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Faris N, Mesto M, Mrad S, El Kebbi O, Asi N, Sawaya RD. Applying Topical Anesthetic on Pediatric Lacerations in the Emergency Department: A Quality Improvement Project. Pediatr Emerg Care 2024; 40:175-179. [PMID: 37616570 DOI: 10.1097/pec.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Caring for pediatric lacerations in the emergency department (ED) is typically painful because of irrigation and suturing. To improve this painful experience, we aimed to increase the use of a topical anesthetic, Eutectic Mixture of Local Anesthetics (EMLA) on eligible pediatric lacerations with an attainable, sustainable, and measurable goal of 60%. The baseline rate of applying topical anesthetic to eligible lacerations was 23% in our ED. We aimed to increase the use of topical anesthetics on eligible pediatric lacerations to a measurable goal of 60% within 3 months of implementing our intervention. METHODS We conducted a prospective, single-center, interrupted time series, ED quality improvement project from November 2019 to July 2020. A multidisciplinary team of physicians and nurses performed a cause-and-effect analysis identifying 2 key drivers: early placement of EMLA and physician buy-in on which we built our Plan, Do, Study, and Act (PDSA) cycles. We collected data on number of eligible patients receiving EMLA, as well as patient and physician feedback via phone calls within 2 days after encounter. Balancing measures included ED length of stay (LOS), patient and physician satisfaction with EMLA, and adverse effects of EMLA. RESULTS We needed 3 PDSA cycles to reach our goal of 60% in 3 months, which was also maintained for 5 months. The PDSA cycles used educational interventions, direct provider feedback about noncompliance, and patient satisfaction results obtained via phone calls. Balancing measures were minimally impacted: 75% good patient satisfaction, no adverse events but an increase in LOS of patients who received EMLA compared with those who did not (1.79 ± 0.66 vs 1.41 ± 0.83 hours, P < 0.001). The main reasons for dissatisfaction for physicians were the increased LOS and the preference for procedural sedation or intranasal medications. CONCLUSIONS With a few simple interventions, our aim of applying EMLA to 60% of eligible pediatric lacerations was attained and maintained.
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Affiliation(s)
- Nagham Faris
- From the Department of Emergency Medicine, The American University of Beirut, Beirut, Lebanon
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Caliskan N, Yildirim G, Bologur H, Gungor H, Karaca Sahin M, Erbay F, Kokcu Karadag Sİ, Ozceker D. Local anesthetics allergy in children: Evaluation of diagnostic tests with Real-Life data. Pediatr Allergy Immunol 2024; 35:e14097. [PMID: 38404118 DOI: 10.1111/pai.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Local anesthetic (LA) drugs are commonly used in clinical practice to provide effective analgesia, including in dentistry and minor surgical procedures. The perception of a high risk of allergy in daily applications leads to the referral of atopic patients and those with other drug allergies to allergy clinics for the evaluation of allergic reactions to LA. The aim of this study was to determine who should be referred to the allergy clinic for LA allergy testing, assess the frequency of LA allergy in pediatric patients, and identify the negative predictive value of skin tests in diagnosis. METHODS January 2017-July 2023, the clinical and laboratory data, as well as the results of drug allergy tests, of patients referred to our pediatric allergy clinic by dentists and physicians performing minor surgical procedures with suspected LA allergy were retrospectively evaluated. RESULTS Our study included a total of 153 patients, comprising 84 girls (54.9%) and 69 boys (45.1%), with a mean age of 8.9 (±3.3) years. The most common reason for referral was a history of non-LA drug allergies (n = 66, 43.2%), followed by asthma (n = 25, 16.3%). Hypersensitivity reactions (HRs) with LA were most commonly associated with articaine (n = 7, 4.8%), followed by lidocaine (n = 6, 4.1%). When intradermal tests were evaluated, 17 patients (11.1%) had a positive test result. The positivity for lidocaine was 70.6% (n = 12), and prilocaine was 29.4% (n = 5). Subcutaneous provocation was administered to 109 patients (71.2%), and one patient exhibited local erythema and swelling with prilocaine. CONCLUSION Although LA allergy is a rare occurrence, consultations of this nature are frequently requested from allergy clinics in real life. Considering the negative predictive value of skin tests performed with LA drugs, the reaction rate appears to be low in patients with atopy or other drug allergies. It is crucial for all relevant healthcare professionals to be knowledgeable about the appropriate approach to suspected LA allergies to avoid unnecessary tests. To the best of our knowledge, our study is the most comprehensive work in the literature that evaluates the results of diagnostic tests in children referred with a suspicion of LA allergy.
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Affiliation(s)
- Nilay Caliskan
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Guler Yildirim
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Hamit Bologur
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Hilal Gungor
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Merve Karaca Sahin
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Fatih Erbay
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | | | - Deniz Ozceker
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
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Gautier N, Lejeune D, Al Zein L, Kesteloot C, Ciccarella Y, Brichant JF, Bouvet L, Cops J, Hadzic A, Gautier PE. The effects of intrathecal morphine on urinary bladder function and recovery in patients having a cesarean delivery - A randomized clinical trial. Anaesth Crit Care Pain Med 2023; 42:101269. [PMID: 37364852 DOI: 10.1016/j.accpm.2023.101269] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Spinal anesthesia with intrathecal morphine (ITM) is a common anesthesia technique for cesarean delivery. The hypothesis was that the addition of ITM will delay micturition in women undergoing cesarean delivery. METHODS Fifty-six ASA physical status I and II women scheduled to undergo elective cesarean delivery under spinal anesthesia were randomized to the PSM group (50 mg prilocaine + 2.5 mcg sufentanil + 100 mcg morphine; n = 30) or PS group (50 mg prilocaine + 2.5 mcg sufentanil; n = 24). The patients in the PS group received a bilateral transverse abdominal plane (TAP) block. The primary outcome was the effect of ITM on the time to micturition and the secondary outcome was the need for bladder re-catheterization. RESULTS The time to first urge to urinate (8 [6-10] hours in the PSM group versus 6 [4-6] hours in the PS group) and the time to first micturition (10 [8-12] hours in the PSM group versus 6 [6-8] hours in the PS group) were significantly (p < 0.001) prolonged in the PSM group. Two patients in the PSM group met the 800 mL criterium for urinary catheterization after 6 and 8 h respectively. CONCLUSION This study is the first randomized trial to demonstrate that the addition of ITM to the standardized mixture of prilocaine and sufentanil significantly delayed micturition.
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Affiliation(s)
- Nicolas Gautier
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Delphine Lejeune
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Lilas Al Zein
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Cédric Kesteloot
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Yannick Ciccarella
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
| | - Jean-François Brichant
- Department of Anesthesiology and Resuscitation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Lionel Bouvet
- Department of Anesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France
| | | | - Admir Hadzic
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology & Algology, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Philippe E Gautier
- Department of Anesthesiology, Clinique Sainte-Anne Saint-Rémi - CHIREC, Anderlecht, Belgium
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Grillo DA, Albano JMR, Valladares T. RE, Mocskos EE, Facelli JC, Pickholz M, Ferraro MB. Molecular dynamics study of the mechanical properties of drug loaded model systems: A comparison of a polymersome with a bilayer. J Chem Phys 2023; 159:174908. [PMID: 37929867 PMCID: PMC10629967 DOI: 10.1063/5.0165478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
In this work we implement a new methodology to study structural and mechanical properties of systems having spherical and planar symmetries throughout Molecular Dynamics simulations. This methodology is applied here to a drug delivery system based in polymersomes, as an example. The chosen model drug was the local anesthetic prilocaine due to previous parameterization within the used coarse grain scheme. In our approach, mass density profiles (MDPs) are used to obtain key structural parameters of the systems, and pressure profiles are used to estimate the curvature elastic parameters. The calculation of pressure profiles and radial MPDs required the development of specific methods, which were implemented in an in-house built version of the GROMACS 2018 code. The methodology presented in this work is applied to characterize poly(ethylene oxide)-poly(butadiene) polymersomes and bilayers loaded with the model drug prilocaine. Our results show that structural properties of the polymersome membrane could be obtained from bilayer simulations, with significantly lower computational cost compared to whole polymersome simulations, but the bilayer simulations are insufficient to get insights on their mechanical aspects, since the elastic parameters are canceled out for the complete bilayer (as consequence of the symmetry). The simulations of entire polymersomes, although more complex, offer a complementary approach to get insights on the mechanical behavior of the systems.
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Affiliation(s)
| | - Juan M. R. Albano
- CONICET - Universidad de Buenos Aires, Instituto de Física de Buenos Aires (IFIBA), Buenos Aires, Argentina
| | - Rufino E. Valladares T.
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Buenos Aires, Argentina
| | | | - Julio C. Facelli
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, Utah 84108, USA
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Hoerner E, Stundner O, Fiegl H, Gasteiger L. Crystallization of short-acting and intermediate-acting local anesthetics when mixed with adjuvants: a semiquantitative light microscopy analysis. Reg Anesth Pain Med 2023; 48:508-512. [PMID: 36928300 DOI: 10.1136/rapm-2023-104398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION The addition of adjuvants to short-acting local anesthetics (LA) is common practice in clinical routine to speed up block onset and decrease pain on injection. In a previous study, we observed the development of microscopic crystal precipitations after bupivacaine or ropivacaine were mixed with adjuvants; this follow-up study is intended to clarify whether crystallization (A) also occurs in short-acting or intermediate-acting LA-adjuvant mixtures, (B) changes over time, and (C) is associated with the solutions' pH. METHODS Lidocaine 2%, prilocaine 2%, mepivacaine 2%, procaine 2% and chloroprocaine 2% were individually mixed with clonidine, dexamethasone, dexmedetomidine, epinephrine, fentanyl, morphine or sodium bicarbonate 8.4% in clinically established ratios. For each mixture, we measured initial pH and recorded crystallization patterns at 0, 15, 30 and 60 min using a standardized, semiquantitative light microscopy approach. RESULTS Lidocaine 2% and mepivacaine 2% plus sodium bicarbonate 8.4%, and mepivacaine 2% plus dexamethasone developed delayed grade 5 crystallization over 1 hour. Prilocaine-based, procaine-based and chloroprocaine-based mixtures showed much less pronounced crystallization, with a maximum of grade 2. Initial pH and grade of crystallization showed weak monotonic relationships at time points t0, t15 and t30 (ρ=-0.17, 0.31 and 0.32, (all p>0.05)) and a moderate relationship time point t60 (ρ=0.57 (p=0.0003)) CONCLUSIONS: Our study revealed high grades of crystallization in lidocaine/mepivacaine-bicarbonate and mepivacaine-dexamethasone mixtures, although these were previously considered safe for local, perineural or neuraxial use. Our findings cast particular doubt on the safety of preparing these formulations for later use.
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Affiliation(s)
- Elisabeth Hoerner
- Anaesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Austria
| | - Ottokar Stundner
- Anaesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Austria
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Heidi Fiegl
- Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Gasteiger
- Anaesthesiology and Intensive Care, Medical University of Innsbruck, Innsbruck, Austria
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Wang F, Liu Z, Niu X, Zhao L, Zhu J, Qi L, Liu L, Liu Z, Sun Y, Diao L, Lu J, Zhou Y, Wang X, Li H. Safety and Pharmacokinetics of PSD502 in Healthy Chinese Male and Female Volunteers: Two Randomized, Double-Blind, Placebo-Controlled, Phase I Trials. Clin Drug Investig 2023; 43:503-515. [PMID: 37380910 DOI: 10.1007/s40261-023-01277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND AND OBJECTIVE PSD502 is a metered-dose spray for premature ejaculation. The two trials aimed to evaluate the safety and pharmacokinetics of PSD502 in healthy Chinese male and female individuals. METHODS Two phase I, randomized, double-blind, placebo-controlled trials were conducted in men (Trial 1) and women (Trial 2). The participants were randomized 3:1 to receive PSD502 (7.5 mg of lidocaine and 2.5 mg of prilocaine per spray) or a placebo. For male individuals, a single dose (three sprays) once daily was applied to the glans penis for 21 days except for nine sprays (three doses) on days 7 and 14, 4 h apart for each dose. For female individuals, two sprays were applied to the vagina and one to the cervix once daily for 7 days. The primary endpoint was safety. Pharmacokinetics analysis was also performed. RESULTS Twenty-four male and 24 female individuals were recruited. Treatment-emergent adverse events occurred in 38.9% (7/18) of male individuals and 66.7% (12/18) of female individuals in the PSD502 group, respectively. Both trials reported 50.0% (3/6) treatment-emergent adverse events for the placebo. No grade ≥ 3 treatment-emergent adverse events, serious adverse events, or treatment-emergent adverse events leading to early withdrawal or discontinuation occurred. After consecutive applications, lidocaine and prilocaine cleared rapidly in both trials. Plasma concentrations exhibited high inter-individual variability. The maximum plasma concentrations of active ingredients were far below the anticipated minimum toxic concentrations. The area under the plasma concentration-time curve of metabolites were ≤ 20% of the parent drugs. No clinically significant accumulations were observed in the two trials. CONCLUSIONS PSD502 was well tolerated and showed low plasma concentrations in healthy Chinese male and female individuals.
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Affiliation(s)
- Fangfang Wang
- Department of Drug Clinical Trial Center, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China
- Department of Cardiology and Institute of Vascular Medicine, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University Third Hospital, Beijing, China
| | - Zhiping Liu
- Department of Drug Clinical Trial Center, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China
| | - Xiaoye Niu
- Department of Drug Clinical Trial Center, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China
| | - Lin Zhao
- Department of Drug Clinical Trial Center, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China
| | - Jixiang Zhu
- Department of Drug Clinical Trial Center, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China
| | - Linjing Qi
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China
| | - Lu Liu
- Shanghai Fosun Pharmaceutical (Group) Co., Ltd, Shanghai, China
| | - Ziyang Liu
- Shanghai Fosun Pharmaceutical (Group) Co., Ltd, Shanghai, China
| | - Yunan Sun
- Shanghai Fosun Pharmaceutical (Group) Co., Ltd, Shanghai, China
| | - Lei Diao
- Shanghai Fosun Pharmaceutical (Group) Co., Ltd, Shanghai, China
| | - Jun Lu
- Shanghai Fosun Pharmaceutical (Group) Co., Ltd, Shanghai, China
| | - Yongchun Zhou
- Jiangsu Wanbang Biopharmaceuticals Co., Ltd, Xuzhou, China
| | - Xiaoye Wang
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China.
| | - Haiyan Li
- Department of Drug Clinical Trial Center, Peking University Third Hospital, Huayuan North Road No. 49, Haidian, Beijing, China.
- Department of Cardiology and Institute of Vascular Medicine, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University Third Hospital, Beijing, China.
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Liu HM, Wu TJ, Liou CM, Chiu WK, Kang YN, Chen C. Patient Comfort with Various Local Infiltration Anesthetics for Minor Oculoplastic Surgery: A Systematic Review and Network Meta-Analysis. J Plast Reconstr Aesthet Surg 2022; 75:3473-3484. [PMID: 35961926 DOI: 10.1016/j.bjps.2022.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures. OBJECTIVES To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort. METHODS This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question. RESULTS Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS. CONCLUSIONS "Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low. THE CLINICAL TRIAL REGISTRATION NUMBER CRD42021260332 (PROSPERO).
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Affiliation(s)
- Hsin-Ming Liu
- Department of Ophthalmology, Mackay Memorial Hospital, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
| | - Ting-Ju Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
| | - Cher-Ming Liou
- Department of Anesthesiology, Chung Shan Medical University Hospital, Chung Shan Medical University; Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
| | - Yi-No Kang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan; Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
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Goffard P, Leloup R, Vercruysse Y, Fils JF, Gautier PE, Kapessidou Y. Comparison of equipotent doses of intrathecal hyperbaric prilocaine 2% and hyperbaric bupivacaine 0.5% for elective caesarean section: A prospective, randomised, controlled, two-centre clinical trial. Eur J Anaesthesiol 2022; 39:227-235. [PMID: 34101713 DOI: 10.1097/eja.0000000000001548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elective caesarean section is performed mainly under spinal anaesthesia using hyperbaric bupivacaine combined with opioids. Despite rapid onset, good quality anaesthesia, bupivacaine provides a long duration of motor block and is related to maternal hypotension. Current policies appeal for implementation of enhanced recovery procedures after caesarean section. Hyperbaric prilocaine is an intermediate-acting local anaesthetic known for its efficacy in ambulatory surgery. Evidence on the clinical relevance of intrathecal prilocaine use for caesarean section is currently lacking. OBJECTIVES We aimed to investigate whether hyperbaric prilocaine would offer a shorter motor block and recovery than bupivacaine, when comparing equipotent doses. We also assessed the characteristics of sensory block, maternal haemodynamics and side effects for both mother and newborn. DESIGN Prospective, randomised, double-blind, controlled, two-centre, clinical trial. SETTING One university teaching hospital and one general teaching hospital in Brussels, Belgium. PATIENTS American Society of Anesthesiologists' physical status 2 parturients (n = 40) undergoing caesarean section under spinal anaesthesia. INTERVENTIONS Patients were randomly assigned to receive spinal anaesthesia using hyperbaric prilocaine 50 mg or hyperbaric bupivacaine 10 mg, both given with sufentanil 2.5 μg and morphine 100 μg. An epidural catheter was introduced as a backup in case of failure. MAIN OUTCOMES The primary outcome was the motor block regression (modified Bromage scale 1 to 6). Secondary outcomes included sensory block characteristics, first unassisted ambulation, maternal side effects, newborns' parameters and overall satisfaction. RESULTS Median [IQR] motor block was significantly shorter in the hyperbaric prilocaine group (110 [104 to 150] min versus 175 [135 to 189] min, P = 0.001). First unassisted ambulation was achieved earlier after prilocaine (204.5 [177 to 246.5] min versus 314 [209.25 to 400] min, P = 0.007), and the incidence of maternal hypotension was significantly higher with bupivacaine (P = 0.033). No supplementary epidural analgesia was needed. CONCLUSION Prilocaine provides shorter motor block, faster recovery and better haemodynamic stability than bupivacaine while offering equivalent surgical anaesthesia. TRIAL REGISTRATION Clinicaltrials.gov: NCT02973048, EudraCT: 2016-003010-26.
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Affiliation(s)
- Philippe Goffard
- From the Department of Anaesthesiology and Pain Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels (PG, RL, YV, YK), Ars Statistica, Nivelles (J-FF) and Department of Anaesthesiology, Clinique Sainte Anne-Saint Remi, CHIREC, Brussels, Belgium (PEG)
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Babandi RM, Agboghoroma OC, Durojaiye KW, Jimoh KO, Essiet EA. Pain Relief for Hysterosalpingography: A Randomized Controlled, Double Blinded Trial Comparing Suppository Diclofenac, Prilocaine/Lignocaine (EMLA) Cream And Placebo. West Afr J Med 2021; 38:1174-1182. [PMID: 35035229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hysterosalpingography is dreaded by women due to pain. Pain intensity varies with different stages of the procedure and the search for an effective analgesia continues. OBJECTIVE To compare the effectiveness of suppository diclofenac (100mg), cervical lidocaine 25mg -prilocaine 25mg cream (5% EMLA) and placebo in pain relief for hysterosalpingography. METHODOLOGY This was a prospective, randomized, double-blinded, placebo-controlled study conducted at National Hospital Abuja, Nigeria, between November 2018 and March 2019. Participants were allocated to three groups (A, B, C). Group A received suppository diclofenac 100mg plus placebo cream, group B got EMLA cream plus placebo suppository while group C received placebo suppository and cream. Pain levels were assessed using Visual Analogue Scale (VAS) at baseline, during 4 different stages of the procedure, at 30 minutes and 24 hours after the procedure. Patients' satisfaction and side effects were also assessed. Data were analyzed using SPSS version 22 (SPSS Inc., Chicago, IL, USA). P value < 0.05 at 95% confidence interval was regarded as statistically significant. RESULTS The most painful step of the procedure was during uterine distension with contrast medium with mean VAS score of 6.33±1.539, 5.37±1.377, 7.03±1.245 in group A, B and C, respectively (p-value <0.05). Mean pain scores during 4 steps of the procedure were found to be significantly lower in EMLA group. Intervention groups were also more satisfied after the procedure. CONCLUSION EMLA 5% cream is a more effective analgesic for HSG compared to both diclofenac and placebo.
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Affiliation(s)
- R M Babandi
- Department of Obstetrics and Gynaecology, National Hospital Abuja, Nigeria
| | - O C Agboghoroma
- Department of Obstetrics and Gynaecology, National Hospital Abuja, Nigeria
| | - K W Durojaiye
- Department of Obstetrics and Gynaecology, National Hospital Abuja, Nigeria
| | - K O Jimoh
- Department of Radiology, National Hospital Abuja, Nigeria
| | - E A Essiet
- Department of Obstetrics and Gynaecology, National Hospital Abuja, Nigeria
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Höbek Akarsu R, Kuş B, Doğukan Akarsu G. Effects of Valsalva Maneuver, EMLA Cream, and Stress Ball for Pregnant Women's Venipuncture Pain. Altern Ther Health Med 2021; 27:108-114. [PMID: 33626021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CONTEXT Peripheral intravenous catheter (PIVC) practice is a common invasive procedure used in the diagnosis and treatment of pregnant women admitted to the hospital. Difficulties experienced during PIVC application are among the most common problems encountered in a medical facility. OBJECTIVE The study intended to evaluate the effects of the Valsalva maneuver, the application of eutectic mixture of local anesthetics (EMLA) cream, and use of a stress ball in controlling the pain and discomfort that developed due to PIVC administration for pregnant women. DESIGN The research team designed the study as a randomized, controlled, single-blind trial. SETTING The research took place at the obstetrics clinic at the Practice and Research Hospital at Yozgat Bozok University in Yozgat, Turkey, between January 2019 and February 2020. PARTICIPANTS Participants were 120 pregnant women who visited the obstetrics clinic and were admitted to the maternity ward of the hospital during that time. INTERVENTION Participants were divided into four groups of 30 women each: (1) the Valsalva maneuver group, (2) the EMLA group, receiving an application of the cream, and (3) the stress-ball group, and (4) the control group. OUTCOME MEASURES Data were collected through the use of a pregnancy information form and a visual analog scale. In the assessment of the data, variance analysis was used with the Kruskal Wallis and Dunn test. RESULTS Only the pain scores of the Valsalva maneuver group were found to be significantly lower than those of the control group, whereas the pain scores of the EMLA and stress-ball groups were similar to those of the control group. CONCLUSIONS The current study can generate awareness in pregnant women in terms of choosing between pharmacological and nonpharmacological practices that nurses use during PIVC insertion. As the only randomized controlled blind study that has been performed on the topic, the current study offers nurses evidence of a way to reduce PIVC pain in pregnant women.
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Akgül B, Aycan İÖ, Hidişoğlu E, Afşar E, Yıldırım S, Tanrıöver G, Coşkunfırat N, Sanlı S, Aslan M. Alleviation of prilocaine-induced epileptiform activity and cardiotoxicity by thymoquinone. Daru 2021; 29:85-99. [PMID: 33469802 PMCID: PMC8149770 DOI: 10.1007/s40199-020-00385-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE This study investigated whether thymoquinone (TQ) could alleviate central nervous system (CNS) and cardiovascular toxicity of prilocaine, a commonly used local anesthetic. METHODS Rats were randomized to the following groups: control, prilocaine treated, TQ treated and prilocaine + TQ treated. Electroencephalography and electrocardiography electrodes were placed and trachea was intubated. Mechanical ventilation was initiated, right femoral artery was cannulated for continuous blood pressure measurements and blood-gas sampling while the left femoral vein was cannulated for prilocaine infusion. Markers of myocardial injury, reactive oxygen/nitrogen species (ROS/RNS) generation and total antioxidant capacity (TAC) were assayed by standard kits. Aquaporin-4 (AQP4), nuclear factor(NF)κB-p65 and -p50 subunit in brain tissue were evaluated by histological scoring. RESULTS Blood pH and partial oxygen pressure, was significantly decreased after prilocaine infusion. The decrease in blood pH was alleviated in the prilocaine + TQ treated group. Prilocaine produced seizure activity, cardiac arrhythmia and asystole at significantly lower doses compared to prilocaine + TQ treated rats. Thymoquinone administration attenuated levels of myocardial injury induced by prilocaine. Prilocaine treatment caused increased ROS/RNS formation and decreased TAC in heart and brain tissue. Thymoquinone increased heart and brain TAC and decreased ROS/RNS formation in prilocaine treated rats. AQP4, NFκB-p65 and NFκB-p50 expressions were increased in cerebellum, cerebral cortex, choroid plexus and thalamic nucleus in prilocaine treated rats. Thymoquinone, decreased the expression of AQP4, NFκB-p65 and NFκB-p50 in brain tissue in prilocaine + TQ treated rats. CONCLUSION Results indicate that TQ could ameliorate prilocaine-induced CNS and cardiovascular toxicity.
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Affiliation(s)
- Barış Akgül
- Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey
| | - İlker Öngüç Aycan
- Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey
| | - Enis Hidişoğlu
- Department of Biophysics, Akdeniz University, Antalya, Turkey
| | - Ebru Afşar
- Department of Medical Biochemistry, Akdeniz University Medical School, 07070 Antalya, Turkey
| | - Sendegül Yıldırım
- Department of Histology and Embryology, Akdeniz University, Antalya, Turkey
| | - Gamze Tanrıöver
- Department of Histology and Embryology, Akdeniz University, Antalya, Turkey
| | - Nesil Coşkunfırat
- Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey
| | - Suat Sanlı
- Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey
| | - Mutay Aslan
- Department of Medical Biochemistry, Akdeniz University Medical School, 07070 Antalya, Turkey
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Al-Melh MA, Badr H, Andersson L. Comparison between Topical and Injection Anesthetics on Pain Related to Orthodontic Miniscrew Placement: A Split-mouth Study. J Contemp Dent Pract 2021; 22:637-643. [PMID: 34393120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIMS AND OBJECTIVES The aims of this study were to compare the anesthetic effect of a lidocaine/prilocaine (L/P) topical anesthetic with placebo on pain from needle sticks and to compare the anesthetic effect of the L/P topical anesthetic with an infiltrative anesthetic on pain from orthodontic miniscrew placement. MATERIALS AND METHODS Pain elimination was analyzed from two interventions: (a) needle stick and (b) miniscrew insertion. When assessing pain from needle stick, one side of the mandible received 2.5% lidocaine/2.5% prilocaine topical anesthetic, and the other side received placebo. When evaluating pain from miniscrew placement, one side of the mandible received L/P topical anesthetic and the other side received infiltrative anesthetic. The findings were recorded on a Visual Analogue Scale after needle stick and after miniscrew placement. Subjective assessment was analyzed by a questionnaire. RESULTS The L/P topical anesthetic significantly eliminated the pain from needle stick (Mann-Whitney test of medians, 29.0 vs 0.0, respectively, p<0.001). However, the injection anesthetic eliminated the pain from the miniscrew placement better than the L/P topical anesthetic (Mann-Whitney test of medians, 0.0 vs 5.5, respectively, p<0.001). Eighty percent of the subjects felt more comfortable with L/P topical anesthetic than injection anesthetic. Pain from needle stick pain was reported to be the most uncomfortable part of the study. CONCLUSION The L/P topical anesthetic efficiently eliminated pain from needle stick. The L/P topical anesthetic did not completely eliminate pain from miniscrew placement as the injection anesthesia, but it did reduce pain to tolerable levels. CLINICAL SIGNIFICANCE L/P topical anesthetics can significantly eliminate pain from needle stick injections, and L/P topical anesthetics can reduce pain from orthodontic miniscrew placement to tolerable levels.
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Affiliation(s)
- Manal A Al-Melh
- Department of Developmental and Preventive Sciences, Kuwait University, Faculty of Dentistry, Kuwait, Phone:+96567722222, e-mail:
| | - Hanan Badr
- Department of Community Medicine, Kuwait University, Faculty of Medicine, Kuwait
| | - Lars Andersson
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Sweden
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Abstract
Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known: • Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods. • A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New: • The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches. • We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.
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Affiliation(s)
- Serena Rossi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Meneses-Santos D, Amorim KS, Dantas ACGC, da Silva RP, de Araújo JSM, Groppo FC, Souza LMA. Comparison of two vasoconstrictors on glycemic levels in diabetic patients. Clin Oral Investig 2020; 24:4591-4596. [PMID: 32440938 DOI: 10.1007/s00784-020-03327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate glycemic levels in diabetic patients before, during, and after extractions using 2% lidocaine with 1:100,000 epinephrine (Lido/Epi) and 3% prilocaine with 0.03 IU/mL felypressin (Prilo/Fely). MATERIALS AND METHODS A double-blind, randomized clinical trial was conducted to evaluate changes in body parameters and glycemic levels in diabetic patients undergoing two anesthetic protocols during dental extractions. During surgery, we evaluated blood pressure (BP), heart rate (HR), saturation (SpO2), and capillary glycemic levels (Gly). These parameters were measured at the following surgical moments: basal, 30 min after medication, incision, tooth removal, suture, and 30 and 60 min after anesthesia. RESULTS Data analysis showed no differences between the groups considering age, weight, and time spent in surgery. Increased systolic BP and decreased diastolic BP were observed in the lido/epi group. No difference was observed in the prilo/fely group among the surgical moments or between the groups regarding BP. No difference was observed in HR and SpO2 between the groups at any surgical moment. However, differences were found when compared the differences in glycemic and basal levels in both groups with greater decreases in blood glucose values for the lido/epi group. In anxiety level evaluation, there was no difference between the different surgical moments. CONCLUSION Thus, both lido/epi and prilo/fely (maximum 3.6 mL) can be safely used in controlled diabetic patients CLINICAL RELEVANCE: The use of lidocaine associated with epinephrine did not increase glycemic levels but leads to decrease over time when associated with an anxiety reduction protocol, offering some advantage over prilocaine plus felypressin for diabetic patients.
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Affiliation(s)
- Daniela Meneses-Santos
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil.
| | - Klinger Souza Amorim
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracibaba, São Paulo, 13414-903, Brazil
| | - Anne Caroline Gercina Carvalho Dantas
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
| | - Ricardo Pedro da Silva
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
| | - Jaiza Samara Macena de Araújo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracibaba, São Paulo, 13414-903, Brazil
| | - Francisco Carlos Groppo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracibaba, São Paulo, 13414-903, Brazil
| | - Liane Maciel Almeida Souza
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
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Abstract
Bier introduced his intravenous technique of local anaesthesia to facilitate palliative surgery on the elbow or knee. He cannulated a suitably large vein in the vicinity of the joint to inject procaine after first isolating the operating site with a proximal and a distal tourniquet. This extra containment of the local anaesthetic solution made it feasible to flush out any unfixed drug with saline before release of the main tourniquet, an advantage which has been lost in the currently fashionable technique of intravenous regional anaesthesia (IVRA) involving a single tourniquet above the elbow or knee and a fine butterfly needle in a vein on the dorsum of the hand or foot. A modern version of Bier's original method is described, conveniently called an intercuff block (ICB), which reintroduces the possibility of effective flushing, offers better operating conditions and engenders new ideas for further study.
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Taddio A, Ohlsson A, Ohlsson K. WITHDRAWN: Lidocaine- prilocaine cream for analgesia during circumcision in newborn boys. Cochrane Database Syst Rev 2015; 2015:CD000496. [PMID: 25840001 PMCID: PMC10762888 DOI: 10.1002/14651858.cd000496.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors have requested this review to be withdrawn. The reason is the intervention, lidocaine‐prilocaine cream for analgesia during neonatal circumcision, is covered in the Cochrane Review of "Pain relief for neonatal circumcision" (Brady‐Fryer 2004). The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Anna Taddio
- Hospital for Sick Children Research InstituteGraduate Department of Pharmaceutical Sciences555 University AvenueTorontoONCanadaM5G 1X8
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1X5
| | - Kristina Ohlsson
- University of Torontoc/o Dr Arne Ohlsson Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation# 14324 County Rd 29WarkworthONCanadaK0K 3K0
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Hizli F, Argun G, Özkul F, Güven O, Arik AI, Başay S, Köşüş A, Günaydin H, Başar H. Novel approach for pain control in patients undergoing prostate biopsy: iliohypogastric nerve block with or without topical application of prilocaine-lidocaine: a randomized controlled trial. Urol J 2015; 12:2014-2019. [PMID: 25703911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/23/2014] [Accepted: 01/11/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE To investigate the efficacy of a novel anesthetic technique called iliohypogastric nerve block (INB) for pain control in patients undergoing prostate biopsy. MATERIALS AND METHODS A total of 59 consecutive patients who underwent transrectal ultrasound guided prostates biopsies were included in the study. Patients were randomized into four groups: (1) control, no method of anesthesia was administered, (2) intrarectal prilocaine-lidocaine cream application, (3) INB and (4) INB + intrarectal prilocaine-lidocaine cream application (combined group). Patients were asked to use a scale of 0-10 in a Visual Analogue Scale (VAS) questionnaire about pain during probe insertion (VAS 1) and prostate biopsy (VAS 2). RESULTS The mean VAS 1 and VAS 2 scores were 0.7 and 4.9 for controls, 0.5 and 1.8 for INB, 0.5 and 2.6 for the intrarectal cream group, and 0.4 and 1.8 for the combined group. The mean VAS 1 scores were not different between groups. However, the mean VAS 2 scores were significantly lower in INB, prilocaine-lidocaine cream and combined groups compared to the control group (P < .001). In addition, the INB group had significantly lower VAS 2 scores compared to the cream application group (P = .03). On the other hand, there was no difference between the INB and combined groups (P = .8). CONCLUSION Any form of anesthesia was superior to none. However, INB alone seemed to be superior to prilocaine-lidocaine cream application in patients undergoing prostate biopsy. Addition of prilocaine-lidocaine cream application to INB may not provide better analgesia.
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Affiliation(s)
- Fatih Hizli
- Department of Urology, Oncology Training and Research Hospital, 06530 Demetevler, Ankara, Turkey.
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Parekh S, Gardener C, Ashley PF, Walsh T. Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents. Cochrane Database Syst Rev 2014; 2014:CD009742. [PMID: 25532729 PMCID: PMC6669268 DOI: 10.1002/14651858.cd009742.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Whilst carrying out dental procedures under general anaesthesia (GA), practitioners routinely give local anaesthetics (LA) intraoperatively to children. Local anaesthetics are used to help manage postoperative pain and reduce bleeding and the physiological response to procedures. Studies of effectiveness of intraoperative LA to date have reported contradictory results. OBJECTIVES To assess the effects of intraoperative local anaesthesia for reducing postoperative pain following general anaesthesia for dental treatment in children and young people aged 17 years or younger. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2013, Issue 12), MEDLINE via OVID (1946 to 02 January 2014), EMBASE via OVID (1980 to 02 January 2014) and Web of Science Conference Proceedings (1990 to 02 January 2014). We searched for ongoing trials in the US National Institutes of Health Register, the metaRegister of Controlled Trials (mRCT) and the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) Clinical Trials Portal. We did not place any restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials in which local anaesthetic was given intraoperatively under general anaesthesia for dental treatment of children and young people aged 17 years or younger. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of risk of bias independently and in duplicate. We contacted authors to clarify omissions in trial reports. In the 'Summary of findings' tables, we elected to report the outcomes pain, distress, postoperative bleeding, and physiological parameters related to the general anaesthetic, as we considered these to be the outcomes of greatest importance to readers of the review. MAIN RESULTS We included 14 trials in this review, with 1152 randomised participants. The studies were published between 1990 and 2009 and were conducted in the United Kingdom, Egypt, Saudi Arabia, and the United States. The age of participants ranged from 2 to 40 years. Three studies were at an overall high risk of bias, seven studies were at an unclear risk of bias, and we judged four studies to be at low risk of bias. The clinical heterogeneity of the included studies precluded pooling of studies in terms of method of administration of LA (e.g., intraligamental injection, infiltration injection, or topical delivery) and variation in the use of supplementary analgesics and follow-up time.Of the seven studies where administration of LA was by infiltration injection, six studies (very low-quality body of evidence, 542 participants analysed, 1 study had overall high risk of bias, 4 studies had overall unclear risk of bias, 1 study had overall low risk of bias) measured postoperative pain. The results were equivocal. There was a decrease in bleeding and increase in soft tissue damage in the LA groups, but we did not judge this to be clinically significant.In the 2 studies where administration of LA was by intraligamental injection, there was no difference in mean pain scores, and they did not report any soft tissue damage (very low-quality body of evidence, 115 participants analysed, 1 study had overall high risk of bias, 1 study had overall unclear risk of bias).One 3-armed study (very low-quality body of evidence, 54 participants analysed, overall high risk of bias) compared the effects of intraligamental and infiltration LA injection with no treatment. There was no evidence of a mean difference in pain, distress, or postoperative anxiety among the three groups.Four studies (very low-quality body of evidence, 343 participants analysed, 2 studies had overall low risk of bias, 2 studies had overall unclear risk of bias) evaluated the effects of topical LA compared with no treatment or placebo. One study (overall unclear risk of bias) with a no-treatment comparator reported lower mean pain in the LA group; all other studies reported no difference in mean pain scores. Two studies reported on bleeding (overall unclear risk of bias): One study reported a clinically insignificant increase in bleeding with no treatment; the other reported no difference.None of the studies reported on participant or child satisfaction. AUTHORS' CONCLUSIONS In this review, it was difficult to reach firm conclusions as to the benefit of using local anaesthetic for dental treatment under general anaesthesia. The information reported in the included studies was comprehensive and applicable to the review question, but ultimately it was not sufficient to address the objective of the review. We were unable to pool the included studies in a meta-analysis because of substantial variation in outcome measures, interventions, and treatment types. The use of supplementary analgesia further obscured the effect of local anaesthetics.Based on the literature review and the results of this review, we recommend further randomised controlled trials that minimise bias through adequate allocation concealment and blinding of participants and assessors, and assess the effect of intraoperative local anaesthetic on the volume and type of anaesthetic used and on the cardiovascular system in participants receiving supplementary analgesics as well. Researchers should give consideration to the impact of any changes on the health and well-being of the participant and report baseline measures of pain or distress, or both, and preoperative anxiety.
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Affiliation(s)
- Susan Parekh
- Unit of Paediatric Dentistry, Department of Craniofacial Growth and Development, UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD, UK.
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Lacroix G, Prunet B, Asencio Y, Montcriol A, Goutorbe P. [Radial nerve block for implantation of radial catheter]. Ann Fr Anesth Reanim 2009; 28:810-811. [PMID: 19647974 DOI: 10.1016/j.annfar.2009.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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ASTROEM A, PERSSON NH, ORTENGREN B. The Effect of Adrenaline on the Toxicities and Absorptions of L 67 (Citanest ®) and Some Other Local Anaesthetics studied in Mice and Rabbits. ACTA ACUST UNITED AC 2009; 21:161-71. [PMID: 14203048 DOI: 10.1111/j.1600-0773.1964.tb01779.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gille J, Gille M, Gahr R, Wiedemann B. [Acute pain management in proximal femoral fractures: femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model]. Anaesthesist 2009; 55:414-22. [PMID: 16320011 DOI: 10.1007/s00101-005-0949-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management. METHODS In a prospective randomised trial of patients attending the emergency department, 100 individuals were selected with a clinically diagnosed proximal femoral fracture. Patients were divided into two equal groups A and B. Group A (n=50) received a catheter-mediated femoral nerve block with 1% prilocaine (40 ml) and post-operatively 0.2% ropivacaine (30 ml) 6 hourly. Group B (n=50) initially received intravenous metamizol (1 g) and a fixed combination of oral tilidine (100 mg) + naloxone (8 mg). Patients aged 90 years or more received a reduced dose (tilidine 75 mg + naloxone 6 mg). In the post-operative period regular oral ibuprofen (400 mg, 8 hourly) in addition to oral tilidine (50 mg) + naloxone (4 mg) was given as required for break through pain. Pain intensity was measured using a verbal rating scale (VRS) from 1 to 5: pain free (=1), mild pain (=2), moderate pain (=3), severe pain (=4), excruciating pain (=5). Pain scores were recorded at rest (R), during passive anteflection (30 degrees) of the hip (PA) on arrival and at 15 and 30 min after initial administration of analgesia. Thereafter, recordings were made 4 times a day up to the third post-operative day. RESULTS Pain scores were comparable for both groups on admission (VRS in R 2.50 vs. 2.46; VRS during PA 4.30 vs. 4.34). Significant pain relief was achieved in both groups following initial administration of analgesia, but the total pain scores in group A were significantly lower than in group B (VRS in R 1.22 vs. 1.58, p<0.01 and VRS during PA 2.66 vs. 3.26; p<0.001). No difference was noted between the two groups during the first 3 post-operative days. No severe complications occurred as a result of analgesia, however, the catheter was dislodged in 20% of patients in group A resulting in the need for systemically administered analgesia. CONCLUSION All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging. Femoral nerve block should be considered as the method of choice. The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management. The cumbersome logistics inherent in this technique within the clinical setting limits its practical application. An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative. The execution of safe, consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocols as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice.
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Affiliation(s)
- J Gille
- Klinik für Anästhesiologie, Intensiv- und Schmerztherapie, Städt Klinikum St Georg, Leipzig, Germany. Jochen.Gille@sankt georg.de
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Yalcin S, Ergul E. A single-surgeon, single-institute experience of 115 Lichtenstein hernia repairs under local anesthesia. BRATISL MED J 2009; 110:43-44. [PMID: 19408830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Repair of an inguinal hernia is one of the most common operations performed in general surgery with significant costs to health care and society. Lichtenstein mesh repair has been the most widely performed groin hernia repair. In this study, we wanted to emphasize the effectiveness of local anesthesia in groin hernia repair by single-surgeon's experience. METHODS One-hundred and fifteen inguinal hernia patients were reviewed between July 2005 and July 2007. 2% Prilocaine was injected for local anesthesia and Lichtenstein polypropylene mesh repair technique was performed. Pain was assessed after operation by using a visual analogue scale (VAS). All patients were controlled at postoperative first week, first month and end of first year. RESULTS 113 (98.26%) of 115 patients were discharged at postoperative 8th hour. The other 2 patients (1.739%) were discharged at postoperative second day. They were followed up two days, because of seroma and pain, individually. Mean VAS score was 3.2 (2.7-4.0 95% CI). There was no statistically significant difference between groups, according to Nyhus classification, right/left inguinal hernia and gender. CONCLUSION Lichtenstein mesh repair under local anesthesia is an effective day case technique, particularly in the elderly and medically unfit patients. The economic benefits are enhanced by low morbidity and low recurrence rates (Ref. 5). Full Text (Free, PDF) www.bmj.sk.
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Affiliation(s)
- Samet Yalcin
- Ankara Ataturk Teaching and Research Hospital, General Surgery Department, Ankara, Turkey
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Tan KL, Kurniawati C, Gold MH. Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after treatment with fractional CO2 laser device. J Drugs Dermatol 2008; 7:774-777. [PMID: 18720695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND/OBJECTIVE Hyperpigmentation occurs in more than 37% of dark-skinned subjects treated with a fully ablative CO2 laser device. This study assessed the risk of postinflammatory hyperpigmentation (PIH) in subjects with skin types 4 and 5 treated once with a specific protocol of treatment using a fractional CO2 laser. METHODS Seven subjects with photodamaged skin received a single facial treatment using a fractional CO2 laser. Anesthesia was limited to a lidocaine and prilocaine cream for 1 hour before the single-pass treatment. Subjects were evaluated for improvement and PIH on alternate days for 14 days, and at 1 month, 3 months, and 6 months posttreatment. RESULTS All subjects achieved improvement in their specific skin conditions and in skin texture. Postinflammatory hyperpigmentation was not observed in any subject. Four subjects experienced no pain during treatment, while 3 reported mild pain. Recovery was associated with minimal pain and itching. CONCLUSION In dark-skinned subjects, fractional CO2 laser treatment and topical anesthesia subjectively improves common skin conditions without PIH.
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Affiliation(s)
- Kee Lee Tan
- Rejuvenate Cosmetic & Slimming Clinic, Perth, Australia.
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Katircioglu K, Ozkalkanli MY, Kalfaoglu H, Sannav S, Ozgurbuz U, Savaci S. Reversal of prilocaine epidural anesthesia using epidural saline or ringer's lactate washout. Reg Anesth Pain Med 2008; 32:389-92. [PMID: 17961836 DOI: 10.1016/j.rapm.2007.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 06/07/2007] [Accepted: 06/07/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Several investigators have described the phenomena of epidural saline washout using bolus injections. This study was designed to determine whether epidural block could be reversed more effectively by infusion of crystalloid solutions via the epidural catheter. METHODS One hundred male patients scheduled for outpatient surgery were enrolled in this study. After 30 min of 2% prilocaine epidural anesthesia, patients were randomly assigned to receive 45 mL of study solution as follows: (1) normal saline bolus (group NSB); (2) Ringer's lactate bolus (group RLB); (3) normal saline infusion (group NSI); (4) Ringer's lactate infusion (group RLI). Patients in the control group received no washout fluid. Motor, sensory blockade and side effects were compared among 5 groups. Ambulation time is defined as the recovery time. RESULTS In the control group, ambulation time (139 +/- 15 min) was significantly longer than in the washout groups (NSB 90 +/- 10, RLB 88 +/- 10, NSI 85 +/- 8, RLI 91 +/- 6 minutes) (P < .001). Two-segment sensory regression time in the control group (86 +/- 15 min) was significantly longer than in groups NSB, RLB, NSI and RLI (55 +/- 8, 51 +/- 4, 58 +/- 8, and 53 +/- 10 minutes, respectively) (P < .001). CONCLUSIONS We concluded that a more rapid recovery of motor and sensory blockade in patients undergoing epidural anesthesia may be achieved by the use of an epidural washout with either bolus or infusion of 45 mL normal saline or Ringer's lactate.
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Affiliation(s)
- Kaan Katircioglu
- Department of Anesthesiology and Reanimation, Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
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Gottehrer NR, Martin JL. The standard of care for nonsurgical periodontal treatment for reducing the dental risk for cardiac disease. Dent Today 2007; 26:100-104. [PMID: 18044123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Neil R Gottehrer
- Institute of Advanced Oral and Physical Health, Havertown, PA, USA.
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Abstract
Pompe's disease or glycogen storage disease type II is a genetic disorder affecting skeletal and cardiac muscle. The infantile form is associated with gross hypertrophic cardiomegaly and death in the early years. General anesthesia is associated with potential major morbidity in these patients. We present our experience of regional anesthetic blocks used in five patients with the infantile form of glycogen storage disease type II with and without sedation for 11 surgical procedures during a clinical trial of replacement therapy for this condition. Both femoral nerve blockade and caudal epidural blockade were used with good result. The relative merits of the type of block are discussed in addition to the choice of sedation and risks of general anesthesia. The avoidance of general anesthesia in the newly presenting patient with Pompe's disease may reduce potential morbidity until enzyme replacement has been established.
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Affiliation(s)
- Robert W M Walker
- Department of Anaesthesia, Manchester Children's Hospital, Manchester, UK.
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Demir E, Kilciler M, Bedir S, Erten K, Ozgok Y. Comparing two local anesthesia techniques for extracorporeal shock wave lithotripsy. Urology 2007; 69:625-8. [PMID: 17445637 DOI: 10.1016/j.urology.2007.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 09/22/2006] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a eutectic mixture of local anesthetics (EMLA) cream compared with dimethyl sulfoxide (DMSO) with lidocaine during extracorporeal shock wave lithotripsy (ESWL) in a prospective randomized study. METHODS Of 167 patients, 85 received 10 g of EMLA cream (EMLA group) and 82 received 10 g of 40% DMSO (DMSO group) with an amount of lidocaine equal to that in the lidocaine gel, applied to the skin of the flank at the area of entry of the shock wave marked by the urologist. A second-generation lithotriptor Siemens Lithostar was used. The degree of pain was rated by the patients using a 10-point visual analog scale. RESULTS In 80 patients in the EMLA group (94%), the entire procedure was performed with no, minor, or tolerable pain after the application of EMLA cream (pain score 5.2 +/- 1.3). In 5 EMLA patients (6%), EWSL was interrupted because of intolerable pain. Of the 82 DMSO patients, 80 (98%) underwent the entire procedure with no, minor, or tolerable pain after the application of DMSO with lidocaine (pain score 3.7 +/- 1.1). In 2 DMSO patients (2%), EWSL was interrupted because of intolerable pain. The pain scores were significantly lower for the DMSO group than for the EMLA group (P = 0.011). CONCLUSIONS Our findings have indicated that the pain scores were significantly lower for the DMSO group than for the EMLA group. In addition to the local anesthetic effect of DMSO, diuretic, anti-inflammatory, muscle relaxant, and hydroxyl radical scavenger effects can be important for patients undergoing ESWL. These effects should be evaluated with new studies of patients undergoing ESWL.
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Affiliation(s)
- Erkan Demir
- Department of Urology, Gulhane Military Medical Academy School of Medicine, Ankara, Turkey.
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Wei H, Chen Y, Xu L, Zheng J. Percutaneous penetration kinetics of lidocaine and prilocaine in two local anesthetic formulations assessed by in vivo microdialysis in pigs. Biol Pharm Bull 2007; 30:830-4. [PMID: 17409532 DOI: 10.1248/bpb.30.830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to characterize and compare the percutaneous penetration kinetics of lidocaine (L) and prilocaine (P) in two local anesthetic formulations by in vivo microdialysis coupled with HPLC. The microdialysis system for studying lidocaine and prilocaine was calibrated by a no-net-flux method in vitro and retrodialysis method in vivo, respectively. A dosage of 0.2 g/cm2 of an in-house P-L formulation (2.5% lidocaine and 2.5% prilocaine, methylcellulose-based) and commercially available Eutectic Mixture of Local Anesthesia (EMLA, 2.5% lidocaine and 2.5% prilocaine, carbopol-based) was separately but symmetrically applied in the dorsal region of pigs. Saline (0.9%, w/v) was perfused into the linear microdialysis probe at a flow rate of 1.5 microl/min. Dialysate was collected upon topical application up to 6 h at 20-min intervals and assessed by HPLC. The results demonstrated the area under the concentration-time curve (AUC(0-6 h)) of lidocaine and prilocaine in EMLA was 71.95+/-23.36 microg h/ml and 38.01+/-14.8 microg h/ml, respectively, in comparison to 167.11+/-56.12 microg h/ml and 87.02+/-30.38 microg h/ml in the P-L formulation. The maximal concentrations (Cmax) of lidocaine and prilocaine in the dermis were 29.2+/-9.08 microg/ml and 16.54+/-5.31 microg/ml in EMLA and 80.93+/-17.98 microg/ml and 43.69+/-12.87 microg/ml in the P-L formulation, respectively. This study indicates a well-calibrated microdialysis system can provide vital real-time information on percutaneous drug delivery and specifically a methylcellulose-based P-L formulation can increase percutaneous absorption of both lidocaine and prilocaine in pigs compared to carbopol-based EMLA.
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Affiliation(s)
- Huilin Wei
- Institute of Dermatology, Peking Union Medical College, Chinese Academy of Medical Sciences, Republic of China.
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Yücel AC, Aksoy A, Ertaş E, Güvenç D. The pH changes of calcium hydroxide mixed with six different vehicles. ACTA ACUST UNITED AC 2007; 103:712-7. [PMID: 17241800 DOI: 10.1016/j.tripleo.2006.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 08/02/2006] [Accepted: 08/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to determine the pH values of calcium hydroxide mixed with sterile saline, glycerin, Xylocaine pump spray, Citanest Octapressin, 0.2% chlorhexidine solution, and Ultracaine DS. STUDY DESIGN pH values of all vehicles were measured by a pH microelectrode before calcium hydroxide powder was added to 2 mL of the vehicle until the solutions were saturated (n = 10). After all the saturated samples were prepared, pH was remeasured at 0, 10, 20, 30, and 45 minutes; 1, 24, and 48 hours; and 7 days. RESULTS When pH changes over the time course were compared, there were no statistically significant differences among mean pH values of 0, 10, 20, 30, 45 minutes, 1 hour, and 24 hours (P = .754) and mean pH values of these groups were significantly lower than the mean pH value of 48 hours and 7 days (P < .05). The highest mean pH value was observed at day 7. When different vehicles were compared, the lowest mean pH value was observed in sterile saline. The mean pH value of Xylocaine was the highest (P < .05). CONCLUSION The result of this study indicated that when calcium hydroxide powder was mixed with glycerin, Xylocaine pump spray, Citanest Octapressin, 0.2% chlorhexidine solution, Ultracaine DS, and sterile saline solution, the mixtures became very highly alkaline. However, the pH values of the mixtures increased significantly after 24 hours. When one of these vehicles is used for root canal medication, a calcium hydroxide mixture might be left in place at least 7 days.
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Affiliation(s)
- Ali Cağin Yücel
- Department of Restorative Dentistry, Ondokuz Mayis University, Faculty of Dentistry, Samsun, Turkey.
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Mayr HO, Entholzner E, Hube R, Hein W, Weig TG. Pre- versus postoperative intraarticular application of local anesthetics and opioids versus femoral nerve block in anterior cruciate ligament repair. Arch Orthop Trauma Surg 2007; 127:241-4. [PMID: 16721618 DOI: 10.1007/s00402-006-0147-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Often anterior cruciate ligament (ACL) reconstruction is performed as outpatient surgery. This requires a patient friendly postoperative pain management. Three common procedures were compared in this trial. METHODS In a prospective, randomized study the effect of postoperative pain management using preoperative intraarticular anesthesia (0.1 mg Fentanyl + 8 ml Bupivacain 0.5%) was compared with postoperative intraarticular anesthesia (0.1 mg Fentanyl + 8 ml Bupivacain 0.5%) and the femoralis 3-in-1 nerve block (20 ml Prilocain 1% + 20 ml Bupivacain 0.5%) in 157 patients who underwent arthroscopic ACL-plasty. RESULTS Preoperative intraarticular anesthesia and the femoralis 3-in-1 nerve block showed the same postoperative analgesia and satisfactory pain scores in most cases. Postoperative intraarticular anesthesia was less effective. CONCLUSION Our data show that in anterior cruciate ligament reconstruction preoperative intraarticular analgesia with Bupivacain/Fentanyl is satisfactory and equal to the femoralis 3-in-1 nerve block with Bupivacain.
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Affiliation(s)
- Hermann O Mayr
- Department of Orthopedic Surgery, OCM-Clinic, Steinerstr 6, 81369, Munich, Germany.
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Murison MSC, Tucker SC. Providing pain relief for laser resurfacing: Effectiveness of the CoolAnalgesia© device. J Plast Reconstr Aesthet Surg 2007; 60:432-6. [PMID: 17349601 DOI: 10.1016/j.bjps.2006.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 04/04/2006] [Indexed: 11/17/2022]
Abstract
Laser resurfacing is a painful procedure, and is therefore usually carried out under general anaesthetic or local anaesthetic with sedation. However, the small but significant risk of adverse events from either of these methods has resulted in an effort to develop other methods of controlling the pain associated with the use of lasers. This trial describes of the use of a cooling device (the CoolAnalgesia device) with a carbon dioxide laser. The only anaesthetic used was a eutectic mixture of lidocaine anaesthetic (EMLA) applied as a cream to the face at least 60 min prior to the procedure. Twenty consecutive patients attending two laser centres for facial resurfacing were recruited. Each patient was asked to assess the level of pain on a visual analogue scale from 1-10 every 2 min during lasering. Only one of the patients had a mean pain score for the duration of the treatment of above five, four patients recorded a pain score of above five at some stage during their treatment, but none requested that the treatment be stopped. It would appear that the CoolAnalgesia device in combination with EMLA cream provides a level of anaesthesia sufficient to allow laser resurfacing without the use of local anaesthetic injections or intra-venous agents.
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Affiliation(s)
- M S C Murison
- Department of Plastic Surgery, Morriston Hospital, Swansea SA6 5NL, UK
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Liberty G, Gal M, Halevy-Shalem T, Michaelson-Cohen R, Galoyan N, Hyman J, Eldar-Geva T, Vatashsky E, Margalioth E. Lidocaine– Prilocaine (EMLA) cream as analgesia for hysterosalpingography: a prospective, randomized, controlled, double blinded study. Hum Reprod 2007; 22:1335-9. [PMID: 17234675 DOI: 10.1093/humrep/del517] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of our study is to evaluate the efficacy of applying lidocaine 25 mg-prilocaine-25 mg/G cream (EMLA 5%) on the uterine cervix for pain relief when performing hysterosalpingography (HSG). METHODS Eighty-two patients undergoing HSG as part of infertility evaluation were randomized into groups receiving EMLA (42) or placebo cream (40) in a double-blinded prospective study from which four women were later excluded. The cream was applied to the uterine cervix by means of a cervical cup 30 min before the HSG. Pain perception related to the HSG procedure was scored by visual analogue scale (VAS) at five predefined steps: after speculum application, after cervical instrumentation of the tenaculum and cannula, at the end of uterine filling, at completion of tubal spillage, and immediately following instrument removal. In addition, the patients were asked to retrospectively rate the pain during the entire procedure in a telephone interview the following day. RESULTS Cervical instrumentation was found to be the most painful step of HSG (P < 0.001). When comparing the VAS pain scores, cervical instrumentation in the EMLA-treated patients was associated with significantly less pain than the control group: 3.3 +/- 2.9 versus 4.9 +/- 2.7, respectively (P = 0.02). CONCLUSIONS Topical application of EMLA 5% cream on the uterine cervix before performing HSG significantly reduced the pain during this procedure.
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Affiliation(s)
- G Liberty
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem.
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Celebi N, Sahin A, Canbay O, Uzümcügil F, Aypar U. Abdominal pain related to mitochondrial neurogastrointestinal encephalomyopathy syndrome may benefit from splanchnic nerve blockade. Paediatr Anaesth 2006; 16:1073-6. [PMID: 16972839 DOI: 10.1111/j.1460-9592.2006.01918.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Patients diagnosed with abdominal pain related to mitochondrial neurogastrointestinal encephalopathy (MNGIE) may benefit from splanchnic nerve blockade. MNGIE, varying in age of onset and rate of progression, is caused by loss of function mutation in thymidine phosphorylase gene. Gastrointestinal dysmotility, pseudo-obstruction and demyelinating sensorimotor peripheral neuropathy (stocking-glove sensory loss, absent tendon reflexes, distal limb weakness, and wasting) are the most prominent manifestations. Patients usually die in early adulthood (mean 37.6 years; range 26-58 years). We report a case of an 18-year-old patient with MNGIE. Our patient's abdominal pain was relieved after splanchnic nerve blockade.
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Affiliation(s)
- Nalan Celebi
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
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Abstract
Endoscopic sinus surgery is one of the most frequent surgical ENT-procedures. Bleeding during surgery may increase complications and may have negative effects on surgery and outcome. The present paper describes strategies to prevent and deal with bleeding during sinus surgery. Preoperative conservative treatment of mucosal inflammation as well the use of adrenalin for decongestion may reduce intraoperative bleeding and hence complications.
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Langan SM, Collins P. Randomized, double-blind, placebo-controlled prospective study of the efficacy of topical anaesthesia with a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% for topical 5-aminolaevulinic acid-photodynamic therapy for extensive scalp actinic keratoses. Br J Dermatol 2006; 154:146-9. [PMID: 16403108 DOI: 10.1111/j.1365-2133.2005.06991.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective treatment modality for the treatment of extensive scalp actinic keratoses (AKs), but pain is a significant drawback when treating large areas with topical PDT using 5-aminolaevulinic acid (ALA) as sensitizer. A recent study has shown that use of tetracaine gel (Ametop) did not significantly reduce pain associated with PDT. OBJECTIVES To assess the benefit of a eutetic mixture of lignocaine 2.5% and prilocaine 2.5% (Emla) on pain during topical ALA-PDT treatment of scalp AKs. METHODS Fourteen men aged 59-83 years with extensive scalp AKs were recruited into a double-blind placebo-controlled study. Two treatment fields were defined (right and left frontal scalp) and were treated 2 weeks apart. These fields were randomized to receive either Emla or Aqueous cream as first or second treatment. ALA 20% cream was applied for 4 h. Topical anaesthesia or Aqueous cream was applied for 2 h. Pain was assessed using a visual analogue scale (0-100 mm) at 3, 6, 12 and 16 min. The instrument used for this was a blinded counter with one side reading 'no pain' to 'worst pain ever' with a numerical scale (0-100) on the reverse side. Pain scores were assessed looking at median and interquartile range and confidence intervals and calculating differences between treatment groups and analysing them using a paired t-test. RESULTS Thirteen patients received treatment to both fields. No significant difference in mean pain scores was seen with the use of Emla cream compared with placebo during treatment of scalp AKs (P = 0.328). There was no significant difference in requirement for oral analgesia following PDT between the two groups (P = 0.06). CONCLUSIONS Our data do not support the routine use of topical anaesthesia with Emla for topical PDT.
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Affiliation(s)
- S M Langan
- City of Dublin Skin and Cancer Hospital, Dublin 2, Ireland.
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Abstract
OBJECTIVE To compare the effect of eutectic mixture of local anaesthetics (EMLA) and a placebo cream on reported pain and observed distress associated with venepuncture, and to investigate effects of procedural information before and distraction during venepuncture. METHODS Children 3-12 years of age undergoing venepuncture under five experimental and a control condition reported their pain at venepuncture on visual scales. Distress was observed when the child entered the waiting room, just before, and during venepuncture. RESULTS Distress increased over the measurement occasions, but a distress-reducing effect of EMLA only was found at the actual venepuncture. The placebo diminished the reported pain, but the effect of EMLA was larger. Procedural information and distraction showed no effects. CONCLUSIONS EMLA reduces pain from venepuncture. The placebo effect probably results from desirable responding. Behavioural distress is a more direct measure than self-reported pain. More sophisticated designs should be used for the provision of procedural information and distraction.
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Koeppe T, Constantinescu MA, Schneider J, Gubisch W. Current trends in local anesthesia in cosmetic plastic surgery of the head and neck: results of a German national survey and observations on the use of ropivacaine. Plast Reconstr Surg 2005; 115:1723-30. [PMID: 15861081 DOI: 10.1097/01.prs.0000161671.34502.40] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to evaluate at the national level the current practice in the use of local anesthetics in cosmetic head and neck surgery and to compare the results with the novel local anesthesia technique used in the authors' department over the past 2 years. METHODS A questionnaire was posted to all 211 board-certified members of the Association of German Plastic Surgeons. The questions related to the daily practice in rhinoplasty, blepharoplasty, otoplasty, face lift, and forehead lift. The focus was laid on anesthesia techniques, local anesthetics, vasoconstricting agents, dosages, activity onset, observed side effects, mean duration of each procedure type, and surgeon satisfaction with the anesthetic used. RESULTS A total of 86 questionnaires (40.8 percent) were returned. The overall analysis revealed that local anesthetics were used in 88.9 percent of all cosmetic procedures of the head and neck. Prilocaine 1% (Xylonest; AstraZeneca, Wedel, Germany) was the most frequently used local anesthetic (32.0 percent), followed by lidocaine 1% (Xylocaine; AstraZeneca) and mepivacaine 1% (Scandicaine; AstraZeneca). Ropivacaine 0.2% (Naropin; AstraZeneca) was used only by 1.1 percent and ropivacaine 0.75% only by 0.9 percent (including two of the authors). Approximately half of the respondents (47.2 percent) used epinephrine 1:100,000 for vasoconstriction. In face lifts, the necessity of repeated "top-up" infiltration was reported in more than half (54.7 percent) of the procedures. Ten percent of surgeons surpassed the maximum recommended dosages when working without ropivacaine. Overall adverse cardiovascular effects were reported in 5.9 percent of rhinoplasties and 8.1 percent of face lifts performed mostly with prilocaine and lidocaine. No adverse cardiovascular reactions or overdoses were noticed with the use of ropivacaine. CONCLUSIONS The survey showed a clear trend toward the increasing use of local anesthetics in cosmetic surgery of the head and neck. Although the use of prilocaine and lidocaine prevailed, adverse cardiovascular reactions in up to 8.1 percent seem high for cosmetic procedures. Furthermore, the need of additional intraoperative top-up infiltration adds to an uncontrolled cumulative effect and patient discomfort. On the basis of their positive 2 years of experience with ropivacaine, the authors strongly believe that ropivacaine offers significant advantages, both in efficacy and prolonged duration of analgesia, while reducing the risk for adverse side effects due to lesser toxicity. This observation deserves further investigation in an established comparative study.
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Affiliation(s)
- Tobias Koeppe
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Stuttgart, Germany
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Broch O, Breucking E. Vergleich von Clonidin und Tramadol als Zusatz zur axillären Plexusblockade mit Prilocain. Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40:526-31. [PMID: 16145640 DOI: 10.1055/s-2005-870205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In a randomized, double-blind study we investigated the effect of clonidine and tramadol added to prilocaine on duration of analgesia, sensory and motor brachial plexus block. 60 patients were randomized in three groups. Group A received 40 ml prilocaine 1,5 % with tramadol 1,5 mg/kg KG, group B 40 ml prilocaine 1,5 % plus clonidine 1,5 microg/kg KG and group C 40 ml prilocaine 1,5 % without any additional medication. We recorded heart rate, blood pressure, oxygen saturation and sedation score at regular intervals. The onset of sensory and motor block was tested every five minutes for thirty minutes. The duration of analgesia, sensory and motor block were evaluated by using a questionnaire. There was no difference between the three groups concerning onset of brachial plexus block and duration of analgesia. But there was a significant prolongation of the duration of sensory and motor block in group B. Haemodynamic parameters remained stable in all patients, there were no significant changes in blood pressure and sedation.
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Affiliation(s)
- O Broch
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
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Abstract
A short cut review was carried out to establish whether a period of fasting increases the safety of Biers' block (intravenous regional anaesthesia). A total of 50 papers were found using the reported search, of which four presented the best 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 best papers are tabulated. A clinical bottom line is stated.
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Affiliation(s)
- Muhammad Ahmad
- Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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Duncan ID, McKinley CA, Pinion SB, Wilson SM. A Double-Blind, Randomized, Placebo-Controlled Trial of Prilocaine and Felypressin (Citanest and Octapressin) for the Relief of Pain Associated with Cervical Biopsy and Treatment with the Semm Coagulator. J Low Genit Tract Dis 2005; 9:171-5. [PMID: 16044058 DOI: 10.1097/01.lgt.0000171663.86847.45] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the anticipated and actual pain experienced in association with preliminary cervical punch biopsies and subsequent ablative treatment with the Semm coagulator, and to test the hypothesis that the intracervical injection of prilocaine with felypressin reduces the intensity of the pain experienced. MATERIALS AND METHODS One hundred consecutive women referred with abnormal cervical smears for colposcopic assessment and considered suitable for treatment with the Semm coagulator were recruited to a double-blind, randomized, prospective, placebo-controlled trial conducted in a colposcopy clinic in a university teaching hospital. Personal particulars were taken and anticipated pain scored. The patients were injected with randomized externally identical vials of prilocaine and felypressin (Citanest and Octapressin) or placebo. After biopsy and treatment, patients scored their actual pain experienced. Pain scores were compared as the main outcome measure. Relative risks with 95% CIs were calculated and compared using the CI Analysis computer programme (Professor Martin J Gardner and the British Medical Journal Version 1.1, copyright 1991). RESULTS Anticipated pain was greater than the actual pain experienced in both groups. Women receiving the local anesthesia experienced a significantly greater reduction in pain (p < .05) with only 4.3% and 6.7% experiencing moderate pain during biopsy and treatment, respectively. The active drug abolished severe pain. In the placebo group, 44.7% felt mild pain at the most. CONCLUSIONS Intracervical injection of prilocaine and felypressin reduces the intensity of pain experienced in women undergoing cervical biopsy and treatment with the Semm coagulator. Its use is commendable but is not absolutely necessary in all cases.
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Affiliation(s)
- Ian D Duncan
- Ninewells Hospital and Medical School, Dundee DD1 9SY, Tayside, Scotland, UK.
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Affiliation(s)
- Ronald S Erkert
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA
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Abstract
BACKGROUND Laser hair removal is an effective therapy for the treatment of hirsutism, hypertrichosis, and pseudofolliculitis barbae. Although side effects are uncommon, pain is described by most patients undergoing long-pulsed neodymium:yttrium-aluminum-garnet (Nd:YAG) 1,064 nm laser therapy. OBJECTIVES To compare the efficacy of topical eutectic mixture of local anesthetics (EMLA) versus topical lidocaine (LMX) in pain control for Nd:YAG 1,064 nm laser hair removal. METHODS Sixty-four patients were enrolled in a double-blind randomized study over a 6-month period. Each patient had half of the treatment area covered with EMLA and the other half with LMX 30 minutes prior to treatment. Neither was applied under occlusion. Immediately following their treatment session, patients completed a visual analog pain scale. RESULTS There was no statistically significant difference in pain control between EMLA and LMX. However, female test subjects demonstrated lower pain scores than male test subjects. CONCLUSIONS Nd:YAG 1,064 nm laser hair removal is a painful procedure. Topical anesthetics have been proven to reduce pain for laser hair removal. There is no statistically significant difference between the two most commonly used topical anesthetics for pain control in laser hair removal. Therefore, cost and minimizing potential side effects should guide the physician in selecting the appropriate anesthetic.
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Affiliation(s)
- Robert A Guardiano
- Department of Dermatology, National Naval Medical Center, Bethesda, Maryland 20889, USA.
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Abstract
Background Analgesia for neonatal circumcision was recently advocated for every male infant, and its use is considered essential by the American Academy of Pediatrics. We compared the post-operative analgesic quality of bupivacaine to that of lidocaine for achieving dorsal penile nerve block (DPNB) when performing neonatal circumcision. Methods Data were obtained from 38 neonates following neonatal circumcision. The infants had received DPNB analgesia with either lidocaine or bupivacaine. The outcome variable was the administration by the parents of acetaminophen during the ensuing 24 hours. Results Seventeen infants received lidocaine and 19 received bupivacaine DPNB. Ten infants in the lidocaine group (59%) were given acetaminophen following circumcision compared to only 3 (16%) in the bupivacaine group (P < 0.01). Regression analysis showed that the only significant variable associated with the need for acetaminophen was the use of lidocaine (R2 = 20.6; P = 0.006). Conclusion DPNB with bupivacaine for neonatal circumcision apparently confers better analgesia than lidocaine as judged by the requirement of acetaminophen over the ensuing 24-hour period.
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Affiliation(s)
- Orit C Stolik-Dollberg
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Shaul Dollberg
- Department of Neonatology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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New drugs for local anesthesia and oral sedation. Dent Today 2004; 23:48. [PMID: 15633821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Marsan A, Kirdemir P, Mamo D, Casati A. Prilocaine or mepivacaine for combined sciatic-femoral nerve block in patients receiving elective knee arthroscopy. Minerva Anestesiol 2004; 70:763-9. [PMID: 15699912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM The aim of this study was to evaluate the onset time of surgical block, recovery of motor function and duration of post-operative analgesia of combined sciatic-femoral nerve block performed with either mepivacaine or prilocaine. METHODS With Ethical Committee approval and written informed consent, 30 ASA physical status I-II patients, undergoing elective arthroscopic knee surgery, received a combined sciatic-femoral nerve block with 30 ml of either 2% mepivacaine (n=15) or 1% prilocaine (n=15). An independent observer recorded the onset time of sensory and motor blocks, the need for intraoperative analgesia supplementation, recovery of motor function, and first request of post-operative pain medication. RESULTS Onset time of nerve block required 15+/-5 min with prilocaine and 12+/-7 min with mepivacaine (p=0.33). No patient required general anesthesia to complete surgery; 3 patients receiving prilocaine (20%) and 2 patients receiving mepivacaine (13%) required 0.1 mg fentanyl intravenously to complete surgery (p=0.99). Recovery of motor function and first request of post-operative pain medication occurred after 238+/-36 min and 259+/-31 min with prilocaine, and 220+/-48 min and 248+/-47 min with mepivacaine (p=0.257 and p=0.43, respectively). Patient satisfaction was good in all studied patients. CONCLUSION Prilocaine 1% provides adequate sensory and motor block for arthroscopic knee surgery, with a clinical profile similar to that produced by 2% mepivacaine, and may be a good option for surgical procedures of intermediate duration and not associated with severe postoperative pain.
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Affiliation(s)
- A Marsan
- Department of Anesthesiology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
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Abstract
BACKGROUND Circumcision is a painful procedure that many newborn males undergo in the first few days after birth. Interventions are available to reduce pain at circumcision; however, many newborns are circumcised without pain management. OBJECTIVES The objective of this review was to assess the effectiveness and safety of interventions for reducing pain at neonatal circumcision. SEARCH STRATEGY We searched Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), MEDLINE (1966 - April 2004), EMBASE (1988 - 2004 week 19), CINAHL (1982 - May week 1 2004), Dissertation Abstracts (1986 - May 2004), Proceedings of the World Congress on Pain (1993 - 1999), and reference lists of articles. Language restrictions were not imposed. SELECTION CRITERIA Randomised controlled trials comparing pain interventions with placebo or no treatment or comparing two active pain interventions in male term or preterm infants undergoing circumcision. DATA COLLECTION AND ANALYSIS Two independent reviewers assessed trial quality and extracted data. Ten authors were contacted for additional information. Adverse effects information was obtained from the trial reports. For meta-analysis, data on a continuous scale were reported as weighted mean difference (WMD) or, when the units were not compatible, as standardized mean difference. MAIN RESULTS Thirty-five trials involving 1,984 newborns were included. Thirty-three trials enrolled healthy, full term neonates, and two enrolled infants born preterm. Fourteen trials involving 592 newborns compared dorsal penile nerve block (DPNB) with placebo or no treatment. Compared to placebo/no treatment, DPNB demonstrated significantly lower heart rate [WMD -35 bpm, 95% CI -41 to -30], decreased time crying [WMD -54 %, 95% CI -64 to -44], and increased oxygen saturation [WMD 3.2 %, 95% CI 2.7 to 3.7]. Six trials involving 190 newborns compared eutectic mixture of analgesics (EMLA) with placebo. EMLA demonstrated significantly lower facial action scores [WMD -46.5, 95% CI -80.4 to -12.6], decreased time crying [WMD - 15.8 %, 95% CI -20.8 to -6.8] and lower heart rate [WMD -15 bpm, 95% CI -19 to -10]. DPNB, compared with EMLA in four trials involving 164 newborns, demonstrated significantly lower heart rate [WMD -17 bpm, 95% CI -23 to -11] and pain scores. When compared with sucrose in two trials involving 126 newborns, DPNB demonstrated less time crying [MD -166 s, 95% CI -211 to -121], and lower heart rate [WMD -27 bpm, 95% CI -33 to -20]. Results obtained for trials comparing oral sucrose and oral analgesics to placebo, and trials of environmental modification were either inconsistent or were not significantly different. Adverse effects included gagging, choking, and emesis in placebo/untreated groups. Minor bleeding, swelling and hematoma were reported with DPNB. Erythema and mild skin pallor were observed with the use of EMLA. Methaemoglobin levels were evaluated in two trials of EMLA, and results were within normal limits. REVIEWERS' CONCLUSIONS DPNB was the most frequently studied intervention and was the most effective for circumcision pain. Compared to placebo, EMLA was also effective, but was not as effective as DPNB. Both interventions appear to be safe for use in newborns. None of the studied interventions completely eliminated the pain response to circumcision.
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Affiliation(s)
- B Brady-Fryer
- Child Health - Critical Care, Capital Health, Royal Alexandra Hospital, 10240 Kingsway, Room 5027-10 DTC, Edmonton, Alberta, Canada, T5H 3V9.
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Apan A, Basar H, Ozcan S, Buyukkocak U. Combination of adenosine with prilocaine and lignocaine for brachial plexus block does not prolong postoperative analgesia. Anaesth Intensive Care 2004; 31:648-52. [PMID: 14719426 DOI: 10.1177/0310057x0303100606] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adenosine analogues have been used by subarachnoid injection for the treatment of inflammatory and neuropathic pain. There is no data on the use of adenosine in peripheral nerve blocks. The aim of the present study was to determine the analgesic efficacy of adenosine in combination with a local anaesthetic solution for brachial plexus (BP) block. With local ethics committee approval, 50 consenting adult patients undergoing upper limb surgery were enrolled in this double-blind, prospective, randomized study. Patients with a history of bronchospastic disease were excluded. Patients were instructed not to take theophylline-containing drugs and beverages for at least one day before surgery or on the first postoperative day. A supraclavicular BP block was performed by injecting a mixture totalling 35 ml made up of prilocaine 1% 10 ml and lignocaine 2% 20 ml with adrenaline 1:200,000, and adenosine 10 mg in 5 ml saline (Group 1) or 5 ml saline (Group 2) as a placebo control group. Postoperative analgesia was assessed by time to first rescue analgesia, analgesic consumption in the first 24 hours, and VAS at rest at 4, 8, 12, 16, 20 and 24 hours. Side-effects were also noted. Vital signs were stable in both groups throughout the operation. There were no significant differences between the groups in onset of motor and sensory block. Time to first pain sensation from block was not significantly longer in the adenosine group (379 +/- 336 min) compared with controls (304 +/- 249 min, mean +/- SD, P = 0.14). Time to first analgesic requirements and analgesic consumption in the first 24 hours were also similar in both study groups. In the present study, the addition of adenosine to local anaesthetic in brachial plexus block did not significantly extend the duration of analgesia.
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Affiliation(s)
- A Apan
- Department of Anaesthesiology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Abstract
BACKGROUND AND OBJECTIVES Multiple anesthetic approaches exist for full-face laser resurfacing. The purpose of this study was to describe an anesthesia technique based on combination of eutectic mixture local anesthetics (EMLA) and remifentanil sedation, that can be utilized by anesthesiologists in the ambulatory environment. STUDY DESIGN/MATERIALS AND METHODS Fifty patients elected for facial laser resurfacing. All patients received topical anesthesia in full face with EMLA cream at 60 minutes (min) before laser procedure. On arrival at the operating room, intravenous (IV) sedation was administered with remifentanil (0.20 mcg/kg/minute), midazolam (1.5- 2 mg bolus IV), and propofol infusion (0.5-1 mg/kg/hour). The subsequent infusion rate of remifentanil was varied to maintain an adequate level of sedation and analgesia. Five minutes before the operation conclusion, the sedation infusion was discontinued. Patients were discharged after achieving a minimum criteria for recovery. RESULTS Almost all the patients were successfully anesthetized by this combination technique, only four patients needed complementary anesthesia with regional nerve blockade. The mean level of sedation scored 2-3 on the Ramsay scale. The mean discharge time was 55 minutes. No complications were observed. CONCLUSIONS The use of a combination of topical EMLA anesthesia and IV conscious sedation based on remifentanil provided an adequate depth of anesthesia for outpatient facial laser resurfacing without complications.
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Abstract
BACKGROUND Topical local anesthetic applications offer painless, effective analgesia with slow onset but prolonged duration and minimal side effects. EMLA (Eczacibasi Pharmaceuticals, Istanbul, Turkey) is the most universally used topical local anesthetic. OBJECTIVE The aim of this prospective, randomized, double-blind study is to evaluate the efficacy of EMLA on total anesthesia of the external ear. METHODS Twenty-two patients with helical lesions were divided into two groups. Group A received EMLA on both the anterior and posterior surfaces of the ear, and group B received EMLA on only one side of the ear. After 120 minutes of occlusive dressing, the surgery was performed. The short form of the McGill Pain Questionnaire and a numerical visual analog scale were used to measure overall pain quality and intensity during and at the end of surgery. RESULTS Visual analog scale scores (four for group A and six for group B6) between two groups using Student's t-test (p=0210) and concerning McGill Pain Questionnaire scores with Wilcoxon signed ranks test (p=0.058) between two groups showed no statistical significant difference. CONCLUSION It seems that EMLA cream is not a good and first option for achieving full anesthesia on the ear because of its poor anesthetic effect. We do not consider EMLA cream to be clinically useful for major surgical attempt on the ear.
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Affiliation(s)
- Nedim Sarifakioglu
- Ankara Training and Research Hospital, Plastic and Reconstructive Surgery Department, Ankara, Turkey.
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