Comparison of the Efficacy of Two Different Local Anesthesia Techniques for Mesotherapy in Temporal Region Alopecia

Introduction Mesotherapy is a wide range of minimally invasive injections. In mesotherapy, a mixture of various tonics is injected into the skin. These include plant extracts, various medications, vitamins, enzymes, hormones, growth factors, and other factors that will help treat alopecia. Most commonly, a mixture of platelet-rich plasma (PRP) and vitamins is used. In mesotherapy treatment for hair regrowth in the temporal region, zygomaticotemporal nerve blocks, supratrochlear nerve blocks, and supraorbital nerve blocks are given. The zygomaticotemporal nerve, supraorbital nerve, and supratrochlear nerve are the branches of the trigeminal nerve. They provide sensation on the lateral side of the forehead, which is the temple region.  Methods A sample size of 100 people was taken for the study who were undergoing mesotherapy in the bilateral temporal region for alopecia. Each group had 50 subjects: group I was given supratrochlear, supraorbital, and zygomaticotemporal nerve blocks as local anesthesia techniques, and group II was given supratrochlear and supraorbital nerve blocks. PRP was injected using an insulin syringe. Pain was assessed using a visual analog scale (VAS). Results During the procedure, a mean VAS of 1 and 3 was observed in groups I and II, respectively, during the procedure (p-value 0.023). A mean VAS of 3 and 5 was observed in groups I and II, respectively, after three hours (p-value 0.000). This shows a significant difference in the pain experienced by the subjects between the groups.  Conclusion This study proves that the zygomaticotemporal nerve, used along with supratrochlear and supraorbital nerve blocks, is better at producing analgesia and reducing pain.

The Origins and Development of Pre-emptive Dermatologic Anesthesia: A Systematic Review

This study delves into the historical trajectory of dermatological anesthesia, tracing its roots from ancient civilizations to modern times. It emphasizes the relentless pursuit of pain relief in dermatologic procedures and the transformative impact of anesthesia on surgical practices. A comprehensive analysis was conducted through an extensive literature review, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review model on the PubMed and Embase databases. A total of 1304 articles were initially identified, with six publications from these databases and 10 additional sources from the World Wide Web included in the study. This systematic approach allowed for a thorough examination of the historical journey of dermatological anesthesia. The historical trajectory outlined in this study highlights the progress in dermatological anesthesia, showcasing its impact on contemporary procedures with a continual emphasis on patient comfort and safety. As medical knowledge expands, the ongoing quest for enhanced pain control in dermatology remains a central focus.

Intraoperative Ultrasound-Guided Selective Glossopharyngeal Nerve Block for Post-tonsillectomy Analgesia: A Case Report

Tonsillectomy can lead to significant postoperative pain, which can impact the recovery process. Traditional analgesic approaches may entail risks due to medication use. Considering that the tonsils are innervated by the glossopharyngeal and maxillary nerves, implementing glossopharyngeal and maxillary nerve blocks can provide analgesia. Ultrasound guidance may improve its effectiveness and safety. A woman in her 30s with recurrent tonsillitis underwent tonsillectomy under general anesthesia. After induction, we performed an ultrasound-guided selective glossopharyngeal nerve block and an ultrasound-guided maxillary nerve block with ropivacaine. No analgesics were required during the six-day hospitalization period. There were no complications from the nerve blocks such as dysphagia or upper airway obstruction. The findings from this case indicated that the ultrasound-guided selective glossopharyngeal nerve block and ultrasound-guided maxillary nerve block provided effective analgesia after tonsillectomy without complications.

Comparison of the Efficacy Between Regional Nerve Block and Ring Block as Local Anesthetic Techniques for Platelet-Rich Plasma Treatment

Introduction Platelet-rich plasma (PRP), a solution of concentrated platelets, has been widely used to promote wound repair and tissue regeneration. In the treatment of pattern hair loss, platelets in PRP secrete an abundance of growth factors, including platelet-derived growth factor (PDGF), fibroblast growth factor(FGF), and many more, which stimulate and increase signaling molecules and accelerate cell proliferation. In the PRP treatment for hair regrowth, the supratrochlear nerve (STN) block and supraorbital nerve (SON) block are given to anesthetize the scalp up to the vertex except for the temporal region. The ring block is the common local anesthetic technique used by infiltrating local anesthetic agents around the target area. The primary objectives were to compare the pain and anesthetic success rates produced by regional nerve blocks and ring blocks. Materials and methods A sample size of 100 patients undergoing PRP treatment for hair regrowth were taken as the subjects for the study. Patients were allotted into two groups by randomization. Group 1 was given regional nerve blocks as the anesthetic technique used for local anesthesia, and group 2 was given ring blocks. In the study group, STN and SON blocks as the regional nerve blocks were given 2% lignocaine with 1:80000 adrenaline to anesthetize the area, and the PRP was injected from the anterior hairline up to the vertex of the scalp, not involving the occipital and temporal regions. In the control group, a ring block was given for the same procedure. Participants from both groups were assessed for the pain and analgesia caused by ring block and regional nerve blocks using the visual analog scale (VAS). Results A mean rank of 30.28 was observed for the regional nerve block technique, and a mean rank of 70.72 was observed for the ring block technique. A p-value of 0.00 that is <0.05 was observed, which shows there is a significant difference in the pain and the analgesia experienced by the subjects between the two groups, during and three hours after the procedure. Conclusion PRP is one of the most commonly used treatments for hair regrowth. The ring block is the common local anesthetic technique used for producing anesthesia, while regional nerve blocks are more effective in producing local anesthesia. This study proves that STN and SON blocks are better anesthetic techniques than the ring block technique for PRP treatment in hair growth.

Vaginal Vault Infiltration with Bupivacaine for Postoperative Pain Control after Total Laparoscopic Hysterectomy: A Randomized control trial

Objectives

The objective of this study was to assess the effect of local infiltration of anesthetic to the vaginal vault on postoperative pain after total laparoscopic hysterectomy.

Materials and Methods

This was a single-center, randomized trial. Women assigned to laparoscopic hysterectomy were randomly divided into two groups. In the intervention group (n = 30), the vaginal cuff was infiltrated with 10 ml of bupivacaine, whereas the control group (n = 30) did not receive local anesthetic infiltration to vaginal vault. The primary outcome measure was to analyze the efficacy of bupivacaine infiltration in the study group by comparing the postoperative pain in both the groups at 1, 3, 6, 12, and 24 h using pain visual analog scale (VAS). The secondary outcome was to measure the need for rescue opioid analgesia.

Results

Group I (intervention group) had lesser mean VAS score at 1^st, 3^rd, 6^th, 12^th, and 24 h compared to Group II (control group). There was an additional requirement of opioid analgesia for postoperative pain in Group II than in Group I, which was statistically significant (P < 0.05).

Conclusion

Injection of local anesthetic into the vaginal cuff increased the number of women experiencing only minor pain after laparoscopic hysterectomy and decreased postoperative opioid usage and its side effects. Local anesthesia of the vaginal cuff is safe and feasible.

Long-term outcome after Bascom's cleft-lift procedure under tumescent local analgesia for pilonidal sinus disease: a cohort study

AIM

Bascom's cleft-lift procedure for pilonidal sinus disease under tumescent local analgesia is feasible and well tolerated with favourable short-term outcomes. We aimed to assess the 10-year treatment success rate after cleft-lift under tumescent local analgesia.

METHOD

This was a single-centre cohort study based on prospectively registered perioperative data and survey data with additional data from electronic medical records. The cleft-lift procedure was performed under tumescent local analgesia in a day-surgical setting at a tertiary referral hospital between 1 July 2008 and 31 March 2014. The primary outcome was the 10-year risk treatment success defined as complete wound healing within 180 days of surgery or no recurrence assessed with competing risk analyses. Secondary outcomes were time to complete wound healing, persistent pain and cosmetic satisfaction.

RESULTS

Two hundred patients with complex pilonidal sinus disease were included. Indication was incomplete wound healing after pilonidal sinus surgery in 43 (21.5%) patients, recurrence after previous intervention in 78 (39.0%) or moderate to complex sinuses assessed by a consultant surgeon in 79 (39.5%). One hundred and ninety-five patients had complete wound healing within 180 days with a median time of 29 days (interquartile range 16-47). The cumulative risk of 10-year recurrence was 11.3% (95% CI 6.2%-16.4%) with a median follow-up time of 8.5 (1.0-10.7) years. Treatment success was 86.1% (95% CI 80.6%-91.5%). No significant predictors were associated with recurrence, and 90% of patients experienced no persistent pain.

CONCLUSION

Cleft-lift performed under tumescent local analgesia has an acceptable 10-year treatment failure rate, making the method feasible in a day-surgery setting.

Effects of thoracolumbar epidural anesthesia with lidocaine on the systemic hemodynamics and hepatic blood flow in propofol anesthetized dogs

General anesthesia reduces hepatic blood flow (HBF) from circulatory depression. Total intravenous anesthesia (TIVA) is associated with decreased circulatory depression compared to inhalation anesthesia, and epidural anesthesia using local anesthetics increases blood flow by blocking the sympathetic nerves and expanding blood vessels. We investigated the effects of thoracolumbar epidural anesthesia with TIVA on HBF in dogs. Six Beagle dogs had epidural catheters placed between T13 and L1 and were anesthetized with propofol and vecuronium. Physiological saline (control) or 2% lidocaine (0.2 ml/kg, followed by 0.2 ml/kg/hr) was administered at 1-2 weeks intervals. Heart rate (HR), cardiac index (CI), mean arterial pressure (MAP), and systemic vascular resistance index (SVRI) were recorded at 10-min intervals from before epidural injections (T0) to 110 min. Indocyanine green test was used to measure HBF during the awake state and until 90 min after epidural injections. HR and CI did not differ between treatments. MAP and SVRI after lidocaine were significantly lower than those of controls, and the lowest MAP value was 65 ± 11 mmHg at T10. Compared to T0, after lidocaine treatment, HBF was significantly higher at T30, T60 and T90 (P<0.05); while, after control treatment, no significant change was evident at any time point. Despite a decrease in MAP by this technique, HBF was either maintained at pre-anesthetic levels or increased in comparison to controls, probably due to vasodilation of the hepatic artery induced by the selective blockade sympathetic ganglia.

Ultrasound-Guided Funicular Block: Ropivacaine Injection into the Tissue around the Spermatic Cord to Improve Analgesia during Orchiectomy in Dogs

Simple Summary

Orchiectomy is a common surgical procedure performed on small animals and postoperative analgesia is very important because pain causes various negative effects that prevent patient recovery. Our study aimed to compare the intraoperative ultrasound-guided funicular block with ropivacaine and general anaesthesia using hypnotic and/or analgesic drugs and the postoperative hemodynamic stability and pain scores. This study demonstrated that the use of ultrasound-guided funicular, using ropivacaine, guarantees long-lasting and high-quality analgesic coverage and minimises the post-surgical pain inevitably associated with orchiectomy. This study stemmed from a general trend towards increasing attention on postoperative pain after orchiectomy in dog. Since veterinarians are becoming more focused on relieving surgical pain, anaesthetists are expected to use better protocols that can minimise pain. In fact, acute postsurgical pain is of great interest due to potential risk of becoming chronic if not treated properly. The routine use of the intraoperative ultrasound-guided funicular block with ropivacaine block is considered a useful alternative for pain management for orchiectomy in dogs, which can be performed under sedation or superficial general anaesthesia. In addition, the intraoperative ultrasound-guided funicular block with ropivacaine block ensures satisfactory analgesic coverage that lasts for at least 6 h postoperatively.

Abstract

Orchiectomy is a common surgical procedure performed on small animals, and it requires postoperative pain management despite its relative simplicity. This study aimed to evaluate the hemodynamic stability, intraoperative administration of additional hypnotic and/or analgesic drugs, and postoperative pain scores following the combination of ultrasound-guided injection of ropivacaine hydrochloride into the spermatic cord and infiltration by the same anaesthetic of the incisional prescrotal line (ROP) or general anaesthesia. Dogs in the ROP group showed greater intraoperative hemodynamic stability and lower pain scores than the control group. The locoregional approach used in this study proved effective in minimising the responses to the surgical stimulus and ensured adequate analgesia intra- and postoperatively. This method, called ultrasound-guided funicular block, allows orchiectomy to be performed under deep sedation without general anaesthesia.

Local infusion of ropivacaine for pain control after osseous free flaps: Randomized controlled trial

BACKGROUND

Donor site pain after osteocutaneous free flap surgery contributes to postoperative morbidity and impairs recovery. We evaluated the efficacy of local infusion of ropivacaine for treating donor-site pain after surgery.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial of patients undergoing osteocutaneous fibula or scapular tip free flaps for head and neck reconstruction at Mount Sinai Hospital. Patients were randomized to receive local infusion of ropivacaine or saline. We compared Visual Analog Scale pain scores for donor-site specific pain 48 hours after surgery.

RESULTS

There were 8 fibular free flap and 10 scapular free flap reconstructions. Average donor-site pain scores were 29 ± 22 and 31 ± 28 mm (P = .88) for placebo and ropivacaine arms, respectively. The trial was stopped after the planned interim analysis for futility of the intervention.

CONCLUSIONS

Local infusion of ropivacaine did not affect donor-site specific pain scores in this population. ClinicalTrials.gov Identifier: NCT03349034.

The effectiveness of electronic pulsed soft tissue vibration compared with topical anaesthesia in reducing the pain of injection of local anaesthetics in adults: a randomized controlled split-mouth clinical trial

The purpose of this study was to evaluate the effectiveness of an electronic hand-held pulsed vibration device on the pain of local analgesia (LA) injection and physiologic changes. A prospective randomized controlled clinical trial using split-mouth (crossover) design was implemented. The control-side injection was performed after using topical anaesthesia. The experimental side injection was carried out without topical anaesthesia, but with the aid of a switched-on vibration device. Overall, 332 dental LA injections were given to 166 patients for routine exodontia. The pain at penetration and pain during injection were significantly lower in the experimental sides (vibrations sides) compared with those of the controls (P<0.001). Similarly, the heart rate changes at penetration and during injections were significantly lower in the experimental sides (P<0.001). The vibration device was clinically and statistically more effective than topical anaesthesia in the reduction of dental injection pain in adults, measured subjectively and objectively, regardless of the gender, injection technique (infiltration or block) or anxiety level.

The effect of a compression bandage on the distribution of radiodense contrast medium after palmar digital nerve blocks

BACKGROUND

Studies have shown proximal diffusion of injected drugs in perineural blocks; such diffusion may affect specificity of the nerve block.

OBJECTIVES

To investigate the effect of a compression bandage applied to the pastern region on proximal diffusion of contrast medium injected over the palmar digital nerves.

STUDY DESIGN

Experimental study, randomised cross-over design.

METHODS

Radiodense contrast medium was injected over the lateral and medial palmar digital nerves of the left front limb of nine mature horses. Each horse was injected on two separate occasions, once with a 5 cm wide compression bandage applied proximal to the injection site and once without. The order of the two treatments was randomised with a wash-out period between treatments of at least 7 days. Radiographs were obtained at 5, 10, 20 and 30 min and distribution of the contrast column assessed.

RESULTS

Proximal distribution of the contrast medium was significantly reduced (P<0.01) with compression bandage. Furthermore, the compression bandage inhibited lymphatic drainage of the injected contrast medium.

MAIN LIMITATIONS

Clinical effect of the differences in diffusion length was not assessed.

CONCLUSIONS

The compression bandage reduced proximal diffusion and lymphatic drainage of contrast material causing it to stay localised around the injection site. Use of compression bandages could thus result in increased specificity of the nerve block and potentially prolong its effect.

A randomized double-blind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy

BACKGROUND

The incidence of temporary gluteal pain after sacrospinous ligament colpopexy ranges from 6.1% to 15.3%. Gluteal pain may occur as a result of injury to S3 to S5 nerve roots that course over the mid-portion of the coccygeus-sacrospinous ligament complex at the time of suspension suture placement. There are no data on the use of injections to prevent postoperative pain from nerve entrapment at the time of suture placement.

OBJECTIVE

The purpose of this study was to determine whether intraoperative local analgesia that is administered at the level of the sacrospinous ligament can lessen the gluteal pain felt by patients postoperatively after sacrospinous ligament colpopexy.

STUDY DESIGN

In a randomized double-blind placebo-controlled trial, women with vaginal apex prolapse who were undergoing surgical treatment with sacrospinous ligament colpopexy underwent intraoperative injection with either 0.25% bupivacaine or normal saline solution. Subjects completed visual analog pain scales (0-10) and the Activities Assessment Scale and recorded the use of pain medications over a 6-week period. The primary outcome was postoperative gluteal pain. A sample size of 50 subjects (25 in each arm) was planned to test the hypothesis that local analgesia administration will lessen postoperative pain compared with placebo.

RESULTS

Between April 2014 and March 2016, 51 women were enrolled in the study, and 46 women underwent sacrospinous ligament colpopexy. On postoperative day 1, 90.2% of all subjects (n=41) reported gluteal pain. At weeks 1 and 2, 63.8% (n=29) and 44.1% (n=20) women reported pain; at weeks 4 and 6, 33.3% (n=15) and 26.9% (n=12) women continued to have some pain. On day 1, the mean score for gluteal pain was 3.7±2.9. By week 1, the score was 1.8±2.6; by week 6, the mean score was 0.1±0.3. There were no differences in pain scores for patients who had undergone injection with 0.25% bupivacaine and those who were injected with normal saline solution. Patients in the placebo group used significantly more nonsteroidal antiinflammatory drugs than the treatment group: adjusted odds ratio, 1.25; 95% confidence interval, 1.04-1.35; P=.01). By 6 weeks, 87.5% of patients had returned to their baseline "light" activity level. There was no difference in time to return to baseline between the groups.

CONCLUSION

Intraoperative administration of local analgesia does not reduce patients' perceptions of postoperative gluteal pain after sacrospinous ligament colpopexy; however, it may reduce the need for pain medication after surgery.

Efficacy of buprenorphine added to 2% lignocaine plus adrenaline 1:80,000 in providing postoperative analgesia after lower third molar surgery

A number of trials have examined the peripheral analgesic effect of opioids, known to have an anti-nociceptive effect at the central and/or spinal cord level. This study aimed to evaluate the efficacy of buprenorphine added to 2% lignocaine with adrenaline 1:80,000 in providing postoperative analgesia after lower third molar surgery. Sixty patients were randomized to three groups: group A received lignocaine 2% with adrenaline 1:80,000 for inferior alveolar nerve block (IANB), along with intramuscular (IM) injection of 1ml saline; group B received buprenorphine mixed with lignocaine 2% with adrenaline 1:80,000 for IANB (0.01mg buprenorphine/ml lignocaine with adrenaline), along with 1ml saline IM; group C received lignocaine 2% with adrenaline 1:80,000 for IANB, along with 0.03mg buprenorphine IM. Mean postoperative pain scores (visual analogue scale; when the patient first felt pain) were 6.0 for group A, 1.0 for group B, and 4.4 for group C. The mean duration of postoperative analgesia was 3.5h in groups A and C and 12h in group B. The mean number of postoperative analgesics consumed was 5.8 in groups A and C and 3.9 in group B. The addition of buprenorphine (0.03mg) to 2% lignocaine with adrenaline 1:80,000 significantly reduced the severity of postoperative pain and prolonged the duration of analgesia, thereby decreasing the need for postoperative analgesics.

Presumptive intraperitoneal envenomation resulting in hemoperitoneum and acute abdominal pain in a dog

OBJECTIVE

To describe the clinical features, diagnostic findings, treatment, and outcome of a dog with acute abdominal pain and hemoperitoneum secondary to a presumptive intraperitoneal (IP) snakebite.

CASE SUMMARY

A 10-month-old castrated male mixed-breed dog was evaluated for suspected snake envenomation. The dog presented recumbent and tachycardic with signs of severe abdominal pain. Two cutaneous puncture wounds and hemoperitoneum were discovered during evaluation. Ultrasonographic examination revealed communication of the wounds with the peritoneal cavity. The dog was treated with supportive care, parenteral analgesia, packed red blood cell and fresh frozen plasma transfusions, crotalid antivenom, and placement of an IP catheter to provide local analgesia. The dog recovered fully and was discharged 5 days after initial presentation.

NEW OR UNIQUE INFORMATION PROVIDED

To our knowledge, this is the first report of IP envenomation accompanied by hemorrhage treated with continuous IP analgesia in the veterinary literature.

Role of 'student-to-student local analgesia administration' on undergraduate students' opinions regarding 'pain-free local analgesia technique' in children

AIM

To examine the role of 'student-to-student local analgesia administration' on undergraduate dental students' opinions regarding pain-free local analgesia techniques in children.

METHODS

Grade 3 (n:29), Grade 4 (n:59) and Grade 5 students (n:28) of Yeditepe University, School of Dentistry, Istanbul, Turkey participated in the study. Informed consent and ethical approval were obtained. Students' opinions were evaluated by means of a short survey administered before and after educational activities. Activities were provided in a didactic manner (theoretical, practical and clinical stages) and lasted for 6 months. Theoretical lectures on 'pain-free local analgesia techniques in children' were given to all classes. In the practical stage, 3rd and 4th grade students were paired and performed infiltration analgesia on each other according to the lectured technique. In the final clinical stage, 4th and 5th grade students were supervised, whilst administering the technique on children during their clinical training.

RESULTS

Before the activities, only 40% of students believed in the possibility of pain-free local analgesia in children, whereas after the educational activities, the percentage had risen to 68% (P = 0.0001). A significant difference was observed between the opinions of 4th grade students who attended the practical stage and 5th grade students who did not.

CONCLUSION

The role of 'student-to-student local analgesia administration' was found to be significant in changing undergraduate students' opinions about pain-free dental injections in children.