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    Antibacterial effects of lidocaine and adrenaline
    (Wiley, 2019) Kesici, Sevgi; Demirci, Mehmet; Kesici, Ugur
    The most commonly used local anaesthetics (LAs) for postoperative analgesia and surgical anaesthesia are lidocaine and bupivacaine. Adrenaline is a vasopressor agent, which is widely used in anaesthesia for many purposes. This study aims to determine the antibacterial efficacy of lidocaine, mupirocin, adrenaline, and lidocaine + adrenaline combination. In our study, the in vitro antimicrobial effect of 1 mL of sterile saline, 20 mg/mL mupirocin, 20 mg/mL lidocaine, 1 mg/mL adrenaline, and 20 mg/mL lidocaine and adrenaline were tested against Staphylococcus aureus American-type culture collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, and Escherichia coli ATCC 25922, classified as Group C (control), Group M (mupirocin), Group L (lidocaine), Group A (adrenaline), and Group LA (lidocaine+adrenaline), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, and E. coli ATCC 25922 were cultured on Mueller-Hinton agar (Oxoid, UK) plates for 18 to 24 hours at 37 degrees C. Colonies from these plates were suspended in sterile saline, and a 0.5 McFarland turbidity standard suspension (corresponding to 1.5 x 10(8) CFU/mL) of each isolate was prepared. In terms of inhibition zone diameters, S. aureus ATCC 29213 values obtained after 12 and 24 hours of incubation were significantly different between groups (P < .001). According to inhibition zone diameters, Group M > Group LA > Group L > Group C = Group A. P. Aeruginosa ATCC 27853 values obtained after 12 and 24 hours of incubation were significantly different between groups (P < .001). According to inhibition zone diameters, Group M > Group LA > Group L = Group C = Group A. E. coli ATCC 25922 values obtained after 12 and 24 hours of incubation were significantly different between groups (P < .001). According to inhibition zone diameters, Group M > Group LA > Group L > Group C = Group A. It is known that LAs have antimicrobial effect potential in addition to their anaesthetic, analgesic, antiarrhythmic, and anti-inflammatory effects. There are also studies showing the antimicrobial effects of vasopressor agents, which are frequently used, particularly in intensive care unit (ICUs). However, it has been observed in the present study that adrenaline alone did not have any antimicrobial effect. Adrenaline, when used in combination with lidocaine, provides a stronger and broad-spectrum antimicrobial activity, suggesting that its combined use in proper indications will be clinically significant. Because the prevention and treatment of wound infections make a positive contribution to wound healing, the potential of antimicrobial effect of LAs can provide successful results in the prevention and treatment of ICU and wound infections. Thus, an important contribution can be made in terms of reducing the costs of antibacterial treatment and reducing morbidity.
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    Antimicrobial effects of local anaesthetics
    (Wiley, 2019) Kesici, Ugur; Demirci, Mehmet; Kesici, Sevgi
    After the introduction of cocaine to the medical practice, local anaesthetics (LA) became essential in pain control. LA infiltration along the incision may be used to provide surgical anaesthesia or postoperative analgesia. This study aimed to compare the antimicrobial effects of the topical antimicrobial agent mupirocine with those of the LA lidocaine and the combination of lidocaine and adrenalin. In our study, the in vitro antimicrobial effects of 1 mL sterile saline, 20 mg/mL mupirocine, 20 mg/mL Lidocaine, and 20 mg/mL Lidocaine and Adrenaline were tested against Staphylococcus aureus American type culture collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, and Escherichia coli ATCC 25922 as Group C (Control), Group M (Mupirocine), Group L (Lidocaine), and Group LA (Lidocaine + adrenaline), respectively. S aureus ATCC 29213, P aeruginosa ATCC 27853, and E coli ATCC 25922 were cultured onto Mueller-Hinton agar (Oxoid, UK) plates for 18 to 24 hours at 37 degrees C. Colonies from these plates were suspended in sterile saline and a 0.5 McFarland turbidity standard suspension (corresponding to 1.5 x 10(8) CFU/mL) of each isolate was prepared. S Aureus ATCC 29213 inhibition zone diameter values of Group M, Group LA, and Group L were significantly higher compared with the group C (P < 0.05). P aeruginosa ATCC 27853 inhibition zone diameter values of Group M and Group LA were significantly higher compared with the group C (P < 0.05). E coli ATCC 25922 inhibition zone diameter values of Group M, Group LA, and Group L were significantly higher compared to the group C (P < 0.05). LA infiltration along the incision may be used to provide surgical anaesthesia or postoperative analgesia. Considering that LAs show antimicrobial effects besides their analgesic effects, they may contribute to preventing the development and reducing the rate of surgical infections, decreasing the requirement to administer antibiotics. However, caution should be exercised not to antagonise the effective treatment of surgical infections, remembering that controversy on the antimicrobial effects of LAs remains in the literature. Therefore, further comprehensive studies with larger patient populations are warranted to demonstrate the antimicrobial effects of LAs.
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    Bacterial inhibition efficiency of prilocaine and bupivacaine
    (Wiley, 2019) Kesici, Sevgi; Demirci, Mehmet; Kesici, Ugur
    This study aimed to demonstrate the antibacterial effects of bupivacaine and prilocaine on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. In our study, the in vitro antimicrobial effects of 20 mg/mL prilocaine and 5 mg/mL bupivacaine were tested against a S. aureus American-type culture collection (ATCC) 29213, P. aeruginosa ATCC 27853, and E. coli ATCC 25922, divided into Group P (Prilocaine) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, and E. coli ATCC 25922 were cultured on Mueller Hinton agar (Oxoid, Basingstoke, UK) plates for 18 to 24 hours at 37 degrees C. In terms of inhibition zone diameters, inhibition of S. aureus ATCC 29213 was observed in both groups at the 12th and 24th hours. The 12th- and 24th-hour S. aureus ATCC 29213 value was significantly higher in Group P compared with Group B (P = .008). At the 12th and 24th hours, inhibition of E. coli ATCC 25922 was observed in both groups. The 12th- and 24th-hour E. coli ATCC 25922 value was significantly higher in Group P compared with Group B (P = .008). In our study, it was seen that prilocaine and bupivacaine had an antimicrobial effect on S. aureus and E. coli. In the comparison between these two local anesthetics (LAs), this effect was found to be significantly higher in prilocaine than bupivacaine. Therefore, we are of the opinion that antimicrobial effect potentials should also be taken into account in the selection of an LA agent in order to prevent the complications of an infection that might develop during LA infiltration and might lead to serious morbidity.
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    Efeitos Antimicrobianos Do Fentanil E Da Bupivacaína: Estudo İn Vitro
    (Elsevier, 2020) Demirci, Mehmet; Kesici, Sevgi; Kesici, Uğur
    Study objective: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. Design: In vitro prospective study. Setting: University Clinical Microbiology Laboratory. Measurements: In our study, in vitro antimicrobial effect of 0.05 mg.mL(-1) fentanyl citrate, 5 mg.mL(-1) bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37 degrees c. Main results: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC 10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 122. hour p = 0.005). Conclusions: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications. (C) 2020 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.
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    Effects of local anesthetics on wound healing
    (Elsevier Science Inc, 2018) Kesici, Sevgi; Kesici, Ugur; Ulusoy, Hulya; Erturkuner, Pelin; Turkmen, Aygen; Arda, Oktay
    Introduction: Local anesthetic infiltration is used widely for post-operative analgesia in many situations. However the effects of local anesthetics on wound healing are not demonstrated clearly. This study planned to evaluate the effects of lidocaine, prilocaine, bupivacaine and levobupivacaine on wound healing, primarily on wound tensile strength and on collagen ultrastructure. Methods: This study was conducted on male Sprague Dawley rats. On days 0, 8th, 15th, and 21st, all animals were weighed and received a preincisional subcutaneous infiltration of 3 mL of a solution according the group. Control saline (C), lidocaine (L) 7 mg.kg(-1), prilocaine (P) 2 mg.kg(-1), bupivacaine (B) 2 mg.kg(-1) and levobupivacaine (LVB) 2.5 mg.kg(-1) . The infiltrations were done at the back region 1.5 cm where incision would be performed at the upper, middle and lower part along the midline, under general anesthesia. Wound tensile strengths were measured after 0.7cm x 2 cm of cutaneous and subcutaneous tissue samples were obtained vertical to incision from infiltrated regions. Tissue samples were also obtained for electron microscopic examination. Evaluations were on the 8th, 15th and 21st days after infiltration. Results: There was no difference between groups in the weights of the rats at the 0th, 8th, 15th and 21st days. The collagen maturation was no statistically different between groups at the 8th and 15th days. The maturation scores of the B and L groups at the 21st day was significantly lower than the Group C (1.40, 1.64 and 3.56; respectively). The wound tensile strength was no statistically different between groups at the 8th and 15th days but at the 21st day the Groups B and LVB had significantly lower value than Group C (5.42, 5.54 and 6.75; respectively). Conclusion: Lidocaine and prilocaine do not affect wound healing and, bupivacaine and levobupivacaine affect negatively especially at the late period. (C) 2018 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda.
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    Spontaneous submucosal hematoma in the sigmoid colon causing complete intestinal obstruction in a patient with cerebral palsy
    (Kuwait Medical Assoc, 2021) Kesici, Ugur; Kesici, Sevgi
    Background: Intestinal submucosal hematoma (ISH) is often associated with coagulopathy and anticoagulant drug use. ISH is frequently seen in the esophagus, duodenum and rarely in small intestine in the gastrointestinal tract. It is very rare in the colon. In this case report, we present a 20-year-old male patient who developed intestinal obstruction due to spontaneous submucosal hematoma in the sigmoid colon. In the light of our English literature review, it was found that this was the first case in which spontaneous submucosal hematoma was detected in the sigmoid colon. Case Report: In this case report, a 20-year-old male patient with a diagnosis of ileus with peroperative spontaneous submucosal hematoma was discussed. The patient had been suffering from inability to defecate and rectal bleeding with mucus for three days. The patient underwent laparotomy with the diagnosis of mechanical intestinal obstruction. Conclusion: ISH is a clinical picture that frequently occurs due to anticoagulant use. It should be investigated in terms of ISH when prolonged international normalized ratio is detected in elderly patients applying with abdominal pain. Surgical treatment should be performed in the presence of unimpaired intestinal obstruction or peritonitis.