Evaluation of pain, disruptive behaviour and anxiety in children aging 5-8 years old undergoing different modalities of local anaesthetic injection for dental treatment: a randomised clinical trial.

Objective: To evaluate the influence of different local anaesthetic techniques in pain, disruptive behaviour and anxiety in children´s dental treatment.Material and methods: This was a randomised and parallel clinical trial. The sample consisted of 105 children (5-8 years old) that were divided into three groups (n = 35) according to the anaesthetic technique: conventional anaesthesia (CA); vibrational anaesthesia (VBA); computer-controlled local anaesthesia delivery (CCLAD). The outcomes were self-perception of pain (Wong-Baker Faces Pain Rating Scale - WBF; Numerical Rating Scale - NRS); disruptive behaviour (Face, Legg, Activity, Cry, Consolability Scale - FLACC); anxiety (Corah's Dental Anxiety Scale; modified Venham Picture test - VPTm) and physiological parameters (blood pressure - systolic - SBP and diastolic - DBP; heart rate - HR; oxygen saturation - SpO2; respiratory rate - RR). Data were statistically analysed with Kruskall-Wallis test and ANOVA for repeated measures with Tukey post hoc test (α = 0.05).Results: All the patients exhibited the same level of dental anxiety at baseline (Corah's Dental Anxiety Scale). There was no difference in self-perception pain, irrespective the evaluation tool used (WBF - p = .864; VAS - p = .761). No differences were detected in disruptive behaviour (FLACC - p = .318); anxiety (VPTm - p = .274); blood pressure (SBP - p = .239; DBP - p = .512); heart rate (p = .728); oxygen saturation (p = .348) and respiratory rate (p = .238) between anaesthetic techniques.Conclusion: Different anaesthetic dental local techniques do not affect the levels of pain, disruptive behaviour, anxiety and physiological parameters in children aged 5-8 years old.

Topical anaesthesia degree is reduced in temporomandibular disorders patients: A novel approach to assess underlying mechanisms of the somatosensory alterations.

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.

Electromyographic characterisation of abdominal wall trigger points developed after caesarean section and response to local anaesthesia: an observational study.

OBJECTIVE: This study examines the electromyography pattern of abdominal trigger points developed after a caesarean section, and the association between clinical response and local anaesthetic injection. DESIGN: Prospective cohort study. SETTING: A tertiary university hospital. POPULATION: Twenty-nine women with chronic pelvic pain associated with trigger points after a caesarean section were included in the study. METHODS: Participants received needle electromyography before treatment, then underwent a treatment protocol consisting of trigger-point injection of 2 ml of 1% lidocaine. The protocol was repeated once a week for 4 weeks. The clinical responses of the patients were compared 1 week after and 3 months after treatment. The clinical trial is registered with the Brazilian Clinical Trials Registry (REBEC) under RBR-42c6gz (www.ensaiosclinicos.gov.br/rg/RBR-42c6gz/). MAIN OUTCOME MEASURES: Needle electromyography and algometry results and pain reduction. RESULTS: Fifteen patients had abnormal electromyography findings; 14 had normal findings. The rates of response 1 week and 3 months after treatment within the abnormal electromyography group were 95 and 87%, respectively. In the normal group, the rate was 38% both 1 week after and 3 months after treatment. CONCLUSIONS: Trigger points developed after caesarean section, even without clinical symptoms or signs of neuralgia, may originate from neuropathies. Electromyographic abnormalities were associated with pain remission after anaesthesia injection; normal electromyography findings were associated with undiagnosed causes of pain, such as adhesions. TWEETABLE ABSTRACT: Trigger points developed after caesarean section are neuropathies, even in the absence of classical neuralgia.

Peri-articular injection of an analgesic mixture in primary total hip arthroplasty: an effective strategy for pain control during the first post-operative day.

BACKGROUND: Previous studies of soft tissue infiltration in hip arthroplasty present variable results. The purpose of this study is to identify whether injection of an analgesic mixture improves pain management during the immediate post-operative period. MATERIALS AND METHODS: This cohort study compared 129 patients that received peri-articular soft tissue injection with 20 ml of 0.25% bupivacaine and 2 ml of ketorolac (30 mg/1 ml) in 28 ml of saline solution, with 71 patients who did not received injections. Pain intensity in the Verbal Analog Scale (VAS), opioid titration, and consumption (mg morphine equivalents) in the post-anaesthetic care unit (PACU) and during the first post-operative day were assessed for both groups. All patients received the same analgesia protocol. RESULTS: Median VAS score in the PACU was 4 (IQR 2-7) in the injection group and 7 (IQR 4-8) in the non-injection group (p = 0.001). Median opioid titration was 0 mg for the injection group and 2.6 mg for the non-injection group (p = 0.011). In the first post-operative day, the difference in VAS scores between groups was statistically significant (p = 0.009), but there was no difference in opioid consumption. CONCLUSION: Soft tissue injection with local anesthetics and non-steroidal anti-inflammatory drugs allows adequate pain control in the immediate post-operative period and reduces the requirement for opioid consumption. We recommend the implementation of this safe and effective strategy in post-operative pain management after primary hip arthroplasty. LEVEL OF EVIDENCE: Level II, cohort study.

Circuncisión neonatal con anestesia local: Resultados de un protocolo estandarizado / Neonatal circumcision with local anesthesia: Results of a standardized protocol

Introducción La circuncisión neonatal es un procedimiento frecuente en EE. UU. y en otros países, y presenta baja tasa de complicación en manos entrenadas. Sin embargo, en Chile recién está siendo incorporado clínicamente a nuestro medio. Nuestro objetivo fue establecer un protocolo local estandarizado de circuncisión neonatal con anestesia local y evaluar sus resultados y las posibles complicaciones. Pacientes y método Protocolo prospectivo estandarizado a pacientes que soliciten circuncisión neonatal cuyos criterios de inclusión fueron: niños < 60 días y < 5 kg. La técnica quirúrgica consiste en anestesia local tópica y bloqueo peneano, atrición del prepucio y mucosa redundante con clamp de Mogen® y sección con bisturí. Se evalúa protocolo utilizado desde noviembre de 2005 a octubre de 2014 por un urólogo pediatra y/o cirujano pediatra entrenados en la técnica. Se registran y analizan complicaciones y condiciones hasta el alta definitiva. Resultados En 9 años se aplicó el protocolo a 108 pacientes. La edad promedio al procedimiento fue de 9 días (1-52). Un paciente (0,9%) presentó sangrado inmediato, requiriendo cirugía posterior. Todos los pacientes fueron dados de alta definitiva de controles al mes, sin otras complicaciones. La razón para realizar el procedimiento fue por solicitud de los padres en el 100% de los casos por razones sociales o religiosas. Conclusión La circuncisión neonatal con anestesia local es un procedimiento sencillo y que en casos seleccionados tiene excelentes resultados, sin mayores complicaciones. Con el debido entrenamiento y adecuando el protocolo inicial, se puede realizar de manera ambulatoria, sin necesidad de someter al niño a los riesgos de la anestesia general en recién nacidos.

Introduction Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. Patients and method A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children < 60 days and < 5 kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. Results The protocol was applied to 108 patients over a 9 year period. The mean age at procedure was 9 days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. Conclusion Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.

Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy.

OBJECTIVE: Intraperitoneal (IP) bupivacaine provides postoperative analgesia in dogs undergoing ovariohysterectomy (OHE) alone or in combination with incisional (INC) bupivacaine. This study investigated whether the combination of INC and IP bupivacaine is superior to IP bupivacaine alone. STUDY DESIGN: Prospective, randomized, blinded clinical study. ANIMALS: Thirty-nine privately owned dogs undergoing OHE, aged 25 ± 23 months and weighing 11.8 ± 5.7 kg. METHODS: Dogs were premedicated with acepromazine (0.05 mg kg(-1) ) and morphine (0.5 mg kg(-1) ) intramuscularly (IM); anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Carprofen (4 mg kg(-1) ) was administered subcutaneously (SC) after intubation. Bupivacaine (3 mg kg(-1) ) IP was administered before complete closure of the linea alba to all dogs. Dogs were randomly assigned into two groups: group B received bupivacaine (n = 20; 1 mg kg(-1) ) and group S received saline (n = 19; 0.2 mL kg(-1) ) INC as a subcutaneous 'splash' before skin closure. Postoperative analgesia was assessed with a dynamic interactive visual analogue scale, the short form of the Glasgow Composite Pain Scale, and mechanical nociceptive threshold (MNT) measurement at 0.5, 1, 2, 4, 6, 8, 12 and 20 hours after surgery by one blinded observer. Parametric data were tested using t-test; nonparametric data were analysed using the two-sample Wilcoxon test (p < 0.05). RESULTS: There was no significant difference between groups with regard to age, weight, surgical and anaesthetic duration, incision length, sedation and pain scores. MNT values decreased in both groups at all time points as compared with the baseline. No dog required rescue analgesia. No postoperative complications were observed. CONCLUSION AND CLINICAL RELEVANCE: Bupivacaine IP and carprofen SC after morphine IM did provide satisfactory postoperative analgesia in dogs undergoing OHE with the anaesthetic protocol used. There appears to be no clinical advantage to adding bupivacaine INC. Neither protocol could prevent the development of primary hyperalgesia.

[Neonatal circumcision with local anesthesia. Results of a standardized protocol]. / Circuncisión neonatal con anestesia local. Resultados de un protocolo estandarizado.

INTRODUCTION: Neonatal circumcision is a common procedure in the US and other countries, with low rates of complications in trained hands. However, it has recently been incorporated into the clinical environment in Chile. Our goal was to establish a local standardised protocol for neonatal circumcision under local anaesthesia, and evaluate the results and possible complications. PATIENTS AND METHOD: A standardised prospective protocol was used on patients who underwent neonatal circumcision. The inclusion criteria were: children <60days and <5kg. The surgical technique used was topical local anaesthesia and penile block, attrition of redundant prepuce and mucosa with Mogen® clamp, and section with scalpel. The protocol was used and evaluated from November 2005 to October 2014 by a paediatric surgeon and/or paediatric urologist trained in the technique. Complications and conditions until final discharge were analysed. RESULTS: The protocol was applied to 108 patients over a 9year period. The mean age at procedure was 9days (1-52). One patient (0.9%) had immediate bleeding, requiring further surgery. All patients were discharged from further medical checks at 1 month, without any other complications. The reason for the procedure was by parental request in 100% of the cases, and always for sociocultural reasons. CONCLUSION: Neonatal circumcision under local anaesthesia is a simple procedure, and has excellent results in selected patients, and with no major complications. With proper training, and adapting the initial protocol, it can be performed on an outpatient basis, without putting the neonates through the risks of general anaesthesia.

Anaesthetic efficacy of bupivacaine 2-hydroxypropyl-ß-cyclodextrin for dental anaesthesia after inferior alveolar nerve block in rats.

Bupivacaine is a long-acting local anaesthetic that is widely used in medicine and dentistry. The duration and intensity of its sensory blockade in animal models is increased by its inclusion in complexes with cyclodextrins. The aim of the present study was to evaluate the anaesthetic efficacy of bupivacaine 2-hydroxypropyl-ß-cyclodextrin (HPßCD) inclusion complex for dental anaesthesia after inferior alveolar nerve block in rats. Thirty rats were each given an injection close to the mandibular foramen of 0.2ml of one of the following formulations: 0.5% bupivacaine alone; 0.5% bupivacaine with 1:200,000 epinephrine; and 0.5% bupivacaine-HPßCD inclusion complex (bupivacaine-HPßCD). The other sides were used as controls, with either 0.9% saline or anaesthetic-free HPßCD solution being injected. The onset, success, and duration of pulpal anaesthesia were assessed by electrical stimulation ("pulp tester") on inferior molars. Results were analysed using ANOVA (Tukey), log rank, and chi square tests (α=5%). There were no differences among the formulations in onset of anaesthesia (p=0.59) or between the bupivacaine plus epinephrine and bupivacaine plus HPßCD in duration of anaesthesia, but bupivacaine plus epinephrine gave significantly higher values than bupivacaine alone (p=0.007). Bupivacaine plus epinephrine was a better anaesthetic than bupivacaine alone (p=0.02), while Bupi-HPßCD gave intermediate results, and therefore did not differ significantly from the other 2 groups (p=0.18 with bupivacaine alone; and p=0.44 with bupivacaine plus epinephrine). The bupivacaine-HPßCD complex showed similar anaesthetic properties to those of bupivacaine with epinephrine.

Comparing lidocaine, bupivacaine and a lidocaine-bupivacaine mixture as a metacarpal block in sheep.

Mechanical sensory blocking effects in the metacarpi of rams were compared following perineural injection of saline, 2% lidocaine (LIDO), 0.5% bupivacaine (BUPI), and a 1:1 (volume/volume) mixture of LIDO-BUPI. Saline was also administered in the contralateral metacarpi. Compared with the saline treatment and contralateral controls, the various treatments induced larger area under the curve (AUC) values 0-60 min post-treatment (AUC0-60). Administration of BUPI and LIDO-BUPI also induced larger AUC60-120 values (P<0.01). The AUC0-60 and AUC60-120 values with LIDO were less than those achieved with LIDO-BUPI and BUPI (P<0.001), and AUC60-120 values with LIDO-BUPI were less than those obtained with BUPI (P<0.05). Anaesthesia occurred within 5 min following the administration of all local anaesthetics and lasted longer in the case of BUPI (110.0 ± 47.3 min) than with LIDO (40.0 ± 13.2 min) (P<0.01). The duration of anaesthesia was 86.9 ± 66.0 min with the LIDO-BUPI combination. Thus this combination offered no apparent advantages over the use of BUPI alone.

Complicaciones postoperatorias en la herniorrafia ambulatoria con malla: estudio comparativo de la tasa de infección del sitio operatorio con y sin profilaxis antibiótica / Antibiotic prophylaxis in mesh inguinal herniorrhapy

The use of antibiotic prophylaxis has been questioned in the inguinal herniorrhaphy with mesh. The aim of this paper is to give account of the efficiency of antibiotic prophylaxis (AP) in the prevention of wound infection in the elective inguinal herniorrhaphy with mesh under local anaesthesia in an ambulatory basis. In the present observacional analytic study, 955 patients were operated upon with a mesh technique during a 10 year period, .in the CRS Hernia Centre in Santiago. In the first group of 250 patients, lgr Cefazolin® was administered iv one hour before the operation, in the second group of 710 patients no antibiotics were used. Demographic variables, associated diseases, the length of surgery were comparable in both groups. The same team of surgeons work in both groups. Wound infection was defined as the presence of pus in the surgical wound associated with a positive bacterial culture. The rate of wound infections was 1.05 percent of the first and 0.35 percent of the second group. This difference was no significant (p < 0.08). The isolated germ was a Staphylo-coccus aureus in all cases. The treatment was ambulatory in all cases. The rate of haematoma and funiculo-testicular fluxion were low. We conclude that the rate of wound infection in mesh herniorrhaphies is low and that the antibiotic prophylaxis does not improve these results. Its routine use in these patients is not justified.

Introducción: El uso de la profilaxis antibiótica en la cirugía hemiaria con malla es controversial. El propósito del presente estudio es establecer la efectividad de la profilaxis antibiótica (PA) en la prevención de la infección del sitio operatorio (ISO) en la herniorrafía con malla efectuada en forma ambulatoria con anestesia local. Material y Método: El estudio observacional analítico se realizó dentro del Programa de Cirugía Ambulatoria del CRS Cordillera, en dos grupos consecutivos de pacientes, el primero que se sometió a PA mediante lgr de Cefazolina® intravenosa, inmediatamente antes del procedimiento quirúrgico, y el segundo en el que se prescindió de ella. Los controles postoperatorios se efectuaron al 7º y 30º día por un cirujano del grupo. Se diagnosticó ISO con la presencia de exudado purulento, con cultivo bacteriano positivo. Resultados: El estudio se efectuó en 955 pacientes operados entre 1998 y 2008. En el primer grupo, constituido por 245 pacientes se usó PA, en el segundo grupo de 710 pacientes se prescindió de ella. Las variables demográficas, antecedentes mórbidos y la duración del acto quirúrgico fueron comparables en ambos grupos. Se registraron 2 casos de infección en el primer grupo (1,05 por ciento) y dos en el segundo (0,35). Esta diferencia no fue significativa. El germen aislado fue en todos los casos el estafilococo dorado. Conclusiones: La tasa ISO en la hemiorrafia inguinal electiva ambulatoria con malla es baja y no se modificó con el uso de PA. Su empleo indiscriminado no aparece justificado en estos pacientes.

Cirugía ambulatoria con anestesia local en el tratamiento de la comunicación buco sinusal mediata y tardía / Ambulatory Surgery using local anaesthesia in the treatment of the mediate and late sinusal oral communication

Se realizó un estudio longitudinal y prospectivo sobre el tratamiento quirúrgico de la comunicación bucosinusal (CBS) mediata o tardía de modo ambulatorio y con anestesia local en el período comprendido entre septiembre del año 2002 y agosto del 2006 cuya muestra estuvo constituida por los 41 pacientes que con ese diagnóstico fueron tratados en el Hospital general docente "Abel Santamaría Cuadrado" (muestreo no probabilístico) en el lapso antes mencionado con el propósito de demostrar que la cirugía de la CBS mediata y tardía se puede realizar de modo satisfactorio con anestesia local y de forma ambulatoria. El trabajo se realizó cumpliendo con los principios de Bioética establecidos. Los resultados fueron procesados estadísticamente utilizando el test de comparación para los estudios comparativos sin la corrección de yates, trabajando con un nivel de confiabilidad de alfa igual o menor que 0.05. Esto permitió concluir que es posible realizar el tratamiento de la CBS mediata o tardía consistente en la antrotomía radical con técnica de Caldwel Lock de modo totalmente satisfactorio, sin complicaciones adicionales a las descritas en esta técnica, utilizando el modo ambulatorio y la anestesia local, que el transoperatorio cursó de forma satisfactoria, teniendo los pacientes una evolución post quirúrgica favorable con las múltiples ventajas que ofrece esta modalidad de tratamiento para el paciente, los familiares, la institución, la sociedad y la economía. El impacto económico es considerable con un ahorro para el hospital tanto por el tipo de anestesia, como por la cirugía ambulatoria de $30 961.174.

A longitudinal prospective study on the surgical ambulatory treatment of the mediate or late oral sinusitis communication was carried out using local anaesthesia in September 2002 and August 2006. Sample was comprised of 41 patients treated in "Abel Santamaría Cuadrado General Hospital" (non-probabilistic sample) .The present study was aimed at proving that the mediate or late surgery of the OCS is able to be ambulatory and performed under local anaesthesia. The bioethical principles were followed. Results were statistically processed using the comparative test for the comparative studies without the Yates correction and working with a confidence level of á= 0.05. It allowed concluding that is possible to prescribe the mediate or late OCS using the radical antrotomy with Caldwell Lock technique successfully. The transoperative period was also successfully using the ambulatory surgery and local anaesthesia, having many advantages for the patient, family and the facility as well as the society and economy. The economical impact is great saving $30 961.174 to the hospital.