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1.
Medicine (Baltimore) ; 100(27): e26527, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232187

RESUMO

ABSTRACT: Interscalene block (ISB) is commonly performed for regional anesthesia in shoulder surgery. Ultrasound-guided ISB enables visualization of the local anesthetic spread and a reduction in local anesthetic volume. However, little is known about the appropriate local anesthetic dose for surgical anesthesia without sedation or general anesthesia. The purpose of our study was to evaluate the appropriate local anesthetic volume by comparing intraoperative analgesics and hemodynamic changes in ISB in arthroscopic shoulder surgery.Overall, 1007 patients were divided into groups 1, 2, and 3 according to the following volume of local anesthetics: 10-19, 20-29, and 30-40 mL, respectively. The use of intraoperative analgesics and sedatives, and the reduction in intraoperative maximum blood pressure and heart rate were compared through retrospective analysis.Fentanyl was used in 55.6% of patients in group 1, which was significantly higher than in those groups 2 and 3 (22.3% and 30.7%, respectively); furthermore, it was also higher than those in groups 2 and 3 in dose-specific comparisons (P < .05). The percent of the maximum reduction in intraoperative systolic blood pressure and heart rate in group 3 was significantly higher than those in groups 1 and 2. Ephedrine administration was lower in group 2 than that in other groups (P < .05). The incidence of hypotensive bradycardic events was lowest (9.1%) at the local anesthetic volume of 24 mL as revealed by the quadratic regression analysis (R2 = 0.313, P = .003).Decreasing the local anesthetic volume to less than 20 mL for ultrasound-guided ISB as the sole anesthesia increases the opioid consumption during shoulder arthroscopic surgery. Local anesthetics >30 mL or increased opioid consumption with <20 mL of local anesthetics could increase the risk of cardiovascular instability intraoperatively. Our findings indicate that 24 mL of local anesthetic could be used to lower the incidence of hypotensive bradycardic events.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroscopia/métodos , Bloqueio do Plexo Braquial/métodos , Artropatias/cirurgia , Dor Pós-Operatória/prevenção & controle , Articulação do Ombro/cirurgia , Anestesia Local , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia de Intervenção
2.
Jt Dis Relat Surg ; 32(2): 290-298, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34145803

RESUMO

OBJECTIVES: The aim of this study was to analyze the postoperative effects of extended nerve blocks and local infiltration analgesia (LIA) on postoperative pain control, muscle weakness, and blood loss after total knee arthroplasty (TKA). PATIENTS AND METHODS: Between February 24th 2020 and July 10th 2020, a total of 161 patients (55 males, 106 females; median age: 69.0 years [IQR 63.0-75.0], range, 41 to 81 years) who underwent primary TKA were randomly allocated into three parallel groups according to their concomitant procedure in a double-blind fashion: (i) those to whom nerve blockade was performed after competition of surgery under the duration of spinal anesthesia (n=50); (ii) those to whom LIA was performed during surgery (n=52), and (iii) control group (n=59). The content of LIA was 10-10 mL of 20 mg lidocaine with 0.01 mg adrenalin and 100 mg ropivacaine, 1 mL (30 mg) ketorolac, and 5 mL (500 mg) tranexamic acid was diluted by 50 mL 0.9% NaCl under aseptic conditions. Outcome parameters were the evaluation of pain until the evening of first postoperative day (24 to 36 h), mobilization, and blood loss within the first three postoperative days. RESULTS: The pain was maximal between 4 and 8 h postoperatively, when the effect of the spinal anesthetic drugs disappeared. During this critical period, tolerable pain (Numerical Rating Scale, NRS ≤3) was observed in 52%, 42%, and 19% of nerve blockade in LIA and control groups, respectively. None of the patients complained of high-intensity pain (NRS >8) in the LIA group, which was a significant difference from the block and control groups (10% and 14%, p<0.008, respectively). There was no significant muscle weakness associated with the use of this extended block. The decrease in hemoglobin level was significantly lower in the LIA group than in the control and block groups (odds ratio [OR]: 0.379, 95% confidence interval [CI]: 0.165-0.874 for nerve blockade vs. LIA, OR: 1.189, 95% CI: 0.491-2.880 for nerve blockade vs. control, OR: 0.319, 95% CI: 0.140-0.727, respectively). The common language effect size for pain in each referred interval in each group and for decrease of hemoglobin between the first and third postoperative days fell between 0.507 and 0.680. CONCLUSION: This study demonstrates that LIA technique offers a fast and safe treatment option for pain relief after TKA. No clinically relevant muscle weakness was observed among groups according to field block applications. Significant advantages were also achieved in blood loss.


Assuntos
Analgesia/métodos , Anestesia Local/métodos , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Hemorragia Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Raquianestesia , Anestésicos Locais , Anti-Inflamatórios não Esteroides , Antifibrinolíticos/administração & dosagem , Método Duplo-Cego , Epinefrina/administração & dosagem , Feminino , Hemoglobinas/metabolismo , Humanos , Cetorolaco , Lidocaína , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Bloqueio Nervoso/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ropivacaina , Ácido Tranexâmico/administração & dosagem , Vasoconstritores/administração & dosagem , Caminhada
3.
J Pak Med Assoc ; 71(5): 1379-1383, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091618

RESUMO

OBJECTIVE: To determine the effect of pre-cooling agent on the intensity of pricking pain at the intraoral injection site in adult patients. METHODS: The in-vivo interventional study was conducted at the Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, from September 2018 to August 2019, and comprised adult patients of either gender. The pricking pain perception during needle administration was assessed using split-mouth technique. Topical anaesthesia benzocaine gel was applied on the left side, which was treated as controls, for 1 min, while on the right side, which was treated as the experimental side, refrigerated cartridge was placed for 2 min. Infiltration anaesthesia was then administered on both sides. Pain perception ratings were measured through visual analogue scale. After profound anaesthesia was achieved, restorative treatment was performed under rubber dam isolation. Data was analysed using SPSS 24. Results: Of the 152 subjects, 77(50.65%) were females and 75(49.34%) were males. The overall mean age was 35.97±8.669 years (range: 21-50 years). The effect of refrigerated cartridge was significant on the intensity of pricking pain at the intraoral injection site in patients aged 41-50 years, and in female patients aged 21-30 years (p<0.05), whereas its effect was non-significant in males aged 21-30 years and patients aged 31-40 years (p>0.05). CONCLUSIONS: Pre-cooling agent was found to be effective in decreasing pricking pain felt by patients.


Assuntos
Anestésicos Locais , Dor , Adulto , Anestesia Local , Benzocaína , Feminino , Humanos , Masculino , Dor/tratamento farmacológico , Medição da Dor
4.
Ugeskr Laeger ; 183(22)2021 05 31.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34060454

RESUMO

The possible impact on the foetus must always be taken into account, whenever non-conservative strategies are considered in pregnancy. As to carpal tunnel syndrome, surgery is usually reserved for severe cases, or when steroid blockades have been insufficient. If only pharmacological considerations are taken into account, surgery with local anaesthetics may however be preferred over blockades. While especially lidocaine is considered quite safe in pregnancy, a foetal risk cannot be ruled out for the synthetic glucocorticoids. Moreover, the duration of exposure is considerably shorter. These issues are summarized and discussed in this review.


Assuntos
Síndrome do Túnel Carpal , Anestesia Local , Anestésicos Locais/efeitos adversos , Síndrome do Túnel Carpal/tratamento farmacológico , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Lidocaína , Gravidez , Esteroides
5.
Actas Dermosifiliogr ; 112(6): 516-519, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34088476

RESUMO

As dermatologic surgeons often have to perform long surgeries with local anesthetic only, they should be familiar with the fundamentals of how to manage 2 potentially serious complications: Hypertensive crises and intraoperative arrhythmias. Hypertensive crises can be classified as 1) hypertensive urgencies, characterized by a significant spike in blood pressure (>180/110 mmHg) without target-organ dysfunction or 2) hypertensive emergencies, characterized by a blood pressure above 180/110 mmHg with progressive target-organ damage. In emergencies, the blood pressure needs to be reduced immediately whereas in urgencies the goal is to reduce it over several days. Care must still be taken not to reduce the blood pressure excessively rapidly in emergencies, however, to avoid ischemic injury to vascular beds that have adapted to a high blood pressure. We recommend that dermatologic surgeons use captopril in hypertensive emergencies because of its safety profile and ease of use. Asymptomatic intraoperative bradycardia does not require treatment, but patients should always be checked to ensure they are alert and responsive. The first step in clinically stable patients with tachycardia is to measure the width of the QRS complex and notify the anesthetist when this is wide. Dermatologic surgeons should also be familiar with the drugs available in the operating room, ensure that they are easily accessible, and identify the most essential ones so they can familiarize themselves with indications and dosage. Patients should be monitored throughout the operation, and material to secure a peripheral intravenous line should be prepared in case of need. Finally, the dermatologic surgeon should know all the staff working in the operating room and be able to locate the specialist in anesthesia and resuscitation.


Assuntos
Hipertensão , Anestesia Local , Anti-Hipertensivos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/etiologia , Emergências , Humanos , Hipertensão/tratamento farmacológico , Infusões Intravenosas
6.
Wiad Lek ; 74(4): 906-910, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34156002

RESUMO

OBJECTIVE: The aim: To provide clinical evaluation of the effectiveness of anesthesia for cystectomy of radicular cysts that have grown into the maxillary si-nus or nasal cavity using different techniques of endonasal block-ade of the nasopalatine nerve. PATIENTS AND METHODS: Materials and methods: Clinical observations were conducted on 52 patients of different age and sex. These patients were diagnosed with large radicular cysts (more than 3.0 cm in diameter) that had grown into the maxillary sinus (33 cases) or into the nasal cavity (19 cases). The surgical excisions of cysts (oroantral cystectomies) were performed un-der local potentiated anesthesia. Patients were divided into two clinical groups, depending on the methods used for endonasal blockade of the nasopalatine nerve: the main and the control group. Patients in the main group underwent endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion. In the control group, the neural blockade was performed at the entry of this nerve into the incisive canal. Pain sensitivity and perception in patients were studied using subjective and objective methods. The data was analyzed by means of the Pearson's chi - square tests. RESULTS: Results: During the enucleation of radicular cysts that grew into the inferior nasal meatus and maxillary sinus in patients of the main group there was no pain observed. There were no manifestations of pain-induced stress neither from the side of autonomic system, nor physical or emotional manifestations of pain, which confirmed the effectiveness of nasopalatine nerve anesthesia. In patients of the control group during similar operation the full effect of local anesthesia was achieved in 56.0% of cases (χ2 - 9,270, р = 0,003). The rest of the patients during cystectomies showed some signs of pain-induced stress from the side of autonomic system or in the form of physical or emotional manifestations. CONCLUSION: Conclusions: Endonasal blockade of the nasopalatine nerve at the point of its emergence from the pterygopalatine ganglion invariably provided a complete analgesia during enucleation of radicular cysts that have grown into the maxillary sinus or nasal cavity. Anesthesia of the nasopalatine nerve at its entry into the incisive canal allows pain-less cystectomy of radicular cysts that have spread to the front of the inferior nasal meatus from the front teeth.


Assuntos
Cistectomia , Cisto Radicular , Anestesia Local , Humanos , Seio Maxilar/cirurgia , Cavidade Nasal
7.
Stomatologiia (Mosk) ; 100(3): 30-34, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34180622

RESUMO

THE AIM OF THE STUDY: Was the assessment of the efficacy of using non-steroidal anti-inflammatory drug Ketorol Express as a preventive analgesia in the treatment of acute pulpitis in molars. MATERIALS AND METHODS: The study comprised 128 individuals, 76 (59.4%) women and 52 (40.6%) men. The mean age was 37.4 years. Two different visual-analog scales were used to evaluate the effectiveness of pain relief and the general well-being of the patient and the doctor. THE RESULTS: Of the study proved that the preventive analgesia with Ketorol Express at a dosage of 20 mg 15 minutes before local anesthesia with 4% articaine with epinephrine 1:200 000 in patients diagnosed with acute pulpitis of molars was effective since local anesthesia high effectiveness, absence of necessity for alternate anesthesia were registered by patients, which coincided with the dentist's opinion. CONCLUSION: Preventive analgesia with Ketorol Express improves the efficacy of local anesthesia in the treatment of acute pulpitis in molars.


Assuntos
Analgesia , Anestesia Dentária , Bloqueio Nervoso , Pulpite , Adulto , Anestesia Local , Anestésicos Locais , Carticaína , Método Duplo-Cego , Feminino , Humanos , Masculino , Dente Molar , Dor , Pulpite/tratamento farmacológico
8.
BMC Oral Health ; 21(1): 321, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172032

RESUMO

BACKGROUND: Different distraction techniques have been used in dentistry and have shown great results in managing anxious pediatric patients specially during local anesthesia administration. One of the recently invented techniques is virtual reality. The purpose of the study was to evaluate the effect of virtual reality distraction on anxiety and pain during buccal infiltration anesthesia in pediatric patients. METHODS: Healthy, cooperative 6- to 12-year-old children requiring buccal infiltration anesthesia were randomly assigned to a test or control group. In the test group, local anesthesia was administered while the subjects were watching a cartoon video using virtual reality goggles. Subjects in the control group watched a cartoon video on a screen during the administration of local anesthesia. To assess anxiety in both groups, heart rate was recorded using a pulse oximeter at five time points: (1) once the subject sets on the dental chair as a baseline; (2) when video is on; (3) at topical anesthesia application; (4) during needle insertion; (5) after the administration of local anesthesia. The face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale and the Wong-Baker FACES pain rating scale were used to assess pain. RESULTS: A total of 50 subjects were included with a mean age of 8.4 ± 1.46 years. Twenty-nine (58.0%) of the subjects were females. The mean heart rate at all time points except baseline was significantly higher among the test group compared to the control group. Multiple regression analysis showed that younger subjects and females had higher mean FLACC behavioral pain assessment scale scores (P = 0.034 and P = 0.004, respectively) regardless of the distraction technique used. Younger subjects and subjects with higher baseline heart rate reported higher mean Wong-Baker FACES pain rating scale score (P = 0.031 and P = 0.010, respectively), controlling for all other variables. CONCLUSION: Female subjects and the younger age group were more likely to report higher pain scores during local anesthesia administration regardless of the type of distraction used. TRIAL REGISTRATION: The study was retrospectively registered in ClinicalTrials.gov with the identifier: NCT04483336 on 23/07/2020.


Assuntos
Anestesia Local , Realidade Virtual , Ansiedade , Criança , Feminino , Humanos , Masculino , Dor , Medição da Dor
9.
Paediatr Drugs ; 23(4): 349-359, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34036532

RESUMO

Lidocaine is an amino amide with a well-established role as a local anesthetic agent. Systemic intravenous administration expands its clinical use to include acute and chronic pain circumstances, such as postoperative pain, neuropathic pain, postherpetic neuralgia, hyperalgesia, visceral pain, and centrally mediated pain. For refractory pain that has not responded to conventional therapy or if further escalation of treatment is prevented by contraindications or side effects to standard therapies, a continuous infusion of lidocaine may be considered as a single intervention or as a sequence of infusions. Here, we review and evaluate published data reflecting the use of lidocaine continuous infusions for pain management in the pediatric population.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Manejo da Dor/métodos , Pediatria/métodos , Adolescente , Anestesia Local/métodos , Criança , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Feminino , Humanos , Infusões Intravenosas , Masculino , Neuralgia/diagnóstico , Neuralgia/tratamento farmacológico , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
10.
Orthopedics ; 44(3): e343-e346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039195

RESUMO

Spinal anesthesia has grown in popularity for total hip arthroplasty (THA) due to its documented low complications. However, the use of a local anesthetic agent dictates the recovery of neuraxial blockade. Bupivacaine has emerged as the most popular choice, but its relatively long-acting effect limits its use with rapid recovery. Although not well studied, ropivacaine may offer a viable alternative with shorter-acting properties. Primary unilateral THA patients who received either ropivacaine or bupivacaine spinal anesthesia were retrospectively reviewed. These groups were compared for common demographics, such as age, sex, and body mass index. The primary outcomes included postoperative ambulation time and distance, post-anesthesia care unit transition time, and selective complications. Five hundred three patients were included. Of these, 227 received ropivacaine and 276 received bupivacaine. The ropivacaine group showed superior ambulation time and distance, quicker post-anesthesia care unit transition, and equivalent complications compared with the bupivacaine group. Ropivacaine shows a clear advantage over bupivacaine for spinal anesthesia during THA when considering rapid recovery. Its use should be strongly considered, especially in the ambulatory setting. [Orthopedics. 2021;44(3):e343-e346.].


Assuntos
Raquianestesia/métodos , Anestésicos Locais/uso terapêutico , Artroplastia de Quadril/métodos , Deambulação Precoce , Ropivacaina/uso terapêutico , Idoso , Anestesia Local , Bupivacaína/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
11.
Eur J Obstet Gynecol Reprod Biol ; 261: 193-199, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33971381

RESUMO

BACKGROUND: Inhalation of nitrous oxide and oxygen (N2O/O2) is used to reduce pain that is spontaneous or induced by procedures. N2O/O2 could be useful in the treatment of the pain in first-trimester termination of pregnancy performed under local anaesthesia and/or minimal sedation (FTOPL). OBJECTIVE: To evaluate the usefulness of N2O/O2 to reduce pain in FTOPL. SEARCH STRATEGY: Electronic databases including PubMed, Embase, and MEDLINE were searched using keywords. STUDY SELECTION: All studies comparing the use of N2O/O2 versus a placebo in the management of pain during FTOPL during the first trimester were included. Of the 199 studies identified, four were deemed eligible for this meta-analysis. DATA COLLECTION: The extracted results were perioperative pain, immediate and delayed postoperative pain, anxiety scores, and the secondary effects (nausea, vomiting). The data were analysed using Comprehensive Meta-Analysis software version 2.2.064. MAIN RESULTS: There was a significant difference in favour of N2O/O2 for perioperative pain (p = 0.006; SMD = - 0.31; 95 % CI, -0.54 - -0.09). No difference was found, however, in postoperative pain, nor was there a difference in the secondary effects (nausea, vomiting) (p = 0.61). A significant decrease in postoperative anxiety scores was seen in the pooled placebo group (p = 0.049; SMD = 0.41; and 95 % CI, 0.001-0.83). CONCLUSIONS: N2O/O2 reduces the pain of FTOPL. N2O/O2 could be recommended in FTOPL.


Assuntos
Aborto Induzido , Óxido Nitroso , Anestesia Local , Feminino , Humanos , Manejo da Dor , Gravidez , Primeiro Trimestre da Gravidez
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(5): 567-572, 2021 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-33998209

RESUMO

Objective: To discuss the method and effectiveness of Wide-awake technique in flexor tendon tenolysis. Methods: The clinical data of 16 patients (22 fingers) with flexor tendon adhesion treated by Wide-awake technique for flexor tendon tenolysis between May 2019 and December 2019 were retrospectively analyzed. The patients were all male, aged from 18 to 55 years old, with an average of 35 years old. Among them, 4 cases (7 fingers) after replantation of severed fingers, 4 cases (7 fingers) after flexor tendon rupture repair, and 8 cases (8 fingers) after open reduction and internal fixation of proximal fractures. The time from the original operation to this operation was 6-18 months, with an average of 8 months. The visual analogue scale (VAS) score was used to evaluate the patient's pain during local anesthesia (when the first needle penetrated the skin), intraoperative, and 24 hours postoperatively; and the recovery of finger movement was evaluated by total finger joint active range of motion (TAM) evaluation system and Strickland (1980) standard after operation. Results: Intraoperative hemostasis and anesthesia were satisfactory, and the patient could fully cooperate with the surgeon in active finger movements. There were different degrees of pain during local anesthesia (VAS score was 2-4), no pain during operation (VAS score was 0), and different degrees of pain after operation (VAS score was 1-8, 9 patients needed analgesics). All incisions healed by first intention after operation. All 16 cases were followed up 9-15 months with an average of 12 months. Finger function was significantly improved, no tendon rupture occurred. At last follow-up, the patients after proximal fracture open reduction and internal fixation were rated as excellent in 4 fingers and good in 4 fingers according to the TAM standard, and both were excellent according to the Strickland (1980) standard; and the patients after replantation of severed fingers and flexor tendon rupture repair were rated as excellent in 4 fingers and good in 10 fingers according to TAM standard, and as excellent in 6 fingers and good in 8 fingers according to Strickland (1980) standard. Conclusion: Wide-awake technique applied in flexor tendon tenolysis can accurately judge the tendon adhesion and release degree through the patient's active activity, achieve the purpose of complete release, and the effectiveness is satisfactory; the effectiveness of tendon adhesion release surgery after fracture internal fixation is better than that of patients after tendon rupture suture and replantation.


Assuntos
Traumatismos dos Dedos , Traumatismos dos Tendões , Adolescente , Adulto , Anestesia Local , Traumatismos dos Dedos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Resultado do Tratamento , Adulto Jovem
13.
Nepal J Ophthalmol ; 13(25): 50-58, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33981097

RESUMO

INTRODUCTION: The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection. MATERIALS AND METHODS: The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain. RESULTS: In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p <0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p<0.001 for both genders). CONCLUSION: Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.


Assuntos
Catarata , Facoemulsificação , Anestesia Local , Anestésicos Locais , Bupivacaína , Feminino , Humanos , Lidocaína , Masculino , Percepção da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Facoemulsificação/efeitos adversos
14.
Gerodontology ; 38(2): 228-231, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34013564

RESUMO

OBJECTIVE: To present a feasible treatment method for fractures of severely atrophic mandibles in high-risk patients undergoing general anaesthesia (GA). CASE REPORT: A 77-year-old man presented with bilateral unfavourable fractures in an atrophic mandible. Pre-anaesthetic consultation revealed that the patient was at high risk for GA due to significant medical comorbid conditions of the patient, such as advanced age, chronic obstructive respiratory disease, diabetes mellitus and atherosclerosis. Thus, a modified treatment, consisting of open reduction and internal fixation using a combination of reconstruction plates and miniplates via an extraoral approach, was planned under local anaesthesia. The patient tolerated the surgical procedure well, without the need for sedation, and uneventful healing was achieved during postoperative period. CONCLUSION: Local anaesthesia may be considered as the anaesthetic technique of choice when managing atrophic mandible fractures to reduce the risk of complications and shorten the time needed for recovery, especially in elders with significant medical comorbidities.


Assuntos
Fraturas Mandibulares , Idoso , Anestesia Local , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Masculino , Mandíbula/cirurgia , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/cirurgia
15.
J Cardiothorac Surg ; 16(1): 95, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879212

RESUMO

BACKGROUND: The aim of this study is to compare the diagnostic efficacy and safety of video-assisted thoracoscopic surgery (VATS) with awake VATS (AVATS) pleural biopsy in undiagnosed exudative pleural effusions. METHODS: The diagnostic efficacy of pleural biopsy by uniportal VATS under general anesthesia or AVATS under local anesthesia and sedation performed by the same surgeon in patients with undiagnosed exudative pleural effusion between 2007 and 2020 were retrospectively evaluated. Test sensitivity, specificity, positive predictive value and negative predictive value were compared as well as age, gender, comorbidities, procedure safety, additional pleural-based interventions, duration time of operation and length of hospital stay. RESULTS: Of 154 patients with undiagnosed exudative pleural effusion, 113 (73.37%) underwent pleural biopsy and drainage with VATS, while 41 (26.62%) underwent AVATS pleural biopsy. Sensitivity, specificity, positive predictive value and negative predictive value were 92, 100, 100, and 85.71% for VATS, and 83.3, 100, 100, and 78.9% for AVATS, respectively. There was no significant difference in diagnostic test performance between the groups, (p = 0.219). There was no difference in the rate of complications [15 VATS (13.3) versus 4 AVATS (9.8%), p = 0.557]. Considering additional pleural-based interventions, while pleural decortication was performed in 13 (11.5%) cases in the VATS group, no pleural decortication was performed in AVATS group, (p = 0.021). AVATS group was associated with shorter duration time of operation than VATS (22.17 + 6.57 min. Versus 51.93 + 8.85 min., p < 0.001). Length of hospital stay was relatively shorter in AVATS but this was not statistically significant different (p = 0.063). CONCLUSIONS: Our study revealed that uniportal AVATS pleural biopsy has a similar diagnostic efficacy and safety profile with VATS in the diagnosis and treatment of patients with undiagnosed pleural effusion who have a high risk of general anesthesia due to advanced age and comorbidities. Accordingly, uniportal AVATS pleural biopsy may be considered in the diagnosis and treatment of all exudative undiagnosed pleural effusions.


Assuntos
Anestesia Geral , Anestesia Local , Sedação Consciente , Pleura/patologia , Derrame Pleural/etiologia , Derrame Pleural/patologia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Pleura/cirurgia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Vigília
16.
Anesth Prog ; 68(1): 19-25, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827123

RESUMO

The aim of this study was to analyze the use of dental local anesthetics in Germany compared with international data. The type and distribution of dental local anesthetics and added vasoconstrictors based on a representative sample of German dentists itemized over a period of 7 years (2011 to 2017) were evaluated and statistically analyzed. The results were compared with international dental local anesthetic consumption data published since 2005. With a consistent market share of nearly 98%, articaine was the first-line local dental anesthetic agent in Germany. During the investigation period, German dental local anesthetics with epinephrine 1:200,000 had ∼50% market shares, whereas formulations with epinephrine 1:100,000 had 40% to 45% market shares. Articaine, with market shares between 38% and 81%, was also the preferred anesthetic agent in various other countries, with the notable exceptions of the United Kingdom and the United States, where lidocaine was the preferred local anesthetic agent. Epinephrine was the preferred vasoconstrictor internationally, similar to Germany. The larger market share of higher concentrated epinephrine 1:100,000 was remarkable, considering the increasing number of medically compromised patients. Increased consideration for using agents with reduced dosages of epinephrine (1:200,000) is generally recommended.


Assuntos
Anestesia Dentária , Anestésicos Locais , Anestesia Local , Carticaína , Odontólogos , Método Duplo-Cego , Epinefrina , Humanos , Lidocaína , Vasoconstritores
17.
Anesth Prog ; 68(1): 10-18, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827126

RESUMO

The objectives of this research were to investigate (a) what was the most effective infusion rate of remifentanil and (b) the degree to which sympathomimetic effects were involved with cardiovascular stimulation by using a power spectral analysis of heart rate variability (HRV). A total of 63 healthy individuals scheduled for sagittal split ramus osteotomy were enrolled and randomly allocated to 1 of 3 groups: remifentanil infusion rate of 0.1, 0.2, or 0.4 µg/kg/min. Anesthesia was maintained with remifentanil and propofol. Before the surgical procedure, 2% lidocaine containing 12.5 µg/mL epinephrine was administered in the surgical field for local anesthesia. Systolic blood pressure (SBP), heart rate (HR), low-frequency (LF) and high-frequency (HF) components in HRV power spectral analysis, and the LF/HF ratio were analyzed. Increases in SBP and HR were observed after local anesthesia in all 3 groups, but no significant differences were observed between the groups. Remifentanil infusion at 0.1 µg/kg/min may be appropriate to minimize cardiovascular stimulation caused by exogenous epinephrine from local anesthesia. Although a rise in the LF/HF ratio was observed after local anesthesia in all groups, no relationship was observed between the cardiovascular changes and the increase in LF/HF ratio. This suggests that sympathomimetic effects are involved to a lesser extent with the cardiovascular stimulation caused by exogenous epinephrine.


Assuntos
Anestesia Local , Anestésicos Locais , Anestésicos Intravenosos/efeitos adversos , Anestésicos Locais/efeitos adversos , Pressão Sanguínea , Epinefrina/efeitos adversos , Frequência Cardíaca , Humanos , Piperidinas/efeitos adversos , Remifentanil/farmacologia
18.
Anesth Prog ; 68(1): 29-32, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33827128

RESUMO

Local anesthesia techniques are widely used in dentistry because of their numerous advantages, including safety. Several articles have been published on local and systemic complications stemming from the use of local anesthesia, one of which is accidental intravascular injection, usually reported during inferior alveolar nerve blocks. A 58-year-old man presented to the dental office for extraction of the lower left first molar. During delivery of a supplemental injection in the buccal vestibular mucosa to anesthetize the buccal nerve, an accidental intra-arterial injection to the facial artery occurred, causing sudden sharp pain and immediate pallor along the course of the facial artery. The pallor resolved in approximately 20 minutes. Buccal infiltration was repeated successfully, and the tooth was extracted uneventfully. This case appears to be the first report in the literature to describe the accidental intravascular injection of local anesthetic involving the facial artery and discuss its clinical implications.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Anestesia Dentária/efeitos adversos , Anestesia Local , Anestésicos Locais/efeitos adversos , Artérias , Humanos , Lidocaína , Masculino , Nervo Mandibular , Pessoa de Meia-Idade , Bloqueio Nervoso/efeitos adversos
19.
Stomatologiia (Mosk) ; 100(2): 40-43, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33874659

RESUMO

AIM: The analysis of the criteria for predicting the effectiveness and safety of the use of periodontal anesthesia methods in the treatment of dental caries was carried out. MATERIALS AND METHODS: The study involved 78 patients: 41 women and 37 men aged from 25 to 56 years without severe somatic pathology, who needed treatment for dental caries. Intraligamental and modified periodontal anesthesia using a 4% articaine solution with different concentrations of vasoconstrictor were used as methods of anesthesia. The «method of the local injection anesthesia of the tooth pulp evaluating¼ was used during the modified periodontal and intraligmental anesthesia which determines the criteria for predicting the effectiveness and safety of the planned anesthesia and which is based on determining the functional parameters of the tooth pulp such as electrical excitability and microcirculation. RESULTS: The obtained results demonstrated the high efficiency and safety of the modified periodontal anesthesia with 4% articaine with epinephrine 1:200 000, which is easier to use and does not require specialized equipment. CONCLUSION: Modified periodontal anesthesia is safe and effective for the treatment of dental caries.


Assuntos
Anestesia Dentária , Cárie Dentária , Adulto , Anestesia Local , Anestésicos Locais , Carticaína , Cárie Dentária/terapia , Método Duplo-Cego , Epinefrina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Orthopade ; 50(5): 415-424, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33847790

RESUMO

Wide awake local anesthesia no tourniquet (WALANT) refers to an anesthesia technique with low bleeding and complication rates, which enables interventions on the hand in an awake patient without the use of a tourniquet. Bleeding control is achieved through addition of vasoconstrictors to the infiltration solution. Since the motor function of the extremity is not affected, it offers the additional possibility of intraoperative active function testing. The WALANT procedure constitutes an established, effective, easily learnt and resource-sparing technique. The spectrum of surgical possibilities with WALANT is wide and covers nearly all elective and many emergency procedures. Due to multiple advantages in contrast to other regional and general anesthesia procedures, WALANT features an increasing spectrum of surgical applications and practitioners. It is therefore of interest for hand surgeons working both in hospitals and private practices.


Assuntos
Anestesia Local , Procedimentos Ortopédicos , Anestésicos Locais , Mãos/cirurgia , Humanos , Torniquetes , Vigília
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