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Ramos PR, Sakata RK, Ribeiro HC, Bonfanti A, Ferraro LHDC. A prospective, comparative study of the analgesic effect between the WALANT technique and local anesthesia associated with sedation for hand surgery. Acta Cir Bras 2023; 38:e384323. [PMID: 37909593 PMCID: PMC10637341 DOI: 10.1590/acb384323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE The primary objective of this study was to compare the WALANT (wide awake, local anesthesia, no tourniquet) technique with local anesthesia associated with sedation in relation to pain intensity for minor hand surgical procedures. The secondary objective was to evaluate the need for analgesic complementation. METHODS A prospective, randomized, comparative, and clinical study was carried out. The sample size in each group was determined after statistical evaluation of the results of a pilot project. The participants were allocated to one of two groups; those in group 1 were submitted to the WALANT technique, and those in group 2, to local anesthesia associated with sedation, for elective surgery. The surgical procedures were carpal tunnel syndrome, De Quervain's tenosynovitis, synovial cyst, finger cyst, and trigger finger. Pain intensity, need for complementation and evolution to complex regional pain syndrome were evaluated. RESULTS There was no difference between groups in pain intensity after WALANT and need for intraoperative complementation. There was no significant difference in the amount of opioid applied postoperatively between the groups. There was no difference between groups regarding comfort during surgery. There was no difference in adverse effects and complications between the groups. Hematoma was the most frequent adverse event. No severe adverse events were observed. CONCLUSIONS The WALANT technique promoted an analgesic effect similar to that of local anesthesia associated with sedation, without increasing adverse effects.
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Affiliation(s)
- Patrick Rech Ramos
- Universidade Federal de São Paulo – Ciência Cirúrgica Interdisciplinar Posgraduation Program – São Paulo (SP) – Brazil
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Endo Y, Sano M, Kayama T, Inuzuka K, Saito T, Katahashi K, Yamanaka Y, Tsuyuki H, Ishikawa N, Naruse E, Takeuchi H, Unno N. The Usefulness of a Three-Microneedle Device for Indocyanine Green Fluorescence Lymphography. Lymphat Res Biol 2023; 21:396-402. [PMID: 36802287 DOI: 10.1089/lrb.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Background: Indocyanine green (ICG) fluorescence lymphography is widely used to diagnose lymphedema. There is little consensus on the appropriate injection method for ICG fluorescence lymphangiography. We used a three-microneedle device (TMD) for skin injection of ICG solution and investigated its usefulness. Methods and Results: Thirty healthy volunteers were injected with ICG solution using a 27-gauge (27G) needle in one foot and a TMD in the other foot. Injection-related pain was evaluated using the Numerical Rating Scale (NRS) and Face Rating Scale (FRS). The skin depth of the injected ICG solution was evaluated by injecting the solution into the skin of amputated lower limbs using a 27G needle or TMD using ICG fluorescence microscopy. The median and interquartile range of the NRS scores was 3 (3-4) and 2 (2-4) in the 27G needle and TMD groups, respectively; that of the FRS scores was 2 (2-3) and 2 (1-2) in the 27G needle and TMD groups, respectively. Injection-related pain was significantly lower with the TMD than with the 27G needle. The lymphatic vessels were similarly visible using both needles. The depth of the ICG solution varied for each injection with a 27G needle (400-1200 μm) and was consistent at ∼300-700 μm below the skin surface using the TMD. Injection depth was significantly different between the 27G needle and the TMD. Conclusions: Injection-related pain decreased using the TMD, and ICG solution depth was consistent on fluorescence lymphography. A TMD may be useful for ICG fluorescence lymphography. Clinical Trials Registry (UMIN-CTR; ID: UMIN000033425).
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Affiliation(s)
- Yusuke Endo
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masaki Sano
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Kayama
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunori Inuzuka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takaaki Saito
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuto Katahashi
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuta Yamanaka
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hajime Tsuyuki
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Nozomu Ishikawa
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Ena Naruse
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Unno
- Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Vascular Surgery, Hamamatsu Medical Center, Hamamatsu, Japan
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Jarragh A, Lari A, Burhamah W, Alherz M, Nouri A, Alshammari Y, Al-Jasim A, AlRefai S, Alnusif N. Comparison of pain and extent of anesthesia in digital blocks for isolated finger lacerations: A randomized controlled trial. Turk J Emerg Med 2022; 22:125-130. [PMID: 35936956 PMCID: PMC9355069 DOI: 10.4103/tjem.tjem_344_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES: Digital injuries are among the most common presentations to the emergency department. In order to sufficiently examine and manage these injuries, adequate, prompt, and predictable anesthesia is essential. In this trial, we aim to primarily compare the degree of pain and anesthesia onset time between the two-injection dorsal block technique (TD) and the single-injection volar subcutaneous block (SV) technique. Further, we describe the temporal and anatomical effects of both techniques for an accurate delineation of the anesthetized regions. METHODS: This is a single-center prospective randomized controlled trial involving patients presenting with isolated wounds to the fingers requiring primary repair under local anesthesia. Patients were randomized to either the SV or TD blocks. The primary outcome was procedure-related pain (Numerical Rating Scale). Further, we assessed the extent of anesthesia along with the anesthesia onset time. RESULTS: A total of 100 patients were included in the final analysis, 50 on each arm of the study. The median pain score during injection was significantly higher in patients who received TD block than patients who received SV block (median [interquartile range] = 4 [2.25, 5.00] vs. 3.00 [2.00, 4.00], respectively, P = 0.006). However, anesthesia onset time was not statistically different among the groups (P = 0.39). The extent of anesthesia was more predictable in the dorsal block compared to the volar block. CONCLUSION: The single-injection volar subcutaneous blocks are less painful with a similar anesthesia onset time. Injuries presenting in the proximal dorsal region may benefit from the two-injection dorsal blocks, given the anatomical differences and timely anesthesia of the region.
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Affiliation(s)
- Ali Jarragh
- Department of Surgery, Kuwait University, Al-Shuwaikh, Kuwait
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Waleed Burhamah
- Department of Plastic Surgery, AlBabtain Hospital, Al-Shuwaikh, Kuwait
| | - Mohammed Alherz
- Department of Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Abdullah Nouri
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Yahia Alshammari
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Ameer Al-Jasim
- Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Sulaiman AlRefai
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
| | - Naser Alnusif
- Department of Orthopedic Surgery, AlRazi Hospital, Al-Shuwaikh, Kuwait
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Tu TY, Hsu CY, Lin PC, Chen CY. Wide-Awake Local Anesthesia With no Tourniquet Versus General Anesthesia for the Plating of Distal Radius Fracture: A Systematic Review and Meta-Analysis. Front Surg 2022; 9:922135. [PMID: 35832499 PMCID: PMC9271796 DOI: 10.3389/fsurg.2022.922135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDistal radius fractures are treated using open reduction and internal fixation and using general anesthesia (GA) or regional blocks. A new technique, wide-awake local anesthesia with no tourniquet (WALANT), allows this operation to be conducted in nonsedated patients without the use of tourniquets.ObjectiveWe analyzed whether WALANT yields better outcomes than GA in the treatment of patients with distal radius fractures.Evidence ReviewWe searched the PubMed, Cochrane Library, Embase, and Scopus databases for cases of distal radius fractures treated using WALANT or GA. The outcomes of interest were duration of preparation for surgery, duration of surgery, blood loss, and length of postoperative hospitalization; visual analog scale (VAS), Mayo wrist score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire score on postoperative day 1; range of motion (ROM); time until bone union; and complication rate.FindingsWe systematically reviewed 4 studies with a total of 263 patients (128 with WALANT and 135 with GA). In comparison with GA, WALANT required less time for preparation for surgery, shorter postoperative hospitalization, and lower postoperative day 1 VAS scores; however, blood loss was greater. Functional outcomes (ROM, QuickDASH score, and Mayo wrist score), complication rates, and times until union did not differ considerably between the two methods.ConclusionThe included studies demonstrated that durations of preparation for surgery and postoperative hospitalization were shorter and pain on postoperative day 1 was less severe with WALANT than with GA. Although blood loss in surgery was greater with WALANT, this technique is a novel and promising alternative to GA.
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Affiliation(s)
- Ting-Yu Tu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Yang Hsu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Chin Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yu Chen
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
- Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
- Correspondence: Chun-Yu Chen
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Adcock SJ, Tucker CB. Buffering lidocaine heightens aversion to cornual nerve injections in dairy calves. J Dairy Sci 2022; 105:4490-4497. [DOI: 10.3168/jds.2021-21012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022]
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Joukhadar N, Lalonde D. How to Minimize the Pain of Local Anesthetic Injection for Wide Awake Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3730. [PMID: 34367856 PMCID: PMC8337068 DOI: 10.1097/gox.0000000000003730] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 01/03/2023]
Abstract
After reading this article, the participant should be able to (1) almost painlessly inject tumescent local anesthesia to anesthetize small or large parts of the body, (2) improve surgical safety by eliminating the need for unnecessary sedation in patients with multiple medical comorbidities, and (3) convert many limb and face operations to wide awake surgery. We recommend the following 13 tips to minimize the pain of local anesthesia injection: (1) buffer local anesthetic with sodium bicarbonate; (2) use smaller 27- or 30-gauge needles; (3) immobilize the syringe with two hands and have your thumb ready on the plunger before inserting the needle; (4) use more than one type of sensory noise when inserting needles into the skin; (5) try to insert the needle at 90 degrees; (6) do not inject in the dermis, but in the fat just below it; (7) inject at least 2 ml slowly just under the dermis before moving the needle at all and inject all local anesthetic slowly when you start to advance the needle; (8) never advance sharp needle tips anywhere that is not yet numb; (9) always inject from proximal to distal relative to nerves; (10) use blunt-tipped cannulas when tumescing large areas; (11) only reinsert needles into skin that is already numb when injecting large areas; (12) always ask patients to tell you every time they feel pain during the whole injection process so that you can score yourself and improve with each injection; (13) always inject too much volume instead of not enough volume to eliminate surgery pain and the need for "top ups."
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Affiliation(s)
- Nadim Joukhadar
- From theDivision of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donald Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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Hockett D, Kress L, Mac Donald R, Krenzischek DA, Maheshwari A. Effectiveness of Buffered Lidocaine for Local Anesthesia During Liver Biopsy. Gastroenterol Nurs 2021; 44:172-176. [PMID: 33927155 PMCID: PMC8162227 DOI: 10.1097/sga.0000000000000542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 05/27/2020] [Indexed: 11/27/2022] Open
Abstract
The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate. Immediately after they received the lidocaine injection, both groups were asked to rate their preprocedure anxiety and pain using a 0-10 visual analog scale. Mean postprocedure pain was statistically significantly different between the two arms with the intervention group reporting less pain (1.65 vs. 2.27, p = .037). Change in pain scores between the two groups were also statistically significantly different with the intervention group reporting a mean change in pain score of 0.93 compared to 1.63 in the control group (p = .021). However, no differences were found for reported anxiety. This study has shown that using sodium bicarbonate with lidocaine significantly decreased pain sensation at the injection site when used for deep visceral anesthesia during percutaneous liver biopsy.
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Affiliation(s)
- Deborah Hockett
- Correspondence to: Deborah Hockett, BSN, RN, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD 21202 ()
| | - Laura Kress
- Deborah Hockett, BSN, RN, is Nurse Clinician III, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Laura Kress, MSN, RN, is Nurse Manager, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Ryan Mac Donald, PhD, is Biostatistician, Mercy Medical Center, Baltimore, Maryland
- Dina A. Krenzischek, PhD, RN, CPAN, CFRE, FAAN, FASPAN, is Director of Professional Practice, Mercy Medical Center, Baltimore, Maryland
- Anurag Maheshwari, MD, is Medical Director for Live Donor Liver Transplantation and Clinical Assistant Professor of Medicine, University of Maryland Medical Center, Baltimore, Maryland; and Transplant Hepatologist, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
| | - Ryan Mac Donald
- Deborah Hockett, BSN, RN, is Nurse Clinician III, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Laura Kress, MSN, RN, is Nurse Manager, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Ryan Mac Donald, PhD, is Biostatistician, Mercy Medical Center, Baltimore, Maryland
- Dina A. Krenzischek, PhD, RN, CPAN, CFRE, FAAN, FASPAN, is Director of Professional Practice, Mercy Medical Center, Baltimore, Maryland
- Anurag Maheshwari, MD, is Medical Director for Live Donor Liver Transplantation and Clinical Assistant Professor of Medicine, University of Maryland Medical Center, Baltimore, Maryland; and Transplant Hepatologist, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
| | - Dina A. Krenzischek
- Deborah Hockett, BSN, RN, is Nurse Clinician III, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Laura Kress, MSN, RN, is Nurse Manager, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Ryan Mac Donald, PhD, is Biostatistician, Mercy Medical Center, Baltimore, Maryland
- Dina A. Krenzischek, PhD, RN, CPAN, CFRE, FAAN, FASPAN, is Director of Professional Practice, Mercy Medical Center, Baltimore, Maryland
- Anurag Maheshwari, MD, is Medical Director for Live Donor Liver Transplantation and Clinical Assistant Professor of Medicine, University of Maryland Medical Center, Baltimore, Maryland; and Transplant Hepatologist, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
| | - Anurag Maheshwari
- Deborah Hockett, BSN, RN, is Nurse Clinician III, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Laura Kress, MSN, RN, is Nurse Manager, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
- Ryan Mac Donald, PhD, is Biostatistician, Mercy Medical Center, Baltimore, Maryland
- Dina A. Krenzischek, PhD, RN, CPAN, CFRE, FAAN, FASPAN, is Director of Professional Practice, Mercy Medical Center, Baltimore, Maryland
- Anurag Maheshwari, MD, is Medical Director for Live Donor Liver Transplantation and Clinical Assistant Professor of Medicine, University of Maryland Medical Center, Baltimore, Maryland; and Transplant Hepatologist, Posner Institute for Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, Maryland
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[Inadvertent descemetorhexis as a complication of chalazion surgery]. J Fr Ophtalmol 2021; 44:e215-e217. [PMID: 33431192 DOI: 10.1016/j.jfo.2020.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 10/22/2022]
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Evidenced-based local anaesthesia-is there a difference in practice between specialties in a major trauma centre? EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:511-516. [PMID: 33456206 PMCID: PMC7794066 DOI: 10.1007/s00238-020-01747-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
Background Local anaesthesia (LA) is used widely in several clinical scenarios in hospital practice. A number of minor trauma wounds are treated under LA at the North Bristol Trust, and on most occasions, these patients are admitted to the emergency department (ED) and treated there. On other occasions, more complex wounds may be treated by the plastic surgery team. The aim of this study is to compare the preferences of LA agents between these departments in cases of minor trauma. The authors also present a narrative review of the literature and determine best practice. Methods A single-centre clinical practice survey was developed and distributed to both departments which involved two case scenarios, one involving a head injury to the occiput (scenario 1) and one nailed repair (scenario 2) both requiring treatment under LA. Results In both scenarios ED favoured lidocaine (89%) whereas the plastic surgery team preferred to mix solutions. In scenario 1, 89% of ED participants chose lidocaine 1%, but only 38% of the plastic surgery team chose it. Forty-two percent of ED chose to use adrenaline but 100% plastic surgery team chose it. Both teams refrained from using adrenaline in digits, but 23% of the plastic surgery team chose it. Eighty-four percent of ED chose 25G needles, and the plastic surgery team’s choices varied. Conclusions This study has shown marked differences in the use of LA between two specialties in a major trauma centre. There is good quality evidence to support the safety of adrenaline use in digits with the addition of sodium bicarbonate to decrease the pain inflicted to the patient upon infiltration of LA. This study serves to raise awareness of the surgical dogma around adrenaline use and provide clinicians with an evidence-based guide to managing minor trauma with LA. Level of evidence: Not ratable.
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Williams VM, Kahn JM, Harkenrider MM, Chino J, Chen J, Fang LC, Dunn EF, Fields E, Mayadev JS, Rengan R, Petereit D, Dyer BA. COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation. Brachytherapy 2020; 19:401-411. [PMID: 32359937 PMCID: PMC7172676 DOI: 10.1016/j.brachy.2020.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic. METHODS AND MATERIALS We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided. RESULTS There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources. CONCLUSIONS Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.
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Affiliation(s)
| | - Jenna M Kahn
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR
| | | | - Junzo Chino
- Department of Radiation Oncology, Duke University, Durham, VA
| | - Jonathan Chen
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Emily F Dunn
- Department of Radiation Oncology, Willamette Valley Cancer Institute and Research Center, Eugene, OR
| | - Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Jyoti S Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Daniel Petereit
- Department of Radiation Oncology, Monument Health Cancer Care Institute, Rapid City, SD
| | - Brandon A Dyer
- Department of Radiation Oncology, University of Washington, Seattle, WA.
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11
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Adcock SJJ, Cruz DM, Tucker CB. Behavioral changes in calves 11 days after cautery disbudding: Effect of local anesthesia. J Dairy Sci 2020; 103:8518-8525. [PMID: 32564957 DOI: 10.3168/jds.2020-18337] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
Hot-iron disbudding results in painful burn wounds that take weeks to heal. Spontaneous behaviors indicative of pain are apparent in the immediate hours after disbudding, but whether they occur later in the healing process is unknown. To evaluate whether ongoing pain was present around the time the necrotic tissue loosens from the scalp, we tested the effect of administration of local anesthetic 11 d after the procedure. Disbudded female Holstein and Jersey calves (n = 24) were randomly assigned to receive an injection of local anesthetic (lidocaine) or saline at the cornual nerve on both sides of the head. We recorded the frequency of 8 behaviors for 75 min: head shakes, head rubs, head scratches, ear flicks, tail flicks, bucks/jumps/kicks, grooming, and transitions between standing and lying. Calves treated with lidocaine shook their heads less and tended to flick their ears less than calves administered saline, consistent with the effects of pain relief previously reported in the immediate hours after disbudding. These calves also rubbed their head against the sides of the pen more often, suggesting lidocaine suppressed wound protective behavior. Head shaking and head scratching became more common in the last 25 min compared with the first 50 min in calves treated with lidocaine, consistent with the return of sensation to the disbudding wounds. No treatment differences in the other behaviors were observed. These results suggest that calves experience ongoing pain 11 d after hot-iron disbudding, adding to a growing body of evidence that pain persists for weeks after the procedure.
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Affiliation(s)
- Sarah J J Adcock
- Center for Animal Welfare, Department of Animal Science, University of California, Davis 95616; Animal Behavior Graduate Group, University of California, Davis 95616
| | - Danielle M Cruz
- Center for Animal Welfare, Department of Animal Science, University of California, Davis 95616
| | - Cassandra B Tucker
- Center for Animal Welfare, Department of Animal Science, University of California, Davis 95616.
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Reconstitution of Injectable Poly-d,l-lactic Acid: Efficacy of Different Diluents and a New Accelerating Method. Plast Reconstr Surg Glob Open 2020; 8:e2829. [PMID: 33154871 PMCID: PMC7605845 DOI: 10.1097/gox.0000000000002829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/06/2020] [Indexed: 11/26/2022]
Abstract
Injectable poly-d,l-lactic acid (PDLLA) is a new collagen-stimulating filler containing PDLLA microspheres and carboxymethyl cellulose. It is available as a lyophilized powder that must be reconstituted with a diluent before administration. The aims of this study were to investigate the efficacy of different diluents and a new accelerating “back-and-forth” method.
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13
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Conditioned place preference reveals ongoing pain in calves 3 weeks after disbudding. Sci Rep 2020; 10:3849. [PMID: 32123190 PMCID: PMC7052132 DOI: 10.1038/s41598-020-60260-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 01/28/2020] [Indexed: 01/25/2023] Open
Abstract
Hot-iron disbudding, a routine procedure that prevents horn bud growth through cauterization, is painful for calves. The resulting burns remain sensitive to touch for weeks, but it is unknown whether calves experience ongoing, non-evoked pain. We evaluated conditioned place preference for analgesia in 44 calves disbudded or sham-disbudded 6 hours (Day 0) or 20 days (Day 20) before testing (n = 11/treatment). Calves were conditioned to associate the effects of a lidocaine cornual nerve block with the location and pattern of a visual stimulus, and a control injection of saline with the contrasting stimulus. On Day 0, disbudded calves tended to prefer the lidocaine-paired stimulus over the saline-paired one, suggesting that they found analgesia rewarding. On Day 20, sham calves avoided the lidocaine-paired stimulus, consistent with humans’ experience of this drug being painful. Disbudded calves on Day 20 did not show this aversion, suggesting that they traded off the short-term pain of the lidocaine with the longer-term analgesia provided. Day 0 sham calves did not avoid the lidocaine-paired stimulus, likely because they received less than half the dose of Day 20 calves during conditioning. Thus, higher doses of lidocaine are aversive to uninjured animals, but disbudded calves are willing to engage in this cost. We conclude that calves experience ongoing pain 3 weeks after disbudding, raising additional welfare concerns about this procedure.
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Trottier ED, Doré-Bergeron MJ, Chauvin-Kimoff L, Baerg K, Ali S. Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatr Child Health 2019; 24:509-535. [PMID: 31844394 PMCID: PMC6901171 DOI: 10.1093/pch/pxz026] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/21/2019] [Indexed: 12/17/2022] Open
Abstract
Common medical procedures to assess and treat patients can cause significant pain and distress. Clinicians should have a basic approach for minimizing pain and distress in children, particularly for frequently used diagnostic and therapeutic procedures. This statement focuses on infants (excluding care provided in the NICU), children, and youth who are undergoing common, minor but painful medical procedures. Simple, evidence-based strategies for managing pain and distress are reviewed, with guidance for integrating them into clinical practice as an essential part of health care. Health professionals are encouraged to use minimally invasive approaches and, when painful procedures are unavoidable, to combine simple pain and distress-minimizing strategies to improve the patient, parent, and health care provider experience. Health administrators are encouraged to create institutional policies, improve education and access to guidelines, create child- and youth-friendly environments, ensure availability of appropriate staff, equipment and pharmacological agents, and perform quality audits to ensure pain management is optimal.
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Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Krista Baerg
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Community Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario
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A physiological assessment of patient pain during surgery with wide-awake local anesthesia. J Orthop 2019; 19:158-161. [PMID: 32025125 DOI: 10.1016/j.jor.2019.11.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/24/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose Patients receiving surgery with wide-awake local anesthesia typically report little or no intraoperative pain. However, self-report assessments of pain are susceptible to bias. In the present study, patient self-report ratings were supplemented with objective physiological measures of electrodermal activity. Methods Fifteen patients receiving forefoot surgery using wide-awake local anesthesia were recruited. Pain ratings and skin conductance responses were acquired during the initial anesthetic injection (into unanesthetized tissue), during a follow-up anesthetic injection (into anesthetized tissue), and during five intraoperative procedures. Results The highest ratings of self-reported pain coincided with the initial anesthetic injection, and pain ratings were similarly low at all remaining measurement points. Fourteen patients reported no pain beyond the initial injection, whereas one patient reported minimal pain during two intraoperative procedures. Skin conductance data were consistent with pain ratings such that responses to the initial injection were significantly larger than responses at any subsequent measurement point. Conclusion These results provide further evidence that patients experience little or no pain during surgery with wide-awake local anesthesia.
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Abstract
Pain management in acute orthopedic injury needs to be tailored to the presentation and patient. Subjective and objective assessment, in conjunction with pathophysiology, should be used to provide symptom control. Ideally, treatment should be administered in an escalating fashion, attempting to manage pain with the lowest dose of the safest medication available. There are also adjunctive therapies, including those that are nonpharmacologic, that can provide additional relief.
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Affiliation(s)
- Nupur Nischal
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Evangeline Arulraja
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Stephen P Shaheen
- Emergency Medicine and Orthopedic Surgery, Division of Emergency Medicine, Department of Orthopedic Surgery, Duke University Medical Center, DUMC Box 3096, Durham, NC 27710, USA.
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Gohel MS. Endovenous ablation of superficial reflux: is it time to focus on technique rather than modality? Eur J Vasc Endovasc Surg 2018; 56:709. [DOI: 10.1016/j.ejvs.2018.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 11/25/2022]
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18
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Buffered local anesthetics reduce injection pain and provide anesthesia for up to 5 hours. J Plast Reconstr Aesthet Surg 2018; 71:1216-1230. [DOI: 10.1016/j.bjps.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 11/23/2022]
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Pinheiro VFDO, da Costa JMV, Cascudo MM, Pinheiro ÊDO, Fernandes MAF, de Araujo IB. Analgesic efficacy of lidocaine and multimodal analgesia for chest tube removal: A randomized trial study. Rev Lat Am Enfermagem 2018; 23:1000-6. [PMID: 26625989 PMCID: PMC4663998 DOI: 10.1590/0104-1169.0498.2642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 05/03/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the analgesic efficacy of subcutaneous lidocaine and multimodal analgesia for chest tube removal following heart surgery. METHODS Sixty volunteers were randomly allocated in two groups; 30 participants in the experimental group were given 1% subcutaneous lidocaine, and 30 controls were given a multimodal analgesia regime comprising systemic anti-inflammatory agents and opioids. The intensity and quality of pain and trait and state anxiety were assessed. The association between independent variables and final outcome was assessed by means of the Chi-squared test with Yates' correction and Fisher's exact test. RESULTS The groups did not exhibit significant difference with respect to the intensity of pain upon chest tube removal (p= 0.47). The most frequent descriptors of pain reported by the participants were pressing, sharp, pricking, burning and unbearable. CONCLUSION The present study suggests that the analgesic effect of the subcutaneous administration of 1% lidocaine combined with multimodal analgesia is most efficacious.
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Abstract
WALANT (wide-awake local anesthesia no tourniquet) appears to be a safe and effective anesthesia technique for many hand and wrist surgeries. Patient satisfaction is high because of the avoidance of preoperative testing and hospital admission. Postoperative recovery is rapid, and procedures can be done in outpatient settings, resulting in substantial savings in time and money.
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21
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Acid-induced experimental knee pain and hyperalgesia in healthy humans. Exp Brain Res 2017; 236:587-598. [PMID: 29250706 DOI: 10.1007/s00221-017-5155-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/14/2017] [Indexed: 01/08/2023]
Abstract
Inflammation and the related acidity in peri-articular structures may be involved in pain generation and hyperalgesia in knee osteoarthritis. This study investigated pain and associated hyperalgesia provoked by infusion of acidic saline into the infrapatellar fat pad. Twenty-eight subjects participated in two sessions in which acidic saline (AS, pH 5) or neutral saline (NS, pH 7.4) were infused into the infrapatellar fat pad for 15 min. Pain intensity, pain area, mechanical and thermal sensitivity, and maximal voluntary knee extension force were recorded. Repeated infusions were performed in 14 subjects. Infusion of AS caused significantly higher pain intensity, larger pain areas, induced hyperalgesia around the infused knee, and reduced extension force. No significant pain facilitation or spreading of hyperalgesia was found after repeated infusions as compared with single infusions. Acidic saline infused into the infrapatellar fat pad provoked pain and localized mechanical hyperalgesia. Thus, this acid-induced pain model may mimic the early-stage responses to tissue injury of knee osteoarthritis.
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Wang K, Luo Y, Asaki T, Graven-Nielsen T, Cairns BE, Arendt-Nielsen T, Arendt-Nielsen L. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm. Scand J Pain 2017; 17:260-266. [DOI: 10.1016/j.sjpain.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 11/17/2022]
Abstract
Abstract
Background and purpose
Acid has long been thought to play an important role in the pain process. Animal study showed that repeated acid stimulation induced central sensitization. The purpose of the study is to investigate muscle pain and hyperalgesia evoked byintramuscular infusion of saline at different pH levels, and to compare the effect of a single versus repeated acid infusions.
Methods
Twenty healthy subjects received infusions of buffered saline (pH 5.0, 6.0, and 7.4) into the brachioradialis muscle in a randomized order. Twelve of the subjects received repeated infusions. The subjects rated the pain intensity on visual analogue scale (VAS). Thermal pain sensitivity, and pressure pain threshold (PPT) were assessed in both arm before, during, immediately after, one hour after, and one day after the infusion. A McGill Pain Questionnaire and pain mapping were completed after each infusion.
Results
The pH 5 solution caused significantly higher pain and larger areas than pH 6.0 or 7.4. The local PPTs were significantly decreased (hyperalgesia) during and immediately after infusion of all three solutions. No significant differences were detected between the first and second infusion.
Conclusions
The intensity of acid-induced muscle pain is pH-dependent. All three solutions induced pressure hyperalgesia at the infusion site. Repeated infusions did not induce increased pain or prolonged hyperalgesia as compared with a single injection. Human intramuscular acidic saline infusion could not produce chronic pain model.
Implications
The acid-induced pain model may reflect the early stage responses to tissue injury of clinical conditions. Repeated intramuscular acidic saline injection model of prolonged hyperalgesia in rodents could not be translated into a human for modelling chronic musculoskeletal pain.
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Affiliation(s)
- Kelun Wang
- SMI , Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
| | - Yi Luo
- SMI , Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
| | - Toshiyuki Asaki
- SMI , Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI , Department of Health Science and Technology , Aalborg University , Aalborg , Denmark
| | - Brian E. Cairns
- SMI , Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
- Center for Neuroplasticity and Pain (CNAP), SMI , Department of Health Science and Technology , Aalborg University , Aalborg , Denmark
| | - Thomas Arendt-Nielsen
- SMI , Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
| | - Lars Arendt-Nielsen
- SMI , Department of Health Science and Technology, Faculty of Medicine , Aalborg University , Aalborg , Denmark
- Center for Neuroplasticity and Pain (CNAP), SMI , Department of Health Science and Technology , Aalborg University , Aalborg , Denmark
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Ismail T, Bürgin J, Todorov A, Osinga R, Menzi N, Largo R, Haug M, Martin I, Scherberich A, Schaefer D. Low osmolality and shear stress during liposuction impair cell viability in autologous fat grafting. J Plast Reconstr Aesthet Surg 2017; 70:596-605. [DOI: 10.1016/j.bjps.2017.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/13/2016] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
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Abstract
Far more attention is now given to pain management in children in the emergency department (ED). When a child arrives, pain must be recognized and evaluated using a pain scale that is appropriate to the child's development and regularly assessed to determine whether the pain intervention was effective. At triage, both analgesics and non-pharmacological strategies, such as distraction, immobilization, and dressing should be started. For mild pain, oral ibuprofen can be administered if the child has not received it at home, whereas ibuprofen and paracetamol are suitable for moderate pain. For patients who still require pain relief, oral opioids could be considered; however, many EDs have now replaced this with intranasal fentanyl, which allows faster onset of pain relief and can be administered on arrival pending either intravenous access or definitive care. Intravenous opioids are often required for severe pain, and paracetamol or ibuprofen can still be considered for their likely opioid-sparing effects. Specific treatment should be used for patients with migraine. In children requiring intravenous access or venipuncture, non-pharmacological and pharmacological strategies to decrease pain and anxiety associated with needle punctures are mandatory. These strategies can also be used for laceration repairs and other painful procedures. Despite the gaps in knowledge, pain should be treated with the most up-to-date evidence in children seen in EDs.
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Affiliation(s)
- Benoit Bailey
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
| | - Evelyne D Trottier
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
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Lundbom JS, Tangen LF, Wågø KJ, Skarsvåg TI, Ballo S, Hjelseng T, Foss OA, Finsen V. The influence of Lidocaine temperature on pain during subcutaneous injection. J Plast Surg Hand Surg 2016; 51:118-121. [DOI: 10.1080/2000656x.2016.1194281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | | | | | | | - Olav A. Foss
- Department of Orthopaedic Surgery, St. Olav’s University Hospital, Trondheim, Norway
| | - Vilhjalmur Finsen
- Faculty of Medicine, NTNU, Trondheim, Norway
- Department of Orthopaedic Surgery, St. Olav’s University Hospital, Trondheim, Norway
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Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med 2016; 34:730-4. [DOI: 10.1016/j.ajem.2016.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/13/2016] [Accepted: 01/19/2016] [Indexed: 11/22/2022] Open
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Effect of perioperative parecoxib sodium on postoperative pain control for transcatheter arterial chemoembolization for inoperable hepatocellular carcinoma: a prospective randomized trial. Eur Radiol 2016; 26:3492-9. [PMID: 26801163 DOI: 10.1007/s00330-016-4207-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/11/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pain is one of the most common side effects of transcatheter arterial chemoembolization (TACE) treatment. This study aimed to assess the analgesic effect of parecoxib sodium for postoperative pain control in patients with inoperable hepatocellular carcinoma (HCC) undergoing TACE. MATERIALS AND METHODS This randomized placebo-controlled prospective clinical study was conducted at a single cancer centre. Patients were randomly assigned to receive parecoxib sodium (experimental group; n = 60) or 0.9 % sodium chloride (control group; n = 60) 1 h before TACE and once every 12 h for 2 days after TACE. Pain level, morphine consumption, adverse events, and quality of life were evaluated and compared between the two groups. RESULTS Pain scores, percentage distribution of pain categories, and morphine consumption were significantly lower in the experimental group than in the control group (P < 0.05). Fever score comparisons revealed significantly better body temperature balance in the experimental group than in the control group (P = 0.024). Quality-of-life scores in the experimental group were significantly better than those in the control group (P < 0.05). CONCLUSIONS Our results demonstrate that the perioperative administration of parecoxib significantly improved its effectiveness in the control of postoperative pain after TACE. KEY POINTS • Perioperative administration of parecoxib is effective for control of pain after TACE. • COX-2 inhibitors provide effective and safe pain control. • Parecoxib helps improve quality-of-life after TACE for patients with inoperable hepatocellular carcinoma.
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Pool SM, Struys MM, van der Lei B. A randomised double-blinded crossover study comparing pain during anaesthetising the eyelids in upper blepharoplasty: First versus second eyelid and lidocaine versus prilocaine. J Plast Reconstr Aesthet Surg 2015; 68:1242-7. [DOI: 10.1016/j.bjps.2015.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/20/2015] [Accepted: 04/26/2015] [Indexed: 10/23/2022]
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Weiss JE, Haines KA, Chalom EC, Li SC, Walco GA, Nyirenda TL, Edelheit B, Kimura Y. A randomized study of local anesthesia for pain control during intra-articular corticosteroid injection in children with arthritis. Pediatr Rheumatol Online J 2015; 13:36. [PMID: 26310855 PMCID: PMC4550066 DOI: 10.1186/s12969-015-0034-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/16/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intra-articular corticosteroid injections (IACI) are routinely used by pediatric rheumatologists in the treatment of chronic arthritis. Frequently, topical anesthetics are used to control procedural pain, but their relative efficacy has not been reported. In this study, we evaluated the level of pain associated with different anesthetic methods, Numby® 900 Iontophoretic Drug Delivery System, or EMLA® cream, with or without subcutaneous buffered lidocaine (SQBL), during IACI of the knee in children with arthritis. METHODS We conducted a prospective study of patients, ages 4 to 21 years old, followed at three pediatric rheumatology centers who were undergoing IACI of a knee joint. Patients were randomized into two treatment groups: 1) topical anesthetic only (EMLA® or Numby® (E/N)), or 2) topical anesthetic (E/N) and SQBL. Pain was assessed at baseline, during topical anesthetic placement, and following the IACI (post-procedure). The Faces Pain Scale-Revised (FPS-R), the Face, Leg, Activity, Cry, Consolability (FLACC) behavioral scale and the parental global assessment (PGA) (0 = best experience, 10 = worst experience) were determined. RESULTS Sixty-three patients (44 females) with a median [IQR] age of 10.8 [IQR = (8.2-14.4)] years (range 4.7-20 years) with active knee arthritis were consented. FPS-R post-procedure (P = 0.03), FLACC (P = 0.02) and PGA (P = 0.01) scores were significantly lower in females treated with E/N plus SQBL compared to patients treated with E/N only. Females in the E/N only group had a significant worsening of their baseline pain (p < 0.0004) and a greater magnitude of change in their baseline FPS-R scores (p < 0.001) from the procedure compared to females in the E/N plus SQBL group who had no worsening of their baseline pain. No significant change in pain level or PGA score was found among males in either treatment group. Pain scores overall were similar to the oligoarthritis patients, a more homogeneous group of patients. Both EMLA® (n = 33) and Numby® (n = 29) were equally well tolerated with no significant difference in median FPS-R administration scores overall. CONCLUSION Our results suggest that a topical anesthetic plus SQBL is more effective for injection pain control than topical anesthesia only. Further studies addressing pain and anxiety will help determine the optimal method of pain control for IACI.
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Affiliation(s)
- Jennifer E. Weiss
- Department of Pediatrics, Section of Rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, NJ 07610 USA
| | - Kathleen A. Haines
- Department of Pediatrics, Section of Rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, NJ 07610 USA
| | - Elizabeth C. Chalom
- Saint Barnabas Medical Center, Pediatric Rheumatology, Livingston, NJ 07039 USA
| | - Suzanne C. Li
- Department of Pediatrics, Section of Rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, NJ 07610 USA
| | - Gary A. Walco
- Department of Anesthesiology & Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Themba L. Nyirenda
- Department of Research, Hackensack University Medical Center, Hackensack, NJ 07601 USA
| | - Barbara Edelheit
- Connecticut Children’s Medical Center, Pediatric Rheumatology, Hartford, CT 06106 USA
| | - Yukiko Kimura
- Department of Pediatrics, Section of Rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, 30 Prospect Ave., Hackensack, NJ 07610 USA
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Giordano CN, Nelson J, Kohen LL, Nijhawan R, Srivastava D. Local Anesthesia: Evidence, Strategies, and Safety. CURRENT DERMATOLOGY REPORTS 2015. [DOI: 10.1007/s13671-015-0110-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Caffarel-Salvador E, Tuan-Mahmood TM, McElnay JC, McCarthy HO, Mooney K, Woolfson A, Donnelly RF. Potential of hydrogel-forming and dissolving microneedles for use in paediatric populations. Int J Pharm 2015; 489:158-69. [DOI: 10.1016/j.ijpharm.2015.04.076] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/24/2015] [Accepted: 04/29/2015] [Indexed: 11/24/2022]
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Best CA, Best AA, Best TJ, Hamilton DA. Buffered lidocaine and bupivacaine mixture - the ideal local anesthetic solution? Plast Surg (Oakv) 2015; 23:87-90. [PMID: 26090348 DOI: 10.4172/plastic-surgery.1000913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The use of injectable local anesthetic solutions to facilitate pain-free surgery is an integral component of many procedures performed by the plastic surgeon. In many instances, a solution that has both rapid onset and prolonged duration of analgesia is optimal. A combination of lidocaine and bupivacaine, plain or with epinephrine, is readily available in most Canadian health care settings where such procedures are performed, and fulfills these criteria. However, commercially available solutions of both medications are acidic and cause a burning sensation on injection. Buffering to neutral pH with sodium bicarbonate is a practical method to mitigate the burning sensation, and has the added benefit of increasing the fraction of nonionized lipid soluble drug available. The authors report on the proportions of the three drugs to yield a neutral pH, and the results of an initial survey regarding the use of the combined solution with epinephrine in hand surgery.
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Affiliation(s)
- Corliss A Best
- Northern Ontario School of Medicine, Sault Ste Marie, Ontario
| | - Alyssa A Best
- London School of Economics and Political Science, London, United Kingdom
| | - Timothy J Best
- Northern Ontario School of Medicine, Sault Ste Marie, Ontario
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Balakrishnan K, Ebenezer V, Dakir A, Kumar S, Prakash D. Bupivacaine versus lignocaine as the choice of locall anesthetic agent for impacted third molar surgery a review. J Pharm Bioallied Sci 2015; 7:S230-3. [PMID: 26015720 PMCID: PMC4439680 DOI: 10.4103/0975-7406.155921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 10/31/2014] [Accepted: 11/09/2014] [Indexed: 11/05/2022] Open
Abstract
One of the most important goal in minor surgical procedures is to achieve proper and sufficient anesthesia and analgesia preoperatively, intraoperatively and in the immediate postoperative period. Several local anesthetic agents have been cited in the literature and studied. Bupivacaine is one of the most common long-acting anesthetic agents being used for surgical removal of impacted third molars. Lignocaine is one of the commonest short-acting anesthetic agents being used for the same procedure. In this review article, the analgesic and anesthetic abilities of the bupivacaine versus lignocaine have been reviewed while surgical removal of impacted third molars.
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Affiliation(s)
- K Balakrishnan
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Vijay Ebenezer
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Abu Dakir
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Saravana Kumar
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
| | - D Prakash
- Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College and Hospital, Chennai, Tamil Nadu, India
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Abstract
The care of wounds is common in pediatric practice. Most simple wounds can be handled by clinicians in the office or by trained emergency medicine clinicians. Knowledge of appropriate wound care, wound repair techniques, and judicious use of antibiotics for prophylaxis ensures the best possible long-term outcomes. The following review describes appropriate recommendations for acute and long-term wound care, management, and special circumstances common to pediatric practice.
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Affiliation(s)
- Kelly D Black
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, and Department of Emergency Medicine, Sanford USD Medical Center and Sanford Children's Hospital, Sioux Falls, SD
| | - Stephen John Cico
- Departments of Pediatrics and Family Medicine, University of South Dakota Sanford School of Medicine, and Department of Emergency Medicine, Sanford USD Medical Center and Sanford Children's Hospital, Sioux Falls, SD
| | - Derya Caglar
- Department of Pediatrics, University of Washington School of Medicine, and Department of Emergency Medicine, Seattle Children's Hospital, Seattle, WA
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Bhargava D, Deshpande A. Twin-mix anesthesia as pterygomandibular nerve block for surgical removal of impacted mandibular third molars. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2015. [DOI: 10.1007/s12548-015-0124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Goldschneider KR, Good J, Harrop E, Liossi C, Lynch-Jordan A, Martinez AE, Maxwell LG, Stanko-Lopp D. Pain care for patients with epidermolysis bullosa: best care practice guidelines. BMC Med 2014; 12:178. [PMID: 25603875 PMCID: PMC4190576 DOI: 10.1186/s12916-014-0178-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 09/09/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) comprises a group of rare disorders that have multi-system effects and patients present with a number of both acute and chronic pain care needs. Effects on quality of life are substantial. Pain and itching are burdensome daily problems. Experience with, and knowledge of, the best pain and itch care for these patients is minimal. Evidence-based best care practice guidelines are needed to establish a base of knowledge and practice for practitioners of many disciplines to improve the quality of life for both adult and pediatric patients with EB. METHODS The process was begun at the request of Dystrophic Epidermolysis Bullosa Research Association International (DEBRA International), an organization dedicated to improvement of care, research and dissemination of knowledge for EB patients worldwide. An international panel of experts in pain and palliative care who have extensive experience caring for patients with EB was assembled. Literature was reviewed and systematically evaluated. For areas of care without direct evidence, clinically relevant literature was assessed, and rounds of consensus building were conducted. The process involved a face-to-face consensus meeting that involved a family representative and methodologist, as well as the panel of clinical experts. During development, EB family input was obtained and the document was reviewed by a wide variety of experts representing several disciplines related to the care of patients with EB. RESULTS The first evidence-based care guidelines for the care of pain in EB were produced. The guidelines are clinically relevant for care of patients of all subtypes and ages, and apply to practitioners of all disciplines involved in the care of patients with EB. When the evidence suggests that the diagnosis or treatment of painful conditions differs between adults and children, it will be so noted. CONCLUSIONS Evidence-based care guidelines are a means of standardizing optimal care for EB patients, whose disease is often times horrific in its effects on quality of life, and whose care is resource-intensive and difficult. The guideline development process also highlighted areas for research in order to improve further the evidence base for future care.
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Affiliation(s)
- Kenneth R Goldschneider
- Pain Management Center, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | - Julie Good
- Lucille Packard Children's Hospital, Department of Anesthesia (by courtesy, Pediatrics), Stanford University, Stanford, California, USA.
| | - Emily Harrop
- Helen and Douglas Hospices, Oxford and John Radcliffe Hospital, Oxford, USA.
| | - Christina Liossi
- University of Southampton, Southampton, UK.
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | - Anne Lynch-Jordan
- Pain Management Center and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | - Anna E Martinez
- National Paediatric Epidermolysis Bullosa Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Lynne G Maxwell
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Danette Stanko-Lopp
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Samarai V, Haghighi N, Sharifi N. Pupil dilation with intra-cameral lidocaine versus topical midriatics during phacoemulsification. Glob J Health Sci 2014; 6:8-12. [PMID: 25363172 PMCID: PMC4796471 DOI: 10.5539/gjhs.v6n7p8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 08/11/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate pupil dilation with intra-cameral injection of preservative-free lidocaine 1% (ICL) versus topical eye midriatics during phacoemulsification. METHODS This case-control study included 40 patients with similar bilateral senile cataract scheduled for phacoemulsification and intraocular lens (IOL) implantation. patient's first eye received topical midriatic eye drops as control group and next eye operated by intra cameral preservative free lidocaine 1% without any preoperative or intraoperative midriatics. We did not add epinephrine to the irrigating solution in either group. The first eyes received 3 drops of cyclopentolate 1% and tropicamide 1% each 5 minutes, with first dose 60 minutes before surgery. The horizontal pupil diameter was measured before and after pupil dilation using the same caliper with operation microscope total surgical time was recorded in both groups. RESULTS Patients included 20 male and 20 female with mean age of 72 and 70.9 years old .4 patients were diabetic and 11 cases had pseudo-exfoliation. Pupil diameter increased in both case and control groups significantly (P value<0.0) but the difference between mean increase in pupil size wasn't significantly different. Mean increase in pupil size was significantly greater in patients without pseudo-exfoliation (4.10 mm vs 3.85 mm, independent t test, P<0.05). There was no significant difference between diabetic and non- diabetic patients regarding of pre- and post-injection diameter of the pupil. CONCLUSION Intra-cameral preservative-free lidocaine 1% supply adequate midriasis during cataract surgery by itself.
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Abstract
In plastic surgery, there are many procedures that can be performed using local instead of general anesthesia. Not only can this help mitigate health care costs, but precious operating-room resources can also be directed to areas of greater need. Common procedures that can be performed under local anesthetics include skin grafts and local flaps. However, as not all patients are suitable for local anesthesia, careful patient selection is necessary to maintain the standard of care. This article describes the detailed surgical approach to using local anesthetics for skin grafts and local flaps.
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Ræder J. Warming and alkalinisation of lidocaine with epinephrine mixture: Some useful aspects at first glance, but not so simple? Scand J Pain 2014; 5:41-42. [DOI: 10.1016/j.sjpain.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Johan Ræder
- Department of Anaesthesiology, Ullevaal , Oslo University Hospital and Faculty of Medicine, University of Oslo , Pb 4950 Nydalen, 0224 Oslo , Norway
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Bhargava D, Sreekumar K, Rastogi S, Deshpande A, Chakravorty N. A prospective randomized double-blind study to assess the latency and efficacy of twin-mix and 2% lignocaine with 1:200,000 epinephrine in surgical removal of impacted mandibular third molars: a pilot study. Oral Maxillofac Surg 2013; 17:275-280. [PMID: 23143710 DOI: 10.1007/s10006-012-0372-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 10/29/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION A prospective randomized double-blind study was conducted to assess the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:200,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae of surgical extraction of impacted mandibular third molars. MATERIAL AND METHODS The study was conducted as a prospective randomized double-blind clinical trial on 20 patients with bilateral impaction of mandibular third molars. A total of 40 interventions were included for the study, 20 with 2% lignocaine with 1:200,000 epinephrine (study group C, control) and 20 with the twin-mix (study group T, twin-mix), with a gap of 1 month between two interventions in a single patient. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia, and the need to re-anesthetize the surgical site were recorded. A 10-point visual analog scale (VAS) was used to assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period. pH of the test anesthetic solutions was also determined using a pH meter. RESULTS Twin-mix was found to be more basic than 2% lignocaine with 1:200,000 epinephrine. Mean VAS value for the pain/sting on local anesthetic injection/block was less in study group T. Time of onset of the local anesthetic was significantly less for the study group T, 51 ± 17.5 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more sever swelling and reduction in mouth opening in the postoperative period. DISCUSSION The addition of dexamethasone to lignocaine and its administration as an intra-space injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.
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Affiliation(s)
- Darpan Bhargava
- Department of Oral and Maxillofacial Surgery, Peoples College of Dental Sciences, Peoples University, Bhanpur, Bhopal, (M.P), India,
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Farhangkhoee H, Lalonde J, Lalonde DH. Teaching medical students and residents how to inject local anesthesia almost painlessly. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 20:169-72. [PMID: 23997583 DOI: 10.1177/229255031202000315] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of the present study was to determine whether it is possible to consistently and reliably teach medical students and resident learners how to administer local anesthetics in an almost painless manner. Using the published technique, 25 consecutive medical students and residents were taught how to inject local anesthetics for carpal tunnel release by watching the senior author perform the technique once. The learner then independently administered the anesthesia to the next patient who then scored the learner's ability to inject the local anesthetic from a pain perspective. The teaching technique is demonstrated in an accompanying online video. The learners were consistently capable of administering local anesthetics with minimal pain. During the injection process, the patients only felt pain once ('hole-in-one') 76% of the time. This pain was attributed to the first 27-gauge needle poke. The other 24% of the time, patients felt pain twice (eagle) during the 5 min injection process. All 25 patients rated the entire pain experience to be less than 2/10. Eighty-four per cent of the patients indicated that the experience was better than local anesthetic given at the dentist's office. Medical students and residents can quickly and reliably learn how to administer local anesthesia for carpal tunnel release with minimal pain to the patient.
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Affiliation(s)
- Hana Farhangkhoee
- Division of Plastic and Reconstructive Surgery, McMaster University, Hamilton, Ontario
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Frank SG, Lalonde DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 20:71-3. [PMID: 23730153 DOI: 10.1177/229255031202000207] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The infiltration of local anesthetics can be painful, which is likely due, in part, to their acidity. In spite of a Cochrane study that recommended neutralizing lidocaine with bicarbonate to decrease the pain of injection, not many surgeons have adopted the practice, and there are many 'recipes' for how much bicarbonate one should add. OBJECTIVE To determine the acidity of lidocaine and the correct ratio of bicarbonate that should be added to neutralize lidocaine to achieve body pH. METHODS Fifty samples each of commonly used anesthetics (lidocaine 1% and 2%, with and without epinephrine 1:100,000) were obtained and tested for pH. Data were also analyzed according to whether the vials had been previously opened. Ten additional samples of lidocaine 1% with 1:100,000 epinephrine were titrated against sodium bicarbonate 8.4% and tested for pH and the presence of precipitate. RESULTS A solution of 1% lidocaine with 1:100,000 epinephrine had a mean (± SD) pH of 4.24±0.42, and 2% lidocaine with 1:100,000 epinephrine had a mean pH of 3.93±0.43. Plain 1% lidocaine had a pH of 6.09±0.16, and plain 2% lidocaine had a pH of 6.00±0.27. Epinephrine-containing solutions were more acidic when they had been previously opened. One per cent lidocaine with epinephrine required 8.4% sodium bicarbonate at a ratio of 1.1 mL:10 mL to 1.8 mL:10 mL to achieve the target tissue pH of 7.38 to 7.62. CONCLUSION Lidocaine with epinephrine was approximately 1000 times more acidic than subcutaneous tissue. The addition of bicarbonate to the local anesthetic solution is simple to perform and is inexpensive. The proper volume ratio of 8.4% sodium bicarbonate to 1% lidocaine with 1:100,000 epinephrine is approximately 1 mL:10 mL. Surgeons should be more aware of the simplicity and value of buffering with bicarbonate to decrease the pain of injection.
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Affiliation(s)
- Simon G Frank
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia
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Lee HJ, Cho YJ, Gong HS, Rhee SH, Park HS, Baek GH. The effect of buffered lidocaine in local anesthesia: a prospective, randomized, double-blind study. J Hand Surg Am 2013; 38:971-5. [PMID: 23566722 DOI: 10.1016/j.jhsa.2013.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Open carpal tunnel decompression under local anesthesia is routinely done by many surgeons. However, patients complain of pain during the injection of local anesthesia. This prospective, double-blind, randomized study was to compare the pain visual analog scale (VAS) scores of local anesthesia using lidocaine with and without sodium bicarbonate in patients with bilateral carpal tunnel syndrome. METHODS Twenty-five patients underwent bilateral simultaneous carpal tunnel decompression. All had topical anesthetic cream applied on the palm and wrist before the lidocaine block. In a randomized manner, half of the hands were blocked with nonbuffered lidocaine and half were blocked with buffered lidocaine. Pain was evaluated on a VAS score. RESULTS The mean pain VAS score in the hand with buffered lidocaine was 4.6 ± 1.5 and 6.5 ± 1.5 for the hand with nonbuffered lidocaine. After adjustment for individual threshold of the pain, the mean pain VAS score changed into 4.6 ± 1.3 with buffered lidocaine and 6.6 ± 1.7 without buffered lidocaine. CONCLUSIONS In open carpal tunnel surgery, the use of buffered lidocaine for local anesthesia reduces the anesthetic pain effectively. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Hyuk Jin Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Abstract
The wide-awake approach to flexor tendon repair has decreased our rupture and tenolysis rates and permitted us to get consistently good results in cooperative patients. The wide-awake surgery allows the repair of gaps of the surgical repair site revealed with intraoperative active movement testing of the repair We are now doing midrange active movement after primary tendon repair. After tenolysis, full-range active motion is possible even before skin closure. We no longer perform flexor tendon repair with the tourniquet, sedation, and muscle paralysis of general or block (Bier or axillary) anesthesia.
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Affiliation(s)
- Donald H Lalonde
- Department of Surgery, Saint John Regional Hospital, Dalhousie University, 400 University Avenue, Saint John NB E2L 4L4, Canada.
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Hamelin ND, St-Amand H, Lalonde DH, Harris PG, Brutus JP. Decreasing the pain of finger block injection: level II evidence. Hand (N Y) 2013; 8:67-70. [PMID: 24426896 PMCID: PMC3574478 DOI: 10.1007/s11552-012-9478-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND There is level II evidence that volunteers prefer the single subcutaneous injection in the midline of the proximal phalanx with lidocaine and epinephrine (SIMPLE) finger block over the classic two dorsal injection block technique. The purpose of this study was to possibly further decrease the pain of digital block injection by examining the effect of the duration of injection on the pain felt by volunteers receiving the SIMPLE block at two different injection rates. METHODS Forty healthy blinded volunteers were injected 2 mL of lidocaine 1 % and epinephrine 1/100,000 in the digital palmar crease of both long fingers, one at a time. Two different rates of injection were used: 8 and 60 s. Pain scores were measured using a visual analogue scale and the volunteers were asked which of injection techniques they preferred. RESULTS The visual analogue scale results revealed less pain with the slow injection (p < 0.001). Thirty three out of 40 volunteers preferred the slow injection rate. No difference could be attributed to sex of participants or to the first hand injected. CONCLUSION Blinded volunteers preferred digital blocks injected over 60 s to the more rapid 8 s. Decreasing the pain of injection only takes a minute of our valuable time for finger blocks.
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Affiliation(s)
- Nicolas D. Hamelin
- Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montréal, Québec Canada H2L 4M1
| | - Hugo St-Amand
- Division of Plastic and Reconstructive Surgery, Hopital de Gatineau, 909 La Vérendrye boulevard, Gatineau, Québec Canada J8P 7H2
| | - Donald H. Lalonde
- Division of Plastic Surgery, Dalhousie University, Hilyard Place, Suite C204, 600 Main Street, Saint John, New Brunswick Canada E2K 1J5
| | - Patrick G. Harris
- Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l’Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montréal, Québec Canada H2L 4M1
| | - Jean-Paul Brutus
- Institut de Chirurgie Spécialisée de Montréal, 6100 avenue du Boisé, suite 112, Montréal, Québec Canada H3S 2W1
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Conroy PH, O'Rourke J. Tumescent anaesthesia. Surgeon 2013; 11:210-21. [PMID: 23375489 DOI: 10.1016/j.surge.2012.12.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/14/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
Tumescent anaesthesia describes the practice of injecting a very dilute solution of local anaesthetic combined with epinephrine and sodium bicarbonate into tissue until it becomes firm and tense (tumescent). It was initially described in the field of liposuction but now surgical applications for the technique are widely varied ranging across vascular surgery, breast surgery, plastic surgery and ENT procedures. It is widely used in both hospital- and office-based environments and may form the sole method of anaesthesia for surgery. Advantages include a reduction in blood loss through both epinephrine-induced vasoconstriction as well as hydrostatic compression from the tumescent effect. Sodium bicarbonate reduces pain associated with the injection of an acidic local anaesthetic solution. Due to the unique pharmacokinetic profile of this technique lidocaine doses of 35 mg/kg bodyweight have been shown to be safe for liposuction procedures. Tumescent lidocaine is absorbed very slowly from subcutaneous tissues producing lower, and more delayed, peak blood levels compared to other routes, as well as extended postoperative analgesia. Slow systemic absorption allows the rapid hepatic plasma clearance of lidocaine to maintain safe local anaesthetic blood levels. This slow absorption from subcutaneous tissue has been likened to a depot injection. Careful attention must be given to appropriate local anaesthetic dosage alterations in cases of co-administration with agents affecting hepatic drug clearance or conditions reducing liver blood supply. Adherence to these pharmacological principles has produced an exemplary safety record for this technique to date.
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Affiliation(s)
- Patrick H Conroy
- Department of Anaesthesia and Intensive Care Medicine, Adelaide, Meath & National Children's Hospital, Tallaght, Dublin 24, Ireland.
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