Therapeutic Use of Low-Dose Local Anesthetics in Pain, Inflammation, and Other Clinical Conditions: A Systematic Scoping Review.

The use of low-dose local anesthetics (LAs) has significantly transformed patient care by providing rapid and effective relief of pain and other clinical conditions while minimizing recovery time. This study aims to identify and describe the existing scientific evidence on the therapeutic use of low-dose LAs in various conditions and to identify gaps in the current literature in order to prioritize future research. This systematic scoping review adhered to the methodological guidelines outlined in the Arksey and O'Malley framework, which includes five distinct stages. Of the 129 studies included, 37.98% (n = 49) were clinical trials, 55.03% (n = 71) were observational studies, and 6.97% (n = 9) were systematic reviews. The most commonly reported indication for the use of low-dose LAs was chronic pain management (72.86%), followed by acute pain management (13.17%). Additionally, non-pain-related indications were also identified (13.95%). Overall, the administration of low-dose, short-acting LAs demonstrated favorable outcomes in terms of pain management and reduction in anxiety and depression scales, thereby having a positive impact on the patients' quality of life. This review represents the first systematic scoping review regarding the therapeutic role of LAs. To substantiate the reported positive effects on efficacy and safety, further rigorous research comprising larger, well-designed randomized controlled trials (RCTs) and long-term outcome monitoring is imperative.

Improvement in post-orthodontic chronic musculoskeletal pain after local anesthetic injections in the trigeminal area: a case series.

Orthodontic treatment has been associated with chronic extraoral pain that is often resistant to common treatments such as drugs or physiotherapy, adversely affecting patients' quality of life. In this case series, we discuss the potential impact of orthodontics on chronic cervical spine pain or gonalgia and explore the long-term effect of local anesthetic injections as a possible therapeutic intervention. Six orthodontic patients with chronic cervical spine pain or gonalgia that substantially affected their quality of life were treated with injections of 0.5% procaine into individual lesions and at palpable points of tissue tension in the oral mucosa and extraoral myofascial areas. All patients in this case series reported significant improvement in their chronic pain, with no residual pain recorded at the 6-month follow-up. Injecting local anesthetic at stress points in the oral mucosal and extraoral myofascial regions may be an effective treatment for post-orthodontic neck and knee pain. Further research is required to better understand the potential benefits of this intervention for patients experiencing orthodontic-related musculoskeletal pain.

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report.

BACKGROUND: Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S. PATIENT CONCERNS AND DIAGNOSES: This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability. INTERVENTIONS AND OUTCOME: Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains. CONCLUSION: Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.

Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review.

BACKGROUND: Localized vulvar pain (LVP) is a common condition among fertile women, with physical and psychosexual implications. Treatment is complex with limited benefits. Neural therapy is a regulatory therapy that uses injections of local anesthetics in low concentrations in specific points to treat different conditions. CASE PRESENTATION: We present the cases of 5 women, ages 33-44 years, with LVP treated with procaine 0.5% injections in painful points. Complete relief from pain occurred in 2 patients, and significant improvement in 3. Only 1 or 2 sessions were required. Initial VAS score was ≥70 and decreased to ≤30 after the intervention. The improvement was maintained over time, with a minimum follow-up period of 6 months. None of the patients were able to have sex or use tampons due to pain, but they were able to resume after the intervention. CONCLUSIONS: In this case series, local injections of procaine showed a favorable outcome. Future randomized clinical trials could help elucidate the role of this intervention in LVP.

Peripheral facial palsy after varicella. Report of two cases and review of the literature.

BACKGROUND: There is little information regarding peripheral facial palsy (PFP) as a complication of varicella. We describe 2 adults who developed varicella-related PFP, in 1 case as a part of Guillain-Barré syndrome (GBS), and review all reported cases of this condition. METHODS: MEDLINE search. RESULTS: A total of 10 cases of isolated varicella-associated PFP have been reported. PFP was diagnosed 3 to 16 days after the onset of skin manifestations. Four (40%) patients developed bilateral PFP. Two patients had varicella meningitis; both were PCR-positive for varicella-zoster virus (VZV) in CSF. CSF IgG antibodies against VZV were demonstrated in 2 other patients. One patient had slight CSF albumino-cytological dissociation. Five patients were treated with acyclovir, and 3 of them also received corticosteroids. Most patients showed a favorable course, with partial or complete recovery of PFP. In addition, 17 patients with GBS after the onset of varicella were reviewed. Mean time to the development of GBS after varicella onset was 9.3 days, and 9 patients had PFP as a part of the neurologic picture. Seven patients (41%) developed respiratory failure requiring mechanical ventilation. Six patients received treatment with intravenous immunoglobulin, and all of them showed optimal evolution. One patient died. CONCLUSIONS: Isolated PFP and GBS are rare peripheral nerve complications after varicella. Treatment should be individualized for each case, depending on the severity of the condition and the clinical evolution.

Treatment outcome in children with tuberculosis in southern Ethiopia.

Our study took place at 8 tuberculosis diagnostic and treatment centres in Sidama Zone, southern Ethiopia. Our objectives were to assess the status of TB treatment in children and risk factors associated with unfavourable outcome. A retrospective study was based on information retained in TB registers of the centres. Demographic characteristics and treatment outcome of children registered between 2002 and 2007 were retrieved. Risk factors for unfavourable outcome (failure, default or death) were calculated. Of 851 (165 with smear-positive, 475 smear-negative and 206 extrapulmonary TB) children, 655 (77%) were cured or completed and 124 (14.6%) had unfavourable outcome. Treatment success rate increased with age from 66% in children <5 y old to 81% in 5-9-y-olds and 85% in >/=10-y-olds (p <0.001). 75% of patients with smear-negative TB had favourable outcome compared to 80.6% for smear-positive cases (p =0.06). Age <5 y, lack of smear conversion in the second month and living in rural areas were independent risk factors for unfavourable treatment outcome. In conclusion, the outcome of TB treatment varies with age, residency and smear results. Reporting only cases with smear-positive TB disproportionally excludes a higher proportion of children than adults. Surveillance systems to monitor TB outcome in children need to be improved.