Simultaneous application of lidocaine and ketamine during ambulatory infusion therapy: a retrospective analysis.

Background: Infusions with lidocaine or ketamine have been separately established in the treatment of chronic pain. This study aims to retrospectively evaluate the effect of combined infusions of lidocaine and ketamine. Materials & methods: Patient records were screened for receipt of combined ambulatory infusions of lidocaine and ketamine from 2012 through 2021. A scoring system was designed to assess pain response retrospectively. Results: A total of 319 patients were included. Median pain reduction in days was 10.00 (interquartile range: 13.25). Side effects were limited to the acute phase of infusions. A total of 41.4% of patients who received concomitant pain medication reported a dose reduction. Conclusion: Our data support combined infusions as a safe therapy option, with good short-, medium- and long-term reductions in pain and great heterogeneity in treatment response. Clinical trial registration: ClinicalTrials.gov (NCT05103319).

What is this study about? This study examined data of patients with chronic pain who received an infusion at our hospital with two drugs, lidocaine and ketamine, in an effort to reduce pain. We examined the records of 319 patients and a total of 2995 infusion protocols to gather our data. We wanted to know how much and for how long pain was reduced by these infusions. Additionally, we tried to identify the specific features of patients who profited the most during our infusions. We also had a look at the side effects of the infusions and wanted to know if patients could reduce their daily pain medication intake when receiving infusions. What were the results? On average, people had less pain for 10 days after the infusions. Women seemed to benefit more than men. Otherwise, we were unable to identify specific features that predicted how much a patient would benefit. Side effects occurred only during the infusions and for a short period afterward. In addition, 41.4% of patients who took pain medication daily were able to reduce their intake. What do the results mean? These results support our clinical experience that infusions with lidocaine and ketamine are safe and can contribute to reduced pain in patients with chronic pain, at least in the short term, and for some patients even longer.

The Preparation of the Recipient Site in Fat Grafting: A Comprehensive Review of the Preclinical Evidence.

BACKGROUND: Several methods to prepare the recipient site in fat grafting have been proposed in recent decades. However, to date, these procedures have never been reviewed exhaustively. The purpose of the present study is to provide a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in preclinical studies, with resulting outcomes and underlying mechanisms of action. METHODS: The PubMed/MEDLINE database was queried to search for preclinical investigations on the preparation of the recipient site in fat grafting using the following algorithm: ((recipient site) AND (fat grafting) OR (lipofilling) OR (lipograft)). A priori criteria were applied to review the resulting articles. RESULTS: Thirteen animal studies met inclusion criteria. Overall, five techniques were identified: external volume expansion, implantation of alloplastic material (silicone sheets), administration of cell-proliferation factors (i.e., vascular endothelial growth factor, adipose tissue-derived stromal vascular fraction, and interleukin-8), ischemia, and microneedling. A positive effect on cellular activity (cell proliferation and angiogenesis) was demonstrated by all studies and achieved with all techniques. Seven of the eight authors who examined this aspect reported enhancement of fat graft survival. CONCLUSIONS: Improvement of fat grafting surgical outcomes is documented preclinically using different recipient-site preparation techniques, particularly through enhancement of vascularization and soft-tissue expansion. This understanding will lead to further clinical research, especially for those cases where improvement of the recipient site is recommended, such as contracted scars or preirradiated tissues.

The Impact of Recipient Site External Expansion in Fat Grafting Surgical Outcomes.

BACKGROUND: The fat grafting process includes the 4 phases of tissue harvesting, processing, recipient-site preparation, and reinjection. Among them, the preparation of the recipient site has never been exhaustively reviewed. We aim to provide a comprehensive overview of the methods to prepare the recipient site through external expansion with the resulting outcomes. METHODS: PubMed/Medline database was searched for studies on fat grafting recipient site preparation by applying the following algorithm: ((fat grafting) OR (lipofilling) OR (lipograft) AND (recipient site)). A priori criteria were used to review the resulting articles and identify those dealing with external expansion. RESULTS: Fourteen studies published from 2008 through 2016 met inclusion criteria (4 case reports, 6 retrospective, and 4 prospective studies), representing 1,274 treated patients. Two devices for preexpansion were used with different protocols: BRAVA system and Kiwi VAC-6000M with a PalmPump. The 13 studies that applied the BRAVA system reported large fat volume transplantation to the breast (average > 200 cc). The most common complications were localized edema (14.2%), temporary bruising, and superficial skin blisters (11.3%), while the most serious was pneumothorax (0.5%). The majority of the studies reported enhancement of fat graft survival, which ranged between 53% and 82% at 6 months to 1 year follow-up, and high satisfaction of patients and surgeon. CONCLUSIONS: External expansion and fat grafting is a promising technique for breast reconstruction and augmentation. However, due to the overall low level of evidence of the available studies, further research is needed to validate the procedure.