Na kazuistice pacienta s úrazovou ránou hlavy prezentují autoři příklad systémové toxické reakce na lokální anestetikum. Klinické příznaky systémové toxické reakce a hemoragického šoku mohou být zprvu podobné. Tachykardie, hypotenze a bezvědomí. Cílem je tedy připomenout, že i z ošetření zdánlivě banálního úrazu se může vyvinout život ohrožující stav. Při ošetření kožní rány suturou v lokální nebo svodné anestezii je incidence vzniku systémové toxické reakce 1:3000 za rok a incidence úmrtí je 1:30 000 za rok.
This case report of a patient with a traumatic head injury provides an example of a systemic toxic reaction to a local anesthetic. Clinical signs of a systemic toxic reaction and hemorrhagic shock may initially be similar: tachycardia, hypotension and unconsciousness. The purpose is thus to remind that even the treatment of a minor injury can develop into a life-threatening condition. When a skin wound is treated using suture under local or regional anesthesia, the annual incidence rate of systemic toxic reactions is 1:3,000 and that of death is 1:30,000.
- MeSH
- Anesthetics, Local MeSH
- Iatrogenic Disease MeSH
- Cardiopulmonary Resuscitation MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Aged MeSH
- Trimecaine * administration & dosage therapeutic use toxicity MeSH
- Accidental Falls MeSH
- Head Injuries, Closed etiology therapy MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. OBJECTIVE AND METHODS: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. RESULTS: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. CONCLUSION: In short, we highlight the importance of ultrasound examination in the management of work (overuse)-related disorders in occupational medicine practice.
- MeSH
- Anesthetics, Local administration & dosage MeSH
- Anti-Inflammatory Agents administration & dosage MeSH
- COVID-19 * epidemiology prevention & control MeSH
- Ganglion Cysts diagnostic imaging etiology MeSH
- Volunteers * MeSH
- Drainage methods MeSH
- Ultrasonography, Interventional MeSH
- Middle Aged MeSH
- Humans MeSH
- Masks MeSH
- Methylprednisolone Acetate administration & dosage MeSH
- Foot Diseases diagnostic imaging etiology MeSH
- Occupational Diseases diagnostic imaging etiology MeSH
- Pandemics MeSH
- Foot Injuries complications MeSH
- Cumulative Trauma Disorders complications MeSH
- SARS-CoV-2 MeSH
- Textile Industry * MeSH
- Trimecaine administration & dosage MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Low back pain (LBP) represents an important subgroup of vertebrogenic pain with estimated prevalence around 80 %. Locally acting injectable collagen for topical application has recently extended the limited range of treatment options. The aim of the study was to evaluate the efficacy and safety of injectable collagen in patients with LBP. Patients suffering from LBP (< three months) were enrolled. They were administered either collagen 4 ml or trimecaine 1 % 4 ml in the form of subcutaneous paravertebral injections into eight pre-specified points (0.5 ml per each point) in the following schedule: two administrations in the first and second week, one in the third week. The pain intensity, Thomayer distance, Oswestry disability index, Lasseque test, quality of life, consumption of rescue medication and safety were evaluated. Exertional and rest pain, evaluated by a visual analogue scale, gradually decreased in both groups. Both treatments showed a statistically significant improvement in mobility and quality of life. The consumption of paracetamol as a rescue medication was significantly lower in patients treated with collagen than in the group treated with trimecaine (p=0.048). The analgesic efficacy of locally acting injectable collagen, as well as an analgesic sparing effect when compared to local anesthetics were demonstrated.
- MeSH
- Acute Pain drug therapy MeSH
- Analgesics administration & dosage MeSH
- Adult MeSH
- Hamamelis MeSH
- Single-Blind Method MeSH
- Collagen administration & dosage MeSH
- Plant Roots chemistry MeSH
- Middle Aged MeSH
- Humans MeSH
- Low Back Pain drug therapy MeSH
- Prospective Studies MeSH
- Plant Extracts administration & dosage MeSH
- Aged MeSH
- Trimecaine administration & dosage MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
Úvod a cíl: Standardním materiálem užívaným pro osteosyntézu obličejového skeletu je titan a jeho sloučeniny. Jednou z nevýhod konvenčního materiálu je nutnost jeho extrakce v indikovaných případech. Řešení situace nabízí degradovatelné materiály. V minulosti se pro tyto účely užívaly materiály na bázi polylaktidové nebo polyglykolidové kyseliny, které se klinicky prokázaly být nevyhovující. Moderním řešením je použití osteosyntetického materiálu z kovových degradovatelných slitin. Autoři prezentují původní práci – výzkum vstřebatelnosti kovových materiálů na bázi magnezia a zinku na biomodelech. Materiál a metodika: K výzkumu bylo použito celkem 12 zvířecích biomodelů – králíků, kterým byly implantovány do tibií šrouby ze tří typů kovů (dvě vstřebatelné slitiny – Zn-2Mg a WE43 – a titan jako standardní materiál). Zvířata byla ve čtyřtýdenních intervalech eutanazována, vzorky kostní tkáně s implantovaným materiálem byly skenovány v mikrofokus-CT a histologicky vyšetřeny. Byla posouzena rychlost degradace materiálů. Výsledky: Doba degradace materiálu je u WE43 za fyziologických podmínek krátká pro stabilizaci fraktury do doby její konsolidace. Materiál Zn-2Mg během 16 týdnů prokázal minimální schopnost degradace. Oba materiály prokázaly přiměřené biologické vlastnosti. Závěr: Degradovatelné materiály na bázi magnezia a zinku jsou z biologického hlediska vyhovující materiály. Z výsledků výzkumu ale vyplývá, že použití obou typů slitin nevyhovuje požadavkům na materiál, tj. zachování pevnosti po dobu 12–24 týdnů a současně vstřebání v racionálním časovém rámci.
Introduction and aim: The standard material used for osteosynthesis of the facial skeleton is the titan and its compounds. One of the disadvantages of the conventional material is the need for its extraction in indicated cases. Degradable material offer a solution to the situation. In the past, materials based on polylactic or polyglycolic acid were used for these purposes. It clinically proved to be unsatisfactory. The modern solution is the use of biodegradable metal alloys. The authors present original research on the degradation of metal materials based on magnesium and zinc on the biomodels. Materials and methods: A total of 12 animal models (rabbits) were used. Screws of 3 types of metals (Zn-2Mg and WE43 degradable alloys and the titanium as a standard material) were implanted in the rabbit’s tibias. The animals were euthanasied in 4-weeks intervals, samples of bone tissue with an implanted material have been scaned under mikrofocus CT and were histologically examined. The rate of degradation of the materials was examined. Results: Time period of degradation of the material WE43 under physiological conditions has been shown to be too short to stabilize the fracture. Material of Zn-2 mg during the 16 weeks showed a minimum ability to degradation. Both materials have demonstrated reasonable biological properties. Conclusion: Degradable materials based on magnesium and zinc are from the biological point of view matching materials. The results of this research indicates that the use of both types of alloys does not satisfy the materials requirments, i.e. retained strength for 12–24 weeks and degradation in reasonable time frame..
- MeSH
- Adjuvants, Anesthesia MeSH
- Analgesics MeSH
- Anesthetics, Local MeSH
- Anti-Bacterial Agents administration & dosage therapeutic use MeSH
- Anti-Inflammatory Agents, Non-Steroidal MeSH
- Models, Biological MeSH
- Diazepam administration & dosage therapeutic use MeSH
- Magnesium therapeutic use MeSH
- Ketamine administration & dosage therapeutic use MeSH
- Ketoprofen administration & dosage therapeutic use MeSH
- Metals therapeutic use MeSH
- Rabbits MeSH
- Models, Animal MeSH
- Titanium therapeutic use MeSH
- Trimecaine administration & dosage therapeutic use MeSH
- Fracture Fixation, Internal methods MeSH
- Absorbable Implants * history utilization MeSH
- Zinc therapeutic use MeSH
- Dental Implants MeSH
- Dental Alloys therapeutic use MeSH
- Animals MeSH
- Check Tag
- Rabbits MeSH
- Animals MeSH
Both the range of motion and load transfer of the sacroiliac (SI) joint improve considerably after lumbar spine surgery. When, following surgery, SI joint pain develops in spite of appropriate physical therapy, injection of an anaesthetic with added corticosteroid into the SI joint is a first choice treatment. The aim of this presentation is to provide information on our experience with this therapy. MATERIAL AND METHODS Thirty-four patients after lumbar spine fusion reported lumbalgia different form pain before surgery. In 14 (41 %) of them, pain in one of the SI joints was diagnosed as the cause. This group included 12 women and two men at an average age of 56 (range, 47 to 68) years. Ten patients underwent lumbosacral fixation and four had segmental ("floating") lumbar spine fusion. All patients experienced lumbalgia at more than 3 months following surgery, at 8 months on the average (range, 4 to 12 months). None of them had SI joint pain before surgery. The diagnosis was based on specific manoeuvres on physical examination of the joint. Each patient was given an injection of 20 mg (0.5 ml) Methylprednisolone (Depo-Medrol?, Pfizer, Puurs, Belgium) and 4.5 ml 1% Mesocain (Zentiva, Praha, CR).They were inquired as to pain relief 24 h later and then at 1, 3 and 6 months after injection. Subjective feelings were assessed by a visual analogue scale (VAS). The results were analysed using descriptive statistics. RESULTS All patients reported pain relief within 24 h of injection, but not its complete resolution. The average VAS score before and after the blockage of the SI joint was 9.1 points (8-10) and 4.8 points (2-7), respectively; this implies improvement by an average of 4.3 points (1-6), i.e., approximately by 47.3% (12.5-62.5). The duration of effects varied greatly from patient to patient. The average interval between injection and pain recurrence lasted for 5 weeks (1 -28). Most frequently, relief was experienced for 2 weeks, or for 6.8 weeks with the standard deviation included. DISCUSSION Sacroiliac joint dysfunction is a very frequent cause of lumbalgia, particularly after lumbar spine surgery. Physical therapy may not always be effective. SI joint arthrodesis is indicated only in rare cases. One of the few possibilities of pain relief involves intra-articular injection of an anaesthetic with corticosteroid for booster effect. The treatment of SI joint blockage after spinal fusion has recently been dealt with in three reports in the international literature; their conclusions are in accordance with the results of this study. CONCLUSIONS Lumbar spine stabilisation surgery may result in overloading the SI joints as the "adjacent segments". An intra-articular injection of anaesthetic can be considered a reliable method for ascertaining the SI joint as the source of a patient's problems. However, even with corticosteroid added, pain relief is not usually long-lasting.
- MeSH
- Anesthetics, Local administration & dosage MeSH
- Lumbar Vertebrae surgery MeSH
- Spinal Fusion MeSH
- Injections, Intra-Articular MeSH
- Middle Aged MeSH
- Humans MeSH
- Low Back Pain therapy MeSH
- Pain Measurement MeSH
- Methylprednisolone analogs & derivatives administration & dosage MeSH
- Sacroiliac Joint MeSH
- Aged MeSH
- Trimecaine administration & dosage MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
This paper presents two cases of using erroneous concentrations of epinephrine during endonasal surgery. The two patients discussed were part of a larger study aimed at monitoring the absorption of epinephrine upon injection into the nasal mucosa. During this study, we observed major cardiovascular reactions in two consecutive patients--ventricular tachycardia with ventricular extrasystole and a significant rise in systolic and diastolic blood pressure and pulse rate. This state required pharmacological intervention. In hindsight, it was found that an erroneous application of ten times higher (1:10,000) concentration of epinephrine than the usual was injected. The applied solution was prepared in our institutional pharmacy and was labelled incorrectly (1:100,000 instead of 1:10,000). The authors have analysed the steps leading to the erroneous applications and recommend safety precautions for the prevention of errors in the concentration levels of epinephrine. Epinephrine injections in concentrations of 1:10,000, followed by analyses of epinephrine levels in venous blood, have not yet been described in available literature.
- MeSH
- Epinephrine administration & dosage adverse effects MeSH
- Anesthetics, Local administration & dosage MeSH
- Adult MeSH
- Injections MeSH
- Middle Aged MeSH
- Humans MeSH
- Medication Errors adverse effects MeSH
- Nose surgery MeSH
- Retrospective Studies MeSH
- Arrhythmias, Cardiac chemically induced MeSH
- Trimecaine administration & dosage MeSH
- Vasoconstrictor Agents administration & dosage adverse effects MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
OBJECTIVES: To compare the analgesic potency and side effects of epidural combination trimecaine with morphine and bupivacaine with fentanyl in postoperative analgesia after a major urological surgery. METHODS: We randomised 150 consecutive patients. In the trimecain/morphine group (n = 75) trimecaine 50 mg with 4 mg morphine was given epidurally in 8 hour intervals. In the bupivacain/fentanyl group (n = 75) the infusion of 0.25 % bupivacaine and fentanyl 2 microg/ml was administered at an infusion rate of 8 ml/h. RESULTS: The postoperative pain scores were lower in the trimecain/morphine group, the difference was significant during the first 6 hours after surgery, there was also a trend toward higher postoperative SpO2 values in this group, the difference was significant 36 hours after surgery. The total sum of postoperative complications and side effects was significantly higher in the bupivacian/fentanyl group (p = 0.002). CONCLUSION: The combination of epidural trimecaine with morphine after a major urological surgery provides a superior analgesia with fewer side effects when compared to epidurally delivered bupivacaine with fentanyl (Tab. 2, Fig. 5, Ref. 17). Full Text (Free, PDF) www.bmj.sk.
- MeSH
- Anesthetics, Local administration & dosage MeSH
- Bupivacaine administration & dosage MeSH
- Analgesia, Epidural MeSH
- Fentanyl administration & dosage MeSH
- Drug Combinations MeSH
- Middle Aged MeSH
- Humans MeSH
- Pain Measurement MeSH
- Morphine administration & dosage MeSH
- Analgesics, Opioid administration & dosage MeSH
- Pain, Postoperative prevention & control MeSH
- Randomized Controlled Trials as Topic MeSH
- Trimecaine administration & dosage MeSH
- Urologic Surgical Procedures MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
- MeSH
- Animal Experimentation statistics & numerical data MeSH
- Financing, Organized MeSH
- Caffeine administration & dosage pharmacology MeSH
- Rabbits anatomy & histology physiology surgery MeSH
- Myocardium MeSH
- Sarcoplasmic Reticulum physiology MeSH
- Systole physiology MeSH
- Trimecaine administration & dosage pharmacology MeSH
- Animals MeSH
- Check Tag
- Rabbits anatomy & histology physiology surgery MeSH
- Animals MeSH
The proportion of fucosylated glycoconjugate-containing rabbit tracheal goblet cells after intratracheal application of trimecaine was studied to evaluate its possible unfavourable effects. This lapine model is comparable with diagnostic findings in humans because airway epithelia in humans and rabbits are similar; tracheal epithelium is also practically identical to bronchial epithelium in both species. Local trimecaine anaesthesia caused a proportional decrease in percentage of the tracheal goblet cells containing both alpha(1-2)- and alpha(1-6)-, alpha(1-3)- and alpha(1-4)-fucosylated glycoconjugates as revealed 10 min postexposure using lectin histochemistry. In previous studies, only mild ultrastructural damage to the airway's epithelium was revealed, but a conspicuous decrease in sialylated glycoconjugate-containing tracheal goblet cells and the dominance of acidic sulphated glycoconjugates were observed as after-effects of the same treatment. Glycoconjugate changes can influence the inner environment of airways (e.g. viscoelastic properties of the airways' mucus and mucosal barrier functions) and thus the patient's defence barriers in airways may be weakened. Concurrently, the histochemical properties of goblet cells can be altered in bronchoscopic specimens. Since trimecaine is widely used as local anaesthesia in airways in bronchoscopy, it is necessary to heed these aforementioned effects.
- MeSH
- Anesthetics, Local administration & dosage adverse effects MeSH
- Administration, Topical MeSH
- Financing, Organized MeSH
- Fucose metabolism MeSH
- Glycoconjugates analysis metabolism MeSH
- Histocytochemistry methods MeSH
- Anesthesia, Endotracheal adverse effects MeSH
- Rabbits MeSH
- Lectins metabolism MeSH
- Goblet Cells chemistry metabolism drug effects MeSH
- Drug Administration Schedule MeSH
- Trachea MeSH
- Trimecaine administration & dosage adverse effects MeSH
- Animals MeSH
- Check Tag
- Rabbits MeSH
- Male MeSH
- Animals MeSH
