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1.
Medicine (Baltimore) ; 99(15): e19721, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282729

RESUMEN

INTRODUCTION: Moderate to severe postoperative pain and associated opioid use may interfere with patients' well-being and course of recovery. Regional anesthetic techniques provide an opportunity for opioid sparing and improved patient outcomes. A new regional technique called the erector spinae plane (ESP) block has the potential to provide effective analgesia after shoulder arthroscopy with minimal risks and decreased opioid consumption. Our primary objective is to determine whether, in patients who undergo arthroscopic shoulder surgery, a preoperative ESP block reduces pain scores as compared to periarticular infiltration at the end of surgery. Additionally, we will also examine other factors such as opioid consumption, sensory block, adverse events, patient satisfaction, and persistent pain. METHODS: This is a 2-arm, single-center, parallel-design, double-blind randomized controlled trial of 60 patients undergoing arthroscopic shoulder surgery. Eligible patients will be recruited in the preoperative clinic. Using a computer-generated randomization, with a 1:1 allocation ratio, patients will be randomized to either the ESP or periarticular infiltration group. Patients will be followed in hospital in the postanesthesia care unit, at 24 hours, and at 1 month. The study with be analyzed as intention-to-treat. DISCUSSION: This study will inform an evidence-based choice in recommending ESP block for shoulder arthroscopy, as well as providing safety data. The merits of the study include its double dummy blinding to minimize observer bias, and its assessment of patient important outcomes, including pain scores, opioid consumption, and patient satisfaction. This study will also help provide an estimate of the incidence of side effects and complications of the ESP block. TRIAL REGISTRATION NUMBER: NCT03691922; Recruited Date of registration: October 2, 2018.


Asunto(s)
Artroscopía/efectos adversos , Bloqueo Nervioso/métodos , Músculos Paraespinales/diagnóstico por imagen , Hombro/cirugía , Ultrasonografía Intervencional/métodos , Analgésicos Opioides/normas , Analgésicos Opioides/uso terapéutico , Anestesia Local/métodos , Canadá/epidemiología , Método Doble Ciego , Economía/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Bloqueo Nervioso/efectos adversos , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/epidemiología , Músculos Paraespinales/efectos de los fármacos , Músculos Paraespinales/inervación , Satisfacción del Paciente , Hombro/patología , Resultado del Tratamiento
2.
Pediatr Dent ; 42(2): 116-122, 2020 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-32276677

RESUMEN

Purpose: The purpose of this study was to use National Poison Data System (NPDS) data to identify cases of local anesthetic (LA) adverse events related to dentistry for children. Methods: NPDS data were queried for all human cases from 2004 to 2018 that identified a parenteral LA agent as the substance, in children 12 years old and younger, which led to a medical outcome classification ranging from moderate to death. For cases that met inclusion criteria, deidentified records with case notes were requested. Results: Twenty-seven dental cases that met review criteria and had available case notes were reviewed. Most subjects were female (N equals 20 out of 27, 74 percent), and the average subject age was 6.8 years. Twenty cases (74 percent) had a moderate effect, seven cases (26 percent) had a major effect, and no fatalities were reported. The most common clinical effects classification was a seizure (N equals 13, 48 percent). One case of LA overdose was identified. Conclusions: No cases of permanent damage or fatal outcomes were found. Seizure activity following the administration of local anesthetic was the most common event, suggesting intravascular administration or a toxic dose.


Asunto(s)
Anestesia Dental , Sobredosis de Droga , Anestesia Local , Niño , Bases de Datos Factuales , Femenino , Humanos , Centros de Control de Intoxicaciones , Estudios Retrospectivos , Estados Unidos
4.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 11-17, Jan.-Mar. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1090557

RESUMEN

Abstract Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve moni- toring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysi- ological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Otológicos/métodos , Monitoreo Intraoperatorio/métodos , Nervio Facial/fisiología , Anestesia Local , Resultado del Tratamiento , Estimulación Eléctrica , Electromiografía
5.
Orthopade ; 49(4): 313-317, 2020 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-32086550

RESUMEN

An effective and safe pain management is nowadays a pivotal component of fast-track endoprosthetics. The analgesic strategies should be opioid-sparing whenever possible because opioids induce side-effects that reduce the well-being of patients and are even associated with a risk of falling. This is not compatible with a fast mobilization. In order to achieve this goal, multimodal pain concepts have proven to be suitable. Decentralized analgesia with epidural and regional catheters as well as the use of local infiltration anesthesia (LIA) can be used; however, catheters are also associated with a muscular deficit and the danger of falling. Therefore, in the fast-track concepts LIA has become established. With respect to knee endoprosthetics many studies have shown that LIA achieves at least comparable results or even superiority in comparison with the use of catheters. It represents a safe and effective procedure with respect to postoperative analgesia and accelerated mobilization. A variety of protocols for the use of LIA can currently be found in the literature. In addition to analgesics the supportive administration of glucocorticoids is increasingly being used, which also reduce pain due to the anti-inflammatory effect; however, regarding this aspect relatively few prospective randomized studies in comparison to LIA are available in the literature.


Asunto(s)
Analgésicos/uso terapéutico , Artroplastia de Reemplazo de Rodilla , Manejo del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Anestesia Local , Anestésicos Locales , Humanos , Manejo del Dolor/métodos , Estudios Prospectivos , Resultado del Tratamiento
6.
J Dent Educ ; 84(2): 166-175, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32043589

RESUMEN

Various preclinical methodologies have been adopted by dental and oral health programs to develop student competence in administering dental local anesthetics (LA). Student-to-student practice is the most common preclinical training method. However, manikin simulation models have been introduced to avoid possible complications and ethical concerns with student-to-student injections. In 2017, the methodology was changed in the Bachelor of Oral Health program at The University of Sydney School of Dentistry in Australia from student-to-student practice to manikin simulation models. The aim of this study was to compare the students' learning experience, perceived confidence, and anxiety in giving their first injections to patients in these two preclinical training methods. A mixed-methods cohort design was used to compare the 2016 (n = 42) and 2017 (n = 32) oral health students' experiences and perceptions and evaluate students' clinical experience after commencing LA practice on patients. Students completed a questionnaire about their perceived level of confidence and anxiety before and after their first LA to a child and an adult for both infiltration and inferior alveolar nerve b lock (IANB) injections. Focus groups were conducted to further investigate the students' experience. The results showed that the perceived confidence and anxiety of the two cohorts did not differ significantly from each other. Although students found it difficult to transition into clinical practice without having experienced LA themselves, the manikin simulation practice provided a safe learning platform that avoided ethical and legal concerns. These findings support the use of manikin simulation models as an alte rnative method for dental local anesthetic preclinical training.


Asunto(s)
Anestésicos Locales , Estudiantes de Odontología , Adulto , Anestesia Local , Australia , Niño , Competencia Clínica , Humanos , Inyecciones , Enseñanza
7.
Med Oral Patol Oral Cir Bucal ; 25(2): e217-e223, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32040470

RESUMEN

BACKGROUND: A single-blinded randomized controlled trial among patients requiring an upper third molar extraction was performed to evaluate the anxiety degree after receiving information or not about the functioning of The Wand system. Secondarily, perceived pain and the need of re-anesthesia were assessed. MATERIAL AND METHODS: Patients were randomly assigned to the experimental group (detailed explanation about The Wand) or control group (no specific information). Local anesthesia with The Wand consisted in a supraperiosteal infiltrative technique injection 1.6 mL at the buccal and 0.2 mL at the palatal side. Distinct questionnaires for assessing dental anxiety and 100-mm visual analog scales to assess pain were delivered. Demographic data, radiological parameters, operative time and type of intervention were also registered. A descriptive bivariate analysis by non-parametric tests to detect differences in anxiety, pain and re-anesthesia was performed by SPSS 22.0 (SPPS Inc. Chicago, USA). RESULTS: A total of 85 patients were assessed for eligibility but 17 participants were lost due to the cancellation of the visit for the surgical intervention. Finally, sixty-eight patients were included (34 participants in each group), 47 women (69.1%) and 21 men (30.9%), with an average age of 28.8 (± 9.3) years. CONCLUSIONS: Patients that received a detailed explanation of The Wand did not have a significant reduction of the anxiety degree and perceived pain during the anesthetic act compared to patients that received no information. The need of re-anesthesia was not related to the anxiety level but was significantly related to increasing operative time.


Asunto(s)
Anestesia Dental , Ansiedad al Tratamiento Odontológico , Adulto , Anestesia Local , Anestésicos Locales , Femenino , Humanos , Masculino , Dimensión del Dolor , Adulto Joven
8.
Eur J Dent Educ ; 24(2): 328-334, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-31981440

RESUMEN

INTRODUCTION: To determine changes in anxiety perceived in students during their first experience injecting local anaesthetic and assess the variability in the perception in the teaching/learning experience as surgeons and patients in relation to gender. MATERIAL AND METHODS: This cross-sectional study was carried out on students enrolled in the Anaesthesia and Resuscitation course at the University of Barcelona. A descriptive and bivariate analysis was carried out using McNemar and Fisher tests. The level of significance was set at a P-value of <.05. RESULTS: Out of 85 students, a total of 71 responses were obtained. Overall, significant anxiety changes associated with the inferior alveolar nerve block were observed, specifically, before and during (P = .003), before and after (P < .001), and during and after (P < .001) the injection. The calm/relaxed category showed significant differences between before and after (P < .001) and during and after (P < .001) the procedure. Opinions and responses from male and female students differed statistically in relation to the injection on each other as preparation for real work situations (P < .023), recognition of landmarks (P < .001), determination of the insertion points (P = .032) and the need for supervision (P = .043). CONCLUSIONS: This study showed that the overall, students felt more anxious before being injecting with the anaesthetic and the students learning to give the local anaesthetic to each other is an appropriate learning method. No gender-related differences were observed in the participants.


Asunto(s)
Anestesia Dental , Anestesia Local , Estudios Transversales , Educación en Odontología , Femenino , Humanos , Masculino , Estudiantes
9.
BJOG ; 127(6): 738-745, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31957130

RESUMEN

OBJECTIVES: To evaluate the impact of preoperative Music Therapy (MT) on pain in first-trimester termination of pregnancy (TOP) under local anaesthesia. DESIGN: Randomised controlled trial comparing women undergoing a first-trimester TOP under local anaesthesia with or without a preoperative MT session. SETTING: University Hospital of Angers from November 2016 to August 2017. POPULATION: Women who underwent first-trimester TOP under local anaesthesia. METHODS: Women allocated to the MT group underwent a preoperative 20-minute session of MT. MAIN OUTCOME MEASURES: Pain was assessed using a visual analogue scale (VAS) just before the procedure, during the procedure, at the end of the procedure and upon returning to the ward. RESULTS: A total of 159 women were randomised (80 in the MT group, and 79 in the control group). Two women were excluded from the control group and six from the MT group. Therefore, 77 women were analysed in the control group and 74 in the MT group. The intensity of pain was similar in the two groups just before the procedure (VAS 4.0 ± 2.9 versus 3.6 ± 2.5; P = 0.78), during the procedure (VAS 5.3 ± 2.5 versus 4.9 ± 2.9; P = 0.78), at the end of the procedure (VAS 2.7 ± 2.4 versus 2.6 ± 2.4; P = 0.43) and upon returning to the ward (VAS 1.8 ± 2.0 versus 1.5 ± 2.0; P = 0.84). The difference in pain between entering the department and returning to the room after the procedure was similar between the MT and control groups (difference in VAS 0.3 ± 2.5 versus 0.3 ± 2.4; P = 0.92). CONCLUSION: An MT session before a TOP under local anaesthesia procedure resulted in no improvement in patient perception of pain during a first-trimester TOP. TWEETABLE ABSTRACT: Music therapy before first-trimester termination of pregnancy under local anaesthesia did not improve the perception of pain.


Asunto(s)
Aborto Inducido/efectos adversos , Musicoterapia/métodos , Dolor Postoperatorio/prevención & control , Primer Trimestre del Embarazo/psicología , Cuidados Preoperatorios/métodos , Aborto Inducido/métodos , Aborto Inducido/psicología , Adulto , Anestesia Local , Femenino , Humanos , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/psicología , Embarazo , Cuidados Preoperatorios/psicología , Resultado del Tratamiento
10.
Medicine (Baltimore) ; 99(1): e18629, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895822

RESUMEN

OBJECTIVES: To compare the effectiveness and safety of epidural anesthesia (EA) with those of local anesthesia (LA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making. METHODS: We searched PubMed, Embase, the Cochrane library, Web of Science, Medline, ScienceDirect, and the China National Knowledge Infrastructure from inception to June 2019 in order to identify randomized and nonrandomized controlled trials comparing EA and LA for PTED. Studies assessing at least 2 of the following indicators were eligible: surgical duration, X-ray exposure time, satisfaction rate, visual analog scale (VAS) scores for pain, Oswestry Disability Index (ODI), and complications. Two assessors evaluated the quality of the literature using the Cochrane Handbook or Newcastle-Ottawa Scale. Meta-analysis was conducted using Review Manager 5.3.3 software. RESULTS: Four randomized controlled trials and 4 retrospective cohort studies involving a total of 1000 patients were included. The LA and EA groups included 473 and 527 patients, respectively. Meta-analysis revealed significant intergroup differences in the intraoperative (P < .00001) and postoperative (P < .00001) lumbar VAS scores, intraoperative (P < .00001) and postoperative (P = .001) leg VAS scores, and anesthesia satisfaction rate (P < .00001), with EA being superior to LA in all aspects. There were no significant intergroup differences in the surgical duration, X-ray exposure time, postoperative ODI, and complication rate. CONCLUSION: EA is as safe as LA and produces better anesthetic effects than does LA in patients undergoing PTED. Therefore, it should be promoted as a reliable anesthetic technique for PTED.


Asunto(s)
Anestesia Epidural , Anestesia Local , Discectomía Percutánea , Humanos
12.
Int Heart J ; 61(1): 60-66, 2020 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-31956143

RESUMEN

Transcatheter aortic valve implantation (TAVI) using a transfemoral approach under local anesthesia with conscious sedation (LACS) is becoming an increasingly common TAVI strategy. However, patients who are awake during the TAVI procedure can experience stress, anxiety, and pain, even when LACS is used. Clinical hypnotherapy is an anxiolytic intervention that can be beneficial for patients undergoing invasive surgery. This study aimed to assess the perioperative outcomes of adjunctive hypnotherapy undergoing transfemoral TAVI with LACS.Consecutive patients (n = 143) with symptomatic severe aortic stenosis who underwent transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy (n = 36) between January 2015 and April 2016 were retrospectively included in the study. The clinical outcomes were compared between the two groups. The LACS with hypnotherapy group had a significantly shorter length of stay in the intensive care unit (ICU; LACS only versus LACS with hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P < 0.01). Moreover, the use of anesthetics (propofol and remifentanil) and norepinephrine was significantly lower in the LACS with hypnotherapy group (e.g., for propofol, LACS only versus LACS with hypnotherapy: 96.4 ± 104.7 mg versus 15.0 ± 31.8 mg, P < 0.001). The multiple regression analysis showed that being male, hypnotherapy, and the composite complication score were independently associated with the length of stay in the ICU.The adjunctive hypnotherapy on LACS among transfemoral TAVI patients may facilitate perioperative management. However, a prospective randomized study is necessary to confirm the efficacy of hypnotherapy among TAVI patients.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Sedación Consciente/métodos , Hipnosis/métodos , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Anestesia Local , Femenino , Humanos , Masculino , Norepinefrina/administración & dosificación , Periodo Perioperatorio , Complicaciones Posoperatorias , Propofol/administración & dosificación , Estudios Prospectivos , Análisis de Regresión , Remifentanilo/administración & dosificación , Estudios Retrospectivos , Resultado del Tratamiento
13.
Ann R Coll Surg Engl ; 102(4): 290-293, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31951146

RESUMEN

INTRODUCTION: Local anaesthetic repair of paraumbilical hernia (PUH) is a commonly performed operation. The aim of this study was to investigate whether local anaesthesia (LA) repair of PUH was feasible in patients with a high body mass index (BMI) and whether BMI had an impact on patient reported pain scores. METHODS: Patients undergoing PUH repair under the care of single consultant in a district general hospital between March 2010 and January 2018 were recruited. Patient demographics, BMI, duration of operation, volume of LA infiltrated and grade of operating surgeon were available from the consultant's database. The database also included prospectively recorded patient reported pain scores based on a numerical scale (0-100) and overall patient satisfaction measured as a percentage. Patients were divided into three BMI categories: <25kg/m2, 25-30kg/m2 and >30 kg/m2. RESULTS: A total of 123 patients underwent PUH repair under LA during the study period. Six patients had no recorded BMI and were excluded from the analysis. Of the remaining 117 patients, 36 (31%) were in the normal BMI range, 35 (30%) in the overweight range and 46 (39%) in the obese range. There was no statistically significant difference between the BMI groups in terms of volume of LA used, duration of operation, postoperative pain scores or patient satisfaction. CONCLUSIONS: LA repair of PUH is feasible for patients with a raised BMI and does not result in higher postoperative pain scores or the need for higher doses of LA.


Asunto(s)
Anestesia Local , Hernia Umbilical/cirugía , Herniorrafia/efectos adversos , Sobrepeso/complicaciones , Dolor Postoperatorio/diagnóstico , Adulto , Anciano , Anestesia General/efectos adversos , Anestésicos Locales/administración & dosificación , Índice de Masa Corporal , Estudios de Factibilidad , Femenino , Hernia Umbilical/complicaciones , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana Edad , Tempo Operativo , Dimensión del Dolor , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Resultado del Tratamiento , Adulto Joven
14.
J Oral Rehabil ; 47(2): 113-122, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31418881

RESUMEN

BACKGROUND: Changes in quantitative sensory testing (QST) parameters following topical anaesthesia could contribute to better elucidate underlying mechanisms of somatosensory alterations in temporomandibular disorder (TMD) pain patients. This placebo-controlled crossover investigation compared the somatosensory profile following topical anaesthesia between TMD patients (n = 20) and healthy participants (n = 20). METHODS: Cold detection threshold, warm detection threshold, cold pain threshold, heat pain threshold, mechanical detection threshold, mechanical pain threshold, wind-up ratio and pressure pain threshold were assessed on the skin overlying the masseter at three consecutive days (baseline and immediately after lidocaine 4%/placebo cream). Mixed ANOVA and a coding system that accounts for the diversity of types of peripheral axons associated with the somatosensory parameters were applied for data analysis. RESULTS: The lidocaine application caused no changes in the somatosensory sensitivity in the masseter region in TMD patients (P > .050), but sensitivity to cold, cold pain, touch and pinprick stimuli were reduced after topical anaesthesia in healthy participants (P < .050). Also, the degree of topical anaesthesia was greater in healthy participants (P = .008). The coding system suggested that TMD patients presented only Aδ-fibre block, whereas a combination of either Aß- and/or C-fibre block was observed in 35% of healthy participants in addition to Aδ-fibre block following lidocaine application. CONCLUSION: Quantitative sensory testing can be successfully applied to identify meaningful differences in the degree of hypoalgesia and hypoesthesia following short-time topical anaesthesia.


Asunto(s)
Anestesia Local , Lidocaína , Umbral del Dolor , Trastornos de la Articulación Temporomandibular , Humanos , Dolor , Dimensión del Dolor
15.
Int J Paediatr Dent ; 30(2): 118-135, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31593320

RESUMEN

This systematic review and meta-analysis analysed whether pain and disruptive behaviour can be decreased by the use of computerized local dental anaesthesia (CDLA) in children. The literature was screened to select randomized clinical trials that compared computerized and conventional anaesthesia. The primary outcome was pain perception during anaesthesia; the secondary, disruptive behaviour. The risk of bias of individual papers and the quality of the evidence were evaluated. After search, 8389 records were found and 20 studies remained for the qualitative and quantitative syntheses. High heterogeneity was detected for both outcomes. For the pain perception, the overall analysis showed a standard mean difference of -0.78 (-1.31, -0.25) favouring CDLA; however, when only studies at low risk of bias were analysed (subgroup analysis), there was no difference between the two techniques [-0.12(-0.46, 0.22)]. For disruptive behaviour, no differences were detected for continuous [-0.26 (-0.68, 0.16)] or dichotomous data [0.81 (0.62, 1.06)]. The quality of evidence was judged as low for pain perception and very low for disruptive behaviour. It is concluded that there is no difference in the pain perception and disruptive behaviour in children subjected to computerized or conventional dental local anaesthesia. Notwithstanding, the quality of the available evidence is low.


Asunto(s)
Anestesia Dental , Anestesia Local , Atención Odontológica , Dolor , Niño , Humanos , Dolor/prevención & control , Odontología Pediátrica
16.
Anaesthesia ; 75(3): 395-405, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31612480

RESUMEN

There are numerous possible techniques for delivering local anaesthetic through peripheral nerve catheters. These include continuous infusions, patient-controlled boluses and programmed intermittent boluses. The optimal delivery regimen of local anaesthetic is yet to be conclusively established. In this review, we identified prospective trials of delivery regimens through peripheral nerve catheters. Our primary outcome was visual analogue scale scores for pain at 48 h. Secondary outcomes were: visual analogue scores at 24 h; patient satisfaction scores; rescue opioid use; local anaesthetic consumption; and nausea and vomiting. Network meta-analysis was used to compare these outcomes. Predefined sub-group analyses were performed. Thirty-three studies enrolling 1934 participants were included. In comparison with continuous infusion, programmed intermittent boluses improved visual analogue pain scores at both 48 and 24 h, the weighted mean difference (95%CI) being -0.63 (-1.12 to -0.14), p = 0.012 and -0.48 (-0.92 to -0.03), p = 0.034, respectively. Programmed intermittent boluses also improved satisfaction scores, the weighted mean difference (95%CI) being 0.70 (0.10-1.31), p = 0.023, and reduced rescue opioid use, the weighted mean difference (95%CI) in oral morphine equivalent at 24 h being -23.84 mg (-43.90 mg to -3.77 mg), p = 0.020. Sub-group analysis revealed that these findings were mostly confined to lower limb and truncal catheter studies; there were few studies of programmed intermittent boluses for upper limb catheters. Programmed intermittent boluses may provide optimal delivery of a local anaesthetic through peripheral nerve catheters. Further research is warranted, particularly to delineate the differences between upper and lower limb catheter locations, which will help clarify the clinical relevance of these findings.


Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Cateterismo/métodos , Nervios Periféricos , Analgesia Controlada por el Paciente , Cateterismo/efectos adversos , Catéteres , Humanos , Dolor/prevención & control
17.
Schmerz ; 34(1): 33-40, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31578650

RESUMEN

BACKGROUND: Optimal perioperative pain management after total knee arthroplasty is necessary to promote mobilization and achieve early rehabilitation. The aim of this study was to determine whether local infiltration anesthesia (LIA) is the better postoperative pain therapy compared to a femoral nerve block (FNB) or a sciatic nerve block (SNB) using routine data. METHODS: Data from the acute pain registry "Qualitätsverbesserung in der postoperativen Schmerztherapie" (QUIPS) were analyzed. The endpoints included postoperative maximal pain, frequency of pain-related movement impairment, nausea, and number of patients requesting opioids postoperatively. The influence of regional anesthesia in addition to general anesthesia was analyzed in 5 groups. RESULTS: In total, the data of 8754 patients could be examined. It was found that the addition of LIA (ß = -0.087 p = 0.000) or FNB (ß = -0.137 p = 0.000) to general anesthesia is associated with a small but significant reduction of postoperative maximum pain. Between LIA, FNB, and SNB no relevant differences could be detected. DISCUSSION: The pain reduction achieved by adding LIA or FNB in patients after total knee arthroplasty is relatively small. Comparison of techniques is hindered as there exists no widely accepted standard for performing LIAs yet.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Bloqueo Nervioso , Dolor Postoperatorio , Anestesia Local , Anestésicos Locales , Artroplastia de Reemplazo de Rodilla/efectos adversos , Nervio Femoral , Humanos , Dolor Postoperatorio/terapia
18.
J Oral Facial Pain Headache ; 34(2020): 92­107, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31560736

RESUMEN

AIMS: To assess the pain and/or unpleasantness and the somatosensory changes caused by two experimental models of trigeminal nerve damage (topical application of capsaicin and local anesthetics) in healthy participants using extensive evaluation tools. METHODS: This double-blinded, randomized, placebo-controlled, crossover study included 20 healthy adult participants who underwent three separate sessions of testing. In each session, the psychophysical quantitative sensory testing (QST) and the electrophysiologic electrically evoked trigeminal "nociceptive-specific" blink reflex (nBR) investigations were performed at baseline. Following a 15-minute topical application of 0.1% capsaicin, 5% EMLA, or Vaseline (placebo) agents, the maximum numeric rating scale pain and unpleasantness scores were recorded. Additionally, qualitative sensory testing and somatosensory mapping were performed. The QST and nBR investigations were repeated immediately after each application. Data were analyzed using repeated-measures analysis of variance. RESULTS: Capsaicin application was associated with significantly higher pain and unpleasantness scores when compared to EMLA and Vaseline (P < .001), with varied bidirectional somatosensory changes among the participants and significant loss of thermosensory function (P < .030). EMLA application induced loss of thermal and mechanical somatosensory function (P < .030) and a significant reduction in electrically evoked pain scores on nBR investigation (P < .001). No significant changes were seen in the electrophysiologic component of the nBR after any of the applications (P = .922). CONCLUSION: Topical capsaicin and EMLA application mimicked certain aspects of somatosensory changes seen in trigeminal nerve damage patients and may be used as surrogate models of such changes.


Asunto(s)
Anestesia Local , Dolor , Traumatismos del Nervio Trigémino , Adulto , Capsaicina , Estudios Cruzados , Método Doble Ciego , Humanos , Nervio Trigémino
20.
Urology ; 135: 159-164, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31626858

RESUMEN

OBJECTIVE: To describe a minimal-incision modified fenestration technique (MIMFeT) for symptomatic hydroceles utilizing local anesthesia. METHODS: A database was maintained for men undergoing in-office MIMFeT for symptomatic hydroceles between June 2015 and August 2018. Following local anesthesia, the hydrocele was sequentially everted through a small upper hemiscrotal incision, excised, and oversewn without delivering the testicle through the wound. Patient demographics and clinical outcomes were subsequently reviewed. RESULTS: A total of 54 men (median age 67) underwent MIMFeT under local anesthesia for symptomatic hydrocele. Median estimated hydrocele size was 250 mL (IQR 150;500). Medical comorbidities included coronary artery disease (12%), hypertension (43%), diabetes (13%), and current antiplatelet or anticoagulant (44%) use. Six patients (11%) were deemed unsafe for monitored or general anesthesia. About 48 patients had follow-up data available (median 9 months; IQR 2-18). Mild recurrent scrotal swelling occurred in 4 patients (8%) and 9/48 (18%) experienced postoperative complications including hematoma (n = 2), prolonged pain (n = 3), wound infection (n = 2), and partial incisional separation (n = 2). No patient required repeat hydrocelectomy. CONCLUSION: Our early results suggest that the MIMFeT for management of symptomatic hydroceles can be safely performed in the office setting under local anesthesia, including in those patients who are determined to be unsafe for monitored and general anesthesia.


Asunto(s)
Anestesia Local , Complicaciones Posoperatorias/epidemiología , Escroto/cirugía , Hidrocele Testicular/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversos , Anciano , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recurrencia , Técnicas de Sutura , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos Masculinos/métodos
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