1
|
Chen Y, Li Q, Liao Y, Wang X, Zhan MY, Li YY, Liu GJ, Xiao L. Preemptive deep parasternal intercostal plane block for perioperative analgesia in coronary artery bypass grafting with sternotomy: a randomized, observer-blind, controlled study. Ann Med 2024; 55:2302983. [PMID: 38375661 PMCID: PMC10880567 DOI: 10.1080/07853890.2024.2302983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE The precise characteristics of deep parasternal intercostal plane block (DPIP), which is useful for providing analgesia during open heart surgery, have not yet been thoroughly elucidated. In this study, we aimed to establish the efficacy, define the cutaneous sensory block area, and determine the duration of preemptive DPIP block at the T3-4 or T4-5 intercostal spaces in patients undergoing coronary artery bypass grafting (CABG) via sternotomy. DESIGN A prospective, single-blind, randomized controlled trial. SETTING Patients were randomly divided into three cohorts, each containing thirty patients. PARTICIPANTS Ninety patients who underwent elective CABG via sternotomy were included in this study. INTERVENTIONS The T3-4 and T4-5 groups received a preoperative single-shot DPIP block at the respective intercostal spaces. The principal objective of the study was to ascertain the optimal dosage of sufentanil administered during surgical procedures involving either a DPIP block or its absence, and to conduct a comparative analysis thereof across distinct injection sites, specifically T3-4 and T4-5. Secondary factors considered were the dosage of postoperative analgesics, the extent of sensory block on the skin, pain levels after extubation, time of recovery from anesthesia (time to extubation), duration of the block, and the occurrence of nausea and vomiting. MEASUREMENTS & MAIN RESULTS Preemptive DPIP block significantly reduced intraoperative sufentanil requirement compared to the control group (T3-4:0.38 ± 0.1, T4-5:0.32 ± 0.10, vs. Control:0.88 ± 0.3 μg/kg/h, p < 0.001). It also resulted in decreased analgesic consumption and numeric rating scale scores on the day of surgery (p < 0.01 compared to the control group). The DPIP block provided accurate anesthetic coverage of the dermatomes in the sternal region and reduced the time to extubation and postoperative nausea. However, the injection point (either via the T3-4 intercostal or the T4-5 intercostal) did not affect the efficacy. Preoperative DPIP block failed to provide adequate analgesia beyond 24 h post-surgery. CONCLUSION Preemptive bilateral DPIP block provided effective analgesia in patients undergoing CABG during surgery and in the early postoperative period. The analgesic effects of the DPIP block in the T3-4 and T4-5 intercostal spaces were comparable.
Collapse
Affiliation(s)
- Yu Chen
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qi Li
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yi Liao
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoe Wang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-ying Zhan
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying-yuan Li
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gai-jiao Liu
- Department of Anesthesiology, Shenzhen Second People’s Hospital, Shenzhen, China
| | - Li Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
2
|
Okayasu I, Tachi M, Ayuse T, Wake H, Komiyama O, De Laat A. Age differences in pain sensitivity and effect of topical lidocaine on the tongue in healthy female subjects. J Oral Sci 2024; 66:26-29. [PMID: 37967923 DOI: 10.2334/josnusd.23-0167] [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: 11/17/2023]
Abstract
PURPOSE To assess the sensitivity and the effect of topical lidocaine on the tongue by quantitative sensory testing, comparing healthy middle-aged female subjects with healthy young female subjects. METHODS Sixteen healthy female subjects including eight in their fifties and eight in their twenties participated. They participated in two sessions at a 2-week interval in randomized order: lidocaine (experimental session) or placebo gel (placebo session) was applied on the tongue tip for 5min. The following parameters were taken on the tongue tip before and after application of the gel in each session: tactile detection threshold (TDT), filament-prick pain detection threshold (FPT), and numerical rating scale (NRS). RESULTS An increase of both TDT and FPT and a decrease of NRS were found after lidocaine application in both middle-aged and young female subjects. In the elder females, an increase of TDT, FPT, and NRS was also found after placebo gel application. However, the changes were not statistically significant, except for FPT in middle-aged subjects. CONCLUSION The reactions found after lidocaine application in middle-aged female subjects could be due to habituation as well as to the post-application effect of placebo gel. Placebo-induced changes appeared more pronounced in the elder females.
Collapse
Affiliation(s)
- Ichiro Okayasu
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University
| | - Mizuki Tachi
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University
| | - Takao Ayuse
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University
| | - Hiroyuki Wake
- Department of Clinical Education in General Dentistry, Graduate School of Biomedical Sciences, Nagasaki University
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo
| | | |
Collapse
|
3
|
Li L, Cai B, Li H, Wei J, Tao L, Ma P. Dermal effects and pharmacokinetic evaluation of the lidocaine/prilocaine cream in healthy Chinese volunteers. BMC Pharmacol Toxicol 2023; 24:51. [PMID: 37828535 PMCID: PMC10571248 DOI: 10.1186/s40360-023-00690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND EMLA cream is a local anesthetic. The pharmacokinetics and dermal effects of a topical anesthetic formulation has not been evaluated in healthy Chinese volunteers. MATERIALS AND METHODS The Pharmacokinetics of the lidocaine/prilocaine test (T) or reference (R, EMLA) cream were evaluated in a fasting, single-dose, two-period crossover bioequivalent study conducted in 40 healthy Chinese volunteers. Meanwhile, the dermal effects including blanching, erythema, temperature sensation, edema, and skin rash were also evaluated during the study. RESULTS After applied 15 g of the cream for 4 h to a 100 cm2 area under plastic occlusive film on the skin of the thigh of healthy volunteers, the results of the pharmacokinetic study showed that the active components absorbed in skin from topical products was relatively low compared with most system absorption drugs. After the removal of the residual anesthetic cream, there was a vascular biphasic response with initial transient blanching which reaches a peak at 4.5 h and later more persisting period erythema. The change of temperature sensory sensitivity reached the peak value at 4.5-6 h.There was no statistically significant difference of the changes after application the lidocaine/prilocaine T or R cream in subjects. In general, the lidocaine/prilocaine T or R cream was well tolerated. CONCLUSION The method described a model for investigations of pharmacokinetics and pharmacodynamics of topical lidocaine/prilocaine cream. Except the plasma drug level indicator, these pharmacodynamics data should also be evaluated in the anesthetic transdermal pharmacokinetics study. CLINICAL TRIAL REGISTRATION CTR20211544; registered in http://www.chinadrugtrials.org.cn/ at September 2021.
Collapse
Affiliation(s)
- Lingjun Li
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, Jiangsu, China.
| | - Baole Cai
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Hongyang Li
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Jun Wei
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Lei Tao
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| | - Pengcheng Ma
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, 210042, Jiangsu, China
| |
Collapse
|
4
|
Bajwa MS, Bashir MM, Bajwa MH, Iqbal Z, Salahuddin MA, Hussain A, Shahzad F. How long to wait after local infiltration anaesthesia: systematic review. BJS Open 2023; 7:zrad089. [PMID: 37768699 PMCID: PMC10538258 DOI: 10.1093/bjsopen/zrad089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/27/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Conflicting evidence exists regarding the optimal waiting time for stable analgesic and vasoconstrictive effects after local infiltration of lidocaine with epinephrine. An objective review is needed to dispel surgical dogma. METHODS This systematic review (PROSPERO ID: CRD42022362414) included RCTs and prospective cohort studies. Primary outcomes were (1) onset of analgesia and (2) onset of stable hypoperfusion, assessed directly, or measured indirectly using perfusion imaging. Other data extracted include waiting strategies, means of outcome assessment, anaesthetic concentrations, volume/endpoint of infiltration, and injection sites. Methodological quality was evaluated using the Cochrane risk-of-bias tool for randomized trials. Articles describing waiting strategies were critically appraised by the Joanna Briggs Institute tools. RESULTS Twenty-four articles were analysed, comprising 1013 participants. Ten investigated analgesia onset. Their pooled mean was 2.1 min (range 0.4-9.0 min). This varied with anatomic site and targeted nerve diameter. Fourteen articles investigated onset of stable hypoperfusion. Four observed bleeding intraoperatively, finding the minimum time to hypoperfusion at 7.0 min in the eyelid skin and 25.0 min in the upper limb. The ten remaining studies used perfusion imaging, reporting a wide range of results (0.0-30.0 min) due to differences in anatomic sites and depth, resolution and artefacts. Studies using near-infrared reflectance spectroscopy and hyperspectral imaging correlated with clinical observations. Thirteen articles discussed waiting strategies, seven relating to large-volume tumescent local infiltration anaesthesia. Different waiting strategies exist for emergency, arthroscopic and cosmetic surgeries, according to the degree of hypoperfusion required. In tumescent liposuction, waiting 10.0-60.0 min is the norm. CONCLUSION Current literature suggests that around 2 min are required for most patients to achieve complete analgesia in all sites and with all anaesthesia concentrations. Waiting around 7 min in eyelids and at least 25 min in other regions results in optimal hypoperfusion. The strategies discussed inform decisions of when and how long to wait.
Collapse
Affiliation(s)
- Mohammad Suleman Bajwa
- Department of Plastic & Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
- Department of Surgery, Montefiore Medical Center, New York, USA
| | - Muhammad Mustehsan Bashir
- Department of Plastic & Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | | | - Zafar Iqbal
- Department of Plastic & Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Aizaz Salahuddin
- Department of Plastic & Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Ahmad Hussain
- Department of Plastic & Reconstructive Surgery/Mayo Burn Centre, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Farooq Shahzad
- Plastic & Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
5
|
Gur A, Tekin E. 10% Lidocaine spray as a local anesthetic in blood gas sampling: A randomized, double-blind, placebo-controlled study. Am J Emerg Med 2021; 49:89-93. [PMID: 34098331 DOI: 10.1016/j.ajem.2021.05.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022] Open
Abstract
AIM Radial artery blood gas sampling is a very common procedure undertaken in the emergency department to evaluate respiratory and metabolic parameters. This intervention causes both anxiety and pain for the patient. Therefore, the current study aimed to examine the analgesic efficacy of lidocaine spray compared to a placebo during radial artery blood gas sampling. METHODS This study was conducted in the emergency department of a tertiary hospital with a randomized, double-blind, placebo-controlled design. A total of 144 patients were randomly divided into two groups: One group (n = 72) received 10% lidocaine spray and the other (n = 72) was the placebo group. The analgesic efficacy of the 10% lidocaine spray was compared with the placebo group using the Visual Analog Scale (VAS). RESULTS In the evaluation of the analgesic efficacy of the 10% lidocaine spray, the VAS score was 1.5 [interquartile range (IQR): 2.0] for the lidocaine group and 5 (IQR: 2.0) for the placebo group. The role of lidocaine spray in reducing pain was statistically significant compared to the placebo (p = 0.000). CONCLUSION In blood gas sampling, 10% lidocaine spray has analgesic efficacy. Therefore, we recommend the use of lidocaine spray while performing arterial blood gas sampling in emergency departments.
Collapse
Affiliation(s)
- Ali Gur
- Ataturk University School of Medicine, Clinical Research, Development and Design Application and Research Center, Erzurum, Turkey; Department of Emergency, School of Medicine, Ataturk University, Erzurum, Turkey.
| | - Erdal Tekin
- Department of Emergency, School of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
6
|
Use of nociceptive threshold testing in cats in experimental and clinical settings: a qualitative review. Vet Anaesth Analg 2020; 47:419-436. [PMID: 32507715 DOI: 10.1016/j.vaa.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/22/2019] [Accepted: 12/31/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of this study was to review the scientific articles on the use of nociceptive threshold testing (NTT) in cats and to summarize the clinical and experimental applications in this species. DATABASES USED Pertinent literature was searched with PubMed, Scopus, Web of Science, Universitätsbibliothek Basel (swissbib Basel Bern) and Google Scholar. The search was then refined manually based first on article titles and abstracts, and subsequently on full texts. CONCLUSIONS Of the four classical acute nociceptive models used for NTT, thermal and mechanical are most commonly used in cats. Thermal stimulation is applicable in experimental settings and has been used in pharmacodynamics studies assessing feline antinociception. Although mechanical stimulation is currently less used in cats, in the future it might play a role in the evaluation of clinical feline pain. However, the low response reliability after stimulus repetition within a narrow time interval represents a major limitation for the clinical use of mechanical thresholds in this species. Challenges remain when thermal thresholds are used to investigate analgesics that have the potential to affect skin temperature, such as opioids and α2-adrenergic agonists, and when a model of inflammatory pain is reproduced in experimental cats with the purpose of evaluating non-steroidal anti-inflammatory drugs as analgesics.
Collapse
|
7
|
Costa YM, Ferreira DMAO, Conti PCR, Baad‐Hansen L, Svensson P, Bonjardim LR. Topical anaesthesia degree is reduced in temporomandibular disorders patients: A novel approach to assess underlying mechanisms of the somatosensory alterations. J Oral Rehabil 2019; 47:113-122. [DOI: 10.1111/joor.12874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Yuri Martins Costa
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| | - Dyna Mara A. O. Ferreira
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Paulo César R. Conti
- Bauru Orofacial Pain Group Bauru Brazil
- Department of Prosthodontics Bauru School of Dentistry University of Sao Paulo Bauru Brazil
| | - Lene Baad‐Hansen
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
| | - Peter Svensson
- Scandinavian Center for Orofacial Neurosciences (SCON) Aarhus Denmark
- Section of Orofacial Pain and Jaw Function Department of Dentistry and Oral Health Aarhus University Aarhus Denmark
- Department of Dental Medicine Karolinska Institutet Huddinge Sweden
| | - Leonardo R. Bonjardim
- Section of Head and Face Physiology Department of Biological Sciences Bauru School of Dentistry University of Sao Paulo Bauru Brazil
- Bauru Orofacial Pain Group Bauru Brazil
| |
Collapse
|
8
|
Okayasu I, Komiyama O, Ayuse T, De Laat A. Effect of 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands evaluated by quantitative sensory testing. J Dent Anesth Pain Med 2018; 18:361-365. [PMID: 30637346 PMCID: PMC6323040 DOI: 10.17245/jdapm.2018.18.6.361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/01/2022] Open
Abstract
Background Recently, we examined the effects of 2% lidocaine gel on the tactile sensory and pain thresholds of the face, tongue and hands of symptom-free individuals using quantitative sensory testing (QST); its effect was less on the skin of the face and hands than on the tongue. Consequently, instead of 2% lidocaine gel, we examined the effect of 8% lidocaine spray on the tactile sensory and pain thresholds of the skin of the face and hands of healthy volunteers. Methods Using Semmes-Weinstein monofilaments, QST of the skin of the cheek and palm (thenar skin) was performed in 20 healthy volunteers. In each participant, two topical sprays were applied. On one side, 0.2 mL of 8% lidocaine pump spray was applied, and on the other side, 0.2 mL of saline pump spray was applied as control. In each participant, QST was performed before and 15 min after each application. Pain intensity was measured using a numeric rating scale (NRS). Results Both the tactile detection threshold and filament-prick pain detection threshold of the cheek and thenar skin increased significantly after lidocaine application. A significant difference between the effect of lidocaine and saline applications was found on the filament-prick pain detection threshold only. NRS of the cheek skin and thenar skin decreased after application of lidocaine, and not after application of saline. Conclusion The significant effect of applying an 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands can be objectively scored using QST.
Collapse
Affiliation(s)
- Ichiro Okayasu
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Japan
| | - Takao Ayuse
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Antoon De Laat
- Department of Oral Health Sciences, KU Leuven, Belgium.,Department of Dentistry, University Hospital Leuven, Belgium
| |
Collapse
|
9
|
Luh JJ, Huang WT, Lin KH, Huang YY, Kuo PL, Chen WS. Effects of Extracorporeal Shock Wave-Mediated Transdermal Local Anesthetic Drug Delivery on Rat Caudal Nerves. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:214-222. [PMID: 29107354 DOI: 10.1016/j.ultrasmedbio.2017.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Cavitation plays a substantial role in the clinical effects of extracorporeal shock wave therapy (ESWT). It is also generally accepted as a major mechanism in sonophoresis. To identify the enhancing effect of extracorporeal shock wave-mediated transdermal drug delivery, 24 Wistar rats were randomly assigned to four groups: (i) topical application of a eutectic mixture of local anesthetics (EMLA); (ii) 1-MHz ultrasound; (iii) ESWT pre-treatment combined with EMLA application; (iv) ESWT concurrent with EMLA application on rat tails. The degree of anesthesia was assessed using the amplitude and latency of sensory nerve action potentials within 5 min after a 60-min EMLA application. The results indicated that ESWT pre-treatment and concurrent ESWT accelerated the anesthetic effects of the EMLA cream on the tail nerve (p < 0.05). This finding might indicate that shock wave-mediated transdermal drug delivery is possible during the ESWT period.
Collapse
Affiliation(s)
- Jer-Junn Luh
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC
| | - Wan-Ting Huang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Medicine & Rehabilitation, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Kwan-Hwa Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC; Department of Physical Therapy, Tzu Chi University, Hualien City, Taiwan, ROC
| | - Yi-You Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan, ROC
| | - Po-Ling Kuo
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC; Department of Electrical Engineering, National Taiwan University, Taipei City, Taiwan, ROC
| | - Wen-Shiang Chen
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei City, Taiwan, ROC.
| |
Collapse
|
10
|
Abdulatif M, Fawzy M, Nassar H, Hasanin A, Ollaek M, Mohamed H. The effects of perineural dexmedetomidine on the pharmacodynamic profile of femoral nerve block: a dose-finding randomised, controlled, double-blind study. Anaesthesia 2016; 71:1177-85. [DOI: 10.1111/anae.13603] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 12/18/2022]
Affiliation(s)
- M. Abdulatif
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - M. Fawzy
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - H. Nassar
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - A. Hasanin
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - M. Ollaek
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| | - H. Mohamed
- Anaesthetic Department; Faculty of Medicine; Cairo University; Cairo Egypt
| |
Collapse
|
11
|
Okayasu I, Komiyama O, Ayuse T, De Laat A. Effect of topical lidocaine in the oral and facial regions on tactile sensory and pain thresholds. Arch Oral Biol 2016; 72:51-55. [PMID: 27541635 DOI: 10.1016/j.archoralbio.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 07/27/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the effect of lidocaine application to the face, tongue and hand on sensory and pain thresholds of symptom-free subjects. DESIGN Eighteen females (mean age 25.7 years, range 22-38) participated. Using Semmes-Weinstein monofilaments, the tactile detection threshold (TDT) and the filament-prick pain detection threshold (FPT) were measured on the cheek skin (CS), tongue tip (TT) and palm side of the thenar skin (TS). Subjects were tested in 2 sessions at a 1week interval in randomised order. Lidocaine (session A) or placebo gel (session B) was applied for 5min. The TDT and FPT were measured before and after application. RESULTS The TDT at all sites in session A significantly increased after 5min, but a significant session effect on the TDT was only found at the TT (P<0.01). On the other hand, there were significant session effects on the FPT at all sites (P<0.01). CONCLUSION These results indicate that the pain threshold (FPT) is more susceptible to local anesthetics than the sensory threshold (TDT), but further study is needed to use topical lidocaine for the control of oral and facial pain in the clinic.
Collapse
Affiliation(s)
- Ichiro Okayasu
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan.
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation, Nihon University School of Dentistry at Matsudo, Japan
| | - Takao Ayuse
- Department of Clinical Physiology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Antoon De Laat
- Department of Oral Health Sciences, KU Leuven, Belgium; Department of Dentistry, University Hospital Leuven, Belgium
| |
Collapse
|
12
|
Said Yekta-Michael S, Stein JM, Marioth-Wirtz E. Evaluation of the anesthetic effect of epinephrine-free articaine and mepivacaine through quantitative sensory testing. Head Face Med 2015; 11:2. [PMID: 25889698 PMCID: PMC4340117 DOI: 10.1186/s13005-015-0061-1] [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: 06/19/2014] [Accepted: 01/21/2015] [Indexed: 11/13/2022] Open
Abstract
Introduction Long lasting anesthesia of the soft tissue beyond the dental treatment affects patients in daily routine. Therefore a sophisticated local anesthesia is needed. The purpose of this study was an evaluation of the clinical use of epinephrine-free local anesthetic solutions in routine short-time dental treatments. Materials and methods In a prospective, single-blind, non-randomized and controlled clinical trial, 31 patients (16 male, 15 female patients) undergoing short-time dental treatment under local anesthesia (plain solutions of articaine 4% and mepivacaine 3%) in area of maxillary canine were tested with quantitative sensory testing QST. Paired-Wilcoxon-testing (signed-rank-test) and Mc Nemar tests have been used for statistical results. Results Significant differences in all tested parameters to the time of measurements were found. Mepivacaine showed a significantly stronger impact for the whole period of measurement (128 min) on thermal and mechanical test parameters and to the associated nerve fibers. Conclusion Plain articaine shows a faster onset of action associated with a shorter time of activity in comparison to plain mepivacaine. In addition to this articaine shows a significant low-graded effect on the tested nerve-fibers and therefore a least affected anesthesia to the patient. The clinical use of an epinephrine-free anesthetic solution can be stated as possible option in short dental routine treatments to the frequently used vasoconstrictor containing local anesthetics. Patients may benefit from shorter numbness.
Collapse
Affiliation(s)
- Sareh Said Yekta-Michael
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Aachen University, Aachen, North Rhine-Westphalia, Germany. .,Interdisciplinary Center for Clinical Research, RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany.
| | - Jamal M Stein
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Aachen University, Aachen, North Rhine-Westphalia, Germany.
| | - Ernst Marioth-Wirtz
- Interdisciplinary Center for Clinical Research, RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany.
| |
Collapse
|
13
|
Tsui BCH, Shakespeare TJ, Leung DH, Tsui JH, Corry GN. Reproducibility of current perception threshold with the Neurometer(®) vs the Stimpod NMS450 peripheral nerve stimulator in healthy volunteers: an observational study. Can J Anaesth 2013; 60:753-60. [PMID: 23690134 DOI: 10.1007/s12630-013-9965-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 05/02/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Current methods of assessing nerve blocks, such as loss of perception to cold sensation, are subjective at best. Transcutaneous nerve stimulation is an alternative method that has previously been used to measure the current perception threshold (CPT) in individuals with neuropathic conditions, and various devices to measure CPT are commercially available. Nevertheless, the device must provide reproducible results to be used as an objective tool for assessing nerve blocks. METHODS We recruited ten healthy volunteers to examine CPT reproducibility using the Neurometer(®) and the Stimpod NMS450 peripheral nerve stimulator. Each subject's CPT was determined for the median (second digit) and ulnar (fifth digit) nerve sensory distributions on both hands - with the Neurometer at 5 Hz, 250 Hz, and 2000 Hz and with the Stimpod at pulse widths of 0.1 msec, 0.3 msec, 0.5 msec, and 1.0 msec, both at 5 Hz and 2 Hz. Intraclass correlation coefficients (ICC) were also calculated to assess reproducibility; acceptable ICCs were defined as ≥ 0.4. RESULTS The ICC values for the Stimpod ranged from 0.425-0.79, depending on pulse width, digit, and stimulation; ICCs for the Neurometer were 0.615 and 0.735 at 250 and 2,000 Hz, respectively. These values were considered acceptable; however, the Neurometer performed less efficiently at 5 Hz (ICCs for the second and fifth digits were 0.292 and 0.318, respectively). CONCLUSION Overall, the Stimpod device displayed good to excellent reproducibility in measuring CPT in healthy volunteers. The Neurometer displayed poor reproducibility at low frequency (5 Hz). These results suggest that peripheral nerve stimulators may be potential devices for measuring CPT to assess nerve blocks.
Collapse
Affiliation(s)
- Ban C H Tsui
- Department of Anesthesiology and Pain Medicine, University of Alberta, 8-120 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada.
| | | | | | | | | |
Collapse
|
14
|
A novel approach of analyzing characteristics of sensory nerve fibers. Scand J Pain 2013; 4:93-94. [DOI: 10.1016/j.sjpain.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
15
|
Krumova EK, Zeller M, Westermann A, Maier C. Lidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers. Pain 2011; 153:273-280. [PMID: 21995882 DOI: 10.1016/j.pain.2011.08.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 07/19/2011] [Accepted: 08/18/2011] [Indexed: 11/26/2022]
Abstract
Topical lidocaine (5%) leads to sufficient pain relief in only 29%-80% of treated patients, presumably by small-fiber block. The reasons for nonresponse are unclear; it may be due to different underlying pain mechanisms or partly insufficient anesthetic effect. Using quantitative sensory testing (QST) following the protocol of the DFNS (German Research Network on Neuropathic Pain), this study aims to assess the type and extent of somatosensory changes after lidocaine application in healthy volunteers. Twenty-six healthy volunteers underwent QST on the volar forearm, including thermal and mechanical detection and pain thresholds, twice before (for baseline retest reliability) and once after 6-hour simultaneous application with lidocaine patch 5% and contralateral placebo in a double-blinded manner. Pre and post differences of QST parameters were analyzed by paired t-test (Bonferroni-corrected alpha 0.0023). QST profiles did not change between the 2 baseline measurements and after the placebo application. Lidocaine application led to a significant change of only the small-fiber-associated thresholds (increase of thermal detection and mechanical pain thresholds, decrease of mechanical pain sensitivity). Tactile detection thresholds representing Aβ function remained unchanged. Interindividually, the extent of the small-fiber block varied widely (eg, thermal detection thresholds: in 54% of the subjects there were only minimal changes; in only 8% were there changes of >60% of the maximal achievable value). Topical lidocaine (5%) induces thermal hypoesthesia and pinprick hypoalgesia, suggesting an isolated but only partial block of Aδ and C fibers of unpredictable extent. Further studies must analyze the influencing factors and determine whether patients with poor analgesic effect, in particular, are those with insufficient small-fiber block.
Collapse
Affiliation(s)
- Elena K Krumova
- Department of Pain Management, BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany
| | | | | | | |
Collapse
|
16
|
Otsuru N, Inui K, Yamashiro K, Miyazaki T, Takeshima Y, Kakigi R. Assessing Aδ Fiber Function With Lidocaine Using Intraepidermal Electrical Stimulation. THE JOURNAL OF PAIN 2010; 11:621-7. [DOI: 10.1016/j.jpain.2009.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 07/09/2009] [Accepted: 10/02/2009] [Indexed: 10/20/2022]
|
17
|
Kanai A, Suzuki A, Okamoto H. Comparison of Cutaneous Anesthetic Effect of 8% Lidocaine Spray with Lidocaine Patch Using Current Perception Threshold Test. PAIN MEDICINE 2010; 11:472-5. [DOI: 10.1111/j.1526-4637.2009.00790.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
18
|
Developing biologically-based assessment tools for physical therapy management of neck pain. J Orthop Sports Phys Ther 2009; 39:388-99. [PMID: 19521014 DOI: 10.2519/jospt.2009.3126] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SYNOPSIS Neck pain is a common and episodic condition that is treated using a spectrum of interventions known to be moderately effective but is associated with a significant incidence of chronic pain. Recently, there has been increased focus on defining biological aspects of neck pain. Studies have indicated that neurophysiological, biomechanical, and motor control abnormalities are present and may be useful either in prognosis or classification. We review some of these findings in the context of our own work defining biological markers that may form the basis for clinical tests that can be used for prognosis, classification, or outcome evaluation in patients with neck pain. We have identified abnormalities in neurophysiology using quantitative sensory testing (vibration, touch, and current perception) and response to cold provocation that are related to neck disability. We have identified altered muscle biochemistry by measuring circulating muscle proteins in a lumbar surgery model and are now applying those methods to whiplash injury. We have incorporated capnography into treatment to address central physiological changes present in some patients by monitoring and training CO2 levels. We have developed an innovative new test, the Neck Walk Index, that captures abnormal control of head movement during slow gait as a means of differentiating patients with neck pain from either unaffected controls or individuals with other pathologies. We have used time-varying 3-dimensional joint orientation kinematics to assess deficits in motor control during an upper extremity reach task, the results showing that poor coordination and control of the shoulder girdle leads to shoulder guarding and inconsistencies in elbow joint movement. Despite some promising early results, future research is needed to determine how these measures help clinicians to diagnose, evaluate, and forecast future outcome for patients who present with neck pain. LEVEL OF EVIDENCE Diagnosis, level 5.
Collapse
|
19
|
Adhesiolysis and targeted steroid/local anesthetic injection during epiduroscopy alleviates pain and reduces sensory nerve dysfunction in patients with chronic sciatica. J Anesth 2008; 22:242-7. [PMID: 18685930 DOI: 10.1007/s00540-008-0616-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 02/08/2008] [Indexed: 10/21/2022]
|
20
|
Abouassaly R, Liu G, Yamada Y, Ukimura O, Daneshgari F. Efficacy of a novel device for assessment of autonomic sensory function in the rat bladder. J Urol 2008; 179:1167-72. [PMID: 18206176 DOI: 10.1016/j.juro.2007.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE We developed and tested the efficacy of an implantable bladder device which, when combined with the Neurometer, can be used to assess fiber specific afferent bladder sensation in the rat. MATERIALS AND METHODS We developed an implantable bladder device that applies selective nerve fiber stimuli (250 Hz for small myelinated Adelta fibers and 5 Hz for unmyelinated C fibers) to the bladder mucosa in the rat to determine bladder sensory perception threshold values. We performed 3 experiments in 55 female Sprague-Dawley rats to examine the effects of our device on voiding habits, assess the interobserver reliability of the sensory perception threshold and determine the effects of intravesical administration of resiniferatoxin (Sigma) and lidocaine on the sensory perception threshold. RESULTS Sensory perception threshold values obtained by 2 blinded, independent observers were not different from each other (p = 0.41). Sensory perception threshold values obtained at the 2 stimulation frequencies remained constant for at least 3 weeks after device implantation. A significant increase in sensory perception threshold values after resiniferatoxin instillation was noted at a stimulus frequency of 5 Hz (p = 0.02), whereas intravesical lidocaine led to an immediate increase in the sensory perception threshold at 250 and 5 Hz. Device implantation led to an early decreased voided volume and increased frequency of voids, although these parameters returned to normal after 4 days. CONCLUSIONS Assessment of bladder afferent sensation with our newly developed device is feasible in rats. It provides sensory perception thresholds that appear to be fiber-type selective for autonomic bladder afferent nerves.
Collapse
Affiliation(s)
- Robert Abouassaly
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | |
Collapse
|
21
|
Kim YJ, Jung MH, Choi YR, Park HJ, Won RS, Lee JY, Jung JK. The Analgesic Efficacy of a 5% Eutectic Mixture of Lidocaine and Prilocaine Prior to Insertion of Spinal and Epidural Block. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.54.4.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yeon Jae Kim
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Mi Hwa Jung
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Young Ryong Choi
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Hue Jung Park
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Rim Soo Won
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jin Kyung Jung
- Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Ayesh EE, Ernberg M, Svensson P. Effects of local anesthetics on somatosensory function in the temporomandibular joint area. Exp Brain Res 2007; 180:715-25. [PMID: 17588187 DOI: 10.1007/s00221-007-0893-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
Abstract
There is a need for systematic studies regarding the pathophysiology and pain mechanisms of somatosensory function in the temporomandibular joint (TMJ). So far, the effects on somatosensory functions of local anesthetics (LA) applied to the auriculotemporal (AT) nerve or intraarticularly (IA) into the TMJ have not been studied systemically. This study aimed to examine in a double-blinded, placebo-controlled manner the effects of LA on mechanical and thermal sensitivity in the TMJ area. Twenty-eight healthy subjects (27.4 +/- 6.2 years) without temporomandibular disorders (TMD) participated. The subjects received an AT nerve block (n = 14) or an IA injection (n = 14) with LA (Bupivacaine, 2.5 mg/ml) on one side, and a placebo injection (isotonic saline) on the contralateral side. Mechanical (tactile and pin-prick) and thermal sensitivity (40 and 5 degrees C) were assessed at 11 standardized points in the TMJ area before injections (baseline) as well as 30 min, 1 and 2 h after injections. All stimuli were rated by the subjects on a 0-100 numerical rating scale (NRS). TMJ pressure pain threshold (PPT) and pressure pain tolerance (PPTOL) were assessed laterally over both TMJs using an algometer. IA injections with LA were not associated with any changes in sensitivity of the TMJ or surrounding area. In contrast, AT nerve blocks with LA caused a decrease over time in the pin-prick sensitivity (P = 0.016), which however, did not differ significantly from saline, and an increase of the PPTs 30 min (P = 0.010) and PPTOLs 30 min, 1 h and 2 h (P < 0.05) after LA injections in comparison to saline. No other measures showed a significant change after the injections. Our results showed that IA bupivacaine injection in healthy subjects has no effect on the sensitivity of the TMJ or surrounding area, while AT nerve block has a more pronounced effect on deep mechanical, but not on superficial mechanical or thermal sensitivity. Further research to investigate the effect of LA on somatosensory functions in TMJ patients in comparison with this study results will give valuable information about the sensitivity in the TMJ area.
Collapse
Affiliation(s)
- Emad E Ayesh
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
| | | | | |
Collapse
|
23
|
Sakai T, Tomiyasu S, Yamada H, Sumikawa K. Evaluation of Allodynia and Pain Associated With Postherpetic Neuralgia Using Current Perception Threshold Testing. Clin J Pain 2006; 22:359-62. [PMID: 16691089 DOI: 10.1097/01.ajp.0000178222.85636.00] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postherpetic neuralgia has various clinical features, and the implicated pathophysiologic mechanisms are controversial. This study was carried out to clarify the roles of peripheral sensory nerves in the production of allodynia and ongoing pain. Current perception threshold (CPT) testing was used to evaluate the sensory function. METHODS The intensities of ongoing pain and dynamic allodynia were assessed using a numeric rating scale (0-10). Assessment of sensory nerve function was performed by a series of 2,000-, 250-, and 5-Hz stimuli using CPT testing. These measurements were made in ipsilateral and contralateral area. RESULTS CPTs at all frequencies in the ipsilateral area were significantly higher than those in the contralateral area. There were significant and inverse correlations between the intensity of allodynia and CPTs at all frequencies. No correlation was found between the intensity of ongoing pain and CPTs at any frequency. There was no correlation between the intensity of ongoing pain and the intensity of dynamic allodynia. CONCLUSIONS The intensity of dynamic allodynia in postherpetic neuralgia correlates with the preserved functions of Abeta, Adelta, and C fibers. In contrast, the intensity of ongoing pain does not correlate with either the preserved function of C fibers or the intensity of dynamic allodynia. Therefore, it is suggested that postherpetic neuralgia might be a pain syndrome including both peripheral and central mechanisms.
Collapse
Affiliation(s)
- Tetsuya Sakai
- Department of Anesthesiology, Nagasaki University School of Medicine, Nagasaki, Japan.
| | | | | | | |
Collapse
|
24
|
Kushikata N, Negishi K, Tezuka Y, Takeuchi K, Wakamatsu S. Is topical anesthesia useful in noninvasive skin tightening using radiofrequency? Dermatol Surg 2005; 31:526-33. [PMID: 15962735 DOI: 10.1111/j.1524-4725.2005.31155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The radiofrequency (RF) system has been applied to Asian skin for noninvasive skin tightening. The only drawback is the pain during the treatment. OBJECTIVE The relationships between the effectiveness of a topical anesthetic at various RF levels and the respective treatment results were compared and assessed after 3 months. SUBJECTS AND METHODS Eighty-four females, ranging in age from 30 to 60 years, were divided into three groups of 28 subjects each. In all groups, the entire bilateral cheeks were treated. Group A underwent RF treatment (ThermaCool TC, Thermage, Hayward, CA, USA) with topical anesthesia and group B without anesthesia, and in group C, half of the face was treated with anesthesia and the other half was not. The degree of pain was recorded. Digital photographs of the patients pre- and post-treatment were objectively assessed by double-blinded physicians. Subjective assessment was performed with questionnaires. RESULTS The average treatment levels for groups A and B were 14.13 and 14.02, respectively. Although anesthesia was useful for pain reduction, it did not allow a significant energy upgrade. In group C, 8 (28.6%) patients showed a statistically insignificant difference in the treatment levels, but not in the results, between the anesthetized and the unanesthetized sides. CONCLUSIONS The use of anesthesia did not affect the final efficacy of the treatment compared with no anesthesia.
Collapse
Affiliation(s)
- Nobuharu Kushikata
- Department of Aesthetic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | | | | | | | | |
Collapse
|
25
|
Liem EB, Joiner TV, Tsueda K, Sessler DI. Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads. Anesthesiology 2005; 102:509-14. [PMID: 15731586 PMCID: PMC1692342 DOI: 10.1097/00000542-200503000-00006] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anesthetic requirement in redheads is exaggerated, suggesting that redheads may be especially sensitive to pain. Therefore, the authors tested the hypotheses that women with natural red hair are more sensitive to pain and that redheads are resistant to topical and subcutaneous lidocaine. METHODS The authors evaluated pain sensitivity in red-haired (n = 30) or dark-haired (n = 30) women by determining the electrical current perception threshold, pain perception, and maximum pain tolerance with a Neurometer CPT/C (Neurotron, Inc., Baltimore, MD). They evaluated the analogous warm and cold temperature thresholds with the TSA-II Neurosensory Analyzer (Medoc Ltd., Minneapolis, MN). Volunteers were tested with both devices at baseline and with the Neurometer after 1-h exposure to 4% liposomal lidocaine and after subcutaneous injection of 1% lidocaine. Data are presented as medians (interquartile ranges). RESULTS Current perception, pain perception, and pain tolerance thresholds were similar in the red-haired and dark-haired women at 2,000, 250, and 5 Hz. In contrast, redheads were more sensitive to cold pain perception (22.6 [15.1-26.1] vs. 12.6 [0-20] degrees C; P = 0.004), cold pain tolerance (6.0 [0-9.7] vs. 0.0 [0.0-2.0] degrees C; P = 0.001), and heat pain (46.3 [45.7-47.5] vs. 47.7 [46.6-48.7] degrees C; P = 0.009). Subcutaneous lidocaine was significantly less effective in redheads (e.g., pain tolerance threshold at 2,000-Hz stimulation in redheads was 11.0 [8.5-16.5] vs. > 20.0 (14.5 to > 20) mA in others; P = 0.005). CONCLUSION Red hair is the phenotype for mutations of the melanocortin-1 receptor. Results indicate that redheads are more sensitive to thermal pain and are resistant to the analgesic effects of subcutaneous lidocaine. Mutations of the melanocortin-1 receptor, or a consequence thereof, thus modulate pain sensitivity.
Collapse
Affiliation(s)
- Edwin B. Liem
- Assistant Professor, Outcomes Research™ Institute and Department of Anesthesiology and Perioperative Medicine, University of Louisville
| | - Teresa V. Joiner
- Research Coordinator, Outcomes Research™ Institute, University of Louisville
| | - Kentaro Tsueda
- Deceased; formerly Associate Professor, Department of Anesthesiology and Perioperative Medicine, University of Louisville
| | - Daniel I. Sessler
- Vice Dean for Research and Associate Vice President for Health Affairs; Director Outcomes Research™ Institute; Lolita & Samuel Weakley Distinguished University Research Chair; and Interim Chair and Professor of Anesthesiology, University of Louisville
| |
Collapse
|