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1.
Compend Contin Educ Dent ; 41(9): 466-473; quiz 474, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33001657

RESUMO

It is well-known that there is an opioid crisis in the United States. Prescription opioid analgesics contribute to this crisis; in 2012, dentists ranked second to family care physicians as the top prescribers. The medical and dental literature demonstrates that dental prescribing practices have been excessive, resulting in leftover medication that could then be diverted, misused, or abused. A multimodal analgesic approach is highly valuable in targeting pain along various points on the peripheral and central pain pathways and includes the use of long-acting local anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids, the last of which are generally reserved for the most severe pain only. The Dental Impaction Pain Model demonstrates that NSAIDs are the frontline drugs for postoperative dental pain. Opioids have their role in postoperative analgesia but should be reserved for severe breakthrough pain or in situations where NSAIDs may be contraindicated.


Assuntos
Analgésicos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Estados Unidos
2.
J Contemp Dent Pract ; 21(6): 604-608, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33025926

RESUMO

AIM: This study aims to evaluate and compare the efficacy of auto-control syringe (ACS) and insulin syringe (IS) for palatal local anesthesia administration in children. MATERIALS AND METHODS: The study was a double-blind, randomized, and crossover trial, comprising 80 children requiring palatal anesthesia bilaterally (total 160 injections). Palatal anesthesia on one side was delivered with ACS in one appointment and contralaterally with IS in the second appointment. One-week washout period was given between first and second appointments. Each child acted as his own control. Each injection technique subjective and objective pain scores were measured twice (during needle prick and during actual deposition of local anesthesia). Subjective and objective evaluation of pain was measured with Wong-Baker FACES pain rating scale (WB-FPS) and the face, leg, activity, cry, and consolability scale (FLACC), respectively. After concluding second appointment, child was asked about their preference between both ACS and IS. Statistical evaluation was performed using Chi-square test. RESULTS: Child reported less pain score for needle prick with IS as opposed to ACS (p value = 0.000416). There was no significant difference between dentist-reported pain scores between any group for both needle prick and local anesthesia administration. There is no significant difference between child reported pain score during administration of local anesthesia between two groups. Irrespective of pain scores, most of the children (96.5%) preferred IS. CONCLUSION: For palatal local anesthesia administration in children, both IS and auto-controlled syringe have similar efficacy. CLINICAL SIGNIFICANCE: Insulin syringe can serve as an economical alternative to the expensive auto-controlled syringe for palatal injections in children.


Assuntos
Anestesia Dentária , Anestésicos Locais , Insulinas , Seringas , Anestesia Dentária/métodos , Anestésicos Locais/administração & dosagem , Criança , Estudos Cross-Over , Humanos , Medição da Dor
3.
Medicine (Baltimore) ; 99(35): e21881, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871917

RESUMO

BACKGROUND: Pain control after total knee arthroplasty has shown many advances; however, the optimal method remains controversial. The purpose of this present study is to assess the efficacy and safety of the addition of local infiltration analgesia to adductor canal block for pain control after primary total knee arthroplasty. METHODS: This prospective randomized controlled research was conducted from January 2018 to June 2019. All the patients and their family members signed the informed consent forms, and this work was authorized via the ethics committee of Jinxiang Hospital Affiliated to Jining Medical College (JXHP0024578). Inclusion criteria were 55 years old or older, who possess the physical status I-III of American Society of Anesthesiologists, and the body mass index in the range of 18 to 30 kg/m. Exclusion criteria were regional and/or neuroaxial anesthesia contraindications, the history of drug allergy involved in the research, neuropathic pain, as well as the chronic pain requiring opioid therapy. Seventy-two patients were divided into 2 groups randomly. Study group (n = 36) received both adductor canal block and local infiltration analgesia. Control group (n = 36) received adductor canal block alone. Primary outcome included postoperative pain score (visual analog scale 0 to 10 cm, in which 0 represents no pain and 10 represents the most severe imaginable pain). The measures of secondary outcome included the knee range of motion, opioid consumption, the hospital stay length as well as the postoperative complications (for instance, pulmonary embolism, deep vein thrombosis, and the wound infection). All the analyses were conducted through utilizing the SPSS for Windows Version 20.0. RESULTS: The results will be shown in .(Table is included in full-text article.) CONCLUSION:: The study will provide more evidence on the combination use of adductor canal block and local infiltration analgesia in the treatment of pain after the total knee arthroplasty. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5832).


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Joelho , Bloqueio Nervoso , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/uso terapêutico , Bupivacaína/administração & dosagem , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Ropivacaina/administração & dosagem , Escala Visual Analógica
4.
Eur J Paediatr Dent ; 21(3): 180-182, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32893647

RESUMO

AIM: In paediatric dentistry it is essentials to reduce axiety and fear induced by local anaesthetic injection, in order to obtain patient's cooperation and achieve a successful treatment. Hence, this review is aiming to primary evaluate pain perception in paediatric patients when using a computer-controlled local anaesthetic delivery system (C-CLADS) compared to traditional injection. MATERIALS AND METHODS: A database literature search was conducted on both MEDLINE and Cochrane Central Register of Controlled Trials and a data extraction table was created to perform a critical evaluation of each scientific article. The primary results were the perception of pain during anaesthesia and the patient's behaviour, the secondary the amount of anaesthetic required and its duration over time. RESULTS: In the review were included 7 clinical studies regarding paediatric patients where split-mouth designs or group division were used. The age range was between 5 and 17 years old. Pain and fear parameters were measured by visual analogue scales, behavioural scales, heart rate and satisfaction questionnaires. CONCLUSION: Substantial heterogeneity between clinical trials was observed, which led to difficult comparison. Computerised devices have proved to be interesting in reducing pain during anaesthesia, improving the approach to the paediatric patient. It is advisable to conduct research with anxious subjects and patients under the age of 4, because no evidence has been found in the literature. It is recommended to conduct further research with anxious subjects and patients below the age of 4, where Relative Analgesia by Langa or pharmacological anxiolysis are frequently used.


Assuntos
Anestesia Dentária , Odontopediatria , Adolescente , Anestesia Local , Anestésicos Locais , Criança , Pré-Escolar , Humanos , Percepção da Dor
5.
J Perioper Pract ; 30(9): 277-282, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32869726

RESUMO

INTRODUCTION: COVID-19 has changed the approach to operating on breast cancer for the benefit of patients, staff and the general population. One approach involves the switch from operating under general to local anaesthetic. We assess whether diluational local anaesthetic is as effective as the current standard approach. METHODS: Postoperative pain was recorded in prospective, consecutive patients undergoing wide local excision under dilutional local anaesthetic (concentration < 1mg/ml). Pain scores were documented at 0, 30 and 60 minutes and compared to a control group consisting of combined general with local anaesthetic. RESULTS: Pain significantly increased in the control group during the postoperative recovery. This was not seen in the dilutional local anaesthetic group that was non-inferior to the standard approach at 0, 30 and 60 minutes. CONCLUSION: Dilutional local anaesthetic provides a safe and effective alternative approach to operating on breast cancer patients whilst avoiding risky general anaesthetic in a COVID-19 pandemic environment.


Assuntos
Anestesia Local/métodos , Anestésicos Locais/uso terapêutico , Neoplasias da Mama/cirurgia , Infecções por Coronavirus , Dor Pós-Operatória/prevenção & controle , Pandemias , Pneumonia Viral , Estudos de Casos e Controles , Difusão , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Medicine (Baltimore) ; 99(33): e21670, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872033

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is an established and successful surgical procedure which is the major treatment for degenerative knee joint diseases. A novel technique to address posterior knee joint pain is the infiltration of local anesthetic between the interspace between the popliteal artery and capsule of the knee (IPACK). The goal of this randomized clinical trial was to assess the efficacy and safety of adding IPACK to adductor canal block (ACB) after TKA. METHODS: This was a prospectively randomized trial that investigated the effectiveness and safety of the IPACK after TKA. Approval from Clinical Studies Ethical Committee in Qilu Hospital of Shandong University was obtained. The inclusion criteria were adult patients undergoing primary unilateral TKA and American Society of Anesthesiologists grade 1 or 2 with normal cognitive function. The patients were randomized to 1 of 2 treatment options: ACB-alone group and ACB + IPACK group. The primary outcome was the total morphine consumption during postoperative 24 hours. Secondary outcomes included postoperative pain score, time to first and total dosage of rescue morphine in postoperative 48 hours, early and late postoperative period (from postoperative day 0-3 months follow-up) performance-based test (Timed-Up and Go test, and quadriceps strength). Postoperative nausea and vomiting, length of hospital stay, patient satisfaction, and other adverse events were also evaluated. RESULTS: It was hypothesized that when combined with a control group, the IPACK block would result in a lower morphine consumption and pain score after TKA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5765).


Assuntos
Artroplastia do Joelho/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Humanos , Morfina/administração & dosagem , Artéria Poplítea , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego
7.
Ther Umsch ; 77(5): 179-184, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32870095

RESUMO

Primary wound care in children Abstract. Successful wound care of infants and children is facilitated by good preparation and a calm atmosphere. There is not only the child as a patient but also the parents, with their fears and concerns. The physician has to take care of both of them. Parent and child should be informed about the therapeutic intervention appropriately. Reassuring of the child and distraction from the procedure are as important as the treatment itself (e. g. wound stitching or application of wound dressing). Topical anesthesia with LET Gel (lidocain, epinephrine, tetracaine), non-stinging methods to clean the wound (NaCl 0,9 % / Polyhexanid (Prontosan®) soaked swabs) and intranasal application of fentanyl / dormicum can be used to avoid fear and pain. Sedation is used deliberately in small children for wound care. Laceration wounds, mainly those affecting the scalp, chin or forehead can be treated in the emergency room without general anesthesia. Extensive wounds, burns and animal bites often require wound care under anesthesia in children.


Assuntos
Anestésicos Locais , Tetracaína , Anestesia Local , Criança , Epinefrina , Humanos , Lactente , Lidocaína
8.
Ther Umsch ; 77(6): 270-273, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32930075

RESUMO

Diagnostic and therapeutic nerve blocks in pain therapy Abstract. Nerve blocks are not only performed in anaesthesiology to enable surgery, but also in pain therapy to diagnose and treat localised pain. For diagnostic purposes a minimal dose of local anaesthetic is applied directly to the nerve. Ultrasound has recently become the most precise and practicable tool to localise the nerve. When the effect of the block lasts as long as the predicted duration of the local anaesthetic, this confirms that the blocked nerve conducts the pain. In such cases, repetitive therapeutic blocks with local anaesthetics can be used to desensitise the nerve. A structural lesion of the nerve caused by heat (radiofrequency ablation), cold (cryoneurolysis) or even surgical nerve dissection can lead to long-term pain reduction. However, there is only weak evidence supporting these therapies and a relevant risk of pain due to deafferentation, and depending on the nerve, there could be persistent motor or sensitivity disturbances. Any intervention in humans includes placebo and nocebo effects. Those effects should be taken into consideration by asking the patient about previous experiences and their expectations for the intervention. The knowledge of placebo and nocebo effects can then be used to make the patient more comfortable during the procedure, to improve therapeutic effects and to reduce side effects. Problematic psychosocial factors and signs of centralised sensitivity should be evaluated in advance in order to consider withholding the use of interventional procedures in sensitised patients.


Assuntos
Bloqueio Nervoso , Anestesia Local , Anestésicos Locais , Humanos , Dor , Manejo da Dor
9.
Quintessence Int ; 51(10): 864-870, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32901242

RESUMO

OBJECTIVE: This prospective, block randomized clinical trial was conducted to evaluate the effect of aromatherapy on the success rate of inferior alveolar nerve block (IANB) in teeth with irreversible pulpitis. METHOD AND MATERIALS: In this clinical trial, 46 patients fulfilling the inclusion criteria were randomly divided into two equal groups: group I (n = 22) received IANB in a closed operatory without any fragrance, whereas group II (n = 24) received IANB in a separate closed operatory saturated with lavender fragrance using a candle warmer. The modified dental anxiety scale (MDAS) for anxiety and visual analog scale (VAS) for pain were recorded preoperatively as well as during access cavity preparation. For MDAS, a total score of more than 18 was considered as tremendously anxious or dental phobic. No or mild pain on VAS was considered as success. Data were analyzed using paired t test and independent sample t test. P < .05 was considered as statistically significant. RESULTS: Difference in mean VAS (P = .749) and MDAS (P = 1.000) between both the groups was statistically nonsignificant. However there was a statistically significant difference in mean VAS (P = .000) and MDAS (P = .001) during access opening. CONCLUSION: Lavender aromatherapy can be used successfully to alleviate dental anxiety as well as to increase the anesthetic success rate of IANB in teeth with irreversible pulpitis.


Assuntos
Anestesia Dentária , Aromaterapia , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Estudos Prospectivos , Pulpite/cirurgia , Pulpite/terapia
10.
Pain Physician ; 23(4S): S239-S270, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942786

RESUMO

BACKGROUND: Multiple randomized controlled trials (RCTs) and systematic reviews have been conducted to summarize the evidence for administration of local anesthetic (lidocaine) alone or with steroids, with discordant opinions, more in favor of equal effect with local anesthetic alone or with steroids. OBJECTIVE: To evaluate the comparative effectiveness of lidocaine alone and lidocaine with steroids in managing spinal pain to assess superiority or equivalency. STUDY DESIGN: A systematic review of RCTs assessing the effectiveness of lidocaine alone compared with addition of steroids to lidocaine in managing spinal pain secondary to multiple causes (disc herniation, radiculitis, discogenic pain, spinal stenosis, and post-surgery syndrome). METHODS: This systematic review was performed utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) for literature search, Cochrane review criteria, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) to assess the methodologic quality assessment and qualitative analysis utilizing best evidence synthesis principles, and quantitative analysis utilizing conventional and single-arm meta-analysis. PubMed, Cochrane Library, US National Guideline Clearinghouse, Google Scholar, and prior systematic reviews and reference lists were utilized in the literature search from 1966 through December 2019. The evidence was summarized utilizing principles of best evidence synthesis on a scale of 1 to 5. OUTCOME MEASURES: A hard endpoint for the primary outcome was defined as the proportion of patients with 50% pain relief and improvement in function. Secondary outcome measures, or soft endpoints, were pain relief and/or improvement in function. Effectiveness was determined as short-term if it was less than 6 months. Improvement that lasted longer than 6 months, was defined as long-term. RESULTS: Based on search criteria, 15 manuscripts were identified and considered for inclusion for qualitative analysis, quantitative analysis with conventional meta-analysis, and single-arm meta-analysis. The results showed Level II, moderate evidence, for short-term and long-term improvement in pain and function with the application of epidural injections with local anesthetic with or without steroid in managing spinal pain of multiple origins. LIMITATIONS: Despite 15 RCTs, evidence may still be considered as less than optimal and further studies are recommended. CONCLUSION: Overall, the present meta-analysis shows moderate (Level II) evidence for epidural injections with lidocaine with or without steroids in managing spinal pain secondary to disc herniation, spinal stenosis, discogenic pain, and post-surgery syndrome based on relevant, high-quality RCTs. Results were similar for lidocaine, with or without steroids.


Assuntos
Corticosteroides/administração & dosagem , Lidocaína/administração & dosagem , Dor Lombar/tratamento farmacológico , Manejo da Dor/métodos , Corticosteroides/efeitos adversos , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/efeitos adversos , Humanos , Injeções Epidurais , Reprodutibilidade dos Testes
11.
Medicine (Baltimore) ; 99(35): e21684, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871884

RESUMO

Ultrasound-guided interscalene block (US-ISB) and nerve stimulator-guided interscalene block (NS-ISB) have both been commonly used for anesthesia in shoulder arthroscopic surgery.This study aims to compare which method provides surgical block as a sole anesthesia. In this retrospective study, 1158 patients who underwent shoulder arthroscopic rotator cuff tear repair surgery under ISB between October 2002 and March 2018 were classified into either the US-ISB or NS-ISB anesthesia groups. Demographic and anesthetic characteristics and intraoperative medications were analyzed after propensity score matching and compared between the 2 groups.There was a 0.5% rate of conversion to general anesthesia in the US-ISB group and a 6.7% rate in the NS-ISB group (P < .001). The volume of local anesthetics used for ISB was 29.7 ±â€Š8.9 mL in the US-ISB group versus 38.1 ±â€Š4.8 mL in the NS-ISB group (P < .001). The intraoperative use of analgesics and sedatives such as fentanyl, midazolam and propofol in combination was significantly lowered in the US-ISB group (P < .001).US-ISB is a more effective and safer approach for providing intense block to NS-ISB because it can decrease the incidence of conversion to general anesthesia and reduce the use of analgesics and sedatives during arthroscopic shoulder surgery.


Assuntos
Artroscopia , Bloqueio Nervoso/métodos , Lesões do Manguito Rotador/cirurgia , Ultrassonografia de Intervenção , Analgésicos/uso terapêutico , Anestesia Geral , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Niger J Clin Pract ; 23(9): 1183-1187, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913154

RESUMO

Aims: This study compared the analgesic effect of apical peri-prostatic block with that of intra-rectal xylocaine gel for trans-rectal ultrasound guided prostate biopsy (TRUS-PBx) in Nigeria. Methods: This is a prospective randomized comparative study carried out over one year in University of Benin Teaching Hospital, Edo State, Nigeria. The participants were randomized into two groups; Group A had 10 mls of intra-rectal xylocaine gel instillation while Group B had apical infiltration of 10 mls of 1% xylocaine all before TRUS-PBx. Result: There was a statistically significant difference in the mean pain score during and one hour after TRUS-PBx between Group A and Group B of the study population respectively (p < 0.0001). Those that had intra-rectal xylocaine gel (Group A) had more pain during and after biopsy. There was no difference in the mean pain score during probe insertion between the two groups (p = 0.952). Conclusion: This study demonstrated the superiority of apical peri-prostatic nerve block over intra rectal xylocaine gel instillation during TRUS-PBx with respect to its anesthetic efficacy. Therefore, centers providing TRUS-PBx in Nigeria should consider apical peri-prostatic nerve block as their mode of anesthesia for the procedure due to its efficacy and high safety profile.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Lidocaína/administração & dosagem , Bloqueio Nervoso/métodos , Dor/prevenção & controle , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Administração Retal , Idoso , Anestésicos Locais/administração & dosagem , Biópsia por Agulha/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/inervação , Reto/patologia , Ultrassonografia de Intervenção
13.
Pain Physician ; 23(4S): S319-S350, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942792

RESUMO

BACKGROUND: Since the late 1940s, corticosteroids have been a mainstay class of agents in multiple interventional techniques and intra-articular injections. Exogenous glucocorticoids are structurally and pharmacologically similar to the endogenous hormones. As such, multiple actions of corticosteroids are exhibited, including those of anti-inflammatory and immunosuppressive effects. Epidural injections, with or without steroids, have been extensively used throughout the world. There are reports of epidural injections starting in 1901, with steroids being added to the local anesthetic since 1952, when steroids were administered into the sacral foramen. PURPOSE: Due to the extensive side effects of steroids in various injections, some have proposed limiting their use in epidurals and intraarticular injections. With the COVID-19 pandemic, the multiple side effects of the steroids have elevated the level of concern and recommendations have been made to utilize local anesthetic alone or the lowest dose of steroids. Fashioned from common expressions of the day, the term "steroid distancing" began to be used and proposed for intraarticular injections of the knee. Consequently, we sought to evaluate the evidence and feasibility of steroid distancing in interventional pain management. METHODS: This focused review of local anesthetics and steroids utilized in interventional pain management for epidural injections, peripheral nerve blocks, and intraarticular injections by multiple database searches. This is a focused narrative review and not a systematic review. Consequently, evidence synthesis was not performed traditionally, but was based on an overview of the available evidence. RESULTS: No significant difference was identified based on whether steroids are added to local anesthetic or not for epidural as well as facet joint injections. However, there was not enough evidence to compare these two groups for peripheral intraarticular injections. LIMITATIONS: The present review is limited by the paucity of literature with bupivacaine alone or bupivacaine with steroids local anesthetic alone or with steroids of intraarticular injections of knee, hip, shoulder and other joints, and intraarticular facet joint injections. CONCLUSION: This review shows an overall lack of significant difference between lidocaine alone and lidocaine with steroids in epidural injections. However, available evidence is limited for bupivacaine alone or with steroids. Evidence is also not available comparing local anesthetic alone with steroids for facet joint or peripheral joint intraarticular injections. Thus, it is concluded that local anesthetic with lidocaine may be utilized for epidural injections, with appropriate patient selection and steroids reserved for non-responsive patients with local anesthetic and with significant radiculitis.


Assuntos
Corticosteroides/uso terapêutico , Anestésicos Locais/uso terapêutico , Infecções por Coronavirus , Manejo da Dor/métodos , Pandemias , Pneumonia Viral , Anti-Inflamatórios/uso terapêutico , Betacoronavirus , Humanos , Injeções Epidurais/métodos , Injeções Intra-Articulares/métodos
14.
Medicine (Baltimore) ; 99(36): e22113, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899094

RESUMO

OBJECTIVE: Effective analgesia during delivery can not only decrease pain, but also have a significant function in ensuring the safety of baby and mother. Sufentanil is generally used opioid with ropivacaine in epidural anesthesia in labor pain management; however it can cause some adverse reaction. Dexmedetomidine is an a2-adrenoceptor agonist with high selectivity. It possesses opioid-sparing and analgesic effects and it is suitable for the long-term and short-term intraoperative sedation. The purpose of this present study is to compare the analgesic effect of ropivacaine with dexmedetomidine against ropivacaine with sufentanyl in epidural labor. METHODS: This is a single center, placebo-controlled randomized trial which will be performed from May 2020 to May 2021. It was authorized via the Institutional Review Committee in the first medical center of Chinese PLA General Hospital (S2018-211-0). One hundred sixty full-term protozoa are included in this work. They are randomly divided into four groups (n = 40 per group): the RD1 group (with the epidural administration of 0.125% ropivacaine + dexmedetomidine of 0.5 µg/mL), and the RD2 group (with the epidural administration of 0.08% ropivacaine + dexmedetomidine 0.5 µg/mL), the RS1 group (with the epidural administration of 0.125% ropivacaine + sufentanil of 0.5 µg/mL), as well as RS2 group (with the epidural administration of 0.08% ropivacaine + sufentanil of 0.5 µg/mL). Clinical outcomes are pain score, a modified Bromage scale, the Ramsay Sedation Scale, and adverse reactions during analgesia. All the needed analyses are implemented through utilizing SPSS for Windows Version 20.0. RESULTS: The first table shows the clinical outcomes between these four groups. CONCLUSION: This current work can provide a primary evidence regarding the clinical outcomes of dexmedetomidine versus sufentanil for labor epidural analgesia. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5877).


Assuntos
Analgesia Obstétrica/métodos , Analgésicos/uso terapêutico , Anestésicos Locais/uso terapêutico , Dexmedetomidina/uso terapêutico , Ropivacaina/uso terapêutico , Sufentanil/uso terapêutico , Analgesia Epidural/métodos , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Quimioterapia Combinada , Feminino , Humanos , Gravidez , Ropivacaina/administração & dosagem , Ropivacaina/efeitos adversos , Sufentanil/administração & dosagem , Sufentanil/efeitos adversos
15.
Bone Joint J ; 102-B(10): 1354-1358, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993329

RESUMO

AIMS: In the UK, fasciectomy for Dupuytren's contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. METHODS: Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks. RESULTS: The mean preoperative contractures were 35.3° (0° to 90°) at the metacarpophalangeal joint (MCPJ), 32.5° (0° to 90°) at proximal interphalangeal joint (PIPJ) (a combined deformity of 67.8°). The mean correction was 33.6° (0° to 90°) for the MCPJ and 18.2° (0° to 70°) for the PIPJ leading to a combined correction of 51.8°. There was a complete deformity correction in 21 fingers (59.5%) and partial correction in 14 digits (37.8%) with no correction in one finger. The mean residual deformities for the partial/uncorrected group were MCP 4.2° (0° to 30°), and PIP 26.1° (0° to 85°). For those achieving a full correction the mean preoperative contracture was less particularly at the PIP joint (15.45° (0° to 60°) vs 55.33° (0° to 90°)). Mean preoperative URAM scores were higher in the fully corrected group (17.4 (4 to 31) vs 14.0 (0 to 28)), but lower at three months post-surgery (0.5 (0 to 3) vs 4.40 (0 to 18)), with both groups showing improvements. Infections occurred in two patients (three digits) and both were successfully treated with oral antibiotics. No other complications were noted. The estimated cost of a fasciectomy under local anaesthetic in the community was £184.82 per patient. The estimated hospital theatre costs for a fasciectomy was £1,146.62 under general anaesthetic (GA), and £1,085.30 under an axillary block. CONCLUSION: This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. Local anaesthetic fasciectomy in a community setting achieves a saving of £961.80 for a GA and £900.48 for an axillary block per case. Cite this article: Bone Joint J 2020;102-B(10):1354-1358.


Assuntos
Anestesia Local/economia , Anestesia Local/métodos , Contratura de Dupuytren/cirurgia , Fasciotomia/economia , Fasciotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Custos e Análise de Custo , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reino Unido
16.
Curr Opin Anaesthesiol ; 33(5): 704-709, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32826626

RESUMO

PURPOSE OF REVIEW: Single injection interscalene block (ISB) provides effective analgesia for shoulder surgery. However, the duration of these is limited. This review summarizes the effectiveness of three potential means of extending the duration of analgesia: perineural infusion of local anesthetic agents, addition of adjuvant drugs to local anesthetics in single-injection nerve block, and utilization of liposomal bupivacaine in the surgical field or in the block itself. RECENT FINDINGS: Perineural infusion of local anesthetics with interscalene catheters provides superior pain relief with reduction of postoperative opioids. Both dexmedetomidine and dexamethasone effectively extend the duration of single injection ISB. Liposomal bupivacaine holds promise when injected perineurally in ISB, either as a sole agent or when mixed with standard bupivacaine. SUMMARY: Interscalene catheters, adjunctive drugs added to local anesthetics in single-injection interscalene brachial plexus blocks, or liposomal bupivacaine may be used to effectively prolong the duration of analgesia for shoulder surgery patients.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/métodos , Plexo Braquial , Bupivacaína/administração & dosagem , Humanos , Dor Pós-Operatória
18.
Medicine (Baltimore) ; 99(31): e21435, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756154

RESUMO

INTRODUCTION: The population of obese individuals is increasing worldwide, and as a result, the number of mothers with super morbid obesity undergoing cesarean sections is also increasing. However, little is known about which anesthetic technique is appropriate for cesarean sections of super morbidly obese parturients. PATIENT CONCERNS: A 35-year-old woman with body mass index 61.3 kg/m at a gestational age of 37 weeks. DIAGNOSIS: The patient was super morbidly obese parturient. INTERVENTIONS: Spinal anesthesia was performed. A spinal needle was inserted into the L4-5 interspinous space in the sitting position. After confirmation of cerebrospinal fluid, 0.5% hyperbaric bupivacaine 9 mg and fentanyl 20 µg were injected into the subarachnoid space. OUTCOMES: After the administration of spinal anesthetics, the nerve block to the T8 dermatome level was confirmed, surgery was performed, and the fetus was delivered. The patient's vital signs were stable until the end of the operation. CONCLUSION: There is no established strategy for selecting a method of anesthesia in patients with morbid obesity (body mass index 40 kg/m or more). For this reason and considering the amount of bupivacaine used for spinal anesthesia, we wanted to share our experience with spinal anesthesia for cesarean section in a super morbidly obese parturients.


Assuntos
Anestesia Obstétrica/métodos , Raquianestesia/instrumentação , Cesárea/métodos , Obesidade Mórbida/cirurgia , Adulto , Analgésicos Opioides/administração & dosagem , Anestesia Epidural/métodos , Anestesia Obstétrica/tendências , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Índice de Massa Corporal , Bupivacaína/administração & dosagem , Feminino , Fentanila/administração & dosagem , Idade Gestacional , Humanos , Injeções Espinhais , Agulhas , Obesidade Mórbida/epidemiologia , Alta do Paciente/normas , Gravidez
19.
Pediatr Dent ; 42(4): 273-281, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32847666

RESUMO

Purpose: Pain on needle insertion and deposition of local anesthetic agents are a cause of anxiety in pediatric patients. Articaine is a potential anesthetic agent whose superior properties reduce the need for multiple insertions, yet it is not commonly used. The purpose of this study was to compare the effectiveness of articaine with lidocaine in pediatric dental anesthesia. Methods: An exhaustive search of the literature was conducted using the electronic databases (Medline, Google Scholar, and Cochrane). Randomized controlled clinical trials evaluating anesthetic effectiveness of articaine and lidocaine in children up to 14 years old by Facial Pain Scale (FPS) and Visual Analog Scale (VAS) were included in the review. Qualitative analysis and risk of bias assessment were done. Values obtained using FPS and VAS were analyzed using a random-effects model. Results: Out of the 25,447 studies obtained from various databases, 11 were considered eligible for inclusion. Assessment of effectiveness using both scales revealed articaine to be significantly better (mean difference [MD] equals -0.46; 95 percent confidence interval [95% CI] equals -0.81 to -0.12; P=0.008; I 2 equals 58 percent; VAS - mean difference equals -0.20, 95% CI equals -0.29 to-0.10, P=0.0001, I 2 equals zero percent). Conclusion: Effectiveness of articaine as a local anesthetic in pediatric dentistry was better than the gold standard lidocaine but the rating difference was small based on the FPS.


Assuntos
Anestesia Dentária , Carticaína , Adolescente , Anestesia Local , Anestésicos Locais , Criança , Método Duplo-Cego , Humanos , Lidocaína
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