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Kalajian TA, Cannella JA, Vasudevan A, Mizelle J, Rendon LF, Nozari A, Ortega R. An overview of local anesthetics in over-the-counter products. Pain Pract 2024; 24:364-373. [PMID: 37750534 DOI: 10.1111/papr.13298] [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: 09/27/2023]
Abstract
Over-the-counter (OTC) local anesthetics have historically been used to alleviate pain in several common conditions including toothache and sore throat. With a rise in chronic conditions and an aging population, there has been an increase in associated chronic pain-related disorders. Individuals with chronic pain often seek OTC treatments for quick and accessible pain relief. There are several common OTC local anesthetics, including benzocaine, lidocaine, and dibucaine, which are readily available to patients in several formulations. In order to appropriately advise patients on the use of local anesthetics, it is important to understand their key characteristics, including the mechanism of action, clinical properties, pharmacokinetics, clinical applications, and adverse reactions, which may occur.
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Affiliation(s)
- Tyler A Kalajian
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Anesthesia & Perioperative Medicine, The Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Ananya Vasudevan
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jack Mizelle
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Anesthesiology & Pain Management, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luis F Rendon
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Ala Nozari
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Rafael Ortega
- Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts, USA
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Maredia H, Sartori-Valinotti JC, Ranganath N, Tosh PK, O'Horo JC, Shah AS. Supportive Care Management Recommendations for Mucocutaneous Manifestations of Monkeypox Infection. Mayo Clin Proc 2023:S0025-6196(23)00030-7. [PMID: 37125977 PMCID: PMC10148669 DOI: 10.1016/j.mayocp.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 05/02/2023]
Affiliation(s)
| | | | - Nischal Ranganath
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - Pritish K Tosh
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
| | - John C O'Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Aditya S Shah
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Hand, Foot, and Mouth Disease: A Narrative Review. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 16:77-95. [PMID: 36284392 DOI: 10.2174/1570180820666221024095837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance. OBJECTIVE This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. METHODS A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review. RESULTS Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. CONCLUSION Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Hong Kong Institute of Integrative Medicine, and the Jockey Club School of Public Health and Primary Care, The Chinese University Hong Kong, Hong Kong
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Ruffin TB, Salinero E, Papa L, Cramm K, Florez C, Chen JG, Ramirez J. Intranasal Fentanyl to Reduce Pain and Improve Oral Intake in the Management of Children With Painful Infectious Mouth Lesions. Pediatr Emerg Care 2022; 38:363-366. [PMID: 35802483 DOI: 10.1097/pec.0000000000002779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Painful infectious mouth conditions such as herpangina, hand-foot-and-mouth disease, and herpetic gingivostomatitis can cause pain, dehydration, and hospitalization in young children. Treatment for these conditions is generally supportive and directed toward pain relief from ulcerative lesions, thus facilitating oral intake, and preventing dehydration. Attempts at oral therapy at home and in the emergency department are often refused and immediately spit back out. This study evaluated the efficacy of intranasal fentanyl (INF) compared with a commonly used oral (PO) acetaminophen/hydrocodone formulation for the treatment of children with painful infectious mouth conditions. METHODS This study was a prospective, nonblinded, randomized controlled noninferiority trial conducted in an academic tertiary care pediatric emergency department. The study enrolled children between the ages of 6 months and 18 years with painful infectious mouth lesions and poor oral intake. Patients were randomized to receive either INF (1.5 μg/kg, intervention) or PO acetaminophen/hydrocodone (0.15 mg/kg, control) based on the dose of hydrocodone. The primary outcome was volume of fluid intake per body weight (in milliliters per kilogram) 60 minutes after analgesic administration. Secondary outcomes included pain scores using a validated visual assessment scale (VAS; 1, no pain; 10, worst pain), hydration score (VAS; 1, well hydrated; 4, very dehydrated), admission rate and overall satisfaction score (VAS; 1, worst; 7, best). A priori power analysis indicated that 34 patients would achieve an 81% power with an α value of 0.05. RESULTS Of the 34 patients enrolled, 17 were randomized to INF and 17 to PO. The demographics between both groups were similar in age, weight, sex, and race. There were no significant differences in parental perception of pain ( P = 0.69) or hydration status ( P = 0.78). Oral fluid intake at 60 minutes was 20 mL/kg for INF versus 18 mL/kg for PO ( P = 0.53). Pain scores at 15 and 30 minutes were 1.7 versus 2.9 ( P = 0.09) and 0.6 versus 1.6 ( P = 0.59). Parental perceptions of pain and hydration status at 60 minutes were 2.2 versus 2.4 ( P = 0.77) and 1.7 versus 1.5 ( P = 0.37). Overall parental satisfaction was 6.4 for INF versus 6.5 for PO ( P = 0.71), and admission rate was 0 vs 12% ( P = 0.49). There were no adverse events such as respiratory, cardiac, or central nervous system depression in either group. CONCLUSIONS Intranasal fentanyl seems to be a safe and effective alternative to acetaminophen with hydrocodone in reducing pain and improving hydration status in children with painful infectious mouth lesions and poor oral intake.
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Affiliation(s)
- Thomas B Ruffin
- From the Arnold Palmer Hospital for Children, Orlando Health
| | - Efren Salinero
- From the Arnold Palmer Hospital for Children, Orlando Health
| | | | - Kelly Cramm
- From the Arnold Palmer Hospital for Children, Orlando Health
| | - Camilo Florez
- From the Arnold Palmer Hospital for Children, Orlando Health
| | - J Gene Chen
- From the Arnold Palmer Hospital for Children, Orlando Health
| | - Jose Ramirez
- From the Arnold Palmer Hospital for Children, Orlando Health
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Singh NV, Gabriele GA, Wilkinson MH. Sucralfate as an Adjunct to Analgesia to Improve Oral Intake in Children With Infectious Oral Ulcers: A Randomized, Double-Blind, Placebo-Controlled Trial. Ann Emerg Med 2021; 78:331-339. [PMID: 33867179 DOI: 10.1016/j.annemergmed.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022]
Abstract
STUDY HYPOTHESIS We hypothesized that sucralfate along with oral analgesics (acetaminophen or ibuprofen) administered in the emergency department leads to a clinically significant improvement in oral intake in children with acute infectious oral ulcers. METHODS This was a randomized, double-blind, placebo-controlled trial of sucralfate versus placebo conducted between 2017 and 2018 in an urban pediatric emergency department. Children aged 6 months to 5 years with acute, infectious oral ulcers and poor oral intake received either acetaminophen at 15 mg/kg or ibuprofen at 10 mg/kg and were then randomized to receive sucralfate at 20 mg/kg per dose up to 1 g or a placebo solution. The primary outcome was oral fluid intake within 60 minutes of medication administration. The secondary outcomes were repeat ED visits, length of stay in ED, intravenous hydration rate, admission rate, adverse event rate, and emergency physician's determination of the adequacy of oral intake. RESULTS One hundred subjects with mild dehydration (clinical dehydration score of 1) and a median age of 1.38 years were enrolled and analyzed (49 in the sucralfate group and 51 in the placebo group). Oral intake 1 hour after drug administration was similar in both the groups: the median intake in the sucralfate group was 9.7 mL/kg and 10.7 mL/kg in the placebo group (difference -1 mL/kg; 95% confidence interval [CI] -2.0 to 4.8). According to the emergency physician's report, the secondary outcomes were significant only for adequate oral intake: 71% in the sucralfate group versus 88% in the placebo group (difference -16.8%; 95% CI -32.2 to -1.4). CONCLUSION Sucralfate as an adjunct to oral analgesics was not superior to placebo in improving oral intake in children with acute oral infectious ulcers.
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Affiliation(s)
- Nidhi V Singh
- Department of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX.
| | | | - Matthew H Wilkinson
- Department of Pediatric Emergency Medicine, University of Texas Austin Dell Medical School, Austin, TX
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Paradise SL, Hu YWE. Infectious Dermatoses in Sport: A Review of Diagnosis, Management, and Return-to-Play Recommendations. Curr Sports Med Rep 2021; 20:92-103. [PMID: 33560033 DOI: 10.1249/jsr.0000000000000808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Infectious dermatoses represent a significant source of morbidity and missed athletic participation among athletes. Close quarters and skin trauma from contact sports can lead to outbreaks among teams and athletic staff. The National Collegiate Athletic Association and National Federation of State High School Associations have published guidance with recommended management and return-to-play criteria for common fungal, bacterial, viral, and parasitic rashes. In addition to rapidly diagnosing and treating infectious dermatoses, team physicians should counsel athletes and athletic staff on proper equipment care and personal hygiene to reduce infection transmission. Clinicians should always consult sport and athlete governing bodies for sport-specific recommendations.
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Affiliation(s)
- Scott L Paradise
- Navy Medicine Readiness and Training Command, Naval Hospital Guam, Agana Heights, GU
| | - Yao-Wen Eliot Hu
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA
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Abstract
Painful diagnostic and therapeutic procedures are common in the emergency department. Adequately treating pain, including the pain of procedures is an essential component of the practice of emergency medicine. Pain management is also part of the core competency for emergency medicine residencies and pediatric emergency medicine fellowships. There are many benefits to providing local and/or topical anesthesia before performing a medical procedure, including better patient and family satisfaction and increased procedural success rates. Local and topical anesthetics when used appropriately, generally, have few, if any, systemic side effects, such as hypotension or respiratory depression, which is an advantage over procedural sedation. Use of local and topical anesthetics can do much toward alleviating the pain and anxiety of pediatric patients undergoing procedures in the emergency department.
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Teoh L, Moses GM. Are teething gels safe or even necessary for our children? A review of the safety, efficacy and use of topical lidocaine teething gels. J Paediatr Child Health 2020; 56:502-505. [PMID: 31898380 DOI: 10.1111/jpc.14769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/24/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
Lidocaine-based teething gels have been widely available in Australia for decades in both commercial preparations and those compounded by pharmacies. However, many case reports have highlighted potential risks and toxicity associated with lidocaine-based teething gels when used in infants and young children, including seizures, respiratory arrest and death. The Australian and New Zealand Society of Paediatric Dentistry and the American Academy of Paediatrics do not recommend topical agents for teething, and the US Food and Drug Administration does not recommend topical lidocaine for this purpose due to concerns of toxicity. Literature supporting the efficacy of lidocaine for teething is scant and difficult to interpret due to the flawed design of the trials conducted and varied formulations used. This opinion article aims to summarise the available literature showing the limited effectiveness and associated risks of topical lidocaine gels for use in teething. In light of these findings, the authors recommend that regulatory bodies such as the Australian Therapeutic Goods Administration review the efficacy and safety of this type of medicine and consider removing the indication for teething or limiting the age of use to older children.
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Affiliation(s)
- Leanne Teoh
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Geraldine M Moses
- Pharmacy Australia Centre of Excellence, University of Queensland, Brisbane, Queensland, Australia
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Daniel RMD, Jason SDO, Jeffrey SJ. BET 2: Does topical lidocaine improve oral intake in children with painful mouth ulcers? Arch Emerg Med 2020; 37:113-114. [DOI: 10.1136/emermed-2019-209390.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A shortcut review was carried out to establish whether topical lidocaine was effective at reducing pain and improving oral intake in children with painful oral lesions. 34 papers were found using the reported searches, of which two presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these two papers are tabulated. It is concluded that in otherwise healthy paediatric patients with painful oral ulcers, treatment with viscous lidocaine does not improve oral intake, although it may provide some pain relief.
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Wei L, Wu S, Shi W, Aldrich AL, Kielian T, Carlson MA, Sun R, Qin X, Duan B. Large-Scale and Rapid Preparation of Nanofibrous Meshes and Their Application for Drug-Loaded Multilayer Mucoadhesive Patch Fabrication for Mouth Ulcer Treatment. ACS APPLIED MATERIALS & INTERFACES 2019; 11:28740-28751. [PMID: 31334627 PMCID: PMC7082812 DOI: 10.1021/acsami.9b10379] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Electrospinning provides a simple and convenient method to fabricate nanofibrous meshes. However, the nanofiber productivity is often limited to the laboratory scale, which cannot satisfy the requirements of practical application. In this study, we developed a novel needleless electrospinning spinneret based on a double-ring slit to fabricate drug-loaded nanofibrous meshes. In contrast to the conventional single-needle electrospinning spinneret, our needless spinneret can significantly improve nanofiber productivity due to the simultaneous formation of multiple jets during electrospinning. Curcumin-loaded poly(l-lactic acid) (PLLA) nanofiber meshes with various concentrations and on the large scale were manufactured by employing our developed needleless spinneret-based electrospinning device. We systematically investigated the drug release behaviors, antioxidant properties, anti-inflammatory attributes, and cytotoxicity of the curcumin-loaded PLLA nanofibrous meshes. Furthermore, a bilayer nanofibrous composite mesh was successfully generated by electrospinning curcumin-loaded PLLA solution and diclofenac sodium loaded poly(ethylene oxide) solution in a predetermined time sequence, which revealed potent antibacterial properties. Subsequently, novel mucoadhesive patches were assembled by combining the bilayer composite nanofibrous meshes with (hydroxypropyl)methyl cellulose based mucoadhesive film. The multilayered mucoadhesive patch has excellent adhesion properties on the porcine buccal mucosa. Overall, our double-ring slit spinneret can provide a novel method to rapidly produce large-scale drug-loaded nanofibrous meshes to fabricate mucoadhesive patches. The multiple-layered mucoadhesive patches enable the incorporation of multiple drugs with different targets of action, such as analgesic, anti-inflammatory, and antimicrobial compounds, for mouth ulcer or other oral disease treatments.
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Affiliation(s)
- Liang Wei
- School of Textile Science and Engineering, Xi’an Polytechnic University, Xi’an 710048, P. R. China
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, P. R. China
- Mary & Dick Holland Regenerative Medicine Program; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Shaohua Wu
- Mary & Dick Holland Regenerative Medicine Program; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- College of Textiles & Clothing, Qingdao University, Qingdao, 266071, P. R. China
| | - Wen Shi
- Mary & Dick Holland Regenerative Medicine Program; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Amy L. Aldrich
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Tammy Kielian
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mark A. Carlson
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Department of Surgery, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Runjun Sun
- School of Textile Science and Engineering, Xi’an Polytechnic University, Xi’an 710048, P. R. China
| | - Xiaohong Qin
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, P. R. China
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA; Department of Surgery, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68516, USA
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Acute gingivostomatitis in children: Epidemiology in the emergency department, pain, and use of codeine before its restriction. Arch Pediatr 2019; 26:80-85. [DOI: 10.1016/j.arcped.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 07/20/2018] [Accepted: 11/10/2018] [Indexed: 11/17/2022]
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What do Clinicians Perceive as a Successful "Trial of Fluids"?: A Secondary Assessment of a Randomized Controlled Trial. Pediatr Emerg Care 2017; 33:230-233. [PMID: 26181504 DOI: 10.1097/pec.0000000000000464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to explore physician perceptions of the amount of fluid that demonstrates a successful "trial of fluids" (adequate fluid intake) in the emergency department in children who have had insufficient fluid intake at home. METHODS This is a secondary analysis of a randomized placebo-controlled trial of viscous lidocaine versus placebo in children aged 6 months to 8 years with acute infectious ulcerative mouth conditions (gingivostomatitis, ulcerative pharyngitis, or hand foot and mouth disease) and poor oral fluid intake. We measured the amount of fluid ingested in 60 minutes after administration of the intervention and related physician perception of adequate intake to measured intake. Given that there was little difference in oral intake between the treatment groups, the 2 arms were pooled for this analysis. RESULTS One hundred participants were recruited (50 per treatment group), all of whom completed the 60-minute trial period. At baseline, 72% were mildly dehydrated, 21% were not dehydrated, and 5% were moderately dehydrated. The participants drank a median of 8.6 mL/kg (interquartile range [IQR], 3.7-14). Clinicians perceived 58% of the participants to have an adequate intake within the first hour after intervention. The median consumption of those whose oral intake was deemed as adequate was 12.6 mL/kg (IQR, 9.4-18.4); for those whose oral intake was not deemed adequate, the median consumption was 2.7 mL/kg (IQR, 0.7-5.3) (rank sum, P < 0.001). CONCLUSIONS In children undergoing trial of fluids, we found that most clinicians perceived a fluid intake greater than 9 mL/kg as adequate and lower than 5 mL/kg as inadequate.
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Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians. CAN J EMERG MED 2016; 19:32-38. [DOI: 10.1017/cem.2016.338] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesGingivostomatitis is a common, painful pediatric presentation, and yet, few studies are available to guide management. We aimed to describe pediatric emergency physicians’ current practice patterns, with respect to analgesic use in children with acute gingivostomatitis, in order to inform future studies.MethodsA national survey was conducted at all 15 national academic pediatric centres.Electronic surveys were distributed to pediatric emergency physicians using a modified Dillman protocol; non-respondents received paper surveys via post. Data were collected regarding demographic characteristics, clinical behaviour, factors that may influence practice, and future directions.ResultsResponse rate was 74% (150/202). Most physicians (72%) preferred the combination of acetaminophen and ibuprofen to either agent alone (ibuprofen 19%, acetaminophen 7%). The preferred second-line analgesics were oral morphine (48%, 72/150) and compounded topical formulas (42%, 64/150). The most commonly cited compounded agent was Benadryl plus Maalox (23%, 35/150). Clinical experience with a medication had the greatest influence on practice pattern, with 52% (78/149) strongly agreeing. The most commonly cited barrier to adequate analgesia was difficulty in the administration of topical or oral medication to children.ConclusionsAs with many other painful conditions, the combination of acetaminophen and ibuprofen was preferred, followed by either agent alone. Oral morphine and topical compounded agents were also frequently prescribed. Regardless of patient age, physicians preferred oral morphine as a second-line agent to treat pain from severe gingivostomatitis. Future research will focus on determining which analgesic and route (oral or topical) is the most effective and best-tolerated choice.
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Robertson JJ. Managing Pharyngeal and Oral Mucosal Pain. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0101-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Efficacy and Safety of a Lidocaine Gel in Patients from 6 Months up to 8 Years with Acute Painful Sites in the Oral Cavity: A Randomized, Placebo-Controlled, Double-Blind, Comparative Study. Int J Pediatr 2015; 2015:141767. [PMID: 26693229 PMCID: PMC4677000 DOI: 10.1155/2015/141767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/16/2015] [Indexed: 11/22/2022] Open
Abstract
Lidocaine is a well-accepted topical anaesthetic, also used in minors to treat painful conditions on mucosal membranes. This randomized, double-blind, placebo-controlled study (registered prospectively as EudraCT number 2011-005336-25) was designed to generate efficacy and safety data for a lidocaine gel (2%) in younger children with painful conditions in the oral cavity. One hundred sixty-one children were included in two subgroups: 4–8 years, average age 6.4 years, treated with verum or placebo and 6 months–<4 years, average age 1.8 years, treated only with verum. Pain reduction was measured from the time prior to administration to 10 or 30 minutes after. In addition, adverse events and local tolerability were evaluated. In group I, pain was reduced significantly after treatment with verum compared to placebo at both time points. In group II, the individual pain rating shift showed statistically significant lower pain after treatment. Only seven out of 161 patients reported an adverse event but none were classified as being related to the study medication. The local tolerability was assessed as very good in over 97% of cases. For painful sites in the oral cavity, a 2% lidocaine gel is a meaningful tool for short-term treatment in the paediatric population.
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Abstract
PURPOSE OF REVIEW Hand-foot-and-mouth disease (HFMD) is a common cause of viral rash in children with classic skin findings which are easily recognized by pediatricians. Recently, several atypical cutaneous manifestations of HFMD have been described. Awareness of these patterns may lead providers to appropriate diagnosis and management. This review also highlights the epidemiological patterns of more virulent strains and emerging research in disease prevention. RECENT FINDINGS Classic HFMD presents with tender lesions on the hands, feet, and oral mucosa. Atypical skin findings in HFMD may be seen in children with atopic dermatitis. These include 'eczema coxsackium', in which eczematous skin is superinfected with coxsackie virus, resembling herpes infection. Nail changes, such as shedding, may follow HFMD after a latency period. Enterovirus 71 is responsible for epidemic outbreaks of HFMD in Asia, with systemic manifestations and occasionally neurological sequelae. Research is underway to develop a vaccine which could curb epidemics, but for the present, supportive care and hygiene measures are the standard of care. SUMMARY Atypical manifestations of HFMD in children with atopic dermatitis may mimic herpetic superinfection. In a child presenting with nail changes, consider antecedent HFMD in the differential diagnosis. The mainstay of treatment for HMFD remains supportive care.
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Cuello-Garcia CA. 50 Years Ago in The Journal of Pediatrics: "Hand, Foot, and Mouth Disease" in Children: An Epidemic Associated with Coxsakie Virus A-16. J Pediatr 2015; 167:85. [PMID: 26117637 DOI: 10.1016/j.jpeds.2015.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Topical anaesthetics, often used by anaesthetists, dentists and dermatologists, have increasingly been recognised for their utility in paediatrics. With topical anaesthetics, the 'ouchless' paediatric practice becomes an achievable goal. The primary drawback to their use is the length of time for anaesthetic effect, but planning ahead and making use of newer formulations and adjuncts can overcome this barrier. This update will review topical anaesthetic formulations available, adjuncts to reduce the time to anaesthesia, adverse effects, common indications and products on the horizon.
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Craig SS, Seith RW, Cheek JA, West A, Wilson K, Egerton-Warburton D. Lignocaine/phenylephrine nasal spray vs. placebo for the pain and distress of nasogastric tube insertion in children: a study protocol for a randomized controlled trial. Trials 2015; 16:30. [PMID: 25622681 PMCID: PMC4318482 DOI: 10.1186/s13063-015-0547-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/31/2014] [Indexed: 12/01/2022] Open
Abstract
Background Patients and clinicians consistently rate insertion of a nasogastric tube (NGT) as one of the most painful and distressing emergency department procedures. Despite this, surveys of emergency clinicians suggest that provision of adequate procedural analgesia is often inconsistent and suboptimal. While many studies have demonstrated the effectiveness of various interventions to reduce pain and distress in adults, there have been few studies in the pediatric population. There are currently no studies comparing the effectiveness of a local anesthetic nasal spray for the prevention of the pain and distress associated with NGT insertion in children. This study aims to compare the analgesic efficacy of a proprietary preparation of lignocaine/phenylephrine nasal spray and placebo for this indication. Methods/Design This is a prospective, randomized, controlled, double-blind superiority trial of 100 children aged 6 months to 5 years weighing at least 6 kg in whom a nasogastric tube is planned to be inserted. These children will be randomized to either intranasal lignocaine/phenylephrine or placebo. Pain severity is the primary outcome measure and will be measured utilizing the Face, Legs, Arms, Cry and Consolability (FLACC) pain severity rating scale. An independent staff member not involved in inserting the NGT and the child’s parents or carer will also record pain and distress on a visual analog scale (VAS). FLACC scores and VAS scores will be presented as median and interquartile range (IQR). Non-normally distributed scores will be compared using a Wilcoxon rank-sum test. Categorical data will be analyzed using Fisher’s exact test. Adverse events will be described as type and incidence. Discussion Previous studies on NGT insertion have not focused on the pediatric population. This study aims to establish the effectiveness of a simple intranasal spray of lignocaine/phenylephrine in children undergoing NGT insertion. A positive result of this study would provide evidence of an effective intervention in a procedure considered by many to be very painful and distressing. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12614000092695, registered on 23 January 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0547-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon S Craig
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia. .,Murdoch Children's Research Institute, Parkville, Australia.
| | - Robert W Seith
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
| | - John A Cheek
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia. .,Murdoch Children's Research Institute, Parkville, Australia. .,Emergency Department, Royal Children's Hospital Melbourne, Parkville, Australia.
| | - Adam West
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
| | - Kathryn Wilson
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
| | - Diana Egerton-Warburton
- Emergency Department, Monash Medical Centre, Monash Health, Clayton, Australia. .,School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.
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Hoffman RJ. Viscous Lidocaine Treatment for Painful Oral Infections in Children: Disappointingly Dismissive of Pediatric Pain. Ann Emerg Med 2014; 64:96-7. [DOI: 10.1016/j.annemergmed.2014.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 02/17/2014] [Accepted: 02/21/2014] [Indexed: 10/25/2022]
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