1.
Bupivacaine drug-induced liver injury: a case series and brief review of the literature.
Chintamaneni, P, Stevenson, HL, Malik, SM
Journal of clinical anesthesia. 2016;:137-41
Abstract
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.
2.
Effect of 5% lidocaine medicated plaster on pain intensity and paroxysms in classical trigeminal neuralgia.
Tamburin, S, Schweiger, V, Magrinelli, F, Brugnoli, MP, Zanette, G, Polati, E
The Annals of pharmacotherapy. 2014;(11):1521-4
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a neuropathic pain condition affecting one or more branches of the trigeminal nerve. It is characterized by unilateral, sudden, shock-like, and brief painful attacks, which follow the distribution of trigeminal nerve branches, and with no other accompanying sensorimotor or autonomic signs and symptoms. Current guidelines stipulate which therapies represent first-, second-, and third-line treatments for TN, but there is a consistent mismatch between the therapeutic guidelines and the patient's preferences and expectations. CASE SUMMARY We report on 2 patients with classical TN in whom conventional drugs for TN were not tolerated. In these patients, treatment with 5% lidocaine medicated plaster (LMP) resulted in reduction of pain intensity and the number of pain paroxysms. DISCUSSION LMP is known to block the sodium channels on peripheral nerves and may cause a selective and partial block of Aδ and C fibers. According to the TN ignition hypothesis, blockage of peripheral afferents by LMP may reduce pain paroxysms. The effect of LMP may outlast the pharmacokinetics of the drug by reducing pain amplification mechanisms in the central nervous system. LMP has limited or no systemic side effects. CONCLUSIONS LMP may be an effective and well-tolerated treatment option for TN in those patients who do not tolerate or who refuse other therapies. Future randomized controlled studies should better address this issue.
3.
Recognizing and treating methemoglobinemia: a rare but dangerous complication of topical anesthetic or nitrate overdose.
Maimo, G, Redick, E
Dimensions of critical care nursing : DCCN. 2004;(3):116-8
Abstract
Methemoglobinemia is a rare but dangerous complication of topical anesthetic overdose administration or exposure to nitrate-containing substances in the hospital or community. Paradoxically, although the patient may present with cyanosis with low oxygen saturation levels, they will not respond to oxygen therapy. Treatment is slow intravenous administration of a titrated dose of methylene blue. Adult and pediatric critical care nurses and respiratory therapists, operating room and procedure/diagnostic center nurses, short-stay or outpatient surgery center staff, and adult and pediatric emergency department nurses and respiratory therapists need to be aware of this potentially fatal condition.