Browsing by Author "Lange, Michael"

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    0.25% Bupivacaine vs 0.5% Bupivacaine vs Mepivicaine/Bupivacaine: Comparisons of 3 local anesthetic regimens used in nerve blocks
    (2022-09-17) Lange, Michael; Yeap, Yar; Ice, Kelsea
    Background: Nerve blocks are a vital component of postoperative pain management. There are many local anesthetics (LA) that are utilized in providing nerve blocks. This study aims to gather information regarding the efficacy of 0.25% Bupivacaine vs 0.5% Bupivacaine vs Mepivacaine/Bupivacaine nerve blocks. Methods: Over a period of 4 months, patients who received a peripheral nerve block for postoperative pain were called within 48hrs of their surgery via telephone and asked standardized questions regarding their pain status. The data was then sorted according to what type of block was performed (Upper extremity[UE]{Supraclavicular, Interscalene, Intercostobrachial,}, Lower extremity[LE]{Femoral, Sciatic, Adductor Canal, Popliteal, Fascia Iliaca}, and other{TAP, PECs I & II, ESP, QL}) and the type of LA that was used (0.25% Bupivacaine, 0.5% Bupivacaine, Mepivacaine/Bupivacaine). Results: Overall, 35.54% of patients experienced pain in the Post Anesthesia Care Unit (PACU) with an average pain score of 6.5/10 (n=127). 47.54% of patients who received a block with 0.25% Bupivacaine experienced pain in the PACU with an average pain score of 6.8/10 (n=60). 32.14% of patients who received a block with 0.5% Bupivacaine experienced pain in the PACU with an average pain score of 5.8/10 (n=27). 0% of patients who received a block with Mepivacaine/Bupivacaine pain in the PACU experienced pain (n=10). The median pain return for 0.5% Bupivacaine, 0.25% Bupivacaine, and Mepivacaine/Bupivacaine were 23.5hrs, 9.5hrs, and 8.83hrs respectively (n=62). The median pain return for LE, UE, and Other blocks was 24.92hrs, 13.67hrs, and 11.87hrs respectively (n=74). The median motor function return for LE and UE blocks was 24.6hrs and 18.73hrs respectively (n=33). The median pain return for LE blocks which used 0.25% Bupivacaine and 0.5% Bupivacaine was 3hrs and 25.21hrs respectively (n=11). The median pain return for UE blocks that used 0.5% Bupivacaine and Mepivacaine/Bupivacaine was 19.83hrs and 8.83hrs respectively (n=13). The median pain return for Other blocks that used 0.25% Bupivacaine and 0.5% Bupivacaine was 9.5hrs and 23.5hrs respectively (n=33). The median motor function return for LE and UE blocks that used 0.5% Bupivacaine was 24.6hrs and 21.83hrs respectively (n=15). The median motor function return of UE blocks that used Mepivacaine/Bupivacaine was 15.96hrs (n=8). Conclusions: 0.5% Bupivacaine provided longer pain control in comparison to 0.25% Bupivacaine and Mepivacaine/Bupivacaine. (0.5% Bupivacaine is the superior local anesthetic for both upper and lower extremity nerve blocks). We conclude that as long as LA toxicity is not a problem, anesthesiologists should use 0.5% Bupivacaine for all nerve blocks to provide patients the maximum benefit from their regional anesthesia.
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    Possible Neuroinflammatory Mechanisms Which May Lead to Long-Term Neurological Disorders in COVID-19 Patients
    (Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020-12-15) Lange, Michael; Shi, Riyi; IU School of Medicine
    This review aims to provide insight into the possible long-term neurological complications that COVID-19 patients may experience after the resolution of intense acute inflammation characterized as “cytokine storm.” Neurological symptoms such as fatigue, headache, dizziness, nausea, confusion, dyspnea, anorexia, malaise, myalgia, ataxia, seizure, hypogeusia, and hyposmia are commonly seen in these patients. COVID-19 related encephalitis is also seen sporadically. However, some researchers believe neuroinflammation is more common than what is reported. Neurological abnormalities that are linked to neuroinflammation are of particular concern because neuroinflammation is hypothesized to cause neurological diseases such as Alzheimer’s Disease, Parkinson’s Disease, and Schizophrenia. Many potential routes can lead to inflammation in the nervous system and elicit neuron cell death in COVID-19 patients. These include the potential neurotropic pathway of the novel coronavirus, CNS parenchymal infectability, thrombotic ischemic stroke, cytokine storm, and blood-brain barrier breakdown. Past pandemics of similar neurotropic viruses could also offer insights regarding the long-term neurological effects of COVID-19. In support of our hypothesis, the Spanish Flu pandemic of 1918-1919 saw an increased incidence of neurodegenerative disease, Parkinson’s disease, and schizophrenia. We do not know exactly what the future will hold for COVID-19 however, it is of paramount importance to attempt to anticipate and prepare for the possible chronic neurological sequelae and mitigate or prevent their effects.