-PICP) and the aminoterminal propeptide of type III pro-collagen (S-PIIINP) as markers for collagen turnover...... (r = 0.37; P = 0.004), height (r = 0.27; P = 0.04), waist circumference (r = 0.35; P = 0.007), as well as with WHR (r = 0.33; P = 0.01) and was inversely correlated to age (r = -0.40; P = 0.002). Compared with randomly selected controls from a large pool of healthy volunteers, the obese patients had...... restriction (P obesity and associated with body fat distribution, suggesting...

  9. Hydroxyapatite reinforced collagen scaffolds with improved architecture and mechanical properties.

    Science.gov (United States)

    Kane, Robert J; Weiss-Bilka, Holly E; Meagher, Matthew J; Liu, Yongxing; Gargac, Joshua A; Niebur, Glen L; Wagner, Diane R; Roeder, Ryan K

    2015-04-01

    Hydroxyapatite (HA) reinforced collagen scaffolds have shown promise for synthetic bone graft substitutes and tissue engineering scaffolds. Freeze-dried HA-collagen scaffolds are readily fabricated and have exhibited osteogenicity in vivo, but are limited by an inherent scaffold architecture that results in a relatively small pore size and weak mechanical properties. In order to overcome these limitations, HA-collagen scaffolds were prepared by compression molding HA reinforcements and paraffin microspheres within a suspension of concentrated collagen fibrils (∼ 180 mg/mL), cross-linking the collagen matrix, and leaching the paraffin porogen. HA-collagen scaffolds exhibited an architecture with high porosity (85-90%), interconnected pores ∼ 300-400 μm in size, and struts ∼ 3-100 μm in thickness containing 0-80 vol% HA whisker or powder reinforcements. HA reinforcement enabled a compressive modulus of up to ∼ 1 MPa, which was an order of magnitude greater than unreinforced collagen scaffolds. The compressive modulus was also at least one order of magnitude greater than comparable freeze-dried HA-collagen scaffolds and two orders of magnitude greater than absorbable collagen sponges used clinically. Moreover, scaffolds reinforced with up to 60 vol% HA exhibited fully recoverable elastic deformation upon loading to 50% compressive strain for at least 100,000 cycles. Thus, the scaffold mechanical properties were well-suited for surgical handling, fixation, and bearing osteogenic loads during bone regeneration. The scaffold architecture, permeability, and composition were shown to be conducive to the infiltration and differentiation of adipose-derive stromal cells in vitro. Acellular scaffolds were demonstrated to induce angiogenesis and osteogenesis after subcutaneous ectopic implantation by recruiting endogenous cell populations, suggesting that the scaffolds were osteoinductive.

  10. Protective effects of bupivacaine against kainic acid-induced seizure and neuronal cell death in the rat hippocampus.

    Science.gov (United States)

    Chiu, Kuan Ming; Wu, Chia Chan; Wang, Ming Jiuh; Lee, Ming Yi; Wang, Su Jane

    2015-01-01

    The excessive release of glutamate is a critical element in the neuropathology of epilepsy, and bupivacaine, a local anesthetic agent, has been shown to inhibit the release of glutamate in rat cerebrocortical nerve terminals. This study investigated whether bupivacaine produces antiseizure and antiexcitotoxic effects using a kainic acid (KA) rat model, an animal model used for temporal lobe epilepsy, and excitotoxic neurodegeneration experiments. The results showed that administering bupivacaine (0.4 mg/kg or 2 mg/kg) intraperitoneally to rats 30 min before intraperitoneal injection of KA (15 mg/kg) increased seizure latency and reduced the seizure score. In addition, bupivacaine attenuated KA-induced hippocampal neuronal cell death, and this protective effect was accompanied by the inhibition of microglial activation and production of proinflammatory cytokines such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α in the hippocampus. Moreover, bupivacaine shortened the latency of escaping onto the platform in the Morris water maze learning performance test. Collectively, these data suggest that bupivacaine has therapeutic potential for treating epilepsy.

  11. Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

    Science.gov (United States)

    Sancho-Puchades, Manuel; Vílchez-Pérez, Miguel A.; Paredes-García, Jordi; Berini-Aytés, Leonardo; Gay-Escoda, Cosme

    2012-01-01

    Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability. Key words:Bupivacaine, articaine, third molar, anesthesia, postoperative pain. PMID:22143739

  12. Comparison of 0.5% Bupivacaine and 0.5% Ropivacaine epidurally in lower limb orthopaedic surgeries

    Directory of Open Access Journals (Sweden)

    Ushma D. Shah

    2017-01-01

    Full Text Available Background: Ropivacaine in equi-potent concentrations with bupivacaine, the degree of motor blockade is less pronounced with ropivacaine, and there is a greater propensity for blocking pain transmitting A-delta and C fibres rather than A-α motor fibres. It appears to have most of the blocking characteristics of bupivacaine. So we have undertaken the study to compare ropivacaine 0.5% (20ml and bupivacaine 0.5% (20ml for epidural anaesthesia in patients undergoing lower limb orthopaedic surgeries. Methods: This double-blind, randomized study involves 60 patients who were undergone orthopaedic surgery, having ASA-I or ASA-II physical status. Out of 60, 30 patients received 20 ml of 0.5% ropivacaine and 30 patients received 20 ml of 0.5% bupivacaine at the L3, 4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, peak time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset. Results: Epidurally, Ropivacaine in comparison to Bupivacaine provides quicker onset, early peak effect and prolonged duration of sensory block and shorter duration of motor block. Ropivacaine provides prolonged effective analgesia. It reduces requirement of rescue analgesics and related side effects. Conclusions: Ropivacaine 0.5% is safer and effective alternative to Bupivacaine in epidural anaesthesia and post operative pain relief.

  13. The effects of bupivacaine and ropivacaine on baroreflex sensitivity with or without respiratory acidosis and alkalosis in rats.

    Science.gov (United States)

    Watanabe, Y; Dohi, S; Iida, H; Ishiyama, T

    1997-02-01

    Systemic toxicity of local anesthetics causes cardiac and central nervous system (CNS) depression that could be enhanced in the presence of respiratory acidosis. We examined a potential suppression of baroreflex function with bupivacaine and ropivacaine during hypercapnic acidosis or hypocapnic alkalosis. Baroreflex sensitivity (BRS) was randomly tested in rats with one of 13 conditions during intravenous administration of saline (control), bupivacaine 1, 2, or 3 mg/kg, or ropivacaine 2, 4, or 6 mg/kg. The effects of bupivacaine (3 mg/kg) or ropivacaine (6 mg/kg) on BRS were also examined during hypercapnic acidosis or hypocapnic alkalosis. The BRS was assessed using a value of delta heart rate/ delta mean arterial pressure after infusion of phenylephrine (3 micrograms/kg). Both bupivacaine and ropivacaine (at the largest dose) significantly suppressed BRS. Acute respiratory acidosis (pHa 7.24 +/- 0.04, Paco2 63 +/- 4 mm Hg) enhanced BRS. The BRS enhanced during acidosis was also suppressed with bupivacaine and ropivacaine, but less so than in the absence of acidosis. The presence of hypocapnic alkalosis (pHa 7.55 +/- 0.03, Paco2 25 +/- 2 mm Hg) did not affect BRS and reversed BRS suppression caused by both drugs. Thus, bupivacaine and ropivacaine affect neuronal control mechanisms for maintaining cardiovascular stability, and acute changes of respiration could significantly modify such suppression.

  14. Collagen Homeostasis and Metabolism

    DEFF Research Database (Denmark)

    Magnusson, S Peter; Heinemeier, Katja M; Kjaer, Michael

    2016-01-01

    The musculoskeletal system and its collagen rich tissue is important for ensuring architecture of skeletal muscle, energy storage in tendon and ligaments, joint surface protection, and for ensuring the transfer of muscular forces into resulting limb movement. Structure of tendon is stable...... inactivity or immobilization of the human body will conversely result in a dramatic loss in tendon stiffness and collagen synthesis. This illustrates the importance of regular mechanical load in order to preserve the stabilizing role of the connective tissue for the overall function of the musculoskeletal...

  15. Lipid Emulsion Inhibits Vasodilation Induced by a Toxic Dose of Bupivacaine via Attenuated Dephosphorylation of Myosin Phosphatase Target Subunit 1 in Isolated Rat Aorta.

    Science.gov (United States)

    Ok, Seong-Ho; Byon, Hyo-Jin; Kwon, Seong-Chun; Park, Jungchul; Lee, Youngju; Hwang, Yeran; Baik, Jiseok; Choi, Mun-Jeoung; Sohn, Ju-Tae

    2015-01-01

    Lipid emulsions are widely used for the treatment of systemic toxicity that arises from local anesthetics. The goal of this in vitro study was to examine the cellular mechanism associated with the lipid emulsion-mediated attenuation of vasodilation induced by a toxic dose of bupivacaine in isolated endothelium-denuded rat aorta. The effects of lipid emulsion on vasodilation induced by bupivacaine, mepivacaine, and verapamil were assessed in isolated aorta precontracted with phenylephrine, the Rho kinase stimulant NaF, and the protein kinase C activator phorbol 12,13-dibutyrate (PDBu). The effects of Rho kinase inhibitor Y-27632 on contraction induced by phenylephrine or NaF were assessed. The effects of bupivacaine on intracellular calcium concentrations ([Ca(2+)]i) and tension induced by NaF were simultaneously measured. The effects of bupivacaine alone and lipid emulsion plus bupivacaine on myosin phosphatase target subunit 1 (MYPT1) phosphorylation induced by NaF were examined in rat aortic vascular smooth muscle cells. In precontracted aorta, the lipid emulsion attenuated bupivacaine-induced vasodilation but had no effect on mepivacaine-induced vasodilation. Y-27632 attenuated contraction induced by either phenylephrine or NaF. The lipid emulsion attenuated verapamil-induced vasodilation. Compared with phenylephrine-induced precontracted aorta, bupivacaine-induced vasodilation was slightly attenuated in NaF-induced precontracted aorta. The magnitude of the bupivacaine-induced vasodilation was higher than that of a bupivacaine-induced decrease in [Ca(2+)]i. Bupivacaine attenuated NaF-induced MYPT1 phosphorylation, whereas lipid emulsion pretreatment attenuated the bupivacaine-induced inhibition of MYPT1 phosphorylation induced by NaF. Taken together, these results suggest that lipid emulsions attenuate bupivacaine-induced vasodilation via the attenuation of inhibition of MYPT1 phosphorylation evoked by NaF.

  16. INFLUENCE OF INTRAVENOUS DEXMEDETOMIDINE INFUSION ON SUBARACHNOID BLOCK WITH BUPIVACAINE IN ADULT INGUINAL HERNIORRHAPHIES

    Directory of Open Access Journals (Sweden)

    Suhara

    2014-09-01

    Full Text Available INTRODUCTION: Central neuraxial blocks with local anaesthetics are popular techniques of anaesthesia which have been extensively used for lower abdominal surgery. Subarachnoid block is a simple technique which requires a small dose of local anaesthetic to provide rapid and reliable surgical anaesthesia and minimal risk of drug toxicity. Duration of spinal anaesthesia may be prolonged by addition of opioids, clonidine, neostigmine, or vasoconstrictor agents to the local anesthetic drug for better post-op pain relief. Intrathecal addition of a low dose of α2-agonist like clonidine or dexmedetomidine results in significant prolongation of the duration of the sensory and motor blockade induced by hyperbaric bupivacaine. This study is designed to investigate the effects of intravenous dexmedetomidine on the duration of sensory and motor blockade induced by intrathecal administration of bupivacaine, and its associated adverse events. AIMS AND OBJEVCTIVES: To determine effect of intravenous Dexmedetomidine on the duration of analgesia with spinal Bupivacaine for adult patients undergoing herniorrhaphy and to assess the incidence of intra operative side effects, if any. STUDY SETTING: This study was done under the department of Anaesthesiology, Azeezia Medical College from March 2013 to October 2013. STUDY DESIGN: A double blind prospective randomized control study was done.50 adults aged 20 to 60 years scheduled for herniorrhaphies were allocated into two study groups, named A and B using computer generated randomization. INTERPRETATIONS AND CONCLUSION: The duration of analgesia of subarachnoid block with heavy 0.5% bupivacaine with intravenous infusion of saline and dexmedetomidine were compared. Post-operative pain was evaluated by Visual Analogue Scale. Duration of analgesia is the time taken from the administration of the drug to the time when the patient complains of pain of > 50 in Visual Analogue Scale. The duration of analgesia was longest in

  17. QUANTITATIVE INVIVO ASSESSMENT OF THE TISSUE-RESPONSE TO DERMAL SHEEP COLLAGEN IN ABDOMINAL-WALL DEFECTS

    NARCIS (Netherlands)

    HUNT, JA; VANDERLAAN, JS; SCHAKENRAAD, J; WILLIAMS, DF

    1993-01-01

    We quantified the tissue response, tissue organization and patency of biodegradable patches for the repair of abdominal wall defects. We used dermal sheep collagen, cross-linked with hexamethylenediisocyanate in a model. The collagen patches were implanted either untreated or plasma polymerized with

  18. REDUCED WOUND CONTRACTION AND SCAR FORMATION IN PUNCH BIOPSY WOUNDS - NATIVE COLLAGEN DERMAL SUBSTITUTES - A CLINICAL-STUDY

    NARCIS (Netherlands)

    DEVRIES, HJC; ZEEGELAAR, JE; MIDDELKOOP, E; GIJSBERS, G; VANMARLE, J; WILDEVUUR, CHR; WESTERHOF, W

    In full-thickness skin wounds dermal regeneration usually fails, resulting in scar formation and wound contraction. We studied dermal regeneration by implantation of collagenous matrices in a human punch biopsy wound model. Matrices were made of native bovine collagen I fibres, and either hyaluronic

  19. Corneal collagen cross-linking

    Directory of Open Access Journals (Sweden)

    Jankov II Mirko

    2010-01-01

    Full Text Available Corneal collagen cross-linking (CXL with riboflavin and ultraviolet-A (UVA is a new technique of corneal tissue strengthening by using riboflavin as a photosensitizer and UVA to increase the formation of intra- and interfibrillar covalent bonds by photosensitized oxidation. Keratocyte apoptosis in the anterior segment of the corneal stroma all the way down to a depth of about 300 microns has been described and a demarcation line between the treated and untreated cornea has been clearly shown. It is important to ensure that the cytotoxic threshold for the endothelium has not been exceeded by strictly respecting the minimal corneal thickness. Confocal microscopy studies show that repopulation of keratocytes is already visible 1 month after the treatment, reaching its pre-operative quantity and quality in terms of functional morphology within 6 months after the treatment. The major indication for the use of CXL is to inhibit the progression of corneal ectasias, such as keratoconus and pellucid marginal degeneration. CXL may also be effective in the treatment and prophylaxis of iatrogenic keratectasia, resulting from excessively aggressive photoablation. This treatment has also been used to treat infectious corneal ulcers with apparent favorable results. Combination with other treatments, such as intracorneal ring segment implantation, limited topography-guided photoablation and conductive keratoplasty have been used with different levels of success.

  20. Effect of 50% enantiomeric excess bupivacaine mixture combined with pancuronium on neuromuscular transmission in rat phrenic nerve-diaphragm preparation; a pilot study.

    Science.gov (United States)

    de Assunção Braga, Angelica de Fátima; Carvalho, Vanessa Henriques; da Silva Braga, Franklin Sarmento; Potério, Gloria Maria Braga; Santos, Filipe Nadir Caparica; Junqueira, Fernando Eduardo Féres

    2015-11-01

    Local anaesthetics are drugs that are widely used in clinical practice. However, the effects of these drugs on the neuromuscular junction and their influence on the blockade produced by non-depolarising neuromuscular blocking drugs are still under investigation. The aim of this study was to evaluate, in vitro, the influence of a 50% enantiomeric excess bupivacaine mixture on neuromuscular transmission and neuromuscular block produced by pancuronium. Rats were distributed into three groups (n = 5) according to the drug studied namely, 50% enantiomeric excess bupivacaine mixture (5 μg/mL); pancuronium (2 μg/mL); 50% enantiomeric excess bupivacaine mixture + pancuronium. The following parameters were evaluated: (1) Effects of a 50% enantiomeric excess bupivacaine mixture on membrane potential (MP) and miniature endplate potentials (MEPPs); (2) amplitude of diaphragmatic response before and 60 min after the addition of a 50% enantiomeric excess bupivacaine mixture; the degree of neuromuscular block with pancuronium and pancuronium combined with a 50% enantiomeric excess bupivacaine mixture. A 50% enantiomeric excess bupivacaine mixture did not alter the amplitude of muscle response (MP) but decreased the frequency and amplitude of MEPP. The block produced by pancuronium was potentiated by a 50% enantiomeric excess bupivacaine mixture. A 50% enantiomeric excess bupivacaine mixture used alone did not affect neuromuscular transmission, but potentiated the neuromuscular block produced by pancuronium. No action was shown on the muscle fibre, and alterations on MEPPs demonstrated a presynaptic action.

  1. [The genetics of collagen diseases].

    Science.gov (United States)

    Kaplan, J; Maroteaux, P; Frezal, J

    1986-01-01

    Heritable disorders of collagen include Ehler-Danlos syndromes (11 types are actually known), Larsen syndrome and osteogenesis imperfecta. Their clinical, genetic and biochemical features are reviewed. Marfan syndrome is closely related to heritable disorders of collagen.

  2. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H

    1994-01-01

    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...... after 2 weeks in the diaphyseal fractures and after 6 weeks in the condylar fractures. The degradation of type I collagen increased after 4 days and reached a maximum at 2 weeks in both groups. The interindividual variation was wide. On a group basis, the turnover of types I and III collagen had...

  3. Condensed cellular seeded collagen gel as an improved biomaterial for tissue engineering of articular cartilage.

    Science.gov (United States)

    Mueller-Rath, Ralf; Gavénis, Karsten; Andereya, Stefan; Mumme, Torsten; Albrand, Monique; Stoffel, Marcus; Weichert, Dieter; Schneider, Ulrich

    2010-01-01

    Three-dimensional autologous chondrocyte implantation based on collagen gel as matrix scaffold has become a clinically applied treatment for focal defects of articular cartilage. However, the low biomechanical properties of collagen gel makes intraoperative handling difficult and creates the risk of early damages to the vulnerable implant. The aim of the study was to create a stabilized form of collagen gel and to evaluate its biomechanical and biochemical properties.Collagen type-I gel was seeded with human articular chondrocytes. 20 samples were subject to condensation which was achieved mechanically by compression and filtration. Control samples were left uncondensed. From both types of gels 10 samples were used for initial biomechanical evaluation by means of unconfined compression and 10 samples were cultivated under standard conditions in vitro. Following cultivation the samples were evaluated by conventional histology and immunohistochemistry. The proliferation rate was calculated and matrix gene expression was quantified by real-time PCR.The biomechanical tests revealed a higher force carrying capacity of the condensed specimens. Strain rate dependency and relaxation was seen in both types of collagen gel representing viscoelastic material properties. Cells embedded within the condensed collagen gel were able to produce extracellular matrix proteins and showed proliferation.Condensed collagen gel represents a mechanically improved type of biomaterial which is suitable for three-dimensional autologous chondrocyte implantation.

  4. COMPARATIVE STUDY BETWEEN INTRATHECAL BUPIVACAINE WITH DEXMEDETOMIDINE AND INTRATHECAL BUPIVACAINE WITH FENTANYL FOR LOWER ABDOMINAL SURGERIES. A RANDOMIZED DOUBLE BLINDED CONTROLLED CLINICAL TRIAL

    Directory of Open Access Journals (Sweden)

    Leelavathy

    2016-05-01

    Full Text Available BACKGROUND Spinal anaesthesia is preferred choice of anaesthesia in lower abdominal surgeries since long time. Various adjuvants have been used with local anaesthetics in spinal anaesthesia to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. This prospective, randomized, double blinded study was conducted to evaluate the onset, duration of sensory and motor blockade, haemodynamic stability and adverse effects of dexmedetomidine and fentanyl when given intrathecally with 0.5% hyperbaric bupivacaine. MATERIALS AND METHODS A total of 60 patients of ASA I and II scheduled for elective lower abdominal surgeries were selected and randomly allocated into 2 groups of 30 each. Group D received 0.5% hyperbaric bupivacaine (15 mg plus dexmedetomidine (10 μg, Group F received 0.5% hyperbaric bupivacaine (15 mg plus 25 μg fentanyl intrathecally. The onset of sensory andmotor blockade, duration of sensory and motor blockade, duration of analgesia, haemodynamic changes and side effects (Nausea, vomiting, pruritus, respiratory depression, bradycardia or hypotension were recorded. RESULTS Onset of sensory blockade was faster in fentanyl group than dexmedetomidine group, but this was statistically insignificant. Patients in dexmedetomidine group (D had faster motor onset (p<0.01 and significantly longer sensory and motor blockade time than patients in fentanyl group (F (p<0.01. Duration of analgesia was better with dexmedetomidine (p<0.01. There were no significant haemodynamic changes or adverse effects in any of the groups. It was observed that sedation was better in Group D. CONCLUSIONS Intrathecal Dexmedetomidine is a better adjuvant than intrathecal Fentanyl with prolonged sensory and motor blockade and profound postoperative analgesia.

  5. A COMPARATIVE STUDY OF CLINICAL EFFECTS OF INTRATHECAL 0.5% BUPIVACAINE WITH CLONIDINE VERSUS 0.5% BUPIVACAINE IN PATI ENTS UNDERGOING MAJOR GYNAECOLO GICAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Penchalaiah

    2015-07-01

    Full Text Available Spinal anaesthesia requires a small volume of drug to produce profound sensory analgesia and motor blockade but has limited duration of action. So a properly chosen adjuvant to local anaesthetic agent produces the best way to achieve a better quality regional block. Hence the present study was undertaken to compare the effects of intrathecal clonidine (30μg and pla cebo, when administered together with hyperbaric bupivacaine 0.5% for major gynaecological surgeries like Total Abdominal hysterectomy, vaginal hysterectomy, and Manchester repair.100 patients posted for elective major gynaecological surgeries were selecte d and allocated randomly into two groups. Each group of 50 patients. Group I : - 0.5% of Hyperbaric Bupivacaine (17.5mg + placebo Group II: - 0.5% of Hyperbaric Bupivacaine (17.5mg + clonidine(30μg. Onset of sensory block, motor block, quality of analgesi a, duration of analgesia and duration motor blockade between two groups were compared and contrasted. Patient vitals like Pulse rate, Blood pressure, Respiratory rate, SPO 2 and ECG were monitored during the study. During the study observed for the side eff ects like Nausea, Vomiting, Hypotension, Bradycardia, and dryness of mouth. CONCLUSIONS : A re Quality of analgesia is excellent in patients receiving clonidine when compared to placebo group. Total duration of analgesia and motor blockade was significantly prolong in clonidine group compared to placebo group. Minimal side effects like mild hypotension, mild sedation, and dryness of mouth were seen in clonidine group which does not require any active intervention.

  6. Long-term effects of knitted silk-collagen sponge scaffold on anterior cruciate ligament reconstruction and osteoarthritis prevention.

    Science.gov (United States)

    Shen, Weiliang; Chen, Xiao; Hu, Yejun; Yin, Zi; Zhu, Ting; Hu, Jiajie; Chen, Jialin; Zheng, Zefeng; Zhang, Wei; Ran, Jisheng; Heng, Boon Chin; Ji, Junfeng; Chen, Weishan; Ouyang, Hong-Wei

    2014-09-01

    Anterior cruciate ligament (ACL) is difficult to heal after injury due to the dynamic fluid environment of joint. Previously, we have achieved satisfactory regeneration of subcutaneous tendon/ligament with knitted silk-collagen sponge scaffold due to its specific "internal-space-preservation" property. This study aims to investigate the long-term effects of knitted silk-collagen sponge scaffold on ACL regeneration and osteoarthritis prevention. The knitted silk-collagen sponge scaffold was fabricated and implanted into a rabbit ACL injury model. The knitted silk-collagen sponge scaffold was found to enhance migration and adhesion of spindle-shaped cells into the scaffold at 2 months post-surgery. After 6 months, ACL treated with the knitted silk-collagen sponge scaffold exhibited increased expression of ligament genes and better microstructural morphology. After 18 months, the knitted silk-collagen sponge scaffold-treated group had more mature ligament structure and direct ligament-to-bone healing. Implanted knitted silk-collagen sponge scaffolds degraded much more slowly compared to subcutaneous implantation. Furthermore, the knitted silk-collagen sponge scaffold effectively protected joint surface cartilage and preserved joint space for up to 18 months post-surgery. These findings thus demonstrated that the knitted silk-collagen sponge scaffold can regenerate functional ACL and prevent osteoarthritis in the long-term, suggesting its clinical use as a functional bioscaffold for ACL reconstruction.

  7. Collagen hydrolysate based collagen/hydroxyapatite composite materials

    Science.gov (United States)

    Ficai, Anton; Albu, Madalina Georgiana; Birsan, Mihaela; Sonmez, Maria; Ficai, Denisa; Trandafir, Viorica; Andronescu, Ecaterina

    2013-04-01

    The aim of this study was to study the influence of collagen hydrolysate (HAS) on the formation of ternary collagen-hydrolysate/hydroxyapatite composite materials (COLL-HAS/HA). During the precipitation process of HA, a large amount of brushite is resulted at pH = 7 but, practically pure HA is obtained at pH ⩾ 8. The FTIR data reveal the duplication of the most important collagen absorption bands due to the presence of the collagen hydrolysate. The presence of collagen hydrolysate is beneficial for the management of bone and joint disorders such as osteoarthritis and osteoporosis.

  8. Pi-Pi complexation of bupivacaine and analogues with aromatic receptors: implications for overdose remediation.

    Science.gov (United States)

    Powell, Evon; Lee, Y H; Partch, Richard; Dennis, Donn; Morey, Timothy; Varshney, Manoj

    2007-01-01

    The interaction of the important but often overdosed local anesthetic bupivacaine, its structural analogs 2,6-dimethylaniline, and N-methyl-2,6-dimethylacetanilide, and cocaine, with several electron deficient aromatic moieties were studied primarily by proton NMR and UV-visible spectroscopy. In solution, the anesthetic, its analogs and cocaine are electron donors and form pi-pi charge transfer complexes with strong aromatic acceptors, as monitored by the upfield changes induced in the NMR chemical shifts (delta) and red-shifted UV-vis wavelength (lamda max) absorbance of the acceptors. The equilibrium binding constant, K, was determined from the 1H NMR charge transfer induced chemical shift changes and used to calculate the free energy (deltaG) for complex formation of three acceptor-donor pairs. HPLC results indicate that the concentrations of free bupivacaine, its analogs and of cocaine are reduced from solution via binding to aromatic-functionalized silica.

  9. Evaluation of the immunogenicity and cell compatibility of avian collagen for biomedical applications.

    Science.gov (United States)

    Peng, Yong Y; Glattauer, Veronica; Ramshaw, John A M; Werkmeister, Jerome A

    2010-06-15

    There have been concerns regarding the suitability of bovine collagen as a biomaterial since the emergence of bovine spongiform encephalopathy. Consequently, collagens from other species may be used if they can meet appropriate standards, including negligible or lack of immunogenicity. In this study, the potential immunogenicity of both monomeric and pepsin-solubilized chicken collagens have been compared with a commercial, pepsin-solubilized bovine collagen that is approved for biomedical implantation. All collagens were poor immunogens compared with ovalbumin. No IgE responses were detected in sera of three strains of mice, and no hypersensitivity reactions were found in guinea pigs in maximization and Buehler tests. IgG(1) antibodies were found although the titre was substantially lower than against ovalbumin. All responses in mice and rabbits were found only when immunizations were performed with adjuvant, and after multiple injections over a long period of time. The response from the monomeric chicken collagen was less than for pepsin-solubilized collagens. Collagen sponges prepared from the two chicken collagen preparations both supported the attachment and growth of mouse fibroblasts. These data indicate that chicken collagen, particularly when monomeric, may be useful in certain biomedical applications.

  10. Synthesis and Characterization of Biocomposite BCP/Collagen for Bone Material Scaffold

    Directory of Open Access Journals (Sweden)

    Anjarsari Anjarsari

    2017-02-01

    Full Text Available AbstractBiphasic calcium phosphate (BCP widely used as implants and scaffolds in different orthopedic and dental application. The aim of this study was to determine synthesis and characteristics of biocomposite BCP/collagen as bone scaffold material. BCP/collagen was classified into three groups: 1 BCP/K5 (5% collagen in scaffold, 2 BCP/K10 (10% collagen in scaffold, and 3 BCP/K15 (15% collagen in scaffold. The samples were characterized by Fourier Transform Infrared (FTIR Spectroscopy, and Scanning Electron Microscope (SEM techniques. Overall, concentration of collagen was not significantly different to the spectrum. However, FTIR analysis shows the change intensity in bio-composite BCP/collagen. Collagen intensity Higher concentration when collagen concentration in scaffold higher. Morphology analysis of the scaffold showed significant differences in pore formation. BCP/K15 was showed pores formed in scaffold. Synthesis of composite BCP/collagen does not affect the spectrum of functional groups, but affects the formation of pores in the bone scaffold material.

  11. Cochlear Implants

    Science.gov (United States)

    A cochlear implant is a small, complex electronic device that can help to provide a sense of sound. People who are ... of-hearing can get help from them. The implant consists of two parts. One part sits on ...

  12. Cochlear Implants

    Science.gov (United States)

    ... imaging (MRI) scans, to evaluate your inner ear anatomy. Cochlear implant surgery Cochlear implant surgery is usually performed as an outpatient procedure under general anesthesia. An incision is made behind the ear ...

  13. 可吸收胶原蛋白线与丝线编织非吸收线在口腔种植中的应用%Absorbable collagen suture and non-absorbable silk suture in oral implantation

    Institute of Scientific and Technical Information of China (English)

    徐海洋; 徐昊; 张丽; 曲晓欣; 赵保东

    2014-01-01

    背景:胶原蛋白线由动物的胶原蛋白制备而成,由于其具备可降解、无排异、易于制备、使用方便等优点,现在已开始大量使用于临床。  目的:比较胶原蛋白线与丝线编织线对口腔种植手术切口愈合的影响。  方法:100例种植手术患者随机等分为可吸收胶原蛋白线组和丝线编织非吸收性缝线组,分别使用2-0带圆针可吸收胶原蛋白缝合线与4-0带圆针丝线编织非吸收性缝线对伤口进行间断无张力缝合。植入后3,5,7 d观察缝线及伤口愈合情况,植入后第7天拆线,植入后14 d复诊。  结果与结论:可吸收胶原蛋白线组患者切口甲级愈合率明显多于丝线编织非吸收性缝线组(P OBJECTIVE:To evaluate the effects of col agen suture and silk suture in wound healing after oral implant surgery. METHODS:100 patients undergoing oral implantation were randomly assigned into col agen suture group and silk suture group. A 2-0 circular needle with absorbable col agen sutures and a 4-0 circular needle with non-absorbable silk sutures were employed for tension-free suture in the two groups. After 3, 5, 7 days of oral implantation, suture threads and wound healing were observed. The suture was removed at 14 days, and patients were reviewed at 14 days. RESULTS AND CONCLUSION:The wound healing was better in the col agen suture group than the silk suture group at grade I (P<0.05). At 7 days postoperatively, the suture thread was mostly absorbed in the col agen group but not in the silk suture group. In addition, material alba was invisible in the col agen suture group but clear in the silk suture group. These results indicate that the col agen suture is more proper for tension-free suture than the silk suture, which is better matched to the healing time and keeps a better oral environment.

  14. Addition of intrathecal Dexamethasone to Bupivacaine for spinal anesthesia in orthopedic surgery

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    Nadia Bani-hashem

    2011-01-01

    Full Text Available Objectives: Spinal anesthesia has the advantage that profound nerve block can be produced in a large part of the body by the relatively simple injection of a small amount of local anesthetic. Intrathecal local anesthetics have limited duration. Different additives have been used to prolong spinal anesthesia. The effect of corticosteroids in prolonging the analgesic effects of local anesthetics in peripheral nerves is well documented. The purpose of this investigation was to determine whether the addition of dexamethasone to intrathecal bupivacaine would prolong the duration of sensory analgesia or not. Methods: We conducted a randomized, prospective, double-blind, case-control, clinical trial. A total of 50 patients were scheduled for orthopedic surgery under spinal anesthesia. The patients were randomly allocated to receive 15 mg hyperbaric bupivacaine 0.5% with 2 cc normal saline (control group or 15 mg hyperbaric bupivacaine 0.5% plus 8 mg dexamethasone (case group intrathecally. The patients were evaluated for quality, quantity, and duration of block; blood pressure, heart rate, nausea, and vomiting or other complications. Results: There were no signification differences in demographic data, sensory level, and onset time of the sensory block between two groups. Sensory block duration in the case group was 119±10.69 minutes and in the control group was 89.44±8.37 minutes which was significantly higher in the case group (P<0.001. The duration of analgesia was 401.92±72.44 minutes in the case group; whereas it was 202±43.67 minutes in the control group (P<0.001. The frequency of complications was not different between two groups. Conclusion: This study has shown that the addition of intrathecal dexamethasone to bupivacaine significantly improved the duration of sensory block in spinal anesthesia without any changes in onset time and complications.

  15. The safety of liposome bupivacaine following various routes of administration in animals

    OpenAIRE

    Joshi GP; Patou G; Kharitonov V

    2015-01-01

    Girish P Joshi,1 Gary Patou,2 Vladimir Kharitonov21Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, TX, 2Pacira Pharmaceuticals, Inc., Parsippany, NJ, USABackground: This report presents results from four preclinical studies evaluating safety and pharmacokinetics (PKs) of liposome bupivacaine following intravascular (intravenous [IV], intra-arterial [IA]), epidural, and intrathecal administration in dogs.Methods: Intravascular administ...

  16. Effects of Oral Gabapentin, Local Bupivacaine and Intravenous Pethidine on Post Tonsillectomy Pain

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    Soroush Amani

    2015-09-01

    Full Text Available Introduction: Tonsillectomy is one of the most common surgeries performed worldwide. Post-operative pain arising from tonsillectomy is one of the earliest complications that can postpone oral nutrition and increase the hospitalization period. Administration of opioids via injection is usually preferred to relive pain in these patients. However, the side effects of this approach prompted us to seek alternative treatments. In this study, the effectiveness of oral gabapentin is compared with an intravenous (IV injection of pethidine and a local injection of bupivacaine in the control of pain after tonsillectomy.   Materials and Methods: This clinical trial was performed on 7-15 year-old patients who were candidates for tonsillectomy at Shahrekord Kashani hospital from 2012–2013. The patients were divided into three groups at random. Group 1 was give 20 mg/kg oral gabapentin 1 hour before anesthesia. In Group 2, 2.5 ml bupivacaine 0.25% was injected into each tonsil bed by a surgeon. In Group 3,1 mg/kg pethidine was injected intravenously after intubation. To assess post-operative pain, the Oucher scale was used in recovery as well as 3,6,12, and 24 hours after surgery.   Results: The pain score was lowest in the gabapentin group and highest in the bupivacaine group during the study. The pain score in the gabapentin group was significantly lower than that in the bupivacaine group (P0.05.   Conclusion:  Gabapentin, with its antihyperalgesic properties and other unknown properties, is a convenient drug for controlling pain following tonsillectomy.

  17. Efficacy of epidural administration of morphine with bupivacaine for orthopaedic surgery in sheep

    OpenAIRE

    Durej M.; Ledecký V.; Michalák D.; Hluchý M.; Kòazovický D.

    2012-01-01

    The aim of the study was to test the hypothesis that epidural administration of morphine with bupivacaine provides more intense and sufficient perioperative analgesia compared with parenterally administrated butorphanol during orthopaedic surgery. Sheep were assigned to group C (control group, 6 sheep) and group E (epidural, 5 sheep). Sheep from group C were pre-medicated with midazolam (0.3 mg/kg, i.m.) and butorphanol (0.2 mg/kg, i.m.). Propofol was used ...

  18. Síntese de colágeno após a implantação de telas de polipropileno em parede abdominal de ratos jovens e velhos Collagen synthesis after the implantation of polypropylene nets in the abdominal wall of young and old rats

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    Maria de Lourdes Pessole Biondo-Simões

    2005-08-01

    collagen I and III synthesis, and still others have reported normal synthesis. The objective of the present study was to determine the collagen deposition occurring through the pores of a propylene net implanted in the abdominal wall of young adult rats compared to old rats. METHODS: Ten male rats aged 100 to 120 days and 10 rats aged 850 to 900 days were used. Under inhalatory anesthesia, a median incision was made in the ventral abdominal wall and a 4 cm² gap was formed. The muscle-aponeurosis plane was removed and the peritoneal plane was maintained. The gap was corrected with a polypropylene mesh fixed with separate 5.0 polypropylene sutures and the skin margins were joined. The animals were sacrificed 30 days later and the ventral abdominal wall with the prosthesis was removed. The flap with the graft was divided into 2 parts, one for the traction assay and the other for histopathological study. The sections obtained were stained with hematoxylin-eosin and Sirius-red and examined under a polarized light microscope using the Image Plus software. RESULTS: The traction assay did not demonstrate a significant difference in resistance between groups. An acute-chronic inflammatory reaction with large quantities of giant foreign body cells was present at similar intensity in both groups, the same being observed for total collagen concentration (p=0.1440 and type I collagen concentration (p=0.3981. In contrast, type III collagen concentration was higher in the sections from old animals (p=0.0364. CONCLUSIONS: These results permit us to conclude that aging does not impair the resistance gain or collagen deposition, although a delayed tissue maturation occurs.

  19. Bone graft materials in fixation of orthopaedic implants in sheep

    DEFF Research Database (Denmark)

    Babiker, Hassan

    2013-01-01

    Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many...... the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking...... bone and includes bone collagen, morphogenetic proteins and growth factors. The combination of DBM with CB and with allograft might improve the healing potential of these grafts around non-cemented orthopaedic implants and thereby the implant fixation. Study I investigates the effect of HA...

  20. Magnetic resonance imaging of trilucent TM breast implants

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    Elson, Elspeth M.; Jones, Annette; King, Rebecca; Chapman, P.; Stanek, Jan; Irvine, Allan T.; Bingham, John B

    2002-04-01

    AIM: To demonstrate the magnetic resonance imaging (MRI) appearances of intact and ruptured Trilucent TM implants with imaging and surgical correlation. The appearances of the implant transponder artefact are also described MATERIALS AND METHODS: A retrospective review of the MRI findings in 34 patients with bilateral subpectoral Trilucent TM breast implants (Lipomatrix, Inc./Collagen Aesthetics International Inc., Neuchatel, Switzerland) was performed. Patients under implant surveillance and those with suspected implant rupture formed the study group. Imaging findings were correlated with surgical appearances. RESULTS: Surgical correlation was available in 53% of patients. Fifty per cent (18/36) of implants were intact at surgery, 50% (18/36) of implants were ruptured. Of the 18 ruptured implants, 17 were intracapsular ruptures and one an extracapsular rupture. The sensitivity of MRI for detection of intracapsular rupture in Trilucent TM breast implants was 82% specificity 76%, positive predictive value 78%, negative predictive value 81% and accuracy 79% in this study group. No case of implant rupture was obscured by the transponder artefact. Four implants were found to have 'pseudocapsules' at surgery (5{center_dot}9%), the implants were intact with fluid present between the implant and capsule. Only one pseudocapsule was demonstrated on MRI. CONCLUSION: Magnetic resonance imaging is currently the most accurate technique for diagnosis of implant rupture in Trilucent TM breast implants. Transponder artefact does not appear to interfere with the assessment of implant rupture. Elson, E. M. et al. (2002)

  1. EFFICACY OF DEXAMETHASONE AS AN ADJUVANT TO BUPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

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    Rakesh

    2015-08-01

    Full Text Available AIMS: Brachial plexus nerve blocks have analgesic and opioid sparing benefits for upper extremity surgery. Single - injection techniques are limited by duration of local anaesthetic agents, however Continuous block techniques can be used for prolonged anaesthesia and analgesia but it presents management challenges. The study was designed to compare the effects of dexamethasone administered as an adjunct to bupivacaine in supraclavicular brachial plexus block on the onset , duration and postoperative analgesia following upper limb surgeries. METHODS AND MATERIAL: A prospective, double - blind study was undertaken in patients scheduled for upper limb surgeries under supraclavicular brachial plexus block. Sixty patients were randomly divided into two groups, Group B and BD . Group B received 30 ml of 0.375% bupivacaine with 2 ml normal saline while Group BD received 30 ml of 0.375% bupivacain with 2ml(8mg dexamethasone for supraclavicular brachial plexus block. The groups were compared regarding quality of sensory and motor blockade, duration of post operative analgesia and intra and postoperative complications. RESULTS: There was a significant increase in duration of motor and sensory block and analgesia in Group BD as compared to Group B patients ( P < 0.0001. No significant side effects were noted. CONCLUSIONS: The addition of 8 mg of dexamethasone to bupivac a ine in supraclavicular brachial plexus block prolongs the duration of motor and sensory block and extends the analgesia period. KEYWORDS: A naesthesia adjuvants; D examethasone; B rachial plexus block .

  2. INTRATHECAL USE OF CLONIDINE WITH HYPERBARIC BUPIVACAINE IN ORTHOPAEDIC SURGERIES OF LOWER LIMB

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    Chandrashekharappa

    2014-04-01

    Full Text Available BACKGROUND: Clonidine, an α2 adrenergic agonist is used as adjuvant to local anesthetics with variable results. We studied effects of the intrathecal use of low dose clonidine with 0.5% hyperbaric bupivacaine on duration of analgesia and hemodynamic parameters. METHOD: This prospective study done on 60 patients belonging to ASA 1 or 2, undergoing orthopedic surgeries of lower limb under subarachnoid block were randomized into two groups(30 patients each, group 1 received saline and group 2 received 30 µg clonidine as adjuvant along with 2.5 ml of 0.5% hyperbaric bupivacaine intrathecal injection. During study, the duration and onset of sensory and motor block, duration of analgesia, and total requirement of rescue analgesics along with hemodynamic changes and side effects of study drugs were recorded. RESULTS: we found time delay in onset of both sensory and motor block in clonidine group which was statistically insignificant, and significant prolongation of both sensory (140.26 minutes Vs. 93.63 minutes and motor blockade (153.74 minutes Vs. 104.79 minutes p-value <0.001. CONCLUSION: Adjuvant use of low dose clonidine (30 µg with hyperbaric bupivacaine prolongs the duration of both sensory and motor blockade, and duration of analgesia without much hemodynamic adverse effects.

  3. Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally.

    Science.gov (United States)

    Jarraya, Anouar; Elleuch, Sahar; Zouari, Jawhar; Smaoui, Mohamed; Laabidi, Sofiene; Kolsi, Kamel

    2016-01-01

    The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (Pbupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

  4. The effect of adding epinephrine to combination of sufentanil and bupivacaine in spinal analgesia during labor

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    Parisa Golfam

    2011-03-01

    Full Text Available Background: Spinal analgesia is one of the effective and rapid methods for labor. It is not commonly used because of short duration of analgesia and motor block, which limits mother's force in labor progression. We attempted to prolong duration and quality of analgesia by adding Epinephrine.Methods: In this quasi-experimental study 90 pregnant women gravid II and III who referred to Motazedi and Imam Reza Educational & Medical Centers were recruited and divided into two groups of case and control (45 subjects in each group. The case group received spinal analgesia using Sufentanil and Bupivacaine, and Epinephrine while the control group received Sufentanil and Bupivacaine. Data including feeling of pain, motor block, duration of analgesia, fetal heart rate, nausea and vomiting, blood pressure was collected and analyzed using chi-square and t test. Results: duration of analgesia and vomiting were significantly increased in the case group. (p=0.001, p=0.01 respectively. Hemodynamic status in mothers and Apgar score of neonates were not significantly different between two groups.Conclusion: It seems that adding Epinephrine to Sufentanil and Bupivacaine could increase analgesia duration without altering in sensory level although could increase nausea and vomiting its recommended in labor analgesia.

  5. EFFECT OF ORAL CLONIDINE PREMEDICATION ON THE ONSET AND DURATION OF SPINAL ANESTHESIA WITH HYPERBARIC BUPIVACAINE

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    Shruthi

    2014-09-01

    Full Text Available BACKGROUND: Spinal anesthesia is the most common technique used for lower abdominal surgeries. Hyperbaric Bupivacaine has limited duration of action. Clonidine has been used to prolong the duration of local anaesthetic. Hence in our study, we studied the effects of oral clonidine premedication on spinal anaesthesia with hyperbaric Bupivacaine with reference to sedation, onset and duration of sensory and motor blockade including its effects on hemodynamic status. METHODS: Prospective randomized, double – blinded placebo, control study, two groups of thirty patients each were selected. One group (Group C received 150μg clonidine tablets and the other group (Group B received placebo, 90 minutes before anesthesia. Primary outcome were sedation, onset and duration of sensory and motor blockade. Hemodynamic and other effects of the study drug were the secondary outcomes. RESULT: It was observed that clonidine premedication resulted in higher incidence of moderate sedation, hastens the onset of sensory block but has no effect on the onset of motor blockade. It prolonged the duration of sensory and motor blockade. Clonidine at a dose of 150μg is not associated with any greater change in heart rate and blood pressure following spinal anesthesia. CONCLUSION: We conclude that oral clonidine premedication,in patients with hyperbaric bupivacaine hastesns the onset of sensory block and prolongs the duration of sensory and motor anesthesia with moderate sedation.

  6. Evaluation of sciatic nerve damage following intraneural injection of bupivacaine, levobupivacaine and lidocaine in rats.

    Science.gov (United States)

    Sen, Oznur; Sayilgan, Nevzat Cem; Tutuncu, Ayse Cigdem; Bakan, Mefkur; Koksal, Guniz Meyanci; Oz, Huseyin

    2016-01-01

    The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. Sixty Wistar rats weighing 200-350g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%), levobupivacaine group 3 (15%), and lidocaine group 6 (30%). In all groups, histopathological damage frequency and severity were more than the motor deficiency. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  7. [Evaluation of sciatic nerve damage following intraneural injection of bupivacaine, levobupivacaine and lidocaine in rats].

    Science.gov (United States)

    Sen, Oznur; Sayilgan, Nevzat Cem; Tutuncu, Ayse Cigdem; Bakan, Mefkur; Koksal, Guniz Meyanci; Oz, Huseyin

    2016-01-01

    The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. Sixty Wistar rats weighing 200-350g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%), levobupivacaine group 3 (15%), and lidocaine group 6 (30%). In all groups, histopathological damage frequency and severity were more than the motor deficiency. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. Evaluation of sciatic nerve damage following intraneural injection of bupivacaine, levobupivacaine and lidocaine in rats

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    Oznur Sen

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: The local anesthetics may cause neurotoxicity. We aimed to compare the neurotoxic potential of different local anesthetics, local anesthetic induced nerve damage and pathological changes of a peripheral nerve. METHODS: Sixty Wistar rats weighing 200-350 g were studied. Rats were assigned into 3 groups and 26-gauge needle was inserted under magnification into the left sciatic nerve and 0.2 mL of 0.5% bupivacaine, 5% levobupivacaine, and 2% lidocaine were injected intraneurally. An individual who was blind to the specifics of the injection monitored the neurologic function on postoperative 1st day, and daily thereafter. Neurologic examination included assessment for the presence and severity of nociception and grasping reflexes. At the 7th day sciatic nerve specimen was taken for evaluation of histopathologic changes. RESULTS: There was no statistical difference detected among groups regarding grasping reflex and histopathologic evaluation. Two cases in bupivacaine group, 1 case in levobupivacaine group and 2 cases in lidocaine group had slight grasping, while 1 case in lidocaine group had no grasping reflex on the seventh day. Severe axonal degeneration was observed in all groups, respectively in bupivacaine group 4 (20%, levobupivacaine group 3 (15%, and lidocaine group 6 (30%. CONCLUSION: In all groups, histopathological damage frequency and severity were more than the motor deficiency.

  9. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine

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    Rajni Gupta

    2011-01-01

    Full Text Available Background: Various adjuvants have been used with local anesthetics in spinal anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. Materials and Methods: Sixty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly allocated to receive either 12.5 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group D, n=30 or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group F, n=30 intrathecal. Results: Patients in dexmedetomidine group (D had a significantly longer sensory and motor block time than patients in fentanyl group (F. The mean time of sensory regression to S1 was 476±23 min in group D and 187±12 min in group F (P<0.001. The regression time of motor block to reach modified Bromage 0 was 421±21 min in group D and 149±18 min in group F (P<0.001. Conclusions: Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 h as compared to fentanyl.

  10. Spinal procaine is less neurotoxic than mepivacaine, prilocaine and bupivacaine in rats.

    Science.gov (United States)

    Takenami, Tamie; Yagishita, Saburo; Nara, Yoshihiro; Tsai, Yang-Hsi; Hiruma, Hiromi; Kawakami, Tadashi; Hoka, Sumio

    2009-01-01

    Lidocaine has been reported to be more neurotoxic than other local anesthetics. Alternatives to lidocaine with lower toxicity and shorter duration of action are desirable. Therefore, we compared the histologic and functional changes induced by intrathecal injection of prilocaine, mepivacaine, procaine, and bupivacaine in rats. Rats (n = 184) randomly received via an intrathecal catheter 0.12 microL/g body weight of 2%, 10%, 16%, or 20% prilocaine, mepivacaine, or procaine; 0%, 0.5%, 2.5%, 4%, or 5% bupivacaine in distilled water; or distilled water or 15% glucose solution alone as a control. We evaluated neurofunction by analyzing walking behavior and sensory threshold and examined the L3 spinal cord, posterior and anterior roots, and cauda equina by light and electron microscopy. The recovery time to normal ambulation after intrathecal injection was significantly faster with procaine than with the other 3 drugs at all concentrations. There were no significant differences in the sensory threshold among the 4 anesthetics. Histologic damage was observed only in rats treated with greater than 16% prilocaine or mepivacaine or with greater than 4% bupivacaine. Histologic damage occurred at the posterior root and posterior white matter and was characterized by axonal degeneration. Rats treated with procaine, even at 20%, showed no histologic abnormalities. In this animal model, the neurotoxicity of intrathecal procaine was the mildest, and the recovery time to ambulation with procaine was the fastest among the 4 tested anesthetics.

  11. Low-dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy: the suitability and impact of adding intrathecal fentanyl.

    Science.gov (United States)

    Atallah, M M; Shorrab, A A; Abdel Mageed, Y M; Demian, A D

    2006-08-01

    Unilateral spinal anaesthesia has been used for lower limb surgery with a stable cardiovascular state and a short recovery unit stay. We sought to test the suitability of low-dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy, a procedure hitherto performed under general anaesthesia. Furthermore, we hypothesized that adding intrathecal fentanyl to bupivacaine may improve the quality of anaesthesia. We randomly allocated, through computer-generated randomization, 108 patients subjected to percutaneous nephrolithotomy to receive either 7.5 mg of hyperbaric bupivacaine 5 mg/ml alone or with the addition of 10 microg of fentanyl. Drugs were given at the L(2)-L(3) interspace with the patient in the lateral decubitus position. The patients remained in this position for 10 min, after which the sensory and motor blocks were assessed. Intra-operative analgesic supplementation, when deemed necessary, was achieved with intravenous fentanyl boluses (25 microg). The sensory and motor blocks after intrathecal bupivacaine and bupivacaine-fentanyl were similar. Sensory block, in both groups, reached the fifth and eighth thoracic dermatomes on the operative and non-operative sides, respectively. Deep motor block occurred on the operative side in all patients and in nearly 50% of patients on the non-operative side. The patients in the bupivacaine-fentanyl group required less intra-operative and post-operative analgesics, and both patients and endoscopists were better satisfied. This study demonstrated, for the first time, that intrathecal low-dose bupivacaine and fentanyl offers a reliable neuraxial block for patients subjected to percutaneous nephrolithotomy, with stable haemodynamics, good post-operative analgesia and acceptable patient and endoscopist satisfaction.

  12. 缬沙坦涂层支架置入兔腹主动脉对血管内膜胶原沉积及AT2受体表达的影响%Influence of valsartan-eluting stent implantation into rabbit abdominal aorta on collagen deposition and AT2 receptor expression

    Institute of Scientific and Technical Information of China (English)

    李贵华; 王雷; 贾三庆; 赵林; 姚道阔; 丁荣晶; 任文林

    2008-01-01

    BACKGROUND:Clinical trials have shown that oral administration of valsartan can decrease in-stent restenosis after stent implantation.But whether valsartan used locally also has the sanle effect and the possible mechanism should be validated.OBJECTIVE:To observe the effect of valsartan-eluting stents on collagen deposition in neointima and AT2 receptor expression after implanting valsartan-eluting stents into rabbit abdominal orta.DESIGN:Randomized and controlled animal experiment.SETTING:Beijing Friendship Hospital.MATERIALS:The experiment was performed at the Laboratory of Beijing Friendship Hospital between October 2004 and March 2006.Fifteen New Zealand white rabbits,irrespective of gender,weighing 2.75-3.25 kg were selected(Animal Laboratory of Beijing Friendship Hospital).The rabbits were adaptively fed for one week.All the operations of rabbits during the experiment were accorded with animal ethical standards.Valsartan powder was presented as a gift by Novartis.China;Reagent of MASSON was provided by Department of Pathology of Beijing Friendship Hospital;1%picrosirius solution was provided by the Department of Pathology of China-Japan Friendship Hospital:Mice-anti-rabbit monoclonal AT2 antibody was product of Santa Cruz Biotechnology (USA);Envision reagent was purphased from Dako;primers were synthesized by SBS Genetech(SBS).METHODS:①The animals were randomized into bare-metal stent group,carrier-eluting stent group and valsartan-eluting stent group with 5 animals in each group.All rabbits were implanted with corresponding types of above-mentioned stents into abdominal aortas down below renal artery.②Quantitative angiography before,immediately after and 3 months after stent implantation were performed to compare vascular diameters of the aortas.③Three months Iater,the rabbits were executed after anaesthesia.The vessels with stents were processed with HE staining.Indices of the vascular neointimal formation,I.e. iBrier and external elastic membrane

  13. Post-operative pain and analgesic requirements after paravertebral block for mastectomy: A randomized controlled trial of different concentrations of bupivacaine and fentanyl

    Directory of Open Access Journals (Sweden)

    V Bhuvaneswari

    2012-01-01

    Full Text Available Background: Paravertebral block (PVB is useful for post-operative analgesia after breast surgery. Bupivacaine is used for PVB at higher concentrations (0.5%, which may lead to systemic toxicity after absorption. Therefore, we proposed to evaluate the efficacy of lower concentrations of bupivacaine with and without fentanyl for thoracic PVB in patients undergoing surgery for carcinoma breast. Methods: Forty-eight patients scheduled for surgery for breast cancer were enrolled in this prospective, randomized, double-blinded, placebo-controlled trial and were allocated to one of four groups: 0.25% bupivacaine with epinephrine 5 mcg/ ml, 0.25% bupivacaine + epinephrine 5 mcg/ ml with 2 mcg/ml fentanyl, 0.5% bupivacaine + epinephrine 5 mcg/ml or isotonic saline. PVB was performed and 0.3 ml/kg of the test drug was administered before induction of general anaesthesia. The primary outcome assessed was post-operative analgesic requirement for a period of 24 h. Secondary outcome measures were post-operative pain scores at rest and on movement of the arm, latency to first opioid, post-operative nausea and vomiting, quality of sleep, ability to move arm and patient satisfaction. Results: The patient characteristics and anaesthetic technique were comparable among the groups. The rescue analgesic consumption as well as cumulative pain scores at rest and on movement were significantly less in 0.25% bupivacaine+epinephrine with fentanyl and 0.5% bupivacaine+epinephrine groups (P<0.05. The average duration of analgesia was found to be 18 h after either 0.25% bupivacaine with epinephrine+fentanyl or 0.5% bupivacaine with epinephrine. Conclusions: Lower concentrations of bupivacaine can be combined with fentanyl to achieve analgesic efficacy similar to bupivacaine at higher concentrations, decreasing the risk of toxicity in PVB.

  14. Epoxy Cross-Linked Collagen and Collagen-Laminin Peptide Hydrogels as Corneal Substitutes

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    May Griffith

    2013-08-01

    Full Text Available A bi-functional epoxy-based cross-linker, 1,4-Butanediol diglycidyl ether (BDDGE, was investigated in the fabrication of collagen based corneal substitutes. Two synthetic strategies were explored in the preparation of the cross-linked collagen scaffolds. The lysine residues of Type 1 porcine collagen were directly cross-linked using l,4-Butanediol diglycidyl ether (BDDGE under basic conditions at pH 11. Alternatively, under conventional methodology, using both BDDGE and 1-Ethyl-3-(3-dimethyl aminopropyl carbodiimide (EDC/N-hydroxysuccinimide (NHS as cross-linkers, hydrogels were fabricated under acidic conditions. In this latter strategy, Cu(BF42·XH2O was used to catalyze the formation of secondary amine bonds. To date, we have demonstrated that both methods of chemical cross-linking improved the elasticity and tensile strength of the collagen implants. Differential scanning calorimetry and biocompatibility studies indicate comparable, and in some cases, enhanced properties compared to that of the EDC/NHS controls. In vitro studies showed that human corneal epithelial cells and neuronal progenitor cell lines proliferated on these hydrogels. In addition, improvement of cell proliferation on the surfaces of the materials was observed when neurite promoting laminin epitope, IKVAV, and adhesion peptide, YIGSR, were incorporated. However, the elasticity decreased with peptide incorporation and will require further optimization. Nevertheless, we have shown that epoxy cross-linkers should be further explored in the fabrication of collagen-based hydrogels, as alternatives to or in conjunction with carbodiimide cross-linkers.

  15. Intraperitoneal And Incisional Bupivacaine Analgesia For Major Abdominal/Gynecologic Surgery: A Placebocontrolled

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    R. Azarfarin

    2006-05-01

    Full Text Available Background:Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gynecologic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebocontrolled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale (VAS on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001, and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001. First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs.1.35±0.36; p<0.001.Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001.Conclusion:A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioidsparing analgesia for 24 h after gynecologic abdominal surgeries.

  16. EFFECT OF DEXMEDETOMIDINE ADDED TO SPINAL BUPIVACAINE FOR TOTAL ABDOMINAL HYSTERECTOMY

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    Vinod

    2014-09-01

    Full Text Available BACKGROUND: Various adjuvants are being used with local anaesthetics in spinal anaesthesia for prolongation of intraoperative and post-operative analgesia. Dexmedetomidine, a highly selective α2 adrenergic agonist is a new neuroaxial adjuvant gaining popularity. AIMS: To evaluate the onset and duration of sensory and motor block, hemodynamic effect, post-operative analgesia and adverse effects of dexmedetomidine given intrathecally with hyperbaric 0.5% bupivacaine. METHODOLOGY: A study was carried out in 30 adult female patients aged 18-55 yrs of ASA grade I and II in each group scheduled for Total abdominal hysterectomy under spinal anaesthesia. Group B received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml of normal saline. Group D received 2.5ml of 0.5% hyperbaric bupivacaine with 10µg of dexmedetomidine in 0.5ml of normal saline. The onset time to reach peak sensory and motor level, regression time of sensory and motor block, rescue analgesia, hemodynamic changes and side effects were recorded. STATISTICAL ANALYSIS USED: Data obtained were tabulated and analyzed using statistical package for social science (SPSS 16.0 evaluation version to calculate the sample size. Descriptive data are presented as Mean ± SD and Continuous data are analyzed by unpaired’t’ test. P<0.05 was considered statistically significant. RESULTS: Patients in dexmedetomidine group (group D had a significantly longer sensory and motor block than patients in bupivacaine group (group B. The mean time of sensory regression to S1 was (323 ± 31 min in group D and (191 ± 15min in group B. The regression time of motor block to reach Bromage 0 was (314 ± 30 min in group D and (163 ± 15 min in group B. The time to rescue analgesia was significantly longer in group D (383 ± 38 min as compared to group B (228.6 ± 15 min. CONCLUSION: Intrathecal dexmedetomidine as adjuvant to spinal bupivacaine is associated with prolonged sensory and motor block, hemodynamic stability

  17. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  18. Poly(DL:lactic acid-castor oil) 3:7-bupivacaine formulation: reducing burst effect prolongs efficacy in vivo.

    Science.gov (United States)

    Sokolsky-Papkov, Marina; Golovanevski, Ludmila; Domb, Abraham J; Weiniger, Carolyn F

    2010-06-01

    Prolonged analgesia may be achieved using a single injection of slow-release local anesthetic formulation. The study objective was to improve the efficacy of a previously reported formulation comprising 10% bupivacaine in poly(DL:lactic acid co castor oil) 3:7. The polymer was loaded with 15% bupivacaine and injected through a 22G needle close to the sciatic nerve of ICR mice. Sensory and motor nerve blockade were measured. The efficacy and toxicity of the polymer-drug combination were determined. Sixty percent of the incorporated bupivacaine was released during 1 week in vitro. During in vitro release no burst effect was seen, suggesting low toxicity of the formulation. Single injection of 0.1 mL of 15% polymer-bupivacaine formulation caused motor block that lasted 64 h and sensory block that lasted 96 h. The MTD of the polymer-drug formulation was established as 0.175 mL. Microscopic examination of the injection sites revealed reversible nerve inflammation and normal internal organs. The polymer poly(DL:lactic acid co castor oil) 3:7 is a safe carrier for prolonged activity of bupivacaine up to 96 h. The increase of drug load in the formulation reduces the drug release rates due to stronger polymer-drug interactions and higher overall hydrophobicity of the formulation.

  19. Primary hepatocyte culture in collagen gel mixture and collagen sandwich

    Institute of Scientific and Technical Information of China (English)

    Ying-Jie Wang; Hong-Ling Liu; Hai-Tao Guo; Hong-Wei Wen; Jun Liu

    2004-01-01

    AIM: To explore the methods of hepatocytes culture in a collagen gel mixture or between double layers of collagen sandwich configuration and to examine the functional and cytomorphological characteristics of cultured hepatocytes.METHODS: A two-step collagenase perfusion technique was used to isolate the hepatocytes from Wistar rats or newborn Chinese experimental piglets. The isolated hepatocytes were cultured in a collagen gel mixture or between double layers of collagen sandwich configuration respectively. The former was that rat hepatocytes were mixed with type I rat tail collagen solution till gelled, and the medium was added onto the gel. The latter was that swine hepatocytes were seeded on a plate precoated with collagen gel for 24 h, then another layer of collagen gel was overlaid, resulting in a sandwich configuration. The cytomorphological characteristics, albumin secretion, and LDH-release of the hepatocytes cultured in these two models were examined.RESULTS: Freshly isolated rat hepatocytes were successfully mixed and fixed in collagen gel, and cultured in the gel condition. During the culture period, the urea synthesized and secreted by rat hepatocytes was detected throughout the period. Likewise, newborn experimental piglet hepatocytes were successfully fixed between the double layers of collagen gel, forming a sandwich configuration.Within a week of culture, the albumin secreted by swine hepatocytes was detected by SDS/PAGE analysis. The typical cytomorphological characteristics of the hepatocytes cultured by the above two culture models were found under a phasecontrast microscope. There was little LDH-release during the culture period.CONCLUSION: Both collagen gel mixture and double layers of collagen sandwich configuration can provide cultural conditions much closer to in vivoenvironment, and are helpful for maintaining specific hepatic fiJnctions and cytomorphological characteristics. A collagen gel mixture culture may be more eligible for the

  20. UV damage of collagen: insights from model collagen peptides.

    Science.gov (United States)

    Jariashvili, Ketevan; Madhan, Balaraman; Brodsky, Barbara; Kuchava, Ana; Namicheishvili, Louisa; Metreveli, Nunu

    2012-03-01

    Fibrils of Type I collagen in the skin are exposed to ultraviolet (UV) light and there have been claims that collagen photo-degradation leads to wrinkles and may contribute to skin cancers. To understand the effects of UV radiation on collagen, Type I collagen solutions were exposed to the UV-C wavelength of 254 nm for defined lengths of time at 4°C. Circular dichroism (CD) experiments show that irradiation of collagen leads to high loss of triple helical content with a new lower thermal stability peak and SDS-gel electrophoresis indicates breakdown of collagen chains. To better define the effects of UV radiation on the collagen triple-helix, the studies were extended to peptides which model the collagen sequence and conformation. CD studies showed irradiation for days led to lower magnitudes of the triple-helix maximum at 225 nm and lower thermal stabilities for two peptides containing multiple Gly-Pro-Hyp triplets. In contrast, the highest radiation exposure led to little change in the T(m) values of (Gly-Pro-Pro)(10) and (Ala-Hyp-Gly)(10) , although (Gly-Pro-Pro)(10) did show a significant decrease in triple helix intensity. Mass spectroscopy indicated preferential cleavage sites within the peptides, and identification of some of the most susceptible sites of cleavage. The effect of radiation on these well defined peptides gives insight into the sequence and conformational specificity of photo-degradation of collagen.

  1. Shining light on collagen: expressing collagen in plants.

    Science.gov (United States)

    Brodsky, Barbara; Kaplan, David L

    2013-07-01

    Collagens are a remarkable group of proteins that are critical from a physiological perspective due to their diverse and versatile functions in vivo. However, collagens are challenging to generate ex vivo for biomaterials or regenerative medicine due to their complex processing and assembly into functional materials. Therefore, collagen availability remains a major unmet need for biomaterials, as relatively limited supplies of the protein in pure form are available mainly through harvesting bovine tissues. This animal source, subsequent to purification, remains associated with significant safety concerns due to the potential carryover of animal-derived diseases. Other more limited sources of animal collagens are also commercially available, as well as collagens generated in heterologous hosts; however, the challenge to these sources remains both economic and structural. The need for new safe sources of collagens remains high, with a significant potential impact in areas of medicine when considering the opportunity to mimic native collagen features. The articles in this issue of the journal focus on plant-derived collagens to address some of these needs. Progress toward plant production of collagens, the ability to self-assemble these recombinant proteins into higher-order structures, and the utility of these materials in various medical applications suggest an important path forward for the field.

  2. Implantable Microimagers

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    Jun Ohta

    2008-05-01

    Full Text Available Implantable devices such as cardiac pacemakers, drug-delivery systems, and defibrillators have had a tremendous impact on the quality of live for many disabled people. To date, many devices have been developed for implantation into various parts of the human body. In this paper, we focus on devices implanted in the head. In particular, we describe the technologies necessary to create implantable microimagers. Design, fabrication, and implementation issues are discussed vis-à-vis two examples of implantable microimagers; the retinal prosthesis and in vivo neuro-microimager. Testing of these devices in animals verify the use of the microimagers in the implanted state. We believe that further advancement of these devices will lead to the development of a new method for medical and scientific applications.

  3. Bupivacaine salts of diflunisal and other aromatic hydroxycarboxylic acids: aqueous solubility and release characteristics from solutions and suspensions using a rotating dialysis cell model.

    Science.gov (United States)

    Østergaard, Jesper; Larsen, Susan W; Parshad, Henrik; Larsen, Claus

    2005-11-01

    In the search for poorly soluble bupivacaine salts potentially enabling prolonged postoperative pain relief after local joint administration in the form of suspensions the solubility of bupivacaine salts of diflunisal and other aromatic hydroxycarboxylic acids were investigated together with the release characteristics of selected 1:1 salts from solutions and suspensions using a rotating dialysis cell model. The poorest soluble bupivacaine salts were obtained from the aromatic ortho-hydroxycarboxylic acids diflunisal, 5-iodosalicylic acid, and salicylic acid (aqueous solubilities: 0.6-1.9 mM at 37 degrees C). Diffusant appearance rates in the acceptor phase upon instillation of solutions of various salts in the donor cell applied to first-order kinetics. Calculated permeability coefficients for bupivacaine and the counterions diflunisal, 5-iodosalicylic acid, and mandelic acid were found to be correlated with the molecular size of the diffusants. Release experiments at physiological pH involving suspensions of the bupivacaine-diflunisal salt revealed that at each sampling point the diflunisal concentration exceeded that of bupivacaine in the acceptor phase. However, after an initial lag period, a steady state situation was attained resulting in equal and constant fluxes of the two diffusants controlled by the permeability coefficients in combination with the solubility product of the salt. Due to the fact that the saturation solubility of the bupivacaine-salicylic acid salt in water exceeded that of bupivacaine at pH 7.4, suspensions of the latter salt were unable to provide simultaneous release of the cationic and anionic species at pH 7.4. The release profiles were characterised by a rapid release of salicylate accompanied by a much slower appearance of bupivacaine in the acceptor phase caused by precipitation of bupivacaine base from the solution upon dissolution of the salt in the donor cell.

  4. The development of the collagen fibre network in tissue-engineered cartilage constructs in vivo. Engineered cartilage reorganises fibre network

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    H Paetzold

    2012-04-01

    Full Text Available For long term durability of tissue-engineered cartilage implanted in vivo, the development of the collagen fibre network orientation is essential as well as the distribution of collagen, since expanded chondrocytes are known to synthesise collagen type I. Typically, these properties differ strongly between native and tissue-engineered cartilage. Nonetheless, the clinical results of a pilot study with implanted tissue-engineered cartilage in pigs were surprisingly good. The purpose of this study was therefore to analyse if the structure and composition of the artificial cartilage tissue changes in the first 52 weeks after implantation. Thus, collagen network orientation and collagen type distribution in tissue-engineered cartilage-carrier-constructs implanted in the knee joints of Göttinger minipigs for 2, 26 or 52 weeks have been further investigated by processing digitised microscopy images of histological sections. The comparison to native cartilage demonstrated that fibre orientation over the cartilage depth has a clear tendency towards native cartilage with increasing time of implantation. After 2 weeks, the collagen fibres of the superficial zone were oriented parallel to the articular surface with little anisotropy present in the middle and deep zones. Overall, fibre orientation and collagen distribution within the implants were less homogenous than in native cartilage tissue. Despite a relatively low number of specimens, the consistent observation of a continuous approximation to native tissue is very promising and suggests that it may not be necessary to engineer the perfect tissue for implantation but rather to provide an intermediate solution to help the body to heal itself.

  5. Comparative effect of lidocaine and bupivacaine on glucose uptake and lactate production in the perfused working rat heart

    Energy Technology Data Exchange (ETDEWEB)

    Cronau, L.H. Jr.; Merin, R.G.; Aboulish, E.; Steenberg, M.L.; Maljorda, A.

    1986-03-01

    It has been suggested that at equivalent therapeutic concentrations, lidocaine and bupivacaine may have different cardiotoxic potency. In the isolated working rat heart preparation, the effect of a range of lidocaine and bupivacaine concentrations on glucose uptake and lactate production (LP) were observed. Insulin was added, 10 ..mu../L, to Ringer's solution containing /sup 3/H-labeled glucose to measure the glycolytic flux (GF). The effect of the local anesthetics on LP at the indicated concentrations were similar. Lidocaine appears to depress the glycolytic flux from exogenous glucose to a lesser degree. Bupivacaine, 10 mg/L, depresses VO/sub 2/ to a greater degree than does lidocaine, 40 mg/L.

  6. The role of collagen receptors Endo180 and DDR-2 in the foreign body reaction against non-crosslinked collagen and gelatin

    NARCIS (Netherlands)

    Ye, Qingsong; Harmsen, Martin C.; Ren, Yijin; Bank, Ruud A.

    2011-01-01

    Despite the use of collagen-derived scaffolds in regenerative medicine, little is known about the degradation mechanisms of these scaffolds in vivo. Non-crosslinked dermal sheep (NDSC) and gelatin disks were implanted subcutaneously in mice. NDSC disks showed a very low degradation rate, despite the

  7. Arterial calcification: Conscripted by collagen

    Science.gov (United States)

    Miller, Jordan D.

    2016-03-01

    In atherosclerotic plaques, patterns of calcification -- which have profound implications for plaque stability and vulnerability to rupture -- are determined by the collagen's content and patterning throughout the plaque.

  8. Reversal of bupivacaine-induced cardiac electrophysiologic changes by two lipid emulsions in anesthetized and mechanically ventilated piglets.

    Science.gov (United States)

    Candela, Damien; Louart, Guillaume; Bousquet, Philippe-Jean; Muller, Laurent; Nguyen, Micheline; Boyer, Jean-Christophe; Peray, Pascale A Fabbro; Goret, Lucie; Ripart, Jacques; Lefrant, Jean-Yves; de La Coussaye, Jean E

    2010-05-01

    Accidental IV administration of bupivacaine can compromise cardiovascular function by inducing lethal arrhythmias whose hemodynamic consequences may be alleviated by lipid emulsions. However, little is known about the electrophysiologic effects of lipid emulsions. In this study, we assessed whether 2 different lipid emulsions can reverse cardiac electrophysiologic impairment induced by the IV administration of bupivacaine in anesthetized and mechanically ventilated piglets. Bupivacaine (4 mg . kg(-1)) was injected over a 30-second period in 26 piglets. Thirty seconds after the end of bupivacaine injection, 1.5 mL . kg(-1) saline solution for the control group, and long-chain triglyceride emulsion (LCT group) or a mixture of long-chain and medium-chain triglyceride emulsion (LCT/MCT group) were infused over 1 minute. Cardiac conduction variables and hemodynamic variables were monitored for 30 minutes after injection. Bupivacaine induced similar electrophysiologic and hemodynamic changes. After 3 minutes, His ventricle intervals (median and interquartiles) were 100 (85-105), 45 (35-55), and 53 (48-73) milliseconds in the control, LCT, and LCT/MCT groups, respectively (P < 0.001 between control and both lipid emulsion groups). Lipid emulsions also reversed the effects on QRS duration, atrial-His, and PQ (the onset of the P wave to the Q wave of the QRS complex) intervals. LCT/MCT emulsion restored the decrease in maximal first derivative of left ventricular pressure (P < 0.01 after 3 minutes versus control group). LCT and LCT/MCT emulsions reversed the lengthening of His ventricle, QRS, atrial-His, and PQ intervals induced by the IV injection of 4 mg . kg(-1) bupivacaine.

  9. The Efficacy of Postoperative Wound Infusion with Bupivacaine for Pain Control after Cesarean Delivery: Randomized Double Blind Clinical Trial

    Directory of Open Access Journals (Sweden)

    Azin Alavi

    2007-06-01

    Full Text Available Objective: This study investigated the efficacy of bupivacaine wound infusion for pain control and opioid sparing effect after cesarean delivery.Materials and methods: We conducted a randomized double blind, placebo controlled clinical trial on 60 parturients undergoing cesarean section at a university hospital in Tehran. Patients were randomized to receive a pump infusion system that was filled with either 0.25% bupivacaine or equal volume of distilled water. A catheter was placed above the fascia and connected to electronic pump for 24 hours. Postoperative analog pain scores and morphine consumption were assessed at 6, 12 and 24 hours. Also time interval to first ambulation, length of hospitalization, complications and patient satisfaction were recorded. Data were analyzed using the SPSS software and P < 0.05 was considered statistically significant. Mann-Whitney u-test, student t-test and chi-square were used. Results: There were no differences in patient demographics and length of hospitalization and patient-generated resting pain scores between the two groups. Pain scores after coughing and leg raise during the first 6 postoperative hours were significantly less in the Bupivacaine group (P<0.001. The total dose of morphine consumption during the 24 hours study period was 2.5 ± 2.5 mg vs. 7.3 ± 2.7 mg for the bupivacaine and control groups, respectively (P<0.001. Compared with the control group, time to first ambulation was shorter in the bupivacaine group (11± 5h vs. 16 ± 4h (P< 0.01. Conclusion: Bupivacaine wound infusion was a simple and safe technique that provides effective analgesia and reduces morphine requirements after cesarean delivery.

  10. Post-thoracotomy pain control: a comparative study of Bupivacaine versus Normal Saline

    Directory of Open Access Journals (Sweden)

    Aghajanzadeh M

    2007-05-01

    Full Text Available Background: Pain control after posterolateral thoracotomy is very important for adequate respiration and to reduce pulmonary complications. Narcotic-induced respiratory depression requires different intercostal nerve block procedures with local anesthesia, such as bupivacaine, through an extrapleural catheter, paravertebral catheter and intrapleural injection in order to control pain and reduce narcotics consumption. The aim of this study is to determine the efficacy of bupivacain versus normal saline (N/S in pain control after thoracotomy. Methods: In a single-blind clinical trial, forty patients were divided into two groups of 20 patients each. Group 1 (G.1 received a single dose (10 ml of bupivacaine 0.5%, followed by continuous infusion of N/S (0.1 ml/kg/h four hours after surgery. Group 2 (G.2 received a single dose (10 ml of bupivacaine 0.5%, followed by a continuous infusion of bupivacaine (0.1 ml/kg/h four hours after surgery. Postoperative pain was assessed every four hours for 48 hours by linear visual analog scale (VAS. If VAS > 5, then pethidine was injected at a dosage of 1 mg/kg/IM. VAS ≤ 3 was considered pain control. Results: TThe mean VAS at 8, 12, 16, 20 and 24 hours after surgery in G.1 was 7.6, 5.5, 6.6, 5.5 and 5.7, respectively, and in G.2 was 3.4, 3.7, 2.8, 2.1 and 1.9, respectively. There were significant differences between the two groups (for 12 hours P<0.001 and for other time points P=0.0001. During the 4-24 hour period after surgery, pain control in G.1 was 5% and in G.2 was 81%. The mean VAS at 28, 32, 36, 40, 44, and 48 hours after surgery in G.1 was 5.2, 5, 5.3, 4.4, 5.1, and 4.8, respectively, and in G.2 was 1.6, 1.8, 1.5, 1.6, 1.5 and 1.4, respectively, with a significant difference between the two groups (P<0.0001. In the first 24 hours, the mean of pethidine injection in G.1 was 3.7 and in G.2 was 0.6 (P<0.0001. In the second 24 hours, the mean pethidine injection in G.1 was 2.2 and in G.2 there was no need

  11. Comparison of low doses of intrathecal bupivacaine in combined spinal epidural anaesthesia with epidural volume extension for caesarean delivery

    OpenAIRE

    Jain, Gaurav; Dinesh K. Singh; Bansal, Pranav; Ahmed, Bashir; Dhama, Satyavir S.

    2012-01-01

    Aims and Objectives: This study aims to compare relative efficacy of three different doses of intrathecal bupivacaine in combined spinal epidural anaesthesia (CSEA) for caesarean delivery. Materials and Methods: In a double blinded manner, 204 cases were randomized into three groups: I, II, and III to receive a dose of 4, 5.5, and 7 mg of hyperbaric bupivacaine with a fixed dose of 25 μg fentanyl intrathecally, and Dextran 40 w/v 10 mL given for epidural volume extension (EVE), in CSEA. Our p...

  12. Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section.

    Science.gov (United States)

    Wei, Chang-Na; Zhou, Qing-He; Wang, Li-Zhong

    2017-08-01

    Currently, there is no consensus on how to determine the optimal dose of intrathecal bupivacaine for an individual undergoing an elective cesarean section. In this study, we developed a regression equation between intrathecal 0.5% hyperbaric bupivacaine volume and abdominal girth and vertebral column length, to determine a suitable block level (T5) for elective cesarean section patients.In phase I, we analyzed 374 parturients undergoing an elective cesarean section that received a suitable dose of intrathecal 0.5% hyperbaric bupivacaine after a combined spinal-epidural (CSE) was performed at the L3/4 interspace. Parturients with T5 blockade to pinprick were selected for establishing the regression equation between 0.5% hyperbaric bupivacaine volume and vertebral column length and abdominal girth. Six parturient and neonatal variables, intrathecal 0.5% hyperbaric bupivacaine volume, and spinal anesthesia spread were recorded. Bivariate line correlation analyses, multiple line regression analyses, and 2-tailed t tests or chi-square test were performed, as appropriate. In phase II, another 200 parturients with CSE for elective cesarean section were enrolled to verify the accuracy of the regression equation.In phase I, a total of 143 parturients were selected to establish the following regression equation: YT5 = 0.074X1 - 0.022X2 - 0.017 (YT5 = 0.5% hyperbaric bupivacaine volume for T5 block level; X1 = vertebral column length; and X2 = abdominal girth). In phase II, a total of 189 participants were enrolled in the study to verify the accuracy of the regression equation, and 155 parturients with T5 blockade were deemed eligible, which accounted for 82.01% of all participants.This study evaluated parturients with T5 blockade to pinprick after a CSE for elective cesarean section to establish a regression equation between parturient vertebral column length and abdominal girth and 0.5% hyperbaric intrathecal bupivacaine volume. This equation can accurately

  13. Intraarticular analgesia after arthroscopic knee surgery: comparison of neostigmine, clonidine, tenoxicam, morphine and bupivacaine.

    Science.gov (United States)

    Alagol, A; Calpur, O U; Usar, P Saral; Turan, N; Pamukcu, Z

    2005-11-01

    We conducted a randomized, placebo-controlled, double blinded study to compare the analgesic effects of intraarticular neostigmine, morphine, tenoxicam, clonidine and bupivacaine in 150 patients undergoing arthroscopic knee surgery. General anaesthesia protocol was same in all patients. At the end of the surgical procedure, patients were randomized into six intraarticular groups equally. Group N received 500 mug neostigmine, Group M received 2 mg morphine, Group T received 20 mg tenoxicam, Group C received 1 microg kg(-1) clonidine, Group B received 100 mg bupivacaine and Group S received saline 20 ml. Visual analog scale scores 0, 30 and 60 min and 2, 4, 6, 12, 24, 48 and 72 h, time to first analgesic need, analgesic consumption at 48 h and 72 h and side effects were noted. Demographic and operational parameters were similar in six groups. All study groups provided analgesia when compared with saline group (P<0.05). Duration of analgesia in Group N and C was longer than other groups (P<0.001). Analgesic consumptions of Group N, C and T were lower than other groups (P<0.01). Pain scores during 2 h postoperatively were lower in all study groups than the control group (P<0.001). In Group B, median pain scores were higher than Groups N and C at 0 min and 30 min postoperatively (P<0.001). Side effects were not significantly different among the six groups. We conclude that the most effective drugs that are administered intraarticularly are neostigmine and clonidine among the five drugs we studied. Tenoxicam provided longer analgesia when compared with morphine and bupivacaine, postoperatively.

  14. Compartment syndrome in a patient treated with perineural liposomal bupivacaine (Exparel).

    Science.gov (United States)

    Soberón, José Raul; Sisco-Wise, Leslie E; Dunbar, Ross M

    2016-06-01

    Acute compartment syndrome is a condition that may result in sensorimotor deficits and loss of function of the affected limb as a result of ischemic injury. It is considered a surgical emergency and prompt diagnosis and treatment results in more favorable outcomes. The use of regional anesthesia is controversial in patients at risk for compartment syndrome due to concern of its potential to mask symptoms of the condition. A 44-year-old African American male presented to surgery for open reduction and internal fixation of a comminuted distal radius fracture. As part of an off-label, investigator-initiated, and institutional review board-approved study, he received a perineural injection of liposomal bupivacaine (Exparel) around the median, ulnar, and radial nerves at the level of the proximal forearm. The following morning, his initial complaints of numbness and incisional pain progressively evolved into worsening numbness, diffuse discomfort, and pain with passive movement. A diagnosis of compartment syndrome was made and he underwent an emergency fasciotomy. The diagnosis of compartment syndrome requires a high index of suspicion and prompt treatment. This patient's changing pattern of symptoms-rather than his pain complaints alone-resulted in the diagnosis of compartment syndrome treated with emergent fasciotomy in spite of finger numbness that was initially attributed to the liposomal bupivacaine. While the use of liposomal bupivacaine did not preclude the diagnosis of compartment syndrome in our patient, it should be used with caution in patients at risk for compartment syndrome until additional data, particularly regarding block characteristics, are available.

  15. Neostigmine does not prolong the duration of analgesia produced by caudal bupivacaine in children undergoing urethroplasty

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    Bhardwaj N

    2007-01-01

    Full Text Available Context : Neostigmine extends the duration of analgesia produced by caudal bupivacaine in children. Aims : To study the effect of different doses of caudal neostigmine on the duration of postoperative analgesia. Settings and Design : A randomized, double-blind study was conducted in 120 boys aged 1-12 years undergoing urethroplasty under combined general and caudal anesthesia. Materials and Methods : Children were administered 1.875 mg/kg bupivacaine alone (Group B, or with 2, 3 or 4 µg/kg of neostigmine (groups BN 2 , BN 3 or BN 4 respectively as caudal drug (0.75 ml/kg. Children with a pain score of 4 or more (OPS and NRS postoperatively were administered rescue analgesic. Time to first analgesic and the number of analgesic doses administered in the 24h were recorded. Statistical Analysis : Parametric data were analyzed using ANOVA. Kaplan-Meier survival curves for the time to first analgesic administration were plotted and compared using log rank analysis. Chi-square test was used to analyze the incidence data. Results : The median [IQR] time to first analgesic in Group B (540 [240-1441] min was similar to that in Groups BN 2 (450 [240-720], BN 3 (600 [360-1020] and BN 4 (990 [420-1441]. Significantly more patients in Groups B (9 [34.6%] and BN 4 (13 [44.8%] required no supplemental analgesic for 24h than those in Groups BN 2 and BN 3 (4 [13.8%] and 4 [13.3%]. The number of analgesic doses required in 24h in the four groups was similar. Conclusion : Addition of neostigmine to 1.875 mg/kg of caudal bupivacaine did not prolong the analgesia following urethroplasty in children.

  16. A case of trigeminal hypersensitivity after administration of intrathecal sufentanil and bupivacaine for labor analgesia.

    Science.gov (United States)

    de Souza Hobaika, Adriano Bechara

    2014-07-01

    Rostral spread of intrathecal drugs and sensitization of supraspinal sites may provoke several adverse effects. This case describes a patient with right hemifacial paresthesia, trismus and dysphasia on the trigeminal nerve distribution after intrathecal sufentanil administration. Primigravida, 34 years, 39 weeks of pregnancy, with hypothyroidism and pregnancy induced hypertension. Allergic to latex. In the use of puran T4, 50 μg /day. When the patient presented cervical dilatation of 4 cm, she requested analgesia. She was placed in the sitting position and a spinal puncture was performed with a 27G needle pencil point in L4/L5 (1.5 mg of bupivacaine plus 7.5 μg of sufentanil). Next, was performed an epidural puncture in the same space. It was injected bupivacaine 0.065%, 10 ml, to facilitate the passage of the catheter. After 5 min lying down in the lateral upright position, she complained of perioral and right hemifacial paresthesia, mainly maxillary and periorbital, as well as trismus and difficulty to speak. The symptoms lasted for 30 min and resolved spontaneously. After 1 h, patient requested supplementary analgesia (12 ml of bupivacaine 0.125%) and a healthy baby girl was born. Temporary mental alterations have been described with the use of fentanyl and sufentanil in combined epidural-spinal analgesia, such as aphasia, difficulty of swallowing, mental confusion and even unconsciousness. In this patient, facial areas with paresthesia indicated by patient appear in clear association with the ophthalmic and maxillary branches of the trigeminal nerve and the occurrence of trismus and dysphagia are in association with the mandibular motor branch. The exact mechanism of rostral spread is not known, but it is speculated that after spinal drug administration, a subsequent epidural dose may reduce the intratecal space and propel the drug into the supraspinal sites.

  17. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

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    Nirmala Jonnavithula

    2015-01-01

    Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

  18. Intratunical bupivacaine and methylprednisolone instillation for scrotal pain after testicular sperm retrieval procedures

    Institute of Scientific and Technical Information of China (English)

    GulK.Talu; TibetErdogru; TanselKaplancan; MustafaBahceci

    2003-01-01

    Aim:To investigate the effect of intratunical instillation of bupivacaine and methylprednisolone for scrotal pain,swelling and peritesticular fibrosis due to testicular sperm retrieval procedures.Methods:A total of 65 patients were randomly divided into two groups.In the instillation group(GI),34 patients were administered 2.5mL of 0.5% bupivacaine combined with 10 mg/mL methylprednisolone before closure of the tunica vaginalis.In the control group (GC),31 patients only received analgesics postoperatively by intramuscular route.The pain(by visual analogue scale,VAS)and duration of pain-free period after surgery between the two groups were evaluated at 2 and 4 h and at days 2 and 7 postoperatively.Results:The mean pain scores were significantly lower in the GI than in the GC group at 2 and 4 h after surgery(P<0.05 and P<0.01,respectively).The mean duration of pain free interval after the procedure was 47.8±16.9(12-76)h in GI,which was significantly longer than that in GC[(9.9±3.6;4-20)h].Besides,in the GI,29% of patients were completely free from pain and 67% had no scrotal swelling,but in the GC,all the patients required additional NSAID injection due to pain and only 3 % had no scrotal swelling.Conclusion:This study confirms that direct intratunical instillation of bupivacaine and methylprednisolone around the testis reduces the postoperative pain,scrotal swelling and peritesticular fibrosis.

  19. Comparison of co-administration of clonidine and pethidine with bupivacaine during spinal anesthesia

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    Farnad Imani

    2011-05-01

    Full Text Available Background: The aim of this study was to evaluate using the combination of pethidine and clonidine in order to produce synergistic effect for blocking of pain pathways in spinal cord and decrease the adverse effects of each drug and comparison it with bupivacaine.Materials and Method: This is a randomized double blind controlled clinical trial which was approved by the ethics committee of Iran University of Medical Sciences. Fifty patients (25 patients in each groups in ASA class 1 or 2 which were selected for surgery on lower limbs, entered into the study. The patients were randomly allocated in two groups and received following regimens: CP (spinal anesthesia with combination of clonidine 0.75 µgr/kg and pethidine 0.75 mg/kg and B (spinal anesthesia with bupivacaine 0.5%, 15 mg.Results: The onset time of sensory block on T10 in group CP (5.9±1.6 min was significantly less than group B (9.2±2.3 min [p<0.001]. The time to complete motor block in group CP (38.8±5.7 min was significantly longer than group B (19.6±4.7 min [p<0.001]. The time to the first analgesic request was significantly longer in the group CP (11.6±2 h than the group B (6±0.8 h [p<0.001]. Mean drop in the systolic blood pressure in group CP (22.6%±2.4% was significantly more than group B (11%±4.3% (p<0.001.Conclusion: It is recommended to use bupivacaine for anesthesia in operations on pelvis and lower limbs but it is better to co-administer clonidine and pethidine in patients who must be avoided from raising blood pressure and heart rate and with less than two hours operation time

  20. A COMPARATIVE STUDY OF INTRATHECAL DEXMEDETOMIDINE AND FENTANYL AS ADJUVANTS TO BUPIVACAINE FOR INFRA - UMBILICAL SURGERIES

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    Ch. Srinivas

    2015-01-01

    Full Text Available BACKGROUND: Several adjuncts like adrenaline,opioids and alpha - 2 adrenergic agonists are being used with local anaesthetics intrathecally for prolongation of intra - operative and post - operative analgesia and to reduce the side - effects of high doses of local anaesthetics. [1] AIM: The present study was done to evaluate the onset and duration of sensory and motor block, hemodynamic effects, pos t - operative analgesia and adverse effects of Dexmedetomidine or Fentanyl given intrathecally with hyperbaric 0.5% Bupivacaine. MATERIALS AND METHODS: Ninety inpatients of ASA class I and II scheduled for various infra - umbilical surgeries under Sub - Arachnoi d Block were randomly divided into three groups of 30 each namely C (Control, D(Dexmedetomidine and F(Fentanyl. All received 12.5mg hyperbaric bupivacaine plus 0.5 ml Normal Saline in Group C (Control,5 μ g Dexmedetomidine (diluted in preservative free Normal saline of 0.5ml in Group D (Dexmedetomidine and 25 μ g Fentanyl (vol 0.5 ml in Group F (Fentanyl. The onset time to reach peak sensory and motor level, the regression time for sensory and motor block, hemodynamic changes and side - effects were not ed. RESULTS: The duration of sensory and motor block,rescue analgesia was significantly prolonged in Dexmedetomidine group when compared to that of the Fentanyl group which is longer than that of Control group. CONCLUSION: Dexmedetomidine 5 μg seems to be better than 25μg Fentanyl as a neuraxial adjuvant to hyperbaric Bupivacaine.

  1. A case of trigeminal hypersensitivity after administration of intrathecal sufentanil and bupivacaine for labor analgesia

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    Adriano Bechara de Souza Hobaika

    2014-01-01

    Full Text Available Rostral spread of intrathecal drugs and sensitization of supraspinal sites may provoke several adverse effects. This case describes a patient with right hemifacial paresthesia, trismus and dysphasia on the trigeminal nerve distribution after intrathecal sufentanil administration. Primigravida, 34 years, 39 weeks of pregnancy, with hypothyroidism and pregnancy induced hypertension. Allergic to latex. In the use of puran T4, 50 μg /day. When the patient presented cervical dilatation of 4 cm, she requested analgesia. She was placed in the sitting position and a spinal puncture was performed with a 27G needle pencil point in L4/L5 (1.5 mg of bupivacaine plus 7.5 μg of sufentanil. Next, was performed an epidural puncture in the same space. It was injected bupivacaine 0.065%, 10 ml, to facilitate the passage of the catheter. After 5 min lying down in the lateral upright position, she complained of perioral and right hemifacial paresthesia, mainly maxillary and periorbital, as well as trismus and difficulty to speak. The symptoms lasted for 30 min and resolved spontaneously. After 1 h, patient requested supplementary analgesia (12 ml of bupivacaine 0.125% and a healthy baby girl was born. Temporary mental alterations have been described with the use of fentanyl and sufentanil in combined epidural-spinal analgesia, such as aphasia, difficulty of swallowing, mental confusion and even unconsciousness. In this patient, facial areas with paresthesia indicated by patient appear in clear association with the ophthalmic and maxillary branches of the trigeminal nerve and the occurrence of trismus and dysphagia are in association with the mandibular motor branch. The exact mechanism of rostral spread is not known, but it is speculated that after spinal drug administration, a subsequent epidural dose may reduce the intratecal space and propel the drug into the supraspinal sites.

  2. Evaluation of the effect of added fentanyl to hyperbaric bupivacaine for spinal anesthesia

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    Mina Jafari-Javid

    2011-01-01

    Full Text Available Background: Potentiating the effect of the intrathecal local anesthetics by intrathecal injection of opiods for intra-abdominal surgeries is known. The objective of this study is to investigate the pain-relieving effects of intrathecal fentanyl to bupivacaine in elective caesarean surgery.Materials and Method: In a double blind clinical trial 60 patients candidate for elective cesarean section. They were studied in two groups. Cases in the control group received 12.5 mg of bupivacaine and in the study group received 8 mg of bupivacaine and 20 µg fentanyl. The parameters taken into consideration were hemodynamic stability, visceral pain, nausea and vomiting, intraoperative shivering, the amount of intraoperative administered dose of fentanyl and ephedrine and postoperative pain. Results: The average blood pressure changes after 5, 10, 20, 60 minutes were lower in the study group. Shivering and ephedrine dose during operation were lower in study group and statistically significant respectively (p=0.01, p=0.001, respectively. Duration of analgesia after operation increased from (115.5±7.5 min in control group to (138.5±9.9 min in study group, but the quality of analgesia during peritoneal manipulation did not change. Pulse rate and vomiting during operation were not statistically different between two groups.Conclusion: Reduction of local anesthetic dose with adding fentanyl may cause hemodynamic stability, increasing the postoperative pain-free time, decrease shivering and vasopressor consumption in spinal anesthesia and reduction of the amount of blood pressure drop during elective cesarean surgery

  3. Comparison of Intraarticular Bupivacaine and Levobupivacaine with Morphine and Epinephrine for Knee Arthroscopy

    Science.gov (United States)

    Ozdemir, Nurdan; Kaya, Fatma Nur; Gurbet, Alp; Yilmazlar, Aysun; Demirag, Burak; Mandiraci, Bilgen Onbasi

    2013-01-01

    Objective: To compare the efficacy of intraarticularly injected bupivacaine with levobupivacaine when administered in combination with morphine and adrenaline for post-operative analgesia and functional recovery after knee surgery. Materials and Methods: Sixty American Society of Anesthesiologists physical status I–II patients were randomized into three groups: Group B was administered 30 mL isobaric 0.5% bupivacaine, 2 mg morphine and 100 μg adrenaline, Group L was administered 30 mL 0.5% levobupivacaine, 2 mg morphine and 100 μg adrenaline, and Group C was administered 30 mL 0.9% NaCl solution into the knee joint by the surgeon at the end of surgery. The morphine usage and visual analog pain scores were recorded regularly afterwards. We also recorded the time that elapsed before each patients’ first mobilization, positive response to straight leg raising, tolerance to 30–50° knee flexion, recovery of quadriceps reflexes and discharge from the hospital. We also recorded patient and surgeon satisfaction. Results: The pain scale values were lower in Groups B and L than in Group C at 2, 4, 6, 8, 12 and 24 hours post-operatively (all p<0.001). In Groups B and L, the time for first analgesic request was longer (p<0.01), the morphine consumption was lower (p<0.001), and the duration of morphine usage was shorter (p<0.001). The times to positive response to straight leg raising, tolerance to 30–50° knee flexion and the first mobilization were shorter in Groups B and L (p<0.001 for all). Conclusion: After arthroscopic knee surgery, intraarticular levobupivacaine combined with morphine and adrenaline decreases analgesic requirements, shortens the postoperative duration of analgesic use and hastens mobilization as effectively as bupivacaine. PMID:25610257

  4. A COMPARATIVE STUDY OF INTRATHECAL DEXMEDETOMIDINE AND FENTANYL AS ADJUVANTS TO BUPIVACAINE

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    Gollapalli Hanumanth

    2016-02-01

    Full Text Available INTRODUCTION Uncontrolled postoperative pain may produce a range of detrimental acute and chronic effects. Spinal anaesthesia provided by bupivacaine may be too short for providing postoperative analgesia. This study is conducted to evaluate the efficacy of intrathecal fentanyl and intrathecal dexmedetomidine as an adjuvant to hyperbaric bupivacaine with regards to the onset and duration of sensory and motor blockade, as well as postoperative analgesia and adverse effects. Hundred patients aged 18-55 years were randomly divided into two groups, each group consisting of 50 patients of either sex belonging to ASA class I and II posted for elective lower abdominal surgeries were given spinal anaesthesia using bupivacaine 0.5%, heavy 2.5 ml with either fentanyl 25µg (group F or 5µg of preservative free dexmedetomidine (group D. Assessment of the sensory and motor blockade were done at the end of each minute till the maximum level achieved. Measurement of blood pressure, pulse rate, respiratory rate and arterial oxygen saturation were obtained. Postoperatively the patients were observed for the duration of analgesia, time taken for complete regression of sensory blockade to S1 and time taken for complete recovery of motor power. RESULTS Our results showed a statistically highly significant prolongation of sensory and motor blockade, and postoperative analgesia in the dexmedetomidine group compared to the fentanyl group. In dexmedetomidine group four out of fifty patients, and in fentanyl group two out of fifty patients developed hypotension. In dexmedetomidine group five out of fifty patients, and in fentanyl group two out of fifty patients developed bradycardia. Incidence of pruritis is significantly high in fentanyl group.

  5. The stability and microbial contamination of bupivacaine, lidocaine and mepivacaine used for lameness diagnostics in horses.

    Science.gov (United States)

    Adler, D M T; Cornett, C; Damborg, P; Verwilghen, D R

    2016-12-01

    Local anaesthetics (LAs) are frequently used for diagnostic procedures in equine veterinary practice. The objective of this study was to investigate the physico-chemical stability and bacterial contamination of bupivacaine, lidocaine and mepivacaine used for lameness examinations in horses. The LAs were stored in 12 different groups at different temperatures (-18 °C to 70 °C), light intensities and in common veterinary field conditions for up to 16 months. The pH, presence of bacterial contamination and concentrations of LAs and methylparaben (a preservative present in lidocaine) were determined serially in both new and repeatedly punctured (RP) vials. Mepivacaine remained chemically stable. A 1.9% increase in bupivacaine concentration was evident in one group, whereas a 1.9-3.7% decrease was noted in six groups. Risk factors associated with a change in concentration were light and RP vials. Lidocaine concentration decreased 6.3% in one group and increased 5.3-7.2% in two groups. Risk factors for degradation were heat and RP vials whereas storage in practice vehicles was a risk factor for increased concentrations. Methylparaben decreased 8.3-75.0% in seven groups, and RP vials, heat and storage in practice vehicles were risk factors for degradation. No contamination was present in any of the LAs and pH remained stable. Commercially available solutions of lidocaine, mepivacaine and bupivacaine stored under common veterinary field conditions are extremely stable and sterile for extended periods. The minor changes in concentration documented in this study are unlikely to affect anaesthetic efficacy during equine lameness examinations. When using products containing methylparaben, degradation of the preservative over time is to be expected. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. The biologic tissue responses to uncoated and coated implanted biomaterials.

    Science.gov (United States)

    Steflik, D E; Corpe, R S; Young, T R; Sisk, A L; Parr, G R

    1999-06-01

    Ultrastructural examination of the morphology and morphometry of the bone supporting uncoated titanium and ceramic implants was assessed in an experimental animal model involving 120 implants placed into the mandibles of 30 adult mongrel dogs. Further, preliminary morphologic and morphometric observations of the bone supporting uncoated and hydroxylapatite-coated endosteal titanium implants was evaluated in a second investigation involving 72 implants placed into the mandibles and maxillae of 6 additional dogs. A densely mineralized collagen fiber matrix was observed directly interfacing with uncoated implants. The only material interposed between the implant and bone matrix was a 20- to 50-nm electron-dense material suggestive of a proteoglycan. Also seen in these same osseointegrated implants were narrow unmineralized zones interposed between the implant and bone matrix. In these zones of remodeling bone, numerous osteoblasts were observed interacting with the collagen fiber matrix. It was shown that a normal homeostasis of anabolic osteoblastic activity and catabolic osteoclastic activity resulted in bone remodeling and the resultant osseointegration of the implants. Hydroxylapatite-coated implants intimately interfaced with healthy bone. The mineralized matrix extended into the microporosity of the HA coating. This matrix contained viable osteocytes.

  7. Effects of intravenous dexmedetomidine on hyperbaric bupivacaine spinal anesthesia: A randomized study

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    Chilkunda N Dinesh

    2014-01-01

    Full Text Available Background and Objectives: The present study was designed to evaluate the effect of intravenous dexmedetomidine on spinal anesthesia with 0.5% of hyperbaric bupivacaine. Materials and Methods: One hundred American Society of Anesthesiologists (ASA physical status I/II patients undergoing elective surgeries under spinal anesthesia were randomized into two groups of 50 each. Immediately after subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine, patients in group D received a loading dose of 1 μg/kg of dexmedetomidine intravenously by infusion pump over 10 min followed by a maintenance dose of 0.5 μg/kg/h till the end of surgery, whereas patients in group C received an equivalent quantity of normal saline. Results: The time taken for regression of motor blockade to modified Bromage scale 0 was significantly prolonged in group D (220.7 ± 16.5 min compared to group C (131 ± 10.5 min (P < 0.001. The level of sensory block was higher in group D (T 6.88 ± 1.1 than group C (T 7.66 ± 0.8 (P < 0.001. The duration for two-dermatomal regression of sensory blockade (137.4 ± 10.9 min vs. 102.8 ± 14.8 min and the duration of sensory block (269.8 ± 20.7 min vs. 169.2 ± 12.1 min were significantly prolonged in group D compared to group C (P < 0.001. Intraoperative Ramsay sedation scores were higher in group D (4.4 ± 0.7 compared to group C (2 ± 0.1 (P < 0.001. Higher proportion of patients in group D had bradycardia (33% vs. 4% (P < 0.001, as compared to group C. The 24-h mean analgesic requirement was less and the time to first request for postoperative analgesic was prolonged in group D than in group C (P < 0.001. Conclusion: Intravenous dexmedetomidine significantly prolongs the duration of sensory and motor block of bupivacaine spinal anesthesia. The incidence of bradycardia is significantly higher when intravenous dexmedetomidine is used as an adjuvant to bupivacaine spinal anesthesia. Dexmedetomidine provides excellent intraoperative

  8. Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block

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    Sandhya Agarwal

    2014-01-01

    Full Text Available Background: We compared the effects of adding dexmedetomidine to a 30 ml solution of 0.325% bupivacaine in supraclavicular brachial plexus block. Onset and duration of sensory and motor block along with the duration of analgesia were the primary endpoints. Materials and Methods: Fifty patients posted for upper limb surgeries were enrolled for a prospective, randomized, double-blind, placebo-controlled trial. Patients were divided into two groups, the control group S and the study group SD. In group S (n = 25, 30 ml of 0.325% bupivacaine + 1 ml normal saline; and in group SD (n = 25, 30 ml of 0.325% bupivacaine + 1 ml (100 μg dexmedetomidine were given for supraclavicular brachial plexus block using the peripheral nerve stimulator. Onset and duration of sensory and motor blocks were assessed along with the duration of analgesia, sedation, and adverse effects, if any. Hemodynamic parameters, like heart rate (HR, systolic arterial blood pressure (SBP, and diastolic arterial blood pressure (DBP were also monitored. Results: Demographic data and surgical characteristics were comparable in both the groups. The onset times for sensory and motor blocks were significantly shorter in SD than S group (P < 0.001, while the duration of blocks was significantly longer (P < 0.001 in SD group. Except for the initial recordings (at 0, 5, 10, and 15 min, heart rate levels in group SD were significantly lower (P < 0.001. SBP and DBP levels in SD group at 15, 30, 45, 60, 90 and 120 min were significantly lower than in S group (P < 0.001. In fact, when the percentage changes in HR/SBP/DBP were compared from 0-5/0-10/0-15/0-30/0-45/0-60/0-90/0-120 min in SD with S group, they came out to be highly significant (P < 0.001 in group SD. The duration of analgesia (DOA was significantly longer in SD group than S group (P < 0.001. Except that, bradycardia was observed in one patient in the group SD, no other adverse effects were observed in either of the groups. Conclusion

  9. Bupivacaine in microcapsules prolongs analgesia after subcutaneous infiltration in humans: a dose-finding study

    DEFF Research Database (Denmark)

    Pedersen, Juri L; Lillesø, Jesper; Hammer, Niels A

    2004-01-01

    In this study, we examined the onset and duration of local analgesic effects of bupivacaine incorporated into biodegradable microcapsules (extended-duration local anesthetic; EDLA) administered as subcutaneous infiltrations in different doses in humans. In 18 volunteers, the skin on the medial calf...... stimuli and sensory thresholds (touch, warm, and cold detection thresholds) were examined by von Frey hairs and contact thermodes. Assessments were made before and 2, 4, 6, 8, 24, 48, 72, 96, and 168 h after the injections. Safety evaluations were performed daily for the first week and at 2 wk, 6 wk...

  10. Combined Spinal Epidural versus Epidural Sufentanil and Bupivacaine in Labour (Clinical and Histological comparative Study

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    Nagia M. Abd El Moeti, *Zinab B. Youssef, *Soaad S. Abd El Aal

    2006-12-01

    Full Text Available Introduction:- Regional analgesia provides excellent pain relif in labour. This study was designed to compare combined spinal eqidural (CSE versus epidural block using a narcotic (sufentanil and local anaesthetic bupivacaine regarding their effects on progress of labour, method of delivery, pain relif, side effects and neonatal outcome. Patients and Methods :-Forty pregnant women ASA I and II were enrolled in this study. The women were randomly allocated to receive either CSE or epidural ( 20 patient of each . In CSE group analgesia was initiated with 10ug sufentanil with 2mg bupivacaine. In epidural group 10ml bupivacaine 0.125%.and 10ug sufentanil injected epidurally. In both groups the continuous infusion of 0.83% bupivacaine with 0.33ug/ml sufentanil at 10ml/hr adjusted as required. Maternal haemodynamics, analgesia characteristics VAPS, degree of motor block, were measured. Duration of labour, cervical dilation, maternal satisfaction and mode of delivery were assessed. Foetal outcome was assessed by 1 and 5 min. Apgar score and umbilical venous blood gases. Maternal and neonatal side effects were observed. The experimental study was done on 30 rats divided into 3 groups 10 rats of each. Control group (A injected intrathecally with saline, group (B injected intrathecally with 1.5ug/kg sufentanil (low dose, and group (C injected intrathecally with 7.5ug/kg sufentanil (high dose, the pervious doses were injected every 2hr. for 3 times then the spinal cord was obtained and stained for histological evaluation. Results:- The clinical study showed that no difference between the 2 groups for the degree of motor block or adequacy of analgesia, mode of delivery and Foetal outcome. The onset of analgesia was faster with CSE technique, more patient satisfaction and more pruritis. The histological results revealed that no detectable significant neurotoxic changes with the use of small dose of intrathecal sufentanil but mild changes occurred with high

  11. The reparative response to cross-linked collagen-based scaffolds in a rat spinal cord gap model.

    Science.gov (United States)

    Cholas, Rahmatullah H; Hsu, Hu-Ping; Spector, Myron

    2012-03-01

    Prior work demonstrated the improvement of peripheral nerve regeneration in gaps implanted with collagen scaffold-filled collagen tubes, compared with nerve autografts, and the promise of such implants for treating gaps in spinal cord injury (SCI) in rats. The objective of this study was to investigate collagen implants alone and incorporating select therapeutic agents in a 5-mm full-resection gap model in the rat spinal cord. Two studies were performed, one with a 6-week time point and one with a 2-week time point. For the 6-week study the groups included: (1) untreated control, (2) dehydrothermally (DHT)-cross-linked collagen scaffold, (3) DHT-cross-linked collagen scaffold seeded with adult rat neural stem cells (NSCs), and (4) DHT-cross-linked collagen scaffold incorporating plasmid encoding glial cell line-derived neurotropic factor (pGDNF). The 2-week study groups were: (1) nontreated control, (2) DHT-cross-linked collagen scaffold; (3) DHT-cross-linked collagen scaffold containing laminin; and (4) carbodiimide-cross-linked collagen scaffold containing laminin. The tissue filling the defect of all groups at 6 weeks was largely composed of fibrous scar; however, the tissue was generally more favorably aligned with the long axis of the spinal cord in all of the treatment groups, but not in the control group. Quantification of the percentage of animals per group containing cystic cavities in the defect showed a trend toward fewer rats with cysts in the groups in which the scaffolds were implanted compared to control. All of the collagen implants were clearly visible and mostly intact after 2 weeks. A band of fibrous tissue filling the control gaps was not seen in the collagen implant groups. In all of the groups there was a narrowing of the spinal canal within the gap as a result of surrounding soft tissue collapse into the defect. The narrowing of the spinal canal occurred to a greater extent in the control and DHT scaffold alone groups compared to the DHT

  12. ENDO180 AND MT1-MMP ARE INVOLVED IN THE PHAGOCYTOSIS OF COLLAGEN SCAFFOLDS BY MACROPHAGES AND IS REGULATED BY INTERFERON-GAMMA

    NARCIS (Netherlands)

    Ye, Qingsong; Xing, Quan; Ren, Yijin; Harmsen, Martin C.; Bank, Ruud A.

    2010-01-01

    Subcutaneously implanted disks of hexamethylenediisocyanate or glutaraldehyde cross-linked sheep collagen (referred to as HDSC and GDSC, respectively) in mice show large differences in degradation rate. Although comparable numbers of macrophages are seen in HDSC and GDSC, phagocytosis of collagen by

  13. Contraction-induced Mmp13 and-14 expression by goat articular chondrocytes in collagen type I but not type II gels

    NARCIS (Netherlands)

    Berendsen, Agnes D.; Vonk, Lucienne A.; Zandieh-Doulabi, Behrouz; Everts, Vincent; Bank, Ruud A.

    2012-01-01

    Collagen gels are promising scaffolds to prepare an implant for cartilage repair but several parameters, such as collagen concentration and composition as well as cell density, should be carefully considered, as they are reported to affect phenotypic aspects of chondrocytes. In this study we

  14. Contraction-induced Mmp13 and-14 expression by goat articular chondrocytes in collagen type I but not type II gels

    NARCIS (Netherlands)

    Berendsen, Agnes D.; Vonk, Lucienne A.; Zandieh-Doulabi, Behrouz; Everts, Vincent; Bank, Ruud A.

    2012-01-01

    Collagen gels are promising scaffolds to prepare an implant for cartilage repair but several parameters, such as collagen concentration and composition as well as cell density, should be carefully considered, as they are reported to affect phenotypic aspects of chondrocytes. In this study we investi

  15. Cross-linked type I and type II collagenous matrices for the repair of full-thickness articular cartilage defects--a study in rabbits.

    NARCIS (Netherlands)

    Buma, P.; Pieper, J.S.; Tienen, Tony van; Susante, J.L.C. van; Kraan, P.M. van der; Veerkamp, J.H.; Berg, W.B. van den; Veth, R.P.H.; Kuppevelt, A.H.M.S.M. van

    2003-01-01

    The physico-chemical properties of collagenous matrices may determine the tissue response after insertion into full-thickness articular cartilage defects. In this study, cross-linked type I and type II collagen matrices, with and without attached chondroitin sulfate, were implanted into full-thickne

  16. Collagen Conduit Versus Microsurgical Neurorrhaphy

    DEFF Research Database (Denmark)

    Boeckstyns, Michel; Sørensen, Allan Ibsen; Viñeta, Joaquin Fores

    2013-01-01

    To compare repair of acute lacerations of mixed sensory-motor nerves in humans using a collagen tube versus conventional repair.......To compare repair of acute lacerations of mixed sensory-motor nerves in humans using a collagen tube versus conventional repair....

  17. Evaluation of a collagen-chitosan hydrogel for potential use as a pro-angiogenic site for islet transplantation.

    Directory of Open Access Journals (Sweden)

    Joanne E McBane

    Full Text Available Islet transplantation to treat type 1 diabetes (T1D has shown varied long-term success, due in part to insufficient blood supply to maintain the islets. In the current study, collagen and collagen:chitosan (10:1 hydrogels, +/- circulating angiogenic cells (CACs, were compared for their ability to produce a pro-angiogenic environment in a streptozotocin-induced mouse model of T1D. Initial characterization showed that collagen-chitosan gels were mechanically stronger than the collagen gels (0.7 kPa vs. 0.4 kPa elastic modulus, respectively, had more cross-links (9.2 vs. 7.4/µm(2, and were degraded more slowly by collagenase. After gelation with CACs, live/dead staining showed greater CAC viability in the collagen-chitosan gels after 18 h compared to collagen (79% vs. 69%. In vivo, collagen-chitosan gels, subcutaneously implanted for up to 6 weeks in a T1D mouse, showed increased levels of pro-angiogenic cytokines over time. By 6 weeks, anti-islet cytokine levels were decreased in all matrix formulations ± CACs. The 6-week implants demonstrated increased expression of VCAM-1 in collagen-chitosan implants. Despite this, infiltrating vWF(+ and CXCR4(+ angiogenic cell numbers were not different between the implant types, which may be due to a delayed and reduced cytokine response in a T1D versus non-diabetic setting. The mechanical, degradation and cytokine data all suggest that the collagen-chitosan gel may be a suitable candidate for use as a pro-angiogenic ectopic islet transplant site.

  18. Transformation of amorphous calcium carbonate to rod-like single crystal calcite via "copying" collagen template.

    Science.gov (United States)

    Xue, Zhonghui; Hu, Binbin; Dai, Shuxi; Du, Zuliang

    2015-10-01

    Collagen Langmuir films were prepared by spreading the solution of collagen over deionized water, CaCl2 solution and Ca(HCO3)2 solution. Resultant collagen Langmuir monolayers were then compressed to a lateral pressure of 10 mN/m and held there for different duration, allowing the crystallization of CaCO3. The effect of crystallization time on the phase composition and microstructure of CaCO3 was investigated. It was found that amorphous calcium carbonate (ACC) was obtained at a crystallization time of 6 h. The amorphous CaCO3 was transformed to rod-like single crystal calcite crystals at an extended crystallization time of 12 h and 24 h, via "copying" the symmetry and dimensionalities of collagen fibers. Resultant calcite crystallites were well oriented along the longitudinal axis of collagen fibers. The ordered surface structure of collagen fibers and electrostatic interactions played key roles in tuning the oriented nucleation and growth of the calcite crystallites. The mineralized collagen possessing both desired mechanical properties of collagen fiber and good biocompatibility of calcium carbonate may be assembled into an ideal biomaterial for bone implants.

  19. Enhanced expression of WD repeat-containing protein 35 via nuclear factor-kappa B activation in bupivacaine-treated Neuro2a cells.

    Directory of Open Access Journals (Sweden)

    Lei Huang

    Full Text Available The family of WD repeat proteins comprises a large number of proteins and is involved in a wide variety of cellular processes such as signal transduction, cell growth, proliferation, and apoptosis. Bupivacaine is a sodium channel blocker administered for local infiltration, nerve block, epidural, and intrathecal anesthesia. Recently, we reported that bupivacaine induces reactive oxygen species (ROS generation and p38 mitogen-activated protein kinase (MAPK activation, resulting in an increase in the expression of WD repeat-containing protein 35 (WDR35 in mouse neuroblastoma Neuro2a cells. It has been shown that ROS activate MAPK through phosphorylation, followed by activation of nuclear factor-kappa B (NF-κB and activator protein 1 (AP-1. The present study was undertaken to test whether NF-κB and c-Jun/AP-1 are involved in bupivacaine-induced WDR35 expression in Neuro2a cells. Bupivacaine activated both NF-κB and c-Jun in Neuro2a cells. APDC, an NF-κB inhibitor, attenuated the increase in NF-κB activity and WDR35 protein expression in bupivacaine-treated Neuro2a cells. GW9662, a selective peroxisome proliferator-activated receptor-γ antagonist, enhanced the increase in NF-κB activity and WDR35 protein expression in bupivacaine-treated Neuro2a cells. In contrast, c-Jun siRNA did not inhibit the bupivacaine-induced increase in WDR35 mRNA expression. These results indicate that bupivacaine induces the activation of transcription factors NF-κB and c-Jun/AP-1 in Neuro2a cells, while activation of NF-κB is involved in bupivacaine-induced increases in WDR35 expression.

  20. The effect of tissue-engineered cartilage biomechanical and biochemical properties on its post-implantation mechanical behavior.

    Science.gov (United States)

    Khoshgoftar, Mehdi; Wilson, Wouter; Ito, Keita; van Donkelaar, Corrinus C

    2013-01-01

    The insufficient load-bearing capacity of today's tissue-engineered (TE) cartilage limits its clinical application. Focus has been on engineering cartilage with enhanced mechanical stiffness by reproducing native biochemical compositions. More recently, depth dependency of the biochemical content and the collagen network architecture has gained interest. However, it is unknown whether the mechanical performance of TE cartilage would benefit more from higher content of biochemical compositions or from achieving an appropriate collagen organization. Furthermore, the relative synthesis rate of collagen and proteoglycans during the TE process may affect implant performance. Such insights would assist tissue engineers to focus on those aspects that are most important. The aim of the present study is therefore to elucidate the relative importance of implant ground substance stiffness, collagen content, and collagen architecture of the implant, as well as the synthesis rate of the biochemical constituents for the post-implantation mechanical behavior of the implant. We approach this by computing the post-implantation mechanical conditions using a composition-based fibril-reinforced poro-viscoelastic swelling model of the medial tibia plateau. Results show that adverse implant composition and ultrastructure may lead to post-implantation excessive mechanical loads, with collagen orientation being the most critical variable. In addition, we predict that a faster synthesis rate of proteoglycans compared to that of collagen during TE culture may result in excessive loads on collagen fibers post-implantation. This indicates that even with similar final contents, constructs may behave differently depending on their development. Considering these aspects may help to engineer TE cartilage implants with improved survival rates.

  1. The structural and optical properties of type III human collagen biosynthetic corneal substitutes

    Science.gov (United States)

    Hayes, Sally; Lewis, Phillip; Islam, M. Mirazul; Doutch, James; Sorensen, Thomas; White, Tomas; Griffith, May; Meek, Keith M.

    2015-01-01

    The structural and optical properties of clinically biocompatible, cell-free hydrogels comprised of synthetically cross-linked and moulded recombinant human collagen type III (RHCIII) with and without the incorporation of 2-methacryloyloxyethyl phosphorylcholine (MPC) were assessed using transmission electron microscopy (TEM), X-ray scattering, spectroscopy and refractometry. These findings were examined alongside similarly obtained data from 21 human donor corneas. TEM demonstrated the presence of loosely bundled aggregates of fine collagen filaments within both RHCIII and RHCIII-MPC implants, which X-ray scattering showed to lack D-banding and be preferentially aligned in a uniaxial orientation throughout. This arrangement differs from the predominantly biaxial alignment of collagen fibrils that exists in the human cornea. By virtue of their high water content (90%), very fine collagen filaments (2–9 nm) and lack of cells, the collagen hydrogels were found to transmit almost all incident light in the visible spectrum. They also transmitted a large proportion of UV light compared to the cornea which acts as an effective UV filter. Patients implanted with these hydrogels should be cautious about UV exposure prior to regrowth of the epithelium and in-growth of corneal cells into the implants. PMID:26159106

  2. Strain driven fast osseointegration of implants

    Directory of Open Access Journals (Sweden)

    Wiesmann Hans-Peter

    2005-09-01

    Full Text Available Abstract Background Although the bone's capability of dental implant osseointegration has clinically been utilised as early as in the Gallo-Roman population, the specific mechanisms for the emergence and maintenance of peri-implant bone under functional load have not been identified. Here we show that under immediate loading of specially designed dental implants with masticatory loads, osseointegration is rapidly achieved. Methods We examined the bone reaction around non- and immediately loaded dental implants inserted in the mandible of mature minipigs during the presently assumed time for osseointegration. We used threaded conical titanium implants containing a titanium2+ oxide surface, allowing direct bone contact after insertion. The external geometry was designed according to finite element analysis: the calculation showed that physiological amplitudes of strain (500–3,000 ustrain generated through mastication were homogenously distributed in peri-implant bone. The strain-energy density (SED rate under assessment of a 1 Hz loading cycle was 150 Jm-3 s-1, peak dislocations were lower then nm. Results Bone was in direct contact to the implant surface (bone/implant contact rate 90% from day one of implant insertion, as quantified by undecalcified histological sections. This effect was substantiated by ultrastructural analysis of intimate osteoblast attachment and mature collagen mineralisation at the titanium surface. We detected no loss in the intimate bone/implant bond during the experimental period of either control or experimental animals, indicating that immediate load had no adverse effect on bone structure in peri-implant bone. Conclusion In terms of clinical relevance, the load related bone reaction at the implant interface may in combination with substrate effects be responsible for an immediate osseointegration state.

  3. Efficacy of Analgesic Effects of Low Dose Intrathecal Clonidine as Adjuvant to Bupivacaine

    Directory of Open Access Journals (Sweden)

    B S Sethi

    2007-01-01

    The maximum dose of clonidine used was70 μg. The meantime from injection to regression of the level of sensory analgesia by two segments was longer in the Clonidine group than in Control group (P< 0.001. The duration of motor blockade was longer in Clonidine group than in Control group (P< 0.05. There was also a significant difference in the duration of analgesia between the two groups (P< 0.001. The rescue analgesia was required earlier in the Control group(mean 223 min compared to the Clonidine group(mean614 min. The number of injections of diclofenacin24 hours was higher for Control group (mean2.66 than Clonidine group (mean 1.16 (P < 0.05. The patients in the Clonidine group had a significant fall in mean arterial pressure and heart rate and were more sedated than those in Control group, however, no therapeutic interventions needed. We concluded that addition of clonidine to bupivacaine in the dose of 1μg.kg -1 significantly increases the duration of spinal analgesia as compared to bupivacaine alone with clinically insignificant influence on haemodynamic parameters and level of sedation.

  4. Bupivacaine in microcapsules prolongs analgesia after subcutaneous infiltration in humans: a dose-finding study

    DEFF Research Database (Denmark)

    Pedersen, Juri L; Lillesø, Jesper; Hammer, Niels A

    2004-01-01

    In this study, we examined the onset and duration of local analgesic effects of bupivacaine incorporated into biodegradable microcapsules (extended-duration local anesthetic; EDLA) administered as subcutaneous infiltrations in different doses in humans. In 18 volunteers, the skin on the medial calf...... was infiltrated with 10 mL of EDLA, and the opposite calf was infiltrated with 10 mL of aqueous bupivacaine (5.0 mg/mL) in a double-blinded, randomized manner. Three different concentrations of EDLA were tested (6.25, 12.5, and 25 mg/mL), with 6 subjects in each group. Pain responses to mechanical and heat...... stimuli and sensory thresholds (touch, warm, and cold detection thresholds) were examined by von Frey hairs and contact thermodes. Assessments were made before and 2, 4, 6, 8, 24, 48, 72, 96, and 168 h after the injections. Safety evaluations were performed daily for the first week and at 2 wk, 6 wk...

  5. Bupivacaine Injection for Management of Lagophthalmos Due to Long-Standing Idiopathic Facial Nerve Palsy.

    Science.gov (United States)

    Rajabi, Mohammad Taher; Shadravan, Mahla; Mazloumi, Mehdi; Tabatabaie, Syed Ziaeddin; Hosseini, Seyedeh Simindokht; Rajabi, Mohammad Bagher

    2015-01-01

    To report the results of bupivacaine injection into the orbicularis oculi muscle to treat lagophthalmos in patients with long-standing Bell palsy. In this prospective interventional case series, bupivacaine, 5 ml of a 0.750% solution, was injected into the preseptal and pretarsal area of the orbicularis oculi in each of 10 patients with idiopathic peripheral facial nerve palsy. The measures of vertical eyelid apertures during open and closed eyes were made before the procedure and 1, 3, and 6 months after injection. A total of 10 eyes including 2 men and 8 women with an average age of 43 years (26-64 years) were studied. The mean amount of lagophthalmos before injection and after 6 months of follow up were 3.9 mm and 2.3 mm, respectively (p = 0.01)). The mean amount of corneal exposure before injection and after 6 months of follow up was 1.05 mm and 0.25 mm, respectively (p lagophthalmos and epiphora.

  6. Syndrome coronarien aigue suite à une injection accidentelle intraveineuse de Bupivacaine

    Science.gov (United States)

    Koita, Siriman Abdoulaye; Bouhabba, Najib; Salaheddine, Fjouji; Bensghir, Mustapha; Charki, Haimeur

    2015-01-01

    Les erreurs médicamenteuses constituent une complication très redoutable en anesthésie. La fréquence des erreurs médicamenteuses par administration serait de l'ordre 1/10 000 à 1/1000. Nous rapportons un cas d'injection accidentelle de bupivacaine en intraveineuse directe. Il s'agissait d'un jeune patient classé ASA I qui était prévu pour cure chirurgicale d'une hydrocèle unilatérale sous rachianesthésie. Une injection de 12,5 mg de bupivacaine et 25 µg de fentanyl étaient injectés après un reflux net du liquide céphalorachidien sans incident. Après installation de la rachianesthésie, le début de l'intervention était autorisé sans incidents. Une sédation de confort était décidée. Juste après apparaissait des troubles de rythme à type tachycardie ventriculaire avec une élévation de taux de troponines en post opératoire. L’évolution était marquée par une normalisation de la troponine au troisième jour post opératoire et sorti de l'hôpital au cinquième jour. PMID:26889325

  7. Efficacy of two doses of tramadol versus bupivacaine in perioperative caudal analgesia in adult hemorrhoidectomy

    Science.gov (United States)

    Farag, Hanan M.; Esmat, Ibrahim M.

    2016-01-01

    Background: The study was conducted to evaluate the perioperative analgesic efficacy of the two doses of caudally administered tramadol versus bupivacaine in adult hemorrhoidectomy. Patients and Methods: A total of 90 patients, aged 20-50 years, undergoing hemorrhoidectomy were randomly scheduled to receive bupivacaine 0.25% in 20 ml (Group B; n = 30), tramadol 1 mg/kg in 20 ml (Group T1; n = 30), tramadol 2 mg/kg in 20 ml (Group T2; n = 30) through caudal route after induction of general anesthesia. Postoperative pain was assessed every hour until the visual analog scale was 6, which is 1st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol, and epinephrine levels and incidence of side effects were also evaluated. Results: Duration of analgesia was longer in Group T2 (20 [1.14] h] compared with the Group B (7 [1.2] h) or Group T1 (12 [0.75] h); all P < 0.001. There were no significant hemodynamic changes. There were not incidences of side effects. Conclusion: Caudal tramadol 2 mg/kg provided a longer duration of postoperative analgesia with rapid onset and no incidence of complications or adverse effects in adult hemorrhoidectomy. PMID:27051362

  8. Comparison of the efficacy of intrathecally administered levobupivacaine and bupivacaine in pre-eclamptic pregnant women

    Directory of Open Access Journals (Sweden)

    Zeynep Baysal Yıldırım

    2011-03-01

    Full Text Available The aim of this study was to compare the efficacy and side effects of levobupivacaine and bupivacaine in pre-eclamptic patients that will undergo caesarean section by spinal anesthesia.Materials and methods: Preeclamptic, 18-45 years-old patients that will undergo a caesarean section were included in the study in a prospective randomized manner. They were separated into two groups: Group B, intrathecally received 2 mL 0.5% bupivacaine (10 mg, while Group L intrathecally received 2 mL 0.5% levobupivacaine (10 mg. Blood pressure and heart rates of the patients were measured and recorded at 3, 6, 9, 12, 15th minutes and thereafter, every 5 minutes during operation. The evaluations were done through the comparison of patient’s and surgeon’s satisfaction between the groups. Visual analog score (VAS was used for comparison.Results: Systolic arterial pressure values at 3, 15, 35 and 40th minutes in Group B were significantly lower than those in Group R (p0.05.Conclusion: Intrathecal levobupivacaine for spinal anesthesia ensured a more stable hemodynamics but both local anesthesia enabled a sufficient and adequate surgical anesthesia in pre-eclamptic patients.

  9. Inclusion complex of S(- bupivacaine and 2-hydroxypropyl-β-cyclodextrin: study of morphology and cytotoxicity

    Directory of Open Access Journals (Sweden)

    C. M. MORAES

    2009-01-01

    Full Text Available

    Local anesthetics (LA belong to a class of pharmacological compounds that attenuate or eliminate pain by binding to the sodium channel of excitable membranes, blocking the influx of sodium ions and the propagation of the nerve impulse. S (- bupivacaine (S(- bvc is a local anesthetic of amino-amide type, widely used in surgery and obstetrics for sustained peripheral and central nerve blockade. This article focuses on the characterization of an inclusion complex of S(- bvc in 2-hydroxypropyl-ß-cyclodextrin (HP-ß-CD. Differential scanning calorimetry, scanning electron microscopy and X-Ray diffraction analysis showed structural changes in the complex. In preliminary toxicity studies, the cell viability tests revealed that the inclusion complex decreased the toxic effect (p<0.001 produced by S(- bvc. These results suggest that the S(- bvc:HP-ß-CD inclusion complex represents a promising agent for the treatment of regional pain. Keywords: S(- bupivacaine; cyclodextrin; inclusion complex.

  10. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound

    Directory of Open Access Journals (Sweden)

    Alexandre Takeda

    2015-06-01

    Full Text Available INTRODUCTION: The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90 of bupivacaine for axillary brachial plexus block. METHODS: Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous. The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability or the same concentration (0.9 probability. Surgical anesthesia was defined as driving force ≤2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4 h after the blockade. RESULTS: MEC90 was 0.241% [R 2: 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4 h. CONCLUSION: This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations.

  11. The effect of mixing 1.5% mepivacaine and 0.5% bupivacaine on duration of analgesia and latency of block onset in ultrasound-guided interscalene block.

    Science.gov (United States)

    Gadsden, Jeff; Hadzic, Admir; Gandhi, Kishor; Shariat, Ali; Xu, Daquan; Maliakal, Thomas; Patel, Vijay

    2011-02-01

    Short- and long-acting local anesthetics are commonly mixed to achieve nerve blocks with short onset and long duration. However, there is a paucity of data on advantages of such mixtures. We hypothesized that a mixture of mepivacaine and bupivacaine results in a faster onset than does bupivacaine and in a longer duration of blockade than does mepivacaine. Sixty-four patients undergoing arthroscopic shoulder surgery (ages 18 to 65 years; ASA physical status I-II) with ultrasound-guided interscalene brachial plexus block as the sole anesthetic were studied. The subjects were randomized to receive 1 of 3 study solutions: 30 mL of mepivacaine 1.5%, 30 mL of bupivacaine 0.5%, or a mixture of 15 mL each of bupivacaine 0.5% and mepivacaine 1.5%. The block onset time and duration of motor and sensory block were assessed. Onset of sensory block in the axillary nerve distribution (superior trunk) was similar among the 3 groups (8.7 ± 4.3 minutes for mepivacaine, 10.0 ± 5.1 minutes for bupivacaine, and 11.3 ± 5.3 minutes for the combination group; P = 0.21 between all groups). The duration of motor block for the combination group (11.5 ± 4.7 hours) was between that of the bupivacaine (16.4 ± 9.4 hours) and mepivacaine (6.0 ± 4.2 hours) groups (P = 0.03 between bupivacaine and combination groups; P = 0.01 between mepivacaine and combination groups). Duration of analgesia was the shortest with mepivacaine (4.9 ± 2.4 hours), longest with bupivacaine (14.0 ± 6.2 hours), and intermediate with the combination group (10.3 ± 4.9 hours) (P mepivacaine vs. combination group; P = 0.01 for bupivacaine vs. combination group). For ultrasound-guided interscalene block, a combination of mepivacaine 1.5% and bupivacaine 0.5% results in a block onset similar to either local anesthetic alone. The mean duration of blockade with a mepivacaine-bupivacaine mixture was significantly longer than block with mepivacaine 1.5% alone but significantly shorter than the block with bupivacaine 0

  12. The safety of liposome bupivacaine 2 years post-launch: a look back and a look forward.

    Science.gov (United States)

    Viscusi, Eugene R

    2015-01-01

    The need for better post-surgical pain management continues to be unmet, despite clinicians' awareness and concern for many years. Opioids remain the standard of care because of their analgesic efficacy; however, opioid use is often associated with adverse effects and poor patient outcomes. Multimodal analgesic regimens have recently been endorsed as a way to provide adequate post-surgical pain control while reducing opioid consumption. Liposome bupivacaine is a liposomal formulation of bupivacaine indicated for a single administration into the surgical site. Based on the available clinical trial data compiled to date, as well as the author's review of publicly available post-marketing safety information, liposome bupivacaine may be a viable addition to currently available therapeutic options for post-surgical analgesia while reducing potential risks associated with use of opioid analgesics, and may represent a useful addition to the multimodal analgesic modalities currently used for post-operative pain management. The potential for its use in other areas is also being investigated. The purpose of this review is to examine the currently available post-marketing safety information on liposome bupivacaine.

  13. Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries

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    Seyed Hamid Reza Faiz

    2012-01-01

    Full Text Available Background: Regional anesthesia is widely used to perform different surgical procedures including those performed on the extremities. In this study, the anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries were assessed. Materials and Methods: In this double-blind randomized clinical trial, 90 patients, candidate for lower extremities surgeries in a training hospital, were recruited. The patients with ASA class I and II aging from 20 to 65 years between 2009 and 2010 were evaluated. The selected patients were randomly assigned to receive either bupivacaine alone (Group A, n=30, or bupivacaine plus magnesium sulphate 50% (Group B, n=30, or bupivacaine plus neostigmine (Group C, n=30. Then sensory and motor onset and complete block and the time of recovery were measured. Results: The sensory block onset time were 3.03 ± 0.981 in group A, 3.90 ± 2.71 in group B and 3.7 ± 1.08 in group C and knee flexion time were not significantly different among the three groups (P > 0.05, whereas the time to complete motor block was significantly longer in group C and motor recovery time were significantly different between groups (P=0.001. Conclusions: According to the obtained results, it may be concluded that magnesium sulphate is a safe and effective adjuvant for increasing the onset time of motor block.

  14. Experimental studies on the accumulation of /sup 99m/Tc-MDP in the bupivacaine hydrochloride induced myopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sone, Shinsuke

    1989-02-01

    It has recently been demonstrated that several /sup 99m/Tc-labeled phosphate compounds accumulate in skeletal muscle in patients with myopathies including Duchenne muscular dystrophy (DMD). However, the mechanism by which these compounds accumulate in skeletal muscles is unknown. In order to analyze the mechanisms of tracer-localization in skeletal muscles of myopathies, the uptake of /sup 99m/Tc-methylendiphosphonate (/sup 99m/Tc-MDP) by muscles examined in rats treated by intramuscular injection of a local anesthetic, bupivacaine. At the same time, the histological and biochemical changes of the injured muscles were studied, and findings obtained were correlated with the procedure of /sup 99m/Tc-MDP uptake. Intramuscular injection of bupivacaine resulted in markedly increased uptake of /sup 99m/Tc-MDP in the injected muscle at 12 and 24 hours after injection. The plasma creatine phosphokinase (CK) concentration increased 2-3 folds during the period from 3 to 24 hours after bupivacaine injection. Four days following injection, the CK isozyme MB activity in muscle increased. Twenty hours after injection of bupivacaine, changes such as hypercontraction and disruptin of myofibrils, Z-band lysis, and swelling of mitochondria occurred. Four days after the injection, myoblasts and myotubes were found in the damaged areas of the muscle. These results show that the increased muscle uptake of /sup 99m/Tc-MDP reflects the early degenerative changes of skeletal muscle.

  15. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general ane

  16. Comparison of Spinal Block Levels between Laboring and Nonlaboring Parturients Using Combined Spinal Epidural Technique with Intrathecal Plain Bupivacaine

    Directory of Open Access Journals (Sweden)

    Yu-Ying Tang

    2012-01-01

    Full Text Available Background. It was suggested that labor may influence the spread of intrathecal bupivacaine using combined spinal epidural (CSE technique. However, no previous studies investigated this proposition. We designed this study to investigate the spinal block characteristics of plain bupivacaine between nonlaboring and laboring parturients using CSE technique. Methods. Twenty-five nonlaboring (Group NL and twenty-five laboring parturients (Group L undergoing cesarean delivery were enrolled. Following identification of the epidural space at the L3-4 interspace, plain bupivacaine 10 mg was administered intrathecally using CSE technique. The level of sensory block, degree of motor block, and hemodynamic changes were assessed. Results. The baseline systolic blood pressure (SBP and the maximal decrease of SBP in Group L were significantly higher than those in Group NL (=0.002 and =0.03, resp.. The median sensory level tested by cold stimulation was T6 for Group NL and T5 for Group L (=0.46. The median sensory level tested by pinprick was T7 for both groups (=0.35. The degree of motor block was comparable between the two groups (=0.85. Conclusion. We did not detect significant differences in the sensory block levels between laboring and nonlaboring parturients using CSE technique with intrathecal plain bupivacaine.

  17. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general ane

  18. Correlation of bupivacaine 0.5% dose and conversion from spinal anesthesia to general anesthesia in cesarean sections

    NARCIS (Netherlands)

    Seljogi, D; Wolff, A P; Scheffer, G J; van Geffen, G J; Bruhn, J

    2016-01-01

    BACKGROUND: Failed spinal anesthesia for cesarean sections may require conversion to general anesthesia. The aim of this study was to determine whether the administered spinal bupivacaine dose for performing a cesarean section under spinal anesthesia was related to the conversion rate to general

  19. Preparation of bupivacaine-loaded poly(epsilon-caprolactone) microspheres by spray drying: drug release studies and biocompatibility.

    Science.gov (United States)

    Blanco, M D; Bernardo, M V; Sastre, R L; Olmo, R; Muñiz, E; Teijón, J M

    2003-03-01

    Poly(epsilon-caprolactone) microspheres containing bupivacaine were prepared by the spray-drying process. The average size of drug loaded microspheres was less than 3 microm in diameter, and the percentage of entrapment efficiency was 91 +/- 3%. In vitro drug release kinetic in phosphate buffer at 37 degrees C showed a hyperbolic profile, with a burst-effect during the first hour. Subcutaneous injection of bupivacaine-loaded microspheres in the back of rats caused an increase in drug concentration in plasma. Maximum bupivacaine concentration in plasma was 237 +/- 58 ng/ml at 105 h, and drug was detected in plasma for 16 days. The half-life time of the drug was increased by more than 125 times with regard to that of the drug administered in a solution by intraperitoneal injection. After 30 days of injection, a mass formed by microspheres surrounded by a thin fibrous capsule was observed. Small blood vessels and multinucleate foreign body giant cells with macrophagic function around microspheres were detected. After 60 days of injection a subcutaneous mass was also observed, which was formed of more degraded dispersed microspheres in conjunctive tissue, which had a normal structure. Thus, bupivacaine-loaded poly(epsilon-caprolactone) microspheres could be considered as a device to be used in the treatment of severe pain that is not responsive to opioids for example in cancer-related syndromes or in intractable herpetic neuralgia.

  20. Acute Post Mastectomy Pain: A Double Blind Randomised Controlled Trial: Intravenous Tramadol Vs Bupivacaine Irrigation through Surgical Drains

    Directory of Open Access Journals (Sweden)

    Anjum S KhanJoad

    2008-01-01

    Both groups had good pain relief. The T group had significantly more nausea (P< 0.007. The T group patients had a higher incidence of vomiting, catheterisation and delayed oral intake, but this was not significant statistically. Bupivacaine administered through the surgical drain offered equivalent postoperative pain relief to intravenous tramadol, with significantly less nausea.

  1. The effect of a single dose of bupivacaine on donor site pain after anterior iliac crest bone harvesting.

    Science.gov (United States)

    Barkhuysen, R; Meijer, G J; Soehardi, A; Merkx, M A W; Borstlap, W A; Bergé, S J; Bronkhorst, E M; Hoppenreijs, T J M

    2010-03-01

    Transplants from the anterior iliac crest are used for most reconstructive procedures in cranio-maxillofacial surgery. The advantages are easy accessibility, the ability to work in two teams and the amount of corticocancellous bone available; disadvantages are postoperative pain and gait disturbances. To reduce donor-site pain, the effect of a single dose of bupivacaine (10 cc of 2.5mg/cc with 1:80.000 epinephrine) was studied. 200 consecutive patients, who underwent anterior iliac crest bone harvesting for reconstructive procedures, were randomly divided into those receiving bupivacaine and those not. They completed a standardized questionnaire. Patients scored the intensity of the pain and difficulties walking at different times with a visual analogue scale. They recorded analgesics used. 98 questionnaires were eligible for analysis. No differences between the bupivacaine and the control group were detected for postoperative pain and gait disturbance. There is no support for administration of a single dose of bupivacaine to reduce pain in the first postoperative days. The surface area of the removed bone had a significant influence on pain and walking; pain is related to the local osseous damage or periosteal stripping rather than to the length of incision or the operation time.

  2. A COMPARATIVE STUDY OF THE EFFECT OF EPIDURAL BUPIVACAINE (0.125% VERSUS EPIDURAL BUPIVACAINE (0.125% AND BUTORPHANOL (2mg FOR POST-OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

    Directory of Open Access Journals (Sweden)

    Krishna

    2014-08-01

    Full Text Available BACKGROUND: Postoperative pain gives rise to various physiological and psychological phenomenons. Epidural analgesia with combination of local anesthetics and opioids provides better pain relief than local anesthetics alone in the postoperative period. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. AIMS: The study was conducted to evaluate the efficacy of addition of opioids to local anesthetics for postoperative pain relief. METHODS: Fifty patients of American society of anesthesiology grade and physical status undergoing lower abdominal surgeries & lower limb surgeries in narayana general hospital, Nellore, were divided into two groups B and BB. Group B was given 0.125% bupivacaine alone and Group BB was given 0.125% bupivacaine plus 2mg of butorphanol postoperatively when the patients first complained of pain. Onset of Analgesia, duration of analgesia, visual analog scores and side effects were compared. RESULTS: The onset of analgesia in group B patients (10ml of 0.125% Bupivacaine was varied from 4-8 minutes (mean 5.2 minutes and duration of analgesia lasted for 2-4 hours (mean 2.98(p<0.0001 where as in group BB patients (2mg butorphanol + 0.125% bupivacaine the onset was 2-4 minutes (mean 2.69 and duration of analgesia lasted for 6-8 hours (mean 6.98 (p<0.0001.The Visual Analog Scores of Group B were in the range of 7 to 9 and Group BB were in the range of 5 to 6 (P<0.0001. CONCLUSION: This study concludes that addition of butorphanol (2mg to bupivacaine (0.125% gives more effective and prolonged duration of postoperative pain relief when administered epidurally, without significant side effects.

  3. BIOCOMPATIBILITY AND TISSUE REGENERATING CAPACITY OF CROSS-LINKED DERMAL SHEEP COLLAGEN

    NARCIS (Netherlands)

    VANWACHEM, PB; VANLUYN, MJA; DAMINK, LHHO; DIJKSTRA, PJ; FEIJEN, J; NIEUWENHUIS, P

    1994-01-01

    The biocompatibility and tissue regenerating capacity of four crosslinked dermal sheep collagens (DSC) was studied. In vitro, the four DSC versions were found to be noncytotoxic or very low in cytoxicity. After subcutaneous implantation in rats, hexamethylenediisocyanate-crosslinked DSC (HDSC) seldo

  4. Effect of Collagen Type I or Type II on Chondrogenesis by Cultured Human Articular Chondrocytes

    NARCIS (Netherlands)

    Rutgers, M.; Saris, Daniël B.F.; Vonk, L.A.; van Rijen, M.H.P.; Akrum, V.; Langeveld, D.; van Boxtel, A.; Dhert, W.J.A.; Creemers, L.B.

    2013-01-01

    Introduction: Current cartilage repair procedures using autologous chondrocytes rely on a variety of carriers for implantation. Collagen types I and II are frequently used and valuable properties of both were shown earlier in vitro, although a preference for either was not demonstrated. Recently,

  5. Effect of Collagen Type I or Type II on Chondrogenesis by Cultured Human Articular Chondrocytes

    NARCIS (Netherlands)

    Rutgers, M.; Saris, D.B.F.; Vonk, L.A.; Rijen, van M.H.P.; Akrum, V.; Langeveld, D.; Boxtel, van A.; Dhert, W.J.A.; Creemers, L.B.

    2013-01-01

    Introduction: Current cartilage repair procedures using autologous chondrocytes rely on a variety of carriers for implantation. Collagen types I and II are frequently used and valuable properties of both were shown earlier in vitro, although a preference for either was not demonstrated. Recently, ho

  6. Efficacy and safety of 0.5% levobupivacaine versus 0.5% bupivacaine for peribulbar anesthesia

    Directory of Open Access Journals (Sweden)

    Pacella E

    2013-05-01

    Full Text Available Elena Pacella,1 Fernanda Pacella,1 Fabiana Troisi,2 Domenico Dell'Edera,3 Paolo Tuchetti,4 Tommaso Lenzi,1 Saul Collini21Department of Sense Organs, Faculty of Medicine and Dentistry, Rome, 2Department of Medical Surgical Sciences and Translational Medicine Sapienza, Faculty of Medicine and Psychology, Roma, University of Rome, Rome, 3Unit of Cytogenetic and Molecular Genetics, Madonna delle Grazie Hospital, Matera, 4National Institute for Health, Migration and Poverty, Rome, ItalyBackground: This randomized double-blind study examined the use of a new anesthetic agent, levobupivacaine 0.5%, which is the S(−-enantiomer of a racemic mixture of bupivacaine, for peribulbar anesthesia and compared it with racemic bupivacaine 0.5% alone or in combination with hyaluronidase 10 IU/mL.Methods: A total of 160 patients undergoing ophthalmic surgery were randomized into four groups (n = 40 each to receive inferotemporal peribulbar injection of levobupivacaine 0.5% (group L, racemic bupivacaine 0.5% (group B, levobupivacaine + hyaluronidase 10 IU/mL (group LH, or racemic bupivacaine + hyaluronidase 10 IU/mL (group BH by two anesthetists and two ophthalmologists in a ratio of 25% each. Ocular akinesia and orbicularis oculi function were evaluated using a three-point scale; a value < 5 points was considered as requiring surgery, and movements were re-evaluated the day following surgery to confirm regression of the block.Results: The time to onset (12 ± 2.6 minutes versus 13 ± 2.8 minutes and duration of anesthesia (185 ± 33.2 minutes versus 188 ± 35.7 minutes were similar between groups L and B. Complete akinesia (score 0 was obtained more frequently when hyaluronidase was used in addition to the anesthetic, with occurrences of 72.5% versus 57.5% in group LH versus L, respectively, and 67.5% versus 45% in group BH versus B. Moderate hypotension (<30% of baseline was observed in four patients (10% in group L, two (5.0% in group B, one (2.5% in group LH

  7. Collagenous Gastritis: A Rare Entity

    Directory of Open Access Journals (Sweden)

    Faten Limaiem

    2015-06-01

    Full Text Available Collagenous gastritis is a rare entity of unknown etiology characterized histologically by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of gastric mucosa. A 40-year-old male presented with a history of chronic intermittent abdominal pain for about 6 months. Physical examination was unremarkable, and biological tests were within normal range. The patient underwent esophagogastroduodenoscopy and colonoscopy which showed a nodular mucosa of the stomach. Biopsies of the duodenum and colon were unremarkable. However, biopsies of the gastric fundus revealed a mild chronic gastritis characterized by lymphocytic and plasma cell infiltration of deep mucosa, without lymphoid follicle formation or active inflammation. No microorganisms were identified on routine hematoxylin and eosin or Giemsa-stained sections. Subepithelial collagen in the gastric biopsies was thickened and showed entrapped capillaries. Subepithelial collagen was highlighted by Masson's trichrome staining and was negative for amyloid by Congo Red. In the areas containing thickened collagen, there were no intraepithelial lymphocytes. The final pathological diagnosis was collagenous gastritis. Collagenous gastritis is an extremely rare disease, but it is important to recognize its characteristic endoscopic and pathologic findings to make a correct diagnosis. Specific therapy for this rare entity has not yet been established. [J Interdiscipl Histopathol 2015; 3(2.000: 68-70

  8. Comparison of bupivacaine, ropivacaine and levobupivacaine with sufentanil for patient-controlled epidural analgesia during labor: a randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    WANG Li-zhong; CHANG Xiang-yang; LIU Xia; HU Xiao-xia; TANG Bei-lei

    2010-01-01

    Background Ropivacaine and levobupivacaine have been introduced into obstetric analgesic practice with the proposed advantages of causing less motor block and toxicity compared with bupivacaine. However, it is still controversial whether both anesthetics are associated with any clinical benefit relative to bupivacaine for labor analgesia. This study aimed to compare the analgesic efficacy, motor block and side effects of bupivacaine, ropivacaine and levobupivacaine at lower concentrations for patient-controlled epidural labor analgesia. Methods Four hundred and fifty nulliparous parturients were enrolled in this randomized clinical trial. A concentration of 0.05%, 0.075%, 0.1%, 0.125% or 0.15% of either bupivacaine (Group B), ropivacaine (Group R) or levobupivacaine (Group L) with sufentanil 0.5 μg/ml was epidurally administered by patient-controlled analgesia mode. Effective analgesia was defined as a visual analogue scale score was ≤30 mm. The relative median potency for each local anesthetic was calculated using a probit regression model. Parturients demographics, sensory and motor blockade, obstetric data, maternal side effects, hourly volumes of local anesthetic used, and others were also noted. Results There were no significant differences among groups in the numbers of effective analgesia, pain scores, hourly local anesthetic amount used, sensory and motor blockade, labor duration and mode of delivery, side effects and maternal satisfaction (P >0.05). The relative median potency was bupivacaine/ropivacaine: 0.828 (0.602-1.091), bupivacaine/levobupivacaine: 0.845 (0.617-1.12), ropivacaine/levobupivacaine: 1.021 (0.774-1.354), respectively. However, a significantly less number of effective analgesia and higher hourly local anesthetic use were observed in the concentration of 0.05% than those of ≥0.1% within each group (P<0.05). Conclusions Using patient-controlled epidural analgesia, lower concentrations of bupivacaine, ropivacaine and levobupivacaine

  9. Goserelin Implant

    Science.gov (United States)

    ... in men (blockage that causes difficulty urinating), or heart or liver disease.tell your doctor if you are pregnant or plan to become pregnant. Goserelin implant should not be used in pregnant women, except ...

  10. Electrostatic effects in collagen fibrillization

    Science.gov (United States)

    Morozova, Svetlana; Muthukumar, Murugappan

    2014-03-01

    Using light scattering and AFM techniques, we have measured the kinetics of fibrillization of collagen (pertinent to the vitreous of human eye) as a function of pH and ionic strength. At higher and lower pH, collagen triple-peptides remain stable in solution without fibrillization. At neutral pH, the fibrillization occurs and its growth kinetics is slowed upon either an increase in ionic strength or a decrease in temperature. We present a model, based on polymer crystallization theory, to describe the observed electrostatic nature of collagen assembly.

  11. Sterile Keratitis following Collagen Crosslinking

    Science.gov (United States)

    Javadi, Mohammad-Ali; Feizi, Sepehr

    2014-01-01

    Purpose: To report a keratoconic eye that developed severe sterile keratitis and corneal scar after collagen crosslinking necessitating corneal transplantation. Case Report: A 26-year-old man with progressive keratoconus underwent collagen crosslinking and presented with severe keratitis 72 hours after the procedure. The initial impression was infectious corneal ulcer and a fortified antibiotic regimen was administered. However, the clinical course and confocal microscopy results prompted a diagnosis of sterile keratitis. The eye developed severe corneal scars leading to reduced visual acuity and necessitating corneal transplantation. Conclusion: Sterile keratitis may develop after collagen crosslinking resulting in profound visual loss leading to corneal transplantation. PMID:25709779

  12. Stability of collagen during denaturation.

    Science.gov (United States)

    Penkova, R; Goshev, I; Gorinstein, S; Nedkov, P

    1999-05-01

    The stability of calf skin collagen (CSC) type I during thermal and chemical denaturation in the presence of glycerol was investigated. Thermal denaturation of type I collagen was performed in the presence of glycerol or in combination with urea and sodium chloride. The denaturation curves obtained in the presence of urea or sodium chloride retained their original shape without glycerol. These curves were shifted upward proportionally to the glycerol concentration in the reaction medium. This means that glycerol and the denaturants act independently. The explanation is based on the difference in the mechanism of their action on the collagen molecule.

  13. Influence of human growth hormone on granulation tissue formation, collagen deposition, and the aminoterminal propeptide of collagen type III in wound chambers in rats.

    Science.gov (United States)

    Rasmussen, L H; Garbarsch, C; Schuppan, D; Moe, D; Hørslev-Pedersen, K; Gottrup, F; Steenfos, H

    1994-01-01

    The influence of growth hormone on granulation tissue formation was investigated in wire mesh cylinders implanted subcutaneously in rats. Two groups of 10 rats (study 1) and 1 group of 12 rats (study 2) were used for the investigation. Growth hormone, 0.02 and 0.2 IU (study 1), 0.05 and 0.2 IU (study 2), or vehicle only, was injected into the cylinders every third day for 16 days. In study 2, wound fluid was aspirated before injection of growth hormone and saved for later analysis of the aminoterminal propeptide of collagen type III. In both studies, growth hormone significantly increased the formation of granulation tissue and of total collagen content dose-dependently, whereas the relative amount of collagen was unaffected by growth hormone treatment. Wound fluid aminopropeptide increased significantly after implantation of the cylinders until day 7, before declining slightly, with no difference between the groups. We conclude that growth hormone stimulated granulation tissue formation and collagen deposition dose-dependently in the wound cylinders when injected every third day. The results suggest that growth hormone treatment does not cause excessive collagen deposition in newly formed granulation tissue.

  14. In vitro characterization and in vivo analgesic and anti-allodynic activity of PLGA-bupivacaine nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, Xavier, E-mail: xavier.garcia@ipsen.com; Escribano, Elvira; Domenech, Josep; Queralt, Josep; Freixes, Joan [University of Barcelona, Department of Pharmacy and Pharmaceutical Technology, Biopharmaceuticals and Pharmacokinetics Unit, School of Pharmacy (Spain)

    2011-05-15

    An injectable controlled release system containing local anesthetics able to provide long-lasting analgesia in nociceptive and neuropathic pain could have a marked impact in pain management. In order to address this issue, bupivacaine, a widely used local anesthetic, has been nanoencapsulated using poly(lactic-co-glycolic acid) from an oil-in-water emulsion by the solvent evaporation technique. Nanoparticles were evaluated in vitro studying their drug release mechanism by fitting different model equations, and in vivo by testing its analgesic and anti-allodynic activity in front of heat-induced nociceptive pain and sciatic nerve chronic constriction injury in rats, respectively. The particle size of the PLGA nanoparticles obtained was of 453 {+-} 29 nm, the encapsulation efficiency, drug loading, and burst effect at 30 min were 82.10 {+-} 0.001, 45.06 {+-} 0.001, and 4.6 {+-} 0.6%, respectively. A prolonged release of the drug in comparison to bupivacaine solution was seen. The mean dissolution time (MDT) obtained for nanoparticles was relatively long (9.44 {+-} 0.56 h) proving the sustained release process, while the dissolution efficiency (DE) (84.10 {+-} 1.01%) was similar to the maximum percentage of drug released. Korsmeyer-Peppas was the best model that fitted our release data. A non-Fickian mechanism was concluded to be involved in the release of bupivacaine from the nanoparticles, taking into account the value of the diffusional exponent obtained (n = 0.95). After local infiltration in the rat, the antinociceptive and anti-allodynic activity of the nanoencapsulated bupivacaine was longer lasting than that of bupivacaine solution. An increase in the values of the area under the curve (AUC) of the antinociceptive and anti-allodynic effect versus time of 67 and 36%, respectively, was observed when the drug was encapsulated.

  15. In vitro characterization and in vivo analgesic and anti-allodynic activity of PLGA-bupivacaine nanoparticles

    Science.gov (United States)

    Garcia, Xavier; Escribano, Elvira; Domenech, Josep; Queralt, Josep; Freixes, Joan

    2011-05-01

    An injectable controlled release system containing local anesthetics able to provide long-lasting analgesia in nociceptive and neuropathic pain could have a marked impact in pain management. In order to address this issue, bupivacaine, a widely used local anesthetic, has been nanoencapsulated using poly(lactic-co-glycolic acid) from an oil-in-water emulsion by the solvent evaporation technique. Nanoparticles were evaluated in vitro studying their drug release mechanism by fitting different model equations, and in vivo by testing its analgesic and anti-allodynic activity in front of heat-induced nociceptive pain and sciatic nerve chronic constriction injury in rats, respectively. The particle size of the PLGA nanoparticles obtained was of 453 ± 29 nm, the encapsulation efficiency, drug loading, and burst effect at 30 min were 82.10 ± 0.001, 45.06 ± 0.001, and 4.6 ± 0.6%, respectively. A prolonged release of the drug in comparison to bupivacaine solution was seen. The mean dissolution time (MDT) obtained for nanoparticles was relatively long (9.44 ± 0.56 h) proving the sustained release process, while the dissolution efficiency (DE) (84.10 ± 1.01%) was similar to the maximum percentage of drug released. Korsmeyer-Peppas was the best model that fitted our release data. A non-Fickian mechanism was concluded to be involved in the release of bupivacaine from the nanoparticles, taking into account the value of the diffusional exponent obtained ( n = 0.95). After local infiltration in the rat, the antinociceptive and anti-allodynic activity of the nanoencapsulated bupivacaine was longer lasting than that of bupivacaine solution. An increase in the values of the area under the curve (AUC) of the antinociceptive and anti-allodynic effect versus time of 67 and 36%, respectively, was observed when the drug was encapsulated.

  16. Intrathecal clonidine with hyperbaric bupivacaine administered as a mixture and sequentially in caesarean section: A randomised controlled study

    Directory of Open Access Journals (Sweden)

    Prachee Sachan

    2014-01-01

    Full Text Available Background and Aims: Mixing adjuvants with hyperbaric bupivacaine in a single syringe before injecting the drugs intrathecally is an age old practice. In doing so, the density of the hyperbaric solution and also of the adjuvant drugs may be altered, thus affecting the spread of drugs. Administering local anaesthetic and the adjuvants separately may minimise the effect of the changes in densities. We aimed to compare block characteristics, intraoperative haemodynamics and post-operative pain relief in parturients undergoing caesarean section (CS after administering hyperbaric bupivacaine and clonidine intrathecally as a mixture and sequentially. Methods: In this single-blind prospective randomised controlled study at a tertiary care centre from 2010 to 12, 60 full-term parturients scheduled for elective CSs were divided into two groups on the basis of technique of intrathecal drug administration. Group M received mixture of clonidine (75 mcg and hyperbaric bupivacaine 0.5% (10 mg intrathecally, whereas Group B received clonidine (75 mcg followed by hyperbaric bupivacaine 0.5% (10 mg through separate syringes. Observational descriptive statistics, analysis of variance test, Wilcoxon test and Chi-square test were used as applicable. Results: Duration of analgesia was significantly longer in Group B (474.33 ± 20.79 min in which the drug was given sequentially than in Group M (337 ± 18.22 min. Furthermore, the time to achieve highest sensory block and complete motor block was significantly less in Group B without any major haemodynamic instability and neonatal outcome. Conclusions: When clonidine and hyperbaric bupivacaine were administered in a sequential manner, block characteristics improved significantly compared to the administration of the mixture of the two drugs.

  17. Contraceptive implants.

    Science.gov (United States)

    McDonald-Mosley, Raegan; Burke, Anne E

    2010-03-01

    Implantable contraception has been extensively used worldwide. Implants are one of the most effective and reversible methods of contraception available. These devices may be particularly appropriate for certain populations of women, including women who cannot use estrogen-containing contraception. Implants are safe for use by women with many chronic medical problems. The newest implant, Implanon (Organon International, Oss, The Netherlands), is the only device currently available in the United States and was approved in 2006. It is registered for 3 years of pregnancy prevention. Contraceptive implants have failure rates similar to tubal ligation, and yet they are readily reversible with a return to fertility within days of removal. Moreover, these contraceptive devices can be safely placed in the immediate postpartum period, ensuring good contraceptive coverage for women who may be at risk for an unintended pregnancy. Irregular bleeding is a common side effect for all progestin-only contraceptive implants. Preinsertion counseling should address possible side effects, and treatment may be offered to women who experience prolonged or frequent bleeding. Thieme Medical Publishers.

  18. A COMPARISON OF SPINAL ANAESTHESIA WITH LEVOBUPIVACAINE AND HYPERBARIC BUPIVACAINE COMBINED WITH FENTANYL IN CAESAREAN SECTION

    Directory of Open Access Journals (Sweden)

    Kurmanadh Kalepalli

    2016-10-01

    Full Text Available BACKGROUND Recent trends in obstetric anaesthesia show increased popularity of regional anaesthesia among obstetric anaesthetists. General anaesthesia in caesarean section is associated with high morbidity and mortality rate when compared with regional anaesthesia. Regional anaesthesia has its own demerits which are primarily related to excessively high spinal blocks and toxicity of local anaesthetics. Reduction in doses and improvement in technique to avoid high level blocks and increased awareness of toxicity of local anaesthetics have contributed to reduction in complications related to regional anaesthesia. The challenges presented by a parturient requiring anaesthesia or analgesia, or both, make the role of obstetric anaesthesiologist both challenging and rewarding. Spinal anesthesia is a popular technique for caesarean delivery. Hyperbaric Bupivacaine in 8% glucose is often used. Plain or glucose-free, Bupivacaine has been frequently referred to as “Isobaric” in the literature, even after Blomqvist and Nilsson demonstrated its hypobaricity. More recently, several studies have confirmed that plain Bupivacaine is indeed hypobaric in comparison with human CSF. Although hyperbaric local anesthetic solutions have a remarkable record of safety, their use is not totally without risk. To prevent unilateral or saddle blocks, patients should move from the lateral or sitting position rapidly to supine position. Hyperbaric solutions may cause sudden cardiac arrest after spinal anesthesia because of the extension of the sympathetic block. The use of truly isobaric solutions may prove less sensitive to position issues. Hyperbaric solutions may cause hypotension or bradycardia after mobilization. Isobaric solutions are favored with respect to their less sensitivity to postural changes. MATERIALS AND METHODS 60 full term parturients of ASA Grade 1 and 2 posted for elective caesarean section under spinal anaesthesia were divided in to two groups. GROUP

  19. Preparation and Characterization of Collagen-GAGs Bioactive Matrices for Tissue Engineering

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Collagen materials were crosslinked by 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC) in the presence of chondroitin sulfate (CS), one of glycosaminoglycans (GAGs). PVA and chitosan were also blended with collagen. The physical and chemical properties of the matrices were characterized by SEM, DSC, and ESCA. L929 cells were implanted on the matrices to show the cytotoxic and the biological characters of the materials. The results indicate that EDC is an effective and non-cytotoxic cross-link reagent, which can replace the common dialdehyde reagent. The attachment of CS can improve the stability of collagen and accelerate cell growth.The addition of PVA can prepare porous matrices with smaller bore size. There are reactions between the chitosan and collagen, and the composite has good biological character. The presence of chitosan can also increase the amount of incorporated CS.

  20. Investigation the Porous Collagen-Chitosan /Glycosaminoglycans for Corneal Cell Culture as Tissue Engineering Scaffold

    Institute of Scientific and Technical Information of China (English)

    LI Qin-Hua; CHEN Jian-Su

    2005-01-01

    The objective of this study was to produce the porous collagen-chitosan/Glycosanminglycans (GAG) for corneal ceil-seed implant as a three-dimensional tissue engineering scaffold to improve the regeneration corneas. The effect of various content of glycerol as form porous agent to collagen-chitosan/GAG preserved a porous dimensional structure was investigated. The heat-drying was used to prepare porous collagen-chitosan /GAG scaffold. The pore morphology of collagenchitosan/GAG was controlled by changing the concentration of glycerol solution and drying methods. The porous structure morphology was observed by SEM. The diameter of the pores form 10 to 50 μm. The highly porous scaffold had interconnecting pores. The corneal cell morphology was observed under the light microscope. These results suggest that collagen-chitosan/GAG showed that corneal cell have formed confluent layers and resemble the surface of normal corneal cell surface.

  1. Bone regeneration by octacalcium phosphate collagen composites in a dog alveolar cleft model.

    Science.gov (United States)

    Matsui, K; Matsui, A; Handa, T; Kawai, T; Suzuki, O; Kamakura, S; Echigo, S

    2010-12-01

    Octacalcium phosphate (OCP) and porcine atelocollagen sponge composites (OCP/Col) markedly enhanced bone regeneration in a rat cranial defect model. To assess clinical application, the authors examined whether OCP/Col would enhance bone regeneration in an alveolar cleft model in an adult dog, which was assumed to reflect patients with alveolar cleft. Disks of OCP/Col or collagen were implanted into the defect and bone regeneration by OCP/Col or collagen was investigated 4 months after implantation. Macroscopically, the OCP/Col-treated alveolus was obviously augmented and occupied by radio-opacity, and the border between the original bone and the defect was indistinguishable. Histological analysis revealed it was filled and bridged with newly formed bone; a small quantity of the remaining implanted OCP was observed. X-ray diffraction patterns of the area of implanted OCP/Col indicated no difference from those of dog bone. In the collagen-treated alveolus, the hollowed alveolus was mainly filled with fibrous connective tissue, and a small amount of new bone was observed at the defect margin. These results suggest that bone was obviously repaired when OCP/Col was implanted into the alveolar cleft model in a dog, and OCP/Col would be a significant bone regenerative material to substitute for autogeneous bone.

  2. COMPARATIVE CLINICAL EVALUATION OF 0.5% ROPIVACAINE AND 0.5% BUPIVACAINE FOR BRACHIAL PLEXUS BLOCK VIA SUPRACLAVICULAR APPROACH FOR UPPER LIMB SURGERIES.

    Directory of Open Access Journals (Sweden)

    Surendra

    2013-11-01

    Full Text Available ABSTRACT: Ropivacaine, a local anesthetic agent with similar pharmacological profile to that of bupivacaine has lower potential for toxic effect. The aim of our study is to compare the anesthetic characteristics of ropivacaine and bupivacaine when used for supraclavicular brachial plexus blockade in upper limb surgeries. Fifty patients was grouped equally and one group R received 0.5% ropivacaine (100mg 20ml and another group B received 0.5% bupivacaine (100mg 20ml. onset & durat ion of sensory and motor blockade, duration of analgesia and associated complications & side effects were recorded. It was found that there were no significant differences in duration of sensory & motor blockade, in complications or any other side effects in both the groups. But ropivacaine provided rapid onset of action and better quality of surgical anesthesia than bupivacaine when used in supraclavicular brachial plexus blockade.

  3. Liposome Bupivacaine for Postsurgical Analgesia in Adult Patients Undergoing Laparoscopic Colectomy: Results from Prospective Phase IV Sequential Cohort Studies Assessing Health Economic Outcomes

    Directory of Open Access Journals (Sweden)

    Keith A. Candiotti, MD

    2014-12-01

    Conclusions: Compared with intravenous opioid PCA, a liposome bupivacaine-based multimodal analgesia regimen reduced postsurgical opioid use, hospital length of stay, and ORAEs, and may lead to improved postsurgical outcomes following laparoscopic colectomy.

  4. Human collagen produced in plants

    Science.gov (United States)

    Shoseyov, Oded; Posen, Yehudit; Grynspan, Frida

    2014-01-01

    Consequential to its essential role as a mechanical support and affinity regulator in extracellular matrices, collagen constitutes a highly sought after scaffolding material for regeneration and healing applications. However, substantiated concerns have been raised with regard to quality and safety of animal tissue-extracted collagen, particularly in relation to its immunogenicity, risk of disease transmission and overall quality and consistency. In parallel, contamination with undesirable cellular factors can significantly impair its bioactivity, vis-a-vis its impact on cell recruitment, proliferation and differentiation. High-scale production of recombinant human collagen Type I (rhCOL1) in the tobacco plant provides a source of an homogenic, heterotrimeric, thermally stable “virgin” collagen which self assembles to fine homogenous fibrils displaying intact binding sites and has been applied to form numerous functional scaffolds for tissue engineering and regenerative medicine. In addition, rhCOL1 can form liquid crystal structures, yielding a well-organized and mechanically strong membrane, two properties indispensable to extracellular matrix (ECM) mimicry. Overall, the shortcomings of animal- and cadaver-derived collagens arising from their source diversity and recycled nature are fully overcome in the plant setting, constituting a collagen source ideal for tissue engineering and regenerative medicine applications. PMID:23941988

  5. Baricity of Bupivacaine on Maternal Hemodynamics after Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial

    Science.gov (United States)

    Atashkhoei, Simin; Abedini, Naghi; Pourfathi, Hojjat; Znoz, Ali Bahrami; Marandi, Pouya Hatami

    2017-01-01

    Background: After spinal anesthesia, patients undergoing cesarean section are more likely to develop hemodynamic changes. The baricity of local anesthetic has an important role on spinal blockade effects. The aim of this study was to compare the isobar and hyperbaric bupivacaine 0.5% plus fentanyl on maternal hemodynamics after spinal anesthesia for C/S. Methods: In this double-blind study, 84 healthy pregnant women undergoing C/S using bupivacaine 0.5% isobar (study group, n=42) or hyperbaric (control group, n=42) for spinal anesthesia were scheduled. The study was conducted from 21 April 2014 to 21 November 2014 at Al-Zahra Hospital, Tabriz, Iran. Parameters such as maternal hemodynamics, block characteristics, side effects, and neonatal Apgar scores were recorded. Data were analyzed using the SPSS software by performing chi-square test, Fisher’s exact test, one-way ANOVA, Mann-Whitney U-test, and student’s t test. Results: The incidence of hypotension in the isobar group was lower than the hyperbaric group, although it was not statistically significant (40.47% vs. 61.9%, P=0.08). The duration of hypotension was shorter in the study group (1.6±7.8 min vs. 7.4±12.5 min, P=0.004). The dose of ephedrine was lower in the study group (2.4±6.6 mg vs. 5.3±10.7 mg, P=0.006). The main maternal side effect is sustained hypotension that was seen in 0 patients of the isobar and 7 (16.66%) of hyperbaric groups (P=0.006). None of the neonates had Apgar score≤7 at 5 min of delivery (P=1.0). Sensory and motor block duration was shorter in the study group (P=0.01). Conclusion: Isobaric bupivacaine is associated with more hemodynamic stability and shorter sensory and motor blockade in mothers under spinal anesthesia for C/S. Trial Registration Number: IRCT201401287013N7

  6. Modern Collagen Wound Dressings: Function and Purpose

    OpenAIRE

    Fleck, Cynthia Ann; Simman, Richard

    2011-01-01

    Collagen, which is produced by fibroblasts, is the most abundant protein in the human body. A natural structural protein, collagen is involved in all 3 phases of the wound-healing cascade. It stimulates cellular migration and contributes to new tissue development. Because of their chemotactic properties on wound fibroblasts, collagen dressings encourage the deposition and organization of newly formed collagen, creating an environment that fosters healing. Collagen-based biomaterials stimulate...

  7. Modern Collagen Wound Dressings: Function and Purpose

    OpenAIRE

    Fleck, Cynthia Ann; Simman, Richard

    2011-01-01

    Collagen, which is produced by fibroblasts, is the most abundant protein in the human body. A natural structural protein, collagen is involved in all 3 phases of the wound-healing cascade. It stimulates cellular migration and contributes to new tissue development. Because of their chemotactic properties on wound fibroblasts, collagen dressings encourage the deposition and organization of newly formed collagen, creating an environment that fosters healing. Collagen-based biomaterials stimulate...

  8. Performance of collagen sponge as a 3-D scaffold for tooth-tissue engineering.

    Science.gov (United States)

    Sumita, Yoshinori; Honda, Masaki J; Ohara, Takayuki; Tsuchiya, Shuhei; Sagara, Hiroshi; Kagami, Hideaki; Ueda, Minoru

    2006-06-01

    Tooth structure can be regenerated by seeding dissociated tooth cells onto polyglycolic acid fiber mesh, although the success rate of tooth production is low. The present study was designed to compare the performance of collagen sponge with polyglycolic acid fiber mesh as a 3-D scaffold for tooth-tissue engineering. Porcine third molar teeth at the early stage of crown formation were enzymatically dissociated into single cells, and the heterogeneous cells were seeded onto collagen sponge or the polyglycolic acid fiber mesh scaffolds. Scaffolds were then cultured to evaluate cell adhesion and ALP activity in vitro. An in vivo analysis was performed by implanting the constructs into the omentum of immunocompromised rats and evaluating tooth production up to 25 weeks. After 24h, there were a significantly higher number of cells attached to the collagen sponge scaffold than the polyglycolic acid fiber mesh scaffold. Similarly, the ALP activity was significantly higher for the collagen sponge scaffold was than the polyglycolic acid fiber mesh scaffold after 7 days of culture. The area of calcified tissue formed in the collagen sponge scaffold was also larger than in the polyglycolic acid fiber mesh scaffold. The results from in vivo experiments show conclusively that a collagen sponge scaffold allows tooth production with a higher degree of success than polyglycolic acid fiber mesh. Taken together, the results from this study show that collagen sponge scaffold is superior to the polyglycolic acid fiber mesh scaffold for tooth-tissue engineering.

  9. Up-regulation of miR-26a promotes neurite outgrowth and ameliorates apoptosis by inhibiting PTEN in bupivacaine injured mouse dorsal root ganglia.

    Science.gov (United States)

    Cui, Changlei; Xu, Gong; Qiu, Jinpeng; Fan, Xiushuang

    2015-08-01

    Local anesthetic of bupivacaine may inhibit neurite outgrowth and induce apoptosis in mouse dorsal root ganglia (DRG) neurons. In this work, we intended to investigate the functional role of microRNA 26a (miR-26a) in regulating bupivacaine-induced nerve injury in DRG neurons. DRG neurons were extracted from C57BL/6 mice and cultured in vitro. Bupivacaine was applied in vitro and it induced apoptosis, inhibited neurite growth, and significantly down-regulated miR-26a gene in DRG neurons. MiR-26a mimic was then used to up-regulate miR-26a expression in DRG neurons. We found that miR-26a up-regulation promoted neurite outgrowth and reduced apoptosis in bupivacaine-injured DRG neurons. Luciferase assay and Western blot confirmed that Phosphatase and tensin homolog (PTEN) was down-stream target of miR-26a in DRG neurons. Ectopic PTEN up-regulation was then able to reverse the protective effect of miR-26a overexpression on bupivacaine-induced nerve injury in DRG neurons. Overall, this work demonstrated that miR-26a had a functional role in regulating bupivacaine-induced nerve injury in DRG neurons. Up-regulating miR-26a to suppress PTEN signaling pathway may be an effective method to protect local anesthetic-induced nerve injury in spinal cord.

  10. A Lipid Emulsion Reverses Toxic-Dose Bupivacaine-Induced Vasodilation during Tyrosine Phosphorylation-Evoked Contraction in Isolated Rat Aortae

    Science.gov (United States)

    Ok, Seong-Ho; Lee, Soo Hee; Kwon, Seong-Chun; Choi, Mun Hwan; Shin, Il-Woo; Kang, Sebin; Park, Miyeong; Hong, Jeong-Min; Sohn, Ju-Tae

    2017-01-01

    The goal of this in vitro study was to examine the effect of a lipid emulsion on toxic-dose bupivacaine-induced vasodilation in a model of tyrosine phosphatase inhibitor sodium orthovanadate-induced contraction in endothelium-denuded rat aortae and to elucidate the associated cellular mechanism. The effect of a lipid emulsion on vasodilation induced by a toxic dose of a local anesthetic during sodium orthovanadate-induced contraction was examined. In addition, the effects of various inhibitors, either bupivacaine alone or a lipid emulsion plus bupivacaine, on protein kinase phosphorylation induced by sodium orthovanadate in rat aortic vascular smooth muscle cells was examined. A lipid emulsion reversed the vasodilation induced by bupivacaine during sodium orthovanadate-induced contraction. The lipid emulsion attenuated the bupivacaine-mediated inhibition of the sodium orthovanadate-induced phosphorylation of protein tyrosine, c-Jun NH2-terminal kinase (JNK), myosin phosphatase target subunit 1 (MYPT1), phospholipase C (PLC) γ-1 and extracellular signal-regulated kinase (ERK). These results suggest that a lipid emulsion reverses toxic-dose bupivacaine-induced vasodilation during sodium orthovanadate-induced contraction via the activation of a pathway involving either tyrosine kinase, JNK, Rho-kinase and MYPT1 or tyrosine kinase, PLC γ-1 and ERK, and this reversal is associated with the lipid solubility of the local anesthetic and the induction of calcium sensitization. PMID:28208809

  11. Assessing Caudal Block Concentrations of Bupivacaine With and Without the Addition of Intravenous Fentanyl on Postoperative Outcomes in Pediatric Patients: A Retrospective Review.

    Science.gov (United States)

    Karkera, Megha M; Harrison, Dale R; Aunspaugh, Jennifer P; Martin, Timothy W

    2016-01-01

    Caudal blocks are a significant and efficacious aspect of pediatric anesthesia, especially in urologic and many general surgery cases. This type of regional anesthesia is common because it has a high success rate and provides between 6 and 8 hours of postoperative pain control. The aim of this study was to determine whether the concentration of bupivacaine or the addition of intravascular (i.v.) fentanyl affected the postanesthesia care unit (PACU) discharge time. A retrospective cohort study comparing the outcomes in pediatric patients who have received varying caudal concentrations with and without the addition of i.v. fentanyl was performed. A total of 849 consecutive patients undergoing hypospadias repairs or circumcisions were reviewed and placed in one of the following 3 groups: 0.125% bupivacaine (group 1), 0.25% bupivacaine (group 2), or one of these concentrations of bupivacaine + i.v. fentanyl intraoperatively (group 3). Total PACU time for each group was 46.1 minutes (group 1), 48.9 minutes (group 2), and 49.7 minutes (group 3). Our results revealed that there is no statistically significant difference between concentrations of bupivacaine administered in a caudal block with or without i.v. fentanyl with regard to the outcome of PACU duration (P = 0.16). Overall, based on the retrospective cohort design, there is no difference in primary and secondary outcomes based on the concentration of bupivacaine, when administered at a volume of 1 mL/kg.

  12. A Lipid Emulsion Reverses Toxic-Dose Bupivacaine-Induced Vasodilation during Tyrosine Phosphorylation-Evoked Contraction in Isolated Rat Aortae

    Directory of Open Access Journals (Sweden)

    Seong-Ho Ok

    2017-02-01

    Full Text Available The goal of this in vitro study was to examine the effect of a lipid emulsion on toxic-dose bupivacaine-induced vasodilation in a model of tyrosine phosphatase inhibitor sodium orthovanadate-induced contraction in endothelium-denuded rat aortae and to elucidate the associated cellular mechanism. The effect of a lipid emulsion on vasodilation induced by a toxic dose of a local anesthetic during sodium orthovanadate-induced contraction was examined. In addition, the effects of various inhibitors, either bupivacaine alone or a lipid emulsion plus bupivacaine, on protein kinase phosphorylation induced by sodium orthovanadate in rat aortic vascular smooth muscle cells was examined. A lipid emulsion reversed the vasodilation induced by bupivacaine during sodium orthovanadate-induced contraction. The lipid emulsion attenuated the bupivacaine-mediated inhibition of the sodium orthovanadate-induced phosphorylation of protein tyrosine, c-Jun NH2-terminal kinase (JNK, myosin phosphatase target subunit 1 (MYPT1, phospholipase C (PLC γ-1 and extracellular signal-regulated kinase (ERK. These results suggest that a lipid emulsion reverses toxic-dose bupivacaine-induced vasodilation during sodium orthovanadate-induced contraction via the activation of a pathway involving either tyrosine kinase, JNK, Rho-kinase and MYPT1 or tyrosine kinase, PLC γ-1 and ERK, and this reversal is associated with the lipid solubility of the local anesthetic and the induction of calcium sensitization.

  13. A Novel HA/β-TCP-Collagen Composite Enhanced New Bone Formation for Dental Extraction Socket Preservation in Beagle Dogs

    Directory of Open Access Journals (Sweden)

    Ko-Ning Ho

    2016-03-01

    Full Text Available Past studies in humans have demonstrated horizontal and vertical bone loss after six months following tooth extraction. Many biomaterials have been developed to preserve bone volume after tooth extraction. Type I collagen serves as an excellent delivery system for growth factors and promotes angiogenesis. Calcium phosphate ceramics have also been investigated because their mineral chemistry resembles human bone. The aim of this study was to compare the performance of a novel bioresorbable purified fibrillar collagen and hydroxyapatite/β-tricalcium phosphate (HA/β-TCP ceramic composite versus collagen alone and a bovine xenograft-collagen composite in beagles. Collagen plugs, bovine graft-collagen composite and HA/β-TCP-collagen composite were implanted into the left and right first, second and third mandibular premolars, and the fourth molar was left empty for natural healing. In total, 20 male beagle dogs were used, and quantitative and histological analyses of the extraction ridge was done. The smallest width reduction was 19.09% ± 8.81% with the HA/β-TCP-collagen composite at Week 8, accompanied by new bone formation at Weeks 4 and 8. The HA/β-TCP-collagen composite performed well, as a new osteoconductive and biomimetic composite biomaterial, for socket bone preservation after tooth extraction.

  14. High-strength mineralized collagen artificial bone

    Science.gov (United States)

    Qiu, Zhi-Ye; Tao, Chun-Sheng; Cui, Helen; Wang, Chang-Ming; Cui, Fu-Zhai

    2014-03-01

    Mineralized collagen (MC) is a biomimetic material that mimics natural bone matrix in terms of both chemical composition and microstructure. The biomimetic MC possesses good biocompatibility and osteogenic activity, and is capable of guiding bone regeneration as being used for bone defect repair. However, mechanical strength of existing MC artificial bone is too low to provide effective support at human load-bearing sites, so it can only be used for the repair at non-load-bearing sites, such as bone defect filling, bone graft augmentation, and so on. In the present study, a high strength MC artificial bone material was developed by using collagen as the template for the biomimetic mineralization of the calcium phosphate, and then followed by a cold compression molding process with a certain pressure. The appearance and density of the dense MC were similar to those of natural cortical bone, and the phase composition was in conformity with that of animal's cortical bone demonstrated by XRD. Mechanical properties were tested and results showed that the compressive strength was comparable to human cortical bone, while the compressive modulus was as low as human cancellous bone. Such high strength was able to provide effective mechanical support for bone defect repair at human load-bearing sites, and the low compressive modulus can help avoid stress shielding in the application of bone regeneration. Both in vitro cell experiments and in vivo implantation assay demonstrated good biocompatibility of the material, and in vivo stability evaluation indicated that this high-strength MC artificial bone could provide long-term effective mechanical support at human load-bearing sites.

  15. Minimally invasive coronary bypass surgery: postoperative pain management using intermittent bupivacaine infiltration.

    Science.gov (United States)

    Borges, M F; Coulson, A S

    1998-04-01

    Minimally invasive direct coronary artery bypass grafting (MIDCAB) is becoming a popular adjunct to standard cardiac bypass surgery in selected patients with accessible single or double vessel disease. However, the limited anterior thoracotomy used to access the heart involves trauma to the muscle tissue during removal of the fourth costal cartilage and a small piece of connected rib, perhaps leading to more severe postoperative pain compared with patients undergoing routine sternotomy. Intrathecal opioids can be used but have limited therapeutic duration and there is concern regarding anticoagulation. We present a case where soft tissue catheters were placed into the depths of the surgical wounds and pain was diminished greatly by intermittent regular infiltration with bupivacaine.

  16. Intrathecal sufentanil or fentanyl as adjuvants to low dose bupivacaine in endoscopic urological procedures

    Directory of Open Access Journals (Sweden)

    Shikha Gupta

    2013-01-01

    Statistical analysis used: Analysis of variance and Chi-square test. Results: The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post-operative analgesic was significantly delayed in Group B patients. Conclusions: Spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.

  17. Pitfalls in chronobiology: a suggested analysis using intrathecal bupivacaine analgesia as an example.

    Science.gov (United States)

    Shafer, Steven L; Lemmer, Bjoern; Boselli, Emmanuel; Boiste, Fabienne; Bouvet, Lionel; Allaouchiche, Bernard; Chassard, Dominique

    2010-10-01

    The duration of analgesia from epidural administration of local anesthetics to parturients has been shown to follow a rhythmic pattern according to the time of drug administration. We studied whether there was a similar pattern after intrathecal administration of bupivacaine in parturients. In the course of the analysis, we came to believe that some data points coincident with provider shift changes were influenced by nonbiological, health care system factors, thus incorrectly suggesting a periodic signal in duration of labor analgesia. We developed graphical and analytical tools to help assess the influence of individual points on the chronobiological analysis. Women with singleton term pregnancies in vertex presentation, cervical dilation 3 to 5 cm, pain score >50 mm (of 100 mm), and requesting labor analgesia were enrolled in this study. Patients received 2.5 mg of intrathecal bupivacaine in 2 mL using a combined spinal-epidural technique. Analgesia duration was the time from intrathecal injection until the first request for additional analgesia. The duration of analgesia was analyzed by visual inspection of the data, application of smoothing functions (Supersmoother; LOWESS and LOESS [locally weighted scatterplot smoothing functions]), analysis of variance, Cosinor (Chronos-Fit), Excel, and NONMEM (nonlinear mixed effect modeling). Confidence intervals (CIs) were determined by bootstrap analysis (1000 replications with replacement) using PLT Tools. Eighty-two women were included in the study. Examination of the raw data using 3 smoothing functions revealed a bimodal pattern, with a peak at approximately 0630 and a subsequent peak in the afternoon or evening, depending on the smoother. Analysis of variance did not identify any statistically significant difference between the duration of analgesia when intrathecal injection was given from midnight to 0600 compared with the duration of analgesia after intrathecal injection at other times. Chronos-Fit, Excel, and

  18. The stability and microbial contamination of bupivacaine, lidocaine and mepivacaine used for lameness diagnostics in horses

    DEFF Research Database (Denmark)

    Adler, D. M. T.; Cornett, C.; Damborg, P.

    2016-01-01

    . Lidocaine concentration decreased 6.3% in one group and increased 5.3–7.2% in two groups. Risk factors for degradation were heat and RP vials whereas storage in practice vehicles was a risk factor for increased concentrations. Methylparaben decreased 8.3–75.0% in seven groups, and RP vials, heat and storage......Local anaesthetics (LAs) are frequently used for diagnostic procedures in equine veterinary practice. The objective of this study was to investigate the physico-chemical stability and bacterial contamination of bupivacaine, lidocaine and mepivacaine used for lameness examinations in horses. The LAs...... were stored in 12 different groups at different temperatures (−18 °C to 70 °C), light intensities and in common veterinary field conditions for up to 16 months. The pH, presence of bacterial contamination and concentrations of LAs and methylparaben (a preservative present in lidocaine) were determined...

  19. Cochlear Implant

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    In this text, the authors recall the main principles and data ruling cochlear implants. Then, a first circle of technical equipment for assistance is presented. This circle includes: device setting (DS), Electrically evoked Auditory Brainstem Responses (EABR), Neural Response Telemetry (NRT), Stapedial Reflex (SR) and Electrodogram Acquisition (EA). This first cycle becomes more and more important as children are implanted younger and younger; the amount of data available with this assistance makes necessary the use of models (implicit or explicit) to handle this information. Consequently, this field is more open than ever.

  20. POROUS POLYMER IMPLANTS FOR REPAIR OF FULL-THICKNESS DEFECTS OF ARTICULAR-CARTILAGE - AN EXPERIMENTAL-STUDY IN RABBIT AND DOG

    NARCIS (Netherlands)

    JANSEN, HWB; VETH, RPH; NIELSEN, HKL; DEGROOT, JH; PENNINGS, AJ

    1992-01-01

    Full-thickness defects of articular cartilage were repaired by implantation of porous polymer implants in rabbits and dogs. The quality of the repair tissue was determined by collagen typing with antibodies. Implants with varying pore sizes and chemical composition were used. The effect of loading

  1. Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound.

    Science.gov (United States)

    Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Falcão, Luiz Fernando dos Reis; Tardelli, Maria Angela

    2015-01-01

    The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block. Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5 mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block; a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4h after the blockade. MEC90 was 0.241% [R(2): 0.978, confidence interval: 0.20-0.34%]. No patient, with successful block, reported pain after 4h. This study demonstrated that ultrasound guided axillary brachial plexus block can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. [Minimum effective concentration of bupivacaine for axillary brachial plexus block guided by ultrasound].

    Science.gov (United States)

    Takeda, Alexandre; Ferraro, Leonardo Henrique Cunha; Rezende, André Hosoi; Sadatsune, Eduardo Jun; Falcão, Luiz Fernando Dos Reis; Tardelli, Maria Angela

    2015-01-01

    The use of ultrasound in regional anesthesia allows reducing the dose of local anesthetic used for peripheral nerve block. The present study was performed to determine the minimum effective concentration (MEC90) of bupivacaine for axillary brachial plexus block (ABPB). Patients undergoing hand surgery were recruited. To estimate the MEC90, a sequential up-down biased coin method of allocation was used. The bupivacaine dose was 5mL for each nerve (radial, ulnar, median, and musculocutaneous). The initial concentration was 0.35%. This concentration was changed by 0.05% depending on the previous block: a blockade failure resulted in increased concentration for the next patient; in case of success, the next patient could receive or reduction (0.1 probability) or the same concentration (0.9 probability). Surgical anesthesia was defined as driving force ≤ 2 according to the modified Bromage scale, lack of thermal sensitivity and response to pinprick. Postoperative analgesia was assessed in the recovery room with numeric pain scale and the amount of drugs used within 4hours after the blockade. MEC90 was 0.241% [R2: 0.978, confidence interval: 0.20%-0.34%]. No successful block patient reported pain after 4hours. This study demonstrated that ultrasound guided ABPB can be performed with the use of low concentration of local anesthetics, increasing the safety of the procedure. Further studies should be conducted to assess blockade duration at low concentrations. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  3. Comparison of Interpleural and Thoracic Epidural Bupivacaine with Buprenorphine for Post-Thoracotomy Analgesia

    Directory of Open Access Journals (Sweden)

    S K Mathur

    2008-01-01

    Full Text Available The study was designed to compare the efficacy of interpleural and thoracic epidural analgesia after thorac-otomy with regard to quality of analgesia and complications. Sixty patients undergoing elective thoracotomy were randomly and equally placed into either interpleural (IP or thoracic epidural (TE group. In IP group an interpleural catheter was placed in paravertebral space under direct vision during surgery and received 0.25% bupivacaine 20 ml with buprenorphine 150 mcg. In TE group an epidural catheter was inserted in the T6-7 / T7-8 interspace and received 0.25% bupivacaine 10 ml with buprenorphine 150 mcg. Dosage were repeated in both the groups to keep a VAS score < 40 for 48 hours post-operatively. Spirometry was done preoperatively and 12, 24 and 36 hours post-opera-tively. Vital parameters were monitored for 48 hours. The mean analgesia time was 331.73±94.03 min and 567.33±127.33 min in IP and TE groups respectively. The VAS score was significantly reduced within the first 30 minutes of injection in both the groups. Post injection VAS was significantly better in TE group. Mean time taken for interpleural and epidural catheter placement was 5.0±0.0 min and 33.83±3.39 min respectively. Postoperative forced expiratory volume in 1 second(FEV1, forced vital capacity (FVC and forced expiratory ratio (FER were similar in both the groups while peak expiratory flow rate (PEFR, maximal expiratory flow (MEF and F50 were slightly better in TE group. Vital parameters showed similar changes in both the groups. The TE group had more complications. Interpleural analgesia, though of shorter duration, is a safe and effective alternative technique for post-thoracotomy analgesia and has a low complication rate.

  4. Efficacy of epidural administration of morphine with bupivacaine for orthopaedic surgery in sheep

    Directory of Open Access Journals (Sweden)

    Durej M.

    2012-01-01

    Full Text Available The aim of the study was to test the hypothesis that epidural administration of morphine with bupivacaine provides more intense and sufficient perioperative analgesia compared with parenterally administrated butorphanol during orthopaedic surgery. Sheep were assigned to group C (control group, 6 sheep and group E (epidural, 5 sheep. Sheep from group C were pre-medicated with midazolam (0.3 mg/kg, i.m. and butorphanol (0.2 mg/kg, i.m.. Propofol was used for induction of general anesthesia in both groups. Sheep from group E were pre-medicated with midazolam, but without butorphanol. Sacrococcegeal epidural analgesia with morphine (0.1 mg/kg and bupivacaine (1 mg/kg was performed. We detected a significant increase in heart rate (19%, p=0.021 during surgery in group C. Two hours after surgery, the heart rate was 14.9% lower than prior to surgery in group E (p=0.017. In group E, throughout the surgery, we measured an insignificant increase in respiratory rate of 1.99%. In the same group, 120 minutes post surgery, we measured an increase in respiratory rate of 14.7%, while in group C there was a smaller increase of only 10.9%. The result from both groups was insignificant (p>0.05. The consumption of isoflurane in group C was higher than in group E by 27.3% (p=0.0043. The mean MAC was in group C higher by 27.6% as it was in group E (0.75% ± 0.25, 0.95 ± 0.3 in Group E and C, respectively. This distinction, according to the Mann-Whitney test, was not significant (p=0.329.

  5. A comparative randomized study of paravertebral block versus wound infiltration of bupivacaine in modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Parul Bansal

    2012-01-01

    Full Text Available Background: Paravertebral block (PVB has the potential to offer long-lasting pain relief because it can uniquely eliminate cortical responses to thoracic dermatomal stimulation. Benefits include a reduction in postoperative nausea and vomiting (PONV, prolonged postoperative pain relief, and potential for ambulatory discharge. Aims: To compare PVB with local infiltration for postoperative analgesia following modified radical mastectomy (MRM. Methods: Forty patients undergoing MRM with axillary dissection were randomly allocated into two groups. Following induction of general anesthesia in group P, a catheter was inserted in the paravertebral space and 0.3 ml/kg of 0.25 % of bupivacaine was administered followed by continuous infusion, while in group L, the surgical incision was infiltrated with 0.3 ml/kg of 0.25 % bupivacaine. Statistical Analysis: The statistical tests were applied as unpaired student ′t′ test/nonparametric test Wilcoxon Mann Whitney test for comparing different parameters such as VAS score and consumption of drugs. The categorical variables such as nausea and vomiting scores, sedation score, and patient satisfaction score were computed by Chi square test/Fisher exact test. Results: VAS score was significantly lower in group P than in group L throughout the postoperative period. The mean alertness score (i.e., less sedation was higher in group P in the postoperative period than group L. The incidence of PONV was less in PVB group. Conclusion: PVB at the end of the surgery results in better postoperative analgesia, lesser incidence of PONV, and better alertness score.

  6. Guided Bone Regeneration with Collagen Membranes and Particulate Graft Materials: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Wessing, Bastian; Lettner, Stefan; Zechner, Werner

    2017-09-22

    The aim of this meta-analysis was to evaluate different methods for guided bone regeneration using collagen membranes and particulate grafting materials in implant dentistry. An electronic database search and hand search were performed for all relevant articles dealing with guided bone regeneration in implant dentistry published between 1980 and 2014. Only randomized clinical trials and prospective controlled studies were included. The primary outcomes of interest were survival rates, membrane exposure rates, bone gain/defect reduction, and vertical bone loss at follow-up. A meta-analysis was performed to determine the effects of presence of membrane cross-linking, timing of implant placement, membrane fixation, and decortication. Twenty studies met the inclusion criteria. Implant survival rates were similar between simultaneous and subsequent implant placement. The membrane exposure rate of cross-linked membranes was approximately 30% higher than that of non-cross-linked membranes. The use of anorganic bovine bone mineral led to sufficient newly regenerated bone and high implant survival rates. Membrane fixation was weakly associated with increased vertical bone gain, and decortication led to higher horizontal bone gain (defect depth). Guided bone regeneration with particulate graft materials and resorbable collagen membranes is an effective technique for lateral alveolar ridge augmentation. Because implant survival rates for simultaneous and subsequent implant placement were similar, simultaneous implant placement is recommended when possible. Additional techniques like membrane fixation and decortication may represent beneficial implications for the practice.

  7. Histopathological reaction over prosthesis surface covered with silicone and polyurethane foam implanted in rats

    OpenAIRE

    Jorge Wagenführ-Júnior; Jurandir Marcondes Ribas Filho; Marcelo Mazza do Nascimento; Fernanda Marcondes Ribas; Marcus Vinícius Wanka; Andressa de Lima Godoi

    2012-01-01

    PURPOSES: To evaluate whether polyurethane foam leads more intense foreign-body reaction than silicone foam. To compare the vascularization of the capsules surrounding the foam implants. To investigate if the capsule of polyurethane foam implanted has greater amount of collagen than that of silicone foam. METHODS: Sixty-four young male Wistar rats were allocated into two groups: polyurethane foam and silicone foam. Subcutaneous discs were implanted into the dorsum of the animals in both group...

  8. Fibronectin coating of collagen modules increases in vivo HUVEC survival and vessel formation in SCID mice.

    Science.gov (United States)

    Cooper, T P; Sefton, M V

    2011-03-01

    Modular tissue engineering is a novel approach to creating scalable, self-assembling, three-dimensional tissue constructs with inherent vascularization. Under initial methods, the subcutaneous implantation of human umbilical vein endothelial cell (HUVEC)-covered collagen modules in immunocompromised mice resulted in significant host inflammation and limited HUVEC survival. A minimally invasive injection technique was used to minimize surgery-related inflammation, and cell death was attributed to extensive apoptosis within 72 h of implantation. Coating collagen modules with fibronectin (Fn) was shown in vivo to reduce short-term HUVEC TUNEL staining by nearly 40%, while increasing long-term HUVEC survival by 30-45%, relative to collagen modules without fibronectin. Consequently, a ∼100% increase in the number of HUVEC-lined vessels was observed with Fn-coated modules, as compared to collagen-only modules, at 7 and 14 days post-implantation. Furthermore, vessels appeared to be perfused with host erythrocytes by day 7, and vessel maturation and stabilization was evident by day 14.

  9. Mesenchymal stem cell-coated sutures enhance collagen depositions in sutured tissues.

    Science.gov (United States)

    Casado, Javier G; Blazquez, Rebeca; Jorge, Inmaculada; Alvarez, Veronica; Gomez-Mauricio, Guadalupe; Ortega-Muñoz, Mariano; Vazquez, Jesus; Sanchez-Margallo, Francisco M

    2014-01-01

    Sutures are commonly used for surgical procedures and new sutures are being developed to improve wound healing. In the past decade, it has been extensively shown that mesenchymal stem cells (MSCs) have a wound healing potential. To benefit the overall wound healing process, we aimed to analyze the usage of pretreated sutures for improving the implantation of MSCs in the tissues. Our results firstly showed that suture pretreatments with gelatin, poly-L-lysine, and NaOH improved the adhesive strength of MSCs to sutures. These cells remained surrounding the sutured tissue and no significant phenotypic changes were found in those cells cultured onto pretreated sutures. In vivo experiments showed that the implantation of MSCs by suturing increases the collagen content in the sutured tissue. Moreover, proteomics analysis of secreted proteins showed that collagen alpha-1(I) chain was the most abundant collagen found. To our knowledge, this is the first report that aimed to improve the implantation of MSCs in tissue by suture pretreatments. Moreover, in vivo experiments suggest that MSC-coated sutures may enhance wound healing and tissue remodeling through the release of different collagen types being applicable for those patients that tend to have difficulty healing.

  10. 3D Printing of Composite Calcium Phosphate and Collagen Scaffolds for Bone Regeneration

    Science.gov (United States)

    Inzana, Jason A.; Olvera, Diana; Fuller, Seth M.; Kelly, James P.; Graeve, Olivia A.; Schwarz, Edward M.; Kates, Stephen L.; Awad, Hani A.

    2014-01-01

    Low temperature 3D printing of calcium phosphate scaffolds holds great promise for fabricating synthetic bone graft substitutes with enhanced performance over traditional techniques. Many design parameters, such as the binder solution properties, have yet to be optimized to ensure maximal biocompatibility and osteoconductivity with sufficient mechanical properties. This study tailored the phosphoric acid-based binder solution concentration to 8.75 wt% to maximize cytocompatibility and mechanical strength, with a supplementation of Tween 80 to improve printing. To further enhance the formulation, collagen was dissolved into the binder solution to fabricate collagen-calcium phosphate composites. Reducing the viscosity and surface tension through a physiologic heat treatment and Tween 80, respectively, enabled reliable thermal inkjet printing of the collagen solutions. Supplementing the binder solution with 1–2 wt% collagen significantly improved maximum flexural strength and cell viability. To assess the bone healing performance, we implanted 3D printed scaffolds into a critically sized murine femoral defect for 9 weeks. The implants were confirmed to be osteoconductive, with new bone growth incorporating the degrading scaffold materials. In conclusion, this study demonstrates optimization of material parameters for 3D printed calcium phosphate scaffolds and enhancement of material properties by volumetric collagen incorporation via inkjet printing. PMID:24529628

  11. Configurational effects of collagen/ALP coatings on enzyme immobilization and surface mineralization

    Science.gov (United States)

    Bosco, R.; Leeuwenburgh, S. C. G.; Jansen, J. A.; van den Beucken, J. J. J. P.

    2014-08-01

    The ultimate goal for surface modifications in bone implants is to achieve biologically active surface able to control and trigger specific tissue response. In this study was evaluated the effects of organic compound, derived from extracellular matrix, involved in tissue mineralization. Alkaline phosphatase (ALP) plays a fundamental role in bone mineralization concurrently with collagen, the main organic components of bones. Electrospray deposition (ESD) was used to coat titanium disks with ALP and collagen at room temperature. To verify the synergistic role of ALP and collagen different conformations of coatings (mixed and layered) were obtained and their mineralization capacity was tested in vitro. The mineralization tests indicated the fundamental role of collagen to increase ALP coating retention. Analyses indicated that the coating conformation has a role; in fact the mixed group showed improved ALP retention, enzymatic activity and unique mineralized surface morphology. ESD demonstrated to be a successful method to deposit organic molecules preserving their properties as indicated by the in vitro results. These findings proved the synergistic effect of ALP and collagen in inducing mineralization offering an intriguing coating constituent for medical device that aim to trigger surface mineralization such as bone implants.

  12. 3D printing of composite calcium phosphate and collagen scaffolds for bone regeneration.

    Science.gov (United States)

    Inzana, Jason A; Olvera, Diana; Fuller, Seth M; Kelly, James P; Graeve, Olivia A; Schwarz, Edward M; Kates, Stephen L; Awad, Hani A

    2014-04-01

    Low temperature 3D printing of calcium phosphate scaffolds holds great promise for fabricating synthetic bone graft substitutes with enhanced performance over traditional techniques. Many design parameters, such as the binder solution properties, have yet to be optimized to ensure maximal biocompatibility and osteoconductivity with sufficient mechanical properties. This study tailored the phosphoric acid-based binder solution concentration to 8.75 wt% to maximize cytocompatibility and mechanical strength, with a supplementation of Tween 80 to improve printing. To further enhance the formulation, collagen was dissolved into the binder solution to fabricate collagen-calcium phosphate composites. Reducing the viscosity and surface tension through a physiologic heat treatment and Tween 80, respectively, enabled reliable thermal inkjet printing of the collagen solutions. Supplementing the binder solution with 1-2 wt% collagen significantly improved maximum flexural strength and cell viability. To assess the bone healing performance, we implanted 3D printed scaffolds into a critically sized murine femoral defect for 9 weeks. The implants were confirmed to be osteoconductive, with new bone growth incorporating the degrading scaffold materials. In conclusion, this study demonstrates optimization of material parameters for 3D printed calcium phosphate scaffolds and enhancement of material properties by volumetric collagen incorporation via inkjet printing.

  13. Optimally oriented grooves on dental implants improve bone quality around implants under repetitive mechanical loading.

    Science.gov (United States)

    Kuroshima, Shinichiro; Nakano, Takayoshi; Ishimoto, Takuya; Sasaki, Muneteru; Inoue, Maaya; Yasutake, Munenori; Sawase, Takashi

    2017-01-15

    The aim was to investigate the effect of groove designs on bone quality under controlled-repetitive load conditions for optimizing dental implant design. Anodized Ti-6Al-4V alloy implants with -60° and +60° grooves around the neck were placed in the proximal tibial metaphysis of rabbits. The application of a repetitive mechanical load was initiated via the implants (50N, 3Hz, 1800 cycles, 2days/week) at 12weeks after surgery for 8weeks. Bone quality, defined as osteocyte density and degree of biological apatite (BAp) c-axis/collagen fibers, was then evaluated. Groove designs did not affect bone quality without mechanical loading; however, repetitive mechanical loading significantly increased bone-to-implant contact, bone mass, and bone mineral density (BMD). In +60° grooves, the BAp c-axis/collagen fibers preferentially aligned along the groove direction with mechanical loading. Moreover, osteocyte density was significantly higher both inside and in the adjacent region of the +60° grooves, but not -60° grooves. These results suggest that the +60° grooves successfully transmitted the load to the bone tissues surrounding implants through the grooves. An optimally oriented groove structure on the implant surface was shown to be a promising way for achieving bone tissue with appropriate bone quality. This is the first report to propose the optimal design of grooves on the necks of dental implants for improving bone quality parameters as well as BMD. The findings suggest that not only BMD, but also bone quality, could be a useful clinical parameter in implant dentistry.

  14. Oriented Collagen Scaffolds for Tissue Engineering

    Directory of Open Access Journals (Sweden)

    Shohta Kodama

    2012-03-01

    Full Text Available Oriented collagen scaffolds were developed in the form of sheet, mesh and tube by arraying flow-oriented collagen string gels and dehydrating the arrayed gels. The developed collagen scaffolds can be any practical size with any direction of orientation for tissue engineering applications. The birefringence of the collagen scaffolds was quantitatively analyzed by parallel Nicols method. Since native collagen in the human body has orientations such as bone, cartilage, tendon and cornea, and the orientation has a special role for the function of human organs, the developed various types of three-dimensional oriented collagen scaffolds are expected to be useful biomaterials for tissue engineering and regenerative medicines.

  15. Comparative evaluation of a biomimic collagen/hydroxyapatite/β-tricaleium phosphate scaffold in alveolar ridge preservation with Bio-Oss Collagen

    Science.gov (United States)

    Wang, Tong; Li, Qing; Zhang, Gui-feng; Zhou, Gang; Yu, Xin; Zhang, Jing; Wang, Xiu-mei; Tang, Zhi-hui

    2016-06-01

    Bone scaffolds are critical in current implant and periodontal regeneration approaches. In this study, we prepared a novel composite type-I collagen and hydroxyapatite (HA)/β-tricaleium phosphate (TCP) scaffold (CHTS) by incorporating type-I collagen and bovine calcined bone granules, prepared as a mixture of 50% HA and 50% TCP, by freeze drying. We then characterized the CHTS and determined its cytotoxic effects. Additionally, ridge preservation experiments were carried out to evaluate the clinical effects of the CHTS. The results demonstrated that the composite scaffolds had good surface morphology and no cytotoxicity. Additionally, an in vivo experiment in an animal model showed that the CHTS performed equally as well as Bio-Oss Collagen, a widely used bone graft in ridge preservation. These findings revealed that the CHTS, which contained natural constituents of bone, could be used as a scaffold for bone regeneration and clinical use.

  16. COMPARISON OF 0.5% ROPIVACAINE & 0.5% BUPIVACAINE IN EPIDURAL ANAESTHESIA FOR PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY

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    Durga Shankar

    2015-07-01

    Full Text Available Ropivacaine is a new intermediate - acting amide local anesthetic which is structurally closely related to a chemical group of amino amides in present clinical use e.g. bupivacaine and mepivacaine . Ropivacaine has pharmacodynamic and pharmacokinetic properties in animals resembling those of bupivacaine. 1 - 3 In human volunteers, ropivacaine has been shown to be less prone than bupivacaine to produce mild central nervous system and cardiovascular changes after intravenous infusion Hence we designed a study to compare ropivacaine 0.5% with bupivacaine 0.5% for epidural anesthesia fo r abdominal hysterectomy. Healthy women, scheduled for elective abdominal hysterectomy were enrolled into this randomized, double - blind, parallel - group study. Epidural block was obtained with 20 ml of ropivacaine (group R or bupivacaine (group B and surgery started when anesthesia reached T6. Heart rate and blood pressure were assessed before the test dose and at five minute intervals for initial 30mins and then every 10mins until the full recovery. At the same intervals, sensory and motor block characteristics were determined. Adverse events were recorded. Sixty patients were enrolled and data available for analysis was 30 ropivacaine and 30 bupivacaine. Mean duration for total sensory blockade was 323.50±39.33mins for R group as compared to 312.0 ± 30.36mins for B group (p>0.05 . Motor onset time in group R was 17.26 ± 1.78 , 25.44 ± 1.79 and 28.28 ± 1.79mins for grade 1, 2 and 3 motor block respectively, compared to 16.73 ± 1.99 , 25.14 ± 2.05 and 28.66 ± 2.82mins for group B (p>0.05 . Duration of motor block in group R was 211.66 ± 32.91mins as compared to 288.66 ± 36.99mins in group B . (P value < 0.0001 . Analgesia was excellent in 83.33% cases and satisfactory in 10 % cases in group R as compared to 86.66% and 3.33% in group B respectively. 6.66% patients in group R and 10% patients in group B required intravenous fentanyl supplement and were

  17. Multiscale analyses of the bone-implant interface.

    Science.gov (United States)

    Cha, J Y; Pereira, M D; Smith, A A; Houschyar, K S; Yin, X; Mouraret, S; Brunski, J B; Helms, J A

    2015-03-01

    Implants placed with high insertion torque (IT) typically exhibit primary stability, which enables early loading. Whether high IT has a negative impact on peri-implant bone health, however, remains to be determined. The purpose of this study was to ascertain how peri-implant bone responds to strains and stresses created when implants are placed with low and high IT. Titanium micro-implants were inserted into murine femurs with low and high IT using torque values that were scaled to approximate those used to place clinically sized implants. Torque created in peri-implant tissues a distribution and magnitude of strains, which were calculated through finite element modeling. Stiffness tests quantified primary and secondary implant stability. At multiple time points, molecular, cellular, and histomorphometric analyses were performed to quantitatively determine the effect of high and low strains on apoptosis, mineralization, resorption, and collagen matrix deposition in peri-implant bone. Preparation of an osteotomy results in a narrow zone of dead and dying osteocytes in peri-implant bone that is not significantly enlarged in response to implants placed with low IT. Placing implants with high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Using high IT to place an implant creates high interfacial stress and strain that are associated with damage to peri-implant bone and therefore should be avoided to best preserve the viability of this tissue. © International & American Associations for Dental Research 2015.

  18. A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

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    Hossam A El Shamaa

    2014-01-01

    Full Text Available Background: One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective α2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery. Patients and Methods: A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients (n = 25 received dexmedetomidine with bupivacaine while Group B patients (n = 25 received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway (LMA was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded. Results: The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no significant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected. Conclusion: The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal

  19. Effect of clonidine as adjuvant in bupivacaine-induced supraclavicular brachial plexus block: A randomized controlled trial

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    Chakraborty Susmita

    2010-01-01

    Full Text Available Objective: Clonidine has been used as adjuvant to local anesthetics in order to extend the duration of analgesia in various regional and central neuraxial blocks. It is previously reported that clonidine added to bupivacaine increases analgesia duration in brachial plexus block. We evaluated the effect of this combination in supraclavicular brachial plexus block for upper limb orthopedic procedures. Materials and Methods: A randomized double-blind placebo controlled trial was done with 70 patients of American Society of Anesthesiologists Grade I or II status undergoing upper limb orthopedic procedures. Group A (n = 35 patients received 25 ml of 0.5% bupivacaine and 0.2 ml (30 mcg clonidine, whereas group B (n = 35 received 25 ml of 0.5% bupivacaine and 0.2 ml normal saline through a supraclavicular approach for brachial plexus block. Vital parameters were recorded 10 min prior to block placement and every 3 min thereafter till the end of the procedure. Onset and duration of both sensory and motor blocks and sedation score were recorded. All patients were observed in postanesthesia care unit and received tramadol injection as soon as they complained of pain as rescue analgesic. Duration of analgesia was taken as the time from placement of block till injection of rescue analgesic. Results: Analgesia duration was 415.4 ± 38.18 min (mean ± standard deviation in Group A (clonidine compared to 194.2 ± 28.74 min in Group B (control. No clinically significant difference was observed in heart rate, blood pressure, and oxygen saturation. Sedation score was higher in the clonidine group. Conclusion: Addition of a small dose of clonidine to 0.5% bupivacaine significantly prolonged the duration of analgesia without producing any clinically important adverse reactions other than sedation.

  20. The effect of bupivacaine with fentanyl temperature on initiation and maintenance of labor epidural analgesia: a randomized controlled study.

    Science.gov (United States)

    Sviggum, H P; Yacoubian, S; Liu, X; Tsen, L C

    2015-02-01

    Labor epidural analgesia is highly effective, but can be limited by slow onset and incomplete blockade. The administration of warmed, compared to room temperature, bupivacaine has resulted in more rapid onset epidural anesthesia. We hypothesized that the administration of bupivacaine with fentanyl at 37°C versus 20°C would result in improved initial and ongoing labor epidural analgesia. In this prospective, randomized, doubled blinded study, 54 nulliparous, laboring women were randomized to receive epidural bupivacaine 0.125% with fentanyl 2 μg/mL (20 mL initial and 6 mL hourly boluses) at either 37°C or 20°C. Pain verbal rating scores (VRS), sensory level, oral temperature, and side effects were assessed after epidural loading (time 0), at 5, 10, 15, 20, 30, 60 min, and at hourly intervals. The primary outcome was the time to achieve initial satisfactory analgesia (VRS ⩽3). Secondary outcomes included ongoing quality of sensory blockade, body temperature and shivering. There were no differences between groups in patient demographics, initial pain scores, cervical dilatation, body temperature or mode of delivery. Epidural bupivacaine at 37°C resulted in shorter mean (±SD) analgesic onset time (9.2±4.7 vs. 16.0±10.5 min, P=0.005) and improved analgesia for the first 15 min after initial bolus (P=0.001-0.03). Although patient temperature increased during the study (Plabor analgesia for the first 15 min. There was no evidence of improved ongoing labor analgesia or differences in side effects between groups. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Impact of dental implant insertion method on the peri-implant bone tissue--an experimental study.

    Science.gov (United States)

    Stamatović, Novak; Matić, Smiljana; Tatić, Zoran; Petković-Curcin, Aleksandra; Vojvodić, Danilo; Rakić, Mia

    2013-09-01

    The function of dental implants depends on their stability in bone tissue over extended period of time, i.e. on osseointegration. The process through which osseointegration is achieved depends on several factors, surgical insertion method being one of them. The aim of this study was to histopathologically compare the impact of the surgical method of implant insertion on the peri-implant bone tissue. The experiment was performed on 9 dogs. Eight weeks following the extraction of lower premolars implants were inserted using the one-stage method on the right mandibular side and two-stage method on the left side. Three months after implantation the animals were sacrificed. Three distinct regions of bone tissue were histopathologically analyzed, the results were scored and compared. In the specimens of one-stage implants increased amount of collagen fibers was found in 5 specimens where tissue necrosis was also observed. Only moderate osteoblastic activity was found in 3 sections. The analysis of bone-to-implant contact region revealed statistically significantly better results regarding the amount of collagen tissue fibers for the implants inserted in the two-stage method (Wa = 59 osteocytes in 3 specimens. No necrotic tissue was found. The analyzed specimens of bone adjacent to two-stage implants revealed a moderate increase in the number of osteocytes in 3 and a marked increase in 6 specimens respectively. This difference was statistically significant (Wb = 106.5 > 105, alpha = 0.05). No necrosis and osteoblastic activity were observed. Better results were achieved by the two-stage method in bone-to-implant contact region regarding the amount of collagen tissue, while the results were identical regarding the osteoblastic activity and bone tissue necrosis. There was no difference between the methods in the bone-implant interface region. In the bone tissue adjacent to the implant the results were identical regarding the amount of collagen tissue, osteoblastic reaction

  2. Preparation and Properties of Collagen-Chitosan/ Glycosaminoglycans as Candidate Tissue Engineering Biomaterials

    Institute of Scientific and Technical Information of China (English)

    LIQin-Hua; HUANGYao-xiong; CHENGJian-su

    2004-01-01

    A novel biomaterial scaffold was created from collagen-chitosan/GAG. Its tensile strength was 8.6MPa(wet state)and degree of swelling water was 60%~75% with higer ultimate elongation 300%. Rabbit corneas of collagen-chitosan/GAG implantation samples in vivo for biodegradation showed that the inplantion samples was complets biodegrable and digested afere 120 day. There was enought time to maintain cell growth,immigrating and proliferation. This biomaterials scaffold can be used for cell culture and in various tissue engineering fields.

  3. A COMPARATIVE STUDY OF INTRATHECAL HYPERBARIC 0.5% BUPIVACAINE VERSUS INTRATHECAL 0.5% ISOBARIC LEVOBUPIVACAINE

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    Kurmanadh K

    2016-09-01

    Full Text Available BACKGROUND Bupivacaine is a long-acting agent capable of producing prolonged anaesthesia and analgesia that can be prolonged even further by the addition of epinephrine. It is substantially more cardiotoxic than lidocaine. The cardiotoxicity of bupivacaine is cumulative and substantially greater than would be predicted by its LA potency. At least part of the cardiotoxicity of bupivacaine maybe mediated centrally because direct injection of small quantities of bupivacaine into the medulla can produce malignant ventricular arrhythmias. Bupivacaine-induced cardiotoxicity can be difficult to treat.[1] Levobupivacaine contains a single enantiomer of bupivacaine hydrochloride and is less cardiotoxic than bupivacaine. It is extensively metabolised with no unchanged drug detected in urine or faeces. Research results suggest that levobupivacaine is a suitable less toxic alternative to bupivacaine.[2] METHODS The study entitled “A Randomised Controlled Double-Blind Comparative Study of 0.5% Levobupivacaine vs. 0.5% Heavy Bupivacaine For Surgeries Below Umbilicus During Spinal Anaesthesia” for various procedures done in the Department of Anaesthesiology at Andhra Medical College at King George Hospital, Visakhapatnam, from November 2011 to October 2012. The study was undertaken after obtaining Hospital Ethics Committee clearance as well as written informed consent from all patients after explaining and reassuring about the spinal procedure. A total of 100 patients of both sexes scheduled for elective lower abdominal surgeries under spinal anaesthesia in the age group of 18 to 55 years and belonging to American Society of Anaesthesiologists (ASA Physical Status I and II were enrolled for the study. The enrolled patients were randomised to one of the two groups of equal-sized prospective, comparative study group using a double-blind protocol design Group B (n=50 received 3.0 mL volume of 0.5% hyperbaric bupivacaine intrathecally and Group L (n=50

  4. Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhan-song; SONG Bo; NIE Fa-chuan; CHEN Jin-mei

    2006-01-01

    Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% upivacaine, .05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26.5±.6 to 13.4±2.0 (P<0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61%) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3.8 to 23. 6±4. 2 and 10. 9±2.6 to 14.3± 2.4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

  5. Bupivacaine in combination with fentanyl or sufentanil in epidural/intrathecal analgesia for labor: a meta-analysis.

    Science.gov (United States)

    Li, Bo; Wang, Huixia; Gao, Chengjie

    2015-05-01

    This study is to compare the effectiveness of combinational use of bupivacaine with fentanyl (BUPI-FEN) and sufentanil (BUPI-SUF) in epidural/intrathecal analgesia for labor. Electronic databases were searched for relevant research papers published between 1985 and 2014. Meta-analyses of mean differences or odds ratios were performed and statistical heterogeneity between the studies tested by I(2) index. Ten studies recruiting a total of 728 women in labor were selected. Concentrations of the anesthetics used as mean ± sd were bupivacaine 0.115 ± 0.056%, fentanyl 0.0007 ± 0.001%, and sufentanil 0.00017 ± 0.00022%. Duration of analgesia was not significantly different between BUPI-SUF and BUPI-FEN administered mothers (mean difference [95%CI] of -33.55 [-74.94, 7.83] minutes; P = .11) under random effects. The onset of analgesia was also not significantly different between both groups (mean difference [95%CI] of -0.61 [-1.38, 0.16] minutes; P = .12). The number of neonates with Apgar score bupivacaine provide similar analgesic properties via the epidural or intrathecal routes for labor pain relief.

  6. Quantitative Mass spectrometric Analysis of Ropivacaine and Bupivacaine in Authentic, Pharmaceutical and Spiked Human Plasma without Chromatographic Separation

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    Nahla N. Salama

    2009-01-01

    Full Text Available The present study employs time of flight mass spectrometry for quantitative analysis of the local anesthetic drugs ropivacaine and bupivacaine in authentic, pharmaceutical and spiked human plasma as well as in the presence of their impurities 2,6-dimethylaniline and alkaline degradation product. The method is based on time of flight electron spray ionization mass spectrometry technique without preliminary chromatographic separation and makes use of bupivacaine as internal standard for ropivacaine, which is used as internal standard for bupivacaine. A linear relationship between drug concentrations and the peak intensity ratio of ions of the analyzed substances is established. The method is linear from 23.8 to 2380.0 ng mL-1 for both drugs. The correlation coefficient was ≥0.996 in authentic and spiked human plasma. The average percentage recoveries in the ranges of 95.39%–102.75% was obtained. The method is accurate (% RE < 5% and reproducible with intra- and inter-assay precision (RSD% < 8.0%. The quantification limit is 23.8 ng mL-1 for both drugs. The method is not only highly sensitive and selective, but also simple and effective for determination or identification of both drugs in authentic and biological fluids. The method can be applied in purity testing, quality control and stability monitoring for the studied drugs.

  7. Combined lipid emulsion and ACLS resuscitation following bupivacaine- and hypoxia-induced cardiovascular collapse in unanesthetized swine.

    Science.gov (United States)

    Bushey, Brent A; Auld, Victor H; Volk, John E; Vacchiano, Charles A

    2011-04-01

    This study examined whether combining lipid emulsion and advanced cardiac life support (ACLS) improves survival in an unanesthetized swine model of bupivacaine- and hypoxia-induced cardiovascular collapse. Arterial and venous catheters and a tracheostomy were surgically placed in 26 swine receiving inhalation anesthesia. After a 1-hour recovery period, bupivacaine (5 mg/kg) was administered intravenously over 15 seconds. Following 1 minute of observation and 3 minutes of mechanical airway obstruction, during which all animals exhibited complete cardiovascular collapse, ACLS was initiated. Animals were randomized to receive either intravenous saline or 20% lipid emulsion commencing with the initiation ofACLS. Survival was defined as a return of spontaneous circulation (ROSC) with unsupported blood pressure greater than 60 mm Hg for 10 minutes after 25 minutes of resuscitation effort. Data collection included electrocardiogram, arterial blood pressure, and arterial and mixed venous oxygen saturations. There was no significant difference in survival between the saline group (4/12, 33%) and lipid emulsion group (6/12, 50%; P > .05). Additionally, there was no significant difference between groups of surviving animals in the time to ROSC (P > .05). The combination of lipid emulsion and ACLS did not improve survival from bupivacaine- and hypoxia-induced cardiovascular collapse in unanesthetized swine.

  8. Analgesic Effect of Intra-Articular Injection of Temperature-Responsive Hydrogel Containing Bupivacaine on Osteoarthritic Pain in Rats

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    Taemin Kim

    2015-01-01

    Full Text Available The present study examined the analgesic effects of slow-releasing bupivacaine from hydrogel on chronic arthritic pain in rats. Osteoarthritis (OA was induced by monosodium iodoacetate (MIA injection into the right knee joint. Hydrogel (HG: 20, 30, and 50 μL and temperature-sensitive hydrogel containing bupivacaine (T-gel: 20, 30, and 50 μL were injected intra-articularly 14 days after MIA injection. Behavioral tests were conducted. The rats showed a significant decrease in weight load and paw withdrawal threshold (PWT. Intra-articular 0.5% bupivacaine (10 and 20 μL significantly reversed MIA-induced decreased PWT, with no effect on weight load. In normal rats, hydrogel did not produce significant changes in PWT but at 30 and 50 μL slightly decreased weight bearing; T-gel did not cause any changes in both the weight load and PWT. In OA rats, T-gel at 20 μL had a significant analgesic effect for 2 days, even though T-gel at 50 μL further reduced the weight load, demonstrating that intra-articular T-gel (20 μL has long-lasting analgesic effects in OA rats. Thus, T-gel designed to deliver analgesics into the joint cavity could be an effective therapeutic tool in the clinical setting.

  9. Safety Evaluation of EXPAREL (DepoFoam Bupivacaine Administered by Repeated Subcutaneous Injection in Rabbits and Dogs: Species Comparison

    Directory of Open Access Journals (Sweden)

    Brigitte M. Richard

    2011-01-01

    Full Text Available EXPAREL (bupivacaine extended-release liposome injection, DepoFoam bupivacaine, is in development for prolonged postsurgical analgesia. Repeat-dose toxicity studies were conducted in rabbits and dogs to compare the potential local and systemic toxicities of EXPAREL and bupivacaine HCl (Bsol, and the reversibility of any effects. Dogs tolerated much larger doses than rabbits. EXPAREL-related minimal-to-moderate granulomatous inflammation was noted at the injection sites. In recovery animals, the granulomatous inflammation was observed less frequently and was characterized by an increased number of multinucleated giant cells. These effects were considered a normal response to liposomes and nonadverse. Rabbits are more sensitive than dogs. In rabbits, convulsions were noted with EXPAREL and more frequently with Bsol; a NOAEL was not identified. In dogs, EXPAREL was well tolerated (NOAEL > 30 mg/kg/dose. The cumulative exposure of EXPAREL in these studies is well in excess of the proposed maximum single-dose exposure that is intended in humans.

  10. Lipid emulsion pretreatment has different effects on mepivacaine and bupivacaine cardiac toxicity in an isolated rat heart model.

    Science.gov (United States)

    Aumeier, C; Kasdorf, B; Gruber, M; Busse, H; Wiese, C H; Zink, W; Graf, B M; Zausig, Y A

    2014-04-01

    The use of lipid emulsions to reduce cardiac toxicity of local anaesthetics (LAs) has shown success in experimental studies and some clinical cases, and thus has been implemented in clinical practice. However, lipid treatment is usually given after the occurrence of neurological or cardiovascular symptoms of systemic intoxication. The aim of this study was to determine if pretreatment with lipid emulsion reduces cardiac toxicity produced by bupivacaine or mepivacaine. Isolated rat hearts were perfused with or without lipid emulsion (0.25 ml kg(-1) min(-1)) before administration of equipotent doses of bupivacaine (250 µM) or mepivacaine (1000 µM). Haemodynamic parameters and times from start of perfusion LA to a 1 min period of asystole and recovery were determined. Pretreatment with lipid emulsion extended the time until occurrence of asystole and decreased times to recovery in bupivacaine-induced cardiac toxicity but not in mepivacaine-induced cardiac toxicity compared with control. Lipid pretreatment impaired rate-pressure product recovery in mepivacaine-intoxicated hearts. This study confirms that pretreatment with a lipid emulsion reduces cardiac toxicity of LAs. The efficacy of pretreatment with lipid emulsion was LA-dependent, so pharmacokinetic properties, such as lipophilicity, might influence the effects of lipid emulsion pretreatment.

  11. Involvement of superoxide generated by NADPH oxidase in the shedding of procoagulant vesicles from human monocytic cells exposed to bupivacaine.

    Science.gov (United States)

    Azma, Toshiharu; Ogawa, Saori; Nishioka, Akira; Kinoshita, Hiroyuki; Kawahito, Shinji; Nagasaka, Hiroshi; Matsumoto, Nobuyuki

    2017-08-17

    It is known that a variety of sized procoagulant vesicles that express tissue factor are released from several types of cells including monocytes by mechanisms related to the induction of apoptosis, while it has not yet been evaluated whether superoxide is involved in the production of such vesicles. Here, we report that a local anesthetic bupivacaine induces apoptosis in human monocytic cells THP-1 within a short observation period, where the shedding of procoagulant vesicles is associated. The property as procoagulant vesicles was evaluated using flow cytometry by the binding of FITC-conjugated fibrinogen to vesicles in the presence of fresh frozen plasma and the suppression of this binding by heparin. Bupivacaine (1 mg/ml) increased the apoptotic cells and procoagulant vesicles. LY294002 (100 µM), that inhibits the recruiting of intracellular component of NADPH oxidase to construct the activated form of this enzyme complex, or superoxide dismutase (1500 unit/ml) suppressed bupivacaine-provoked induction of apoptosis and the increase of procoagulant vesicles. We suggest that this simple experimental system is useful to explore the molecular mechanisms of action of superoxide in the shedding of procoagulant vesicles from human monocytic cells.

  12. Reduced collagen accumulation after major surgery

    DEFF Research Database (Denmark)

    Jorgensen, L N; Kallehave, F; Karlsmark, T;

    1996-01-01

    The preoperative and postoperative wound-healing capacity of 23 patients undergoing elective major abdominal, thoracic or urological surgery was tested objectively by the subcutaneous accumulation of hydroxyproline and proline in an expanded polytetrafluoroethylene (ePTFE) tube. Before scheduled...... surgery two ePTFE tubes were implanted for removal after 5 and 10 days. This was repeated for each patient immediately after surgery. After 10 days a higher amount of hydroxyproline was measured before than after operation (median 2.91 (range 0.37-14.45) versus 1.45 (range 0.26-6.94) micrograms/cm, P = 0.......01)). This decline was significantly higher in the six patients who had a postoperative infection (median 3.02 (range -0.06 to 6.14) versus 0.36 (range -1.56 to 12.60) micrograms/cm, P = 0.02). This study shows that major surgery is associated with impairment of subcutaneous collagen accumulation in a test wound...

  13. Articular cartilage collagen: an irreplaceable framework?

    Directory of Open Access Journals (Sweden)

    D R Eyre

    2006-11-01

    Full Text Available Adult articular cartilage by dry weight is two-thirds collagen. The collagen has a unique molecular phenotype. The nascent type II collagen fibril is a heteropolymer, with collagen IX molecules covalently linked to the surface and collagen XI forming the filamentous template of the fibril as a whole. The functions of collagens IX and XI in the heteropolymer are far from clear but, evidently, they are critically important since mutations in COLIX and COLXI genes can result in chondrodysplasia syndromes. Here we review what is known of the collagen assembly and present new evidence that collagen type III becomes covalently added to the polymeric fabric of adult human articular cartilage, perhaps as part of a matrix repair or remodelling process.

  14. Collagen crosslinks in chondromalacia of the patella.

    Science.gov (United States)

    Väätäinen, U; Kiviranta, I; Jaroma, H; Arokosi, J; Tammi, M; Kovanen, V

    1998-02-01

    The aim of the study was to determine collagen concentration and collagen crosslinks in cartilage samples from chondromalacia of the patella. To study the extracellular matrix alterations associated to chondromalacia, we determined the concentration of collagen (hydroxyproline) and its hydroxylysylpyridinoline and lysylpyridinoline crosslinks from chondromalacia foci of the patellae in 12 patients and 7 controls from apparently normal cadavers. The structure of the collagen network in 8 samples of grades II-IV chondromalacia was examined under polarized light microscopy. The full-thickness cartilage samples taken with a surgical knife from chondromalacia lesions did not show changes in collagen, hydroxylysylpyridinoline and lysylpyridinoline concentration as compared with the controls. Polarized light microscopy showed decreased birefringence in the superficial cartilage of chondromalacia lesions, indicating disorganization or disappearance of collagen fibers in this zone. It is concluded that the collagen network shows gradual disorganization with the severity of chondromalacia lesion of the patella without changes in the concentration or crosslinks of collagen.

  15. Enhanced stabilization of collagen by furfural.

    Science.gov (United States)

    Lakra, Rachita; Kiran, Manikantan Syamala; Usha, Ramamoorthy; Mohan, Ranganathan; Sundaresan, Raja; Korrapati, Purna Sai

    2014-04-01

    Furfural (2-furancarboxaldehyde), a product derived from plant pentosans, has been investigated for its interaction with collagen. Introduction of furfural during fibril formation enhanced the thermal and mechanical stability of collagen. Collagen films treated with furfural exhibited higher denaturation temperature (Td) (pcollagen films did not have any cytotoxic effect. Rheological characterization showed an increase in shear stress and shear viscosity with increasing shear rate for treated collagen. Circular dichroism (CD) studies indicated that the furfural did not have any impact on triple helical structure of collagen. Scanning electron microscopy (SEM) of furfural treated collagen exhibited small sized porous structure in comparison with untreated collagen. Thus this study provides an alternate ecologically safe crosslinking agent for improving the stability of collagen for biomedical and industrial applications.

  16. [Disc electrophoresis of collagen protein (author's transl)].

    Science.gov (United States)

    Reitmayr, P; Verzár, F

    1975-01-01

    The composition of proteins extracted from tendon collagen is investigated by disc electrophoresis. No qualitative differences can be demonstrated between young and old collagen. The action of formaldehyde and methionine on the tendons has no effect on the electrophoretic picture.

  17. Collagen based barrier membranes for periodontal guided bone regeneration applications.

    Science.gov (United States)

    Sheikh, Zeeshan; Qureshi, Javairia; Alshahrani, Abdullah M; Nassar, Heba; Ikeda, Yuichi; Glogauer, Michael; Ganss, Bernhard

    2017-01-01

    Certain cell populations within periodontal tissues possess the ability to induce regeneration, provided they have the opportunity to populate the wound or defect. Guided regeneration techniques have been investigated for regenerating periodontal tissues and such therapies usually utilize barrier membranes. Various natural and synthetic barrier membranes have been fabricated and tested to prevent epithelial and connective tissue cells from invading while allowing periodontal cells to selectively migrate into the defect. This paper focuses on the literature relevant to the use and potential of resorbable collagen membranes in GBR procedures, sites of periodontal and intrabony defects, in cases of socket and alveolar ridge preservation and at implant sites. The results of their use in GBR procedures has shown them to be effective and comparable with non-resorbable membranes with regards to clinical attachment gain, probing depth reduction and defect bone filling. They have also shown to prevent epithelial ingrowth into the defect space during the initial wound healing phase postsurgically. Collagen membranes have also been used for root coverage and GBR procedures and have shown good success rates comparable to subepithelial connective tissue grafts and expanded-polytetrafluoroethylene (e-PTFE) membranes. The future for periodontal tissue engineering is very exciting with the use of barrier membranes expected to continue playing a critical role. However, long-term clinical trials are required to further evaluate and confirm the efficacy of the available collagen barrier membranes for periodontal and bone regeneration use.

  18. Collagen Type I Conduits for the Regeneration of Nerve Defects

    Directory of Open Access Journals (Sweden)

    Silvan Klein

    2016-03-01

    Full Text Available To date, reliable data to support the general use of biodegradable materials for bridging nerve defects are still scarce. We present the outcome of nerve regeneration following type I collagen conduit nerve repair in patients with large-diameter nerve gaps. Ten patients underwent nerve repair using a type I collagen nerve conduit. Patients were re-examined at a minimal follow-up of 14.0 months and a mean follow-up of 19.9 months. Regeneration of nerve tissue within the conduits was assessed by nerve conduction velocity (NCV, a static two-point discrimination (S2PD test, and as disability of arm shoulder and hand (DASH outcome measure scoring. Quality of life measures including patients’ perceived satisfaction and residual pain were evaluated using a visual analog scale (VAS. No implant-related complications were observed. Seven out of 10 patients reported being free of pain, and the mean VAS was 1.1. The mean DASH score was 17.0. The S2PD was below 6 mm in 40%, between 6 and 10 mm in another 40% and above 10 mm in 20% of the patients. Eight out of 10 patients were satisfied with the procedure and would undergo surgery again. Early treatment correlated with lower DASH score levels. The use of type I collagen in large-diameter gaps in young patients and early treatment presented superior functional outcomes.

  19. Collagen Mimetic Peptides: Progress Towards Functional Applications

    OpenAIRE

    Yu, S. Michael; Li, Yang; Kim, Daniel

    2011-01-01

    Traditionally, collagen mimetic peptides (CMPs) have been used for elucidating the structure of the collagen triple helix and the factors responsible for its stabilization. The wealth of fundamental knowledge on collagen structure and cell-extracellular matrix (ECM) interactions accumulated over the past decades has led to a recent burst of research exploring the potential of CMPs to recreate the higher order assembly and biological function of natural collagens for biomedical applications. A...

  20. Biology, chemistry and pathology of collagen

    Energy Technology Data Exchange (ETDEWEB)

    Fleischmajer, R.; Olsen, B.R.; Kuhn, K.

    1985-01-01

    This book consists of five parts and a section of poster papers. Some of the articles are: Structure of the Type II Collagen Gene; Structural and Functional Analysis of the Genes for ..cap alpha..2(1) and ..cap alpha..1(III) collagens; Structure and Expression of the Collagen Genes of C. Elegans; Molecular Basis of Clinical Heterogeneity in the Ehlers-Danlos Syndrome; and Normal and Mutant Human Collagen Genes.

  1. Short Implants: New Horizon in Implant Dentistry.

    Science.gov (United States)

    Jain, Neha; Gulati, Manisha; Garg, Meenu; Pathak, Chetan

    2016-09-01

    The choice of implant length is an essential factor in deciding the survival rates of these implants and the overall success of the prosthesis. Placing an implant in the posterior part of the maxilla and mandible has always been very critical due to poor bone quality and quantity. Long implants can be placed in association with complex surgical procedures such as sinus lift and bone augmentation. These techniques are associated with higher cost, increased treatment time and greater morbidity. Hence, there is need for a less invasive treatment option in areas of poor bone quantity and quality. Data related to survival rates of short implants, their design and prosthetic considerations has been compiled and structured in this manuscript with emphasis on the indications, advantages of short implants and critical biomechanical factors to be taken into consideration when choosing to place them. Studies have shown that comparable success rates can be achieved with short implants as those with long implants by decreasing the lateral forces to the prosthesis, eliminating cantilevers, increasing implant surface area and improving implant to abutment connection. Short implants can be considered as an effective treatment alternative in resorbed ridges. Short implants can be considered as a viable treatment option in atrophic ridge cases in order to avoid complex surgical procedures required to place long implants. With improvement in the implant surface geometry and surface texture, there is an increase in the bone implant contact area which provides a good primary stability during osseo-integration.

  2. Quantification of collagen fibers in canine uteri treated with medroxyprogesterone acetate

    Directory of Open Access Journals (Sweden)

    Paulo Salinas

    Full Text Available ABSTRACT: Collagen plays essential roles in remodeling uterine tissue during decidualization, implantation, pregnancy and involution. To understand whether the progestational agent medroxyprogesterone acetate (MPA can modify the organization and deposit of collagen in the uteri of normal bitches (Canis Tlupus familiaris, we assessed uterine tissues by histochemistry. Uteri were grouped as: nulliparous (n=11, multiparous (n=11 and treated with MPA (n=11; nulliparous with two treatments; 5mg/kg; i.m.. The amount, location and birefringence of interstitial collagen types I and III in the fold and base of the endometrial stroma and the myometrial muscular layers were studied on sections stained with Picrosirius Red by polarized light microscopy and evaluated by ANOVA. No differences were observed in the endometrium. In the myometrium, differences were observed in collagen type I between MPA-treated and nulliparous uteri vs. multiparous (p<0.05, and differences in collagen type III between nulliparous and multiparous uteri vs. MPA-treated (p=0.0001. In conclusion, two doses of MPA had no significant effect on the investigated collagens in the extracellular matrix.

  3. Mechanical and biocompatible characterization of a cross-linked collagen-hyaluronic acid wound dressing.

    Science.gov (United States)

    Kirk, James F; Ritter, Gregg; Finger, Isaac; Sankar, Dhyana; Reddy, Joseph D; Talton, James D; Nataraj, Chandra; Narisawa, Sonoko; Millán, José Luis; Cobb, Ronald R

    2013-01-01

    Collagen scaffolds have been widely employed as a dermal equivalent to induce fibroblast infiltrations and dermal regeneration in the treatment of chronic wounds and diabetic foot ulcers. Cross-linking methods have been developed to address the disadvantages of the rapid degradation associated with collagen-based scaffolds. To eliminate the potential drawbacks associated with glutaraldehyde cross-linking, methods using a water soluble carbodiimide have been developed. In the present study, the glycosaminoglycan (GAG) hyaluronic acid (HA), was covalently attached to an equine tendon derived collagen scaffold using 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide (EDC) to create ntSPONGE The HA was shown to be homogeneously distributed throughout the collagen matrix. In vitro analyses of the scaffold indicated that the cross-linking enhanced the biological stability by decreasing the enzymatic degradation and increasing the thermal denaturation temperature. The material was shown to support the attachment and proliferation of mouse L929 fibroblast cells. In addition, the cross-linking decreased the resorption rate of the collagen as measured in an intramuscular implant model in rabbits. The material was also shown to be biocompatible in a variety of in vitro and in vivo assays. These results indicate that this cross-linked collagen-HA scaffold, ntSPONGE has the potential for use in chronic wound healing.

  4. Synthesis of reduced collagen crosslinks

    NARCIS (Netherlands)

    Nieuwendijk, A.M.C.H. van den; Benningshof, J.C.J.; Wegmann, V.; Bank, R.A.; Koppele, J.M. te; Brussee, J.; Gen, A. van der

    1999-01-01

    A new synthetic route to reduced collagen crosslinks (LNL and HLNL) is described in this report. It enables an enantioselective synthesis of LNL. HLNL was obtained as a mixture of two diastereoisomers. This method also provides the possibility to introduce radio-labels during the synthesis.

  5. Fracture mechanics of collagen fibrils

    DEFF Research Database (Denmark)

    Svensson, Rene B; Mulder, Hindrik; Kovanen, Vuokko

    2013-01-01

    Tendons are important load-bearing structures, which are frequently injured in both sports and work. Type I collagen fibrils are the primary components of tendons and carry most of the mechanical loads experienced by the tissue, however, knowledge of how load is transmitted between and within...

  6. Synthesis of reduced collagen crosslinks

    NARCIS (Netherlands)

    Nieuwendijk, A.M.C.H. van den; Benningshof, J.C.J.; Wegmann, V.; Bank, R.A.; Koppele, J.M. te; Brussee, J.; Gen, A. van der

    1999-01-01

    A new synthetic route to reduced collagen crosslinks (LNL and HLNL) is described in this report. It enables an enantioselective synthesis of LNL. HLNL was obtained as a mixture of two diastereoisomers. This method also provides the possibility to introduce radio-labels during the synthesis.

  7. EFFICACY OF DEXMEDETOMIDINE AS AN ADJUVANT TO BUPIVACAINE FOR CAUDAL ANALGESIA IN PAEDIATRIC PATIENTS UNDERGOING LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Vijay

    2014-07-01

    Full Text Available CONTEXT: Various adjuvants such as opioids or α2 agonists are being used to improve the quality and duration of caudal analgesia with local anesthetics. Dexmedetomidine a α2 agonist is used frequently in adult patients to enhance the local anesthetic effect. However there is little literature regarding its effectiveness in pediatric caudal analgesia. The objective of this study was to assess the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in increasing the duration of caudal analgesia. AIM: The aim of this study was to investigate the effect of adding Dexmedetomidine to caudal Bupivacaine and observe the effect on the duration of analgesia in the post-operative period. SETTINGS AND DESIGN: One year hospital based Double Blind Randomized Controlled Trial. METHODS AND MATERIAL: Sixty children, aged 1-6 years, undergoing lower abdominal surgeries were included in this prospective randomized double-blind study. The patients were randomly divided into two groups: Group I received Bupivacaine (0.25% 1ml/kg plus 1 ml of normal saline in the caudal epidural space. Group II was administered Bupivacaine (0.25% 1ml/ with Dexmedetomidine 2 mcg/ ml diluted to 1 ml of normal saline in the caudal epidural space. All anesthetic and surgical techniques were standardized. Heart rate, blood pressure, oxygen saturation, respiratory rate were monitored continuously. Surgery was started 10-15 minutes after the injection and confirming adequacy of caudal block. Duration of analgesia was assessed using FLACC scale (Face, Legs, Activity, Cry, Consolability scale. The time from administration of caudal anesthesia to the first time the FLACC score equal or greater than 4 was considered as the duration of caudal analgesia. Paracetamol suppository was used as rescue analgesia with a loading dose of 40mg/kg. STATISTICAL ANALYSIS: Mann-Whitney test and Student ‘t’test was used to compare the data obtained in the two groups. RESULTS: The

  8. Liposomal Bupivacaine Suspension Can Reduce Lengths of Stay and Improve Discharge Status of Patients Undergoing Total Knee Arthroplasty.

    Science.gov (United States)

    Chughtai, Morad; Cherian, Jeffrey Jai; Mistry, Jaydev B; Elmallah, Randa D K; Bennett, Alicia; Mont, Michael A

    2016-04-01

    The purpose of this study was to use a large hospital database to assess: (1) length of hospital stay (LOS) and (2) discharge status among patients undergoing total knee arthroplasty (TKA) with or without the use of a liposomal bupivacaine suspension injection. We utilized an all-payer hospital administrative database from July 1, 2013 to June 30, 2014. We then selected patients age 18 years or older who had an inpatient stay for TKA in the data window based on International Classification of Diseases, Ninth Revision (ICD-9) procedure codes (ICD-9-CM = 81.54), which resulted in 103,152 TKA patients. Patients who had nerve blocks were excluded, which resulted in 94,828 TKA patients. The TKA cohort who received a liposomal bupivacaine suspension consisted of 14,668 patients (9,211 females; 5,457 males) who had a mean age of 66 years, while the TKAs without injections or block consisted of 80,160 patients (49,699 females; 30,461 males) who had a mean age of 66 years. Analyses of LOS were performed using a linear model, controlling for age, sex, race, region, Charlson index, and operating time. Discharge status to home versus rehabilitation or short-term nursing facility was evaluated using logistic regression analysis controlling for the above covariates. The adjusted mean LOS for the injection cohort was significantly shorter at 2.58 days compared with 2.98 days in the no injection cohort. The unadjusted distribution of patients being discharged to home compared with short-term nursing facility or rehabilitation was higher in the injection cohort compared with the cohort who did not receive injections (73.2 vs. 66.6%). Logistic regression analysis demonstrated that there was a higher likelihood of being discharged to home with liposomal bupivacaine. Patients who underwent TKA with liposomal bupivacaine had a significantly shorter LOS and a higher likelihood of being discharged to home. These results suggest that liposomal bupivacaine may represent a promising

  9. Liposome bupivacaine for improvement in economic outcomes and opioid burden in GI surgery: IMPROVE Study pooled analysis

    Directory of Open Access Journals (Sweden)

    Cohen SM

    2014-06-01

    Full Text Available Stephen M Cohen,1 Jon D Vogel,2 Jorge E Marcet,3 Keith A Candiotti4 1Atlanta Colon and Rectal Surgery, PA, Atlanta, GA, USA; 2General Surgery Clinic, University of Colorado, Aurora, CO, USA; 3Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; 4Department of Anesthesiology, University of Miami Leonard Miller School of Medicine, Miami, FL, USA Abstract: Postsurgical pain management remains a significant challenge. Liposome bupivacaine, as part of a multimodal analgesic regimen, has been shown to significantly reduce postsurgical opioid consumption, hospital length of stay (LOS, and hospitalization costs in gastrointestinal (GI surgery, compared with intravenous (IV opioid-based patient-controlled analgesia (PCA. Pooled results from open-label studies comparing a liposome bupivacaine-based multimodal analgesic regimen with IV opioid PCA were analyzed. Patients (n=191 who underwent planned surgery and received study drug (IV opioid PCA, n=105; multimodal analgesia, n=86 were included. Liposome bupivacaine-based multimodal analgesia compared with IV opioid PCA significantly reduced mean (standard deviation [SD] postsurgical opioid consumption (38 [55] mg versus [vs] 96 [85] mg; P<0.0001, postsurgical LOS (median 2.9 vs 4.3 days; P<0.0001, and mean hospitalization costs (US$8,271 vs US$10,726; P=0.0109. The multimodal analgesia group reported significantly fewer patients with opioid-related adverse events (AEs than the IV opioid PCA group (P=0.0027; there were no significant between-group differences in patient satisfaction scores at 30 days. A liposome bupivacaine-based multimodal analgesic regimen was associated with significantly less opioid consumption, opioid-related AEs, and better health economic outcomes compared with an IV opioid PCA-based regimen in patients undergoing GI surgery. Study registration: This pooled analysis is based on data from Phase IV clinical trials registered on the US National

  10. A collagen defect in homocystinuria.

    Science.gov (United States)

    Kang, A H; Trelstad, R L

    1973-10-01

    The biochemical mechanism accounting for the connective tissue abnormalities in homocystinuria was explored by examining the effects of various amino acids known to accumulate in the plasma of patients with this disease on cross-link formation in collagen. Neutral salt solutions of purified, rat skin collagen, rich in cross-link precursor aldehydes, were polymerized to native type fibrils by incubating at 37 degrees C in the presence of homocysteine, homocystine, or methionine. After the polymerization was completed, each sample was examined for the formation of covalent intermolecular cross-links, assessed indirectly by solubility tests and directly by measuring the cross-link compounds after reduction with tritiated sodium borohydride and hydrolysis. Collagen solutions containing homocysteine (0.01 M-0.1 M) failed to form insoluble fibrils. Furthermore, much less of the reducible cross-links, Delta(6,7) dehydrohydroxylysinonorleucine, Delta(6,7) dehydrohydroxylysinohydroxynorleucine, and histidino-dehydrohydroxymerodesmosine were formed in the preparations containing homocysteine as compared with the control and the samples containing methionine or homocystine. The content of the precursor aldehydes, alpha-aminoadipic-delta-semialdehyde (allysine) and the aldol condensation product, was also markedly diminished in tropocollagen incubated with homocysteine. It is concluded that homocysteine interferes with the formation of intermolecular cross-links that help stabilize the collagen macromolecular network via its reversible binding to the aldehydic functional groups. Analysis of the collagen cross-links in skin biopsy samples obtained from three patients with documented homocystinuria showed that the cross-links were significantly decreased as compared with the age-matched controls, supporting the tentative conclusions reached from the in vitro model studies. In addition, the solubility of dermal collagen in non-denaturing solvents was significantly increased in

  11. The P-glycoprotein inhibitor quinidine decreases the threshold for bupivacaine-induced, but not lidocaine-induced, convulsions in rats.

    Science.gov (United States)

    Funao, Tomoharu; Oda, Yutaka; Tanaka, Katsuaki; Asada, Akira

    2003-10-01

    To examine whether inhibition of P-glycoprotein (P-gp) activity by quinidine affects the central nervous system toxicity of lidocaine and racemic bupivacaine (bupivacaine). Forty male Sprague-Dawley rats were randomly divided into four groups (n = 10). Fifteen minutes following administration of 15 mg x kg(-1) of quinidine (QL and QB groups) or saline (L and B groups), lidocaine (L and QL groups, 4 mg x kg(-1) x min(-1)) or bupivacaine (B and QB groups, 1 mg x kg(-1) x min(-1)) was infused until convulsions occurred. Concentrations of lidocaine and its primary metabolite, monoethylglycinexylidide (MEGX) and bupivacaine in plasma and in the brain at the onset of convulsions were measured by high-performance liquid chromatography. There were no differences in the dose of lidocaine required to induce convulsions between the L and QL groups. There were no differences in the concentrations of total (L = 17.2 +/- 3.5, QL = 16.6 +/- 2.6 micro g x mL(-1)) or unbound lidocaine (L = 7.8 +/- 2.5, QL = 7.3 +/- 2.3 micro g x mL(-1)), total (L = 1.2 +/- 0.5, QL = 1.3 +/- 0.7 micro g x mL(-1)) or unbound MEGX (L = 0.9 +/- 0.5, QL = 0.8 +/- 0.4 micro g x mL(-1)) in plasma, total lidocaine or MEGX in the