Incidence of post-surgical hypoparathyroidism (POSH) after total thyroidectomy.

Post-surgical hypoparathyroidism (POSH) is a recognised complication of total thyroidectomy, leading to hypocalcaemia and its associated adverse effects. This retrospective study aimed to determine the incidence of POSH and identify perioperative predictors for its development. Data from patients who underwent total or completion thyroidectomy between January 2017 and July 2022 were retrospectively analysed. The incidence of POSH was assessed, and patients were categorised into transient or prolonged POSH at six months postoperatively. Potential predictors for POSH were investigated including gender, histological diagnosis, and preoperative thyroid function. A total of 133 adult patients were included in the study. The incidence of patients recovering from transient POSH within six months was 15%, and 5% had prolonged POSH beyond six months of surgery. Parathyroid hormone (PTH) levels normalised in 83% of prolonged POSH patients within 14-33 months, reducing the incidence of persistent POSH to 0.75%. Despite normal PTH levels, overall, 3% had persistent marginally low calcium levels (mean 2.11 mmol/L) in keeping with relative parathyroid insufficiency. Histological diagnosis of malignancy was the only significant risk factor for both transient and prolonged POSH (RR 2.95, CI 1.54 to 5.67, p = 0.001) in this cohort. Cautious capsular dissection during thyroidectomy and protection of the parathyroid glands and vascular supply produce a low incidence of POSH. Although the vast majority of patients with POSH recover after six months, hypocalcaemia may persist due to relative parathyroid insufficiency, requiring long-term calcium supplementation. Further research is needed to determine the best strategies for preventing and treating this condition.

The Role of Topical Anesthetics in the Treatment of Pediatric Facial Lacerations.

PURPOSE: Pediatric facial lacerations (PLACS) are a common emergency, often requiring a general anesthetic (GA) or sedation if infiltration of local anesthetic (LA) cannot be tolerated. Topical anesthetics are a well-established and accepted alternative to infiltrations for facial lacerations which can reduce the need for general anesthesia. We report our experience following the introduction of topical 5% cocaine w/v and 1:2000 adrenaline gel (TCA) in a single center. METHODS: A secondary data analysis of 11 months attendances with PLACS following the introduction of TCA as part of a service improvement project. RESULTS: Fifty-three patients had wounds suitable for use of TCA. Twenty-three patients were treated with TCA, 14 with TCA alone and 9 with top-up local anesthetic infiltration (TCA + LA). Fourteen patients were treated using LA alone and 16 underwent GA. No adverse reactions were recorded. CONCLUSION: Topical anesthetics are a safe and effective alternative to infiltration of local anesthetic for PLACS and can be used to avoid the additional risks posed by sedation or GA. We recommend more departments introduce a topical anesthetic for this purpose.

Intravenous cannula used for continuous intraoral mandibular nerve block in trigeminal neuralgia.

Trigeminal neuralgia is a chronic pain condition affecting one or more distributions of the trigeminal nerve. Patients with this condition experience short, sharp, shooting pain attacks, which can progress to longer, more frequent durations. The pain is often difficult to control. We report of a man who was admitted with severe neuralgia of the third division of the trigeminal nerve. Talking and any oral intake triggered a severe agonising pain. The latter made the regular oral intake of analgesia challenging. The pain was temporarily controlled with frequent local anaesthesia (LA). Dental core trainees were performing regular inferior alveolar nerve blocks which significantly improved patients' condition allowing him to communicate and have oral intake. Subsequently, a catheter was placed allowing for a continuous anaesthesia. The connecting tube of the cannula was then used by nursing staff to administer LA providing pain relief without the need of repeated intraoral injections.