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1.
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
2.
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
3.
Ann Ital Chir ; 91: 273-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877380

RESUMO

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Betacoronavirus/isolamento & purificação , Implante de Prótese Vascular/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Endovasculares/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesia Local , Aneurisma Dissecante/complicações , Antibioticoprofilaxia , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Aneurisma da Aorta Torácica/complicações , Contraindicações de Procedimentos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/transmissão , Darunavir/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Enoxaparina/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Nasofaringe/virologia , Salas Cirúrgicas , Isolamento de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/transmissão , Ritonavir/uso terapêutico , Isquemia do Cordão Espinal/prevenção & controle , Artéria Vertebral/cirurgia
4.
Medicine (Baltimore) ; 99(33): e18958, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871967

RESUMO

We performed this meta-analysis to evaluate the effects of epidural anesthesia and local anesthesia on the surgical outcomes of lumbar disc herniation (DH).Electronic databases including PubMed, EMBASE, Cochrane Library, and the Chinese Academic Journal Full-text Database were searched to identify randomized controlled trials (RCTs) that reported on the effects of local anesthesia and epidural anesthesia in lumbar DH surgical management. Evaluation indicators included: onset time of anesthesia, patient satisfaction, and the rate of adverse effects. There were 6 RCTs with a total of 606 patients in this meta-analysis: 274 cases in the local anesthesia group and 332 in the epidural anesthesia group.This meta-analysis demonstrated that the epidural anesthesia group had a better analgesic effect, a lower adverse effect rate (mean difference [MD] = 0.21, 95% confidence interval [CI] [0.08, 0.54], P = .001) and a better satisfaction rate: (MD = 6.54, 95% CI [2.77, 15.45], P < .0001). The duration of anesthesia was not statistically significant.Epidural anesthesia is a better choice for lumbar DH surgery compared to local anesthesia.


Assuntos
Anestesia Epidural , Anestesia Local , Deslocamento do Disco Intervertebral/tratamento farmacológico , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
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
6.
Ther Umsch ; 77(5): 199-206, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32870096

RESUMO

Treatment of acute injuries of the hand Abstract. Injuries to the hand are a common presentation in primary care units. When accurately assessed, many open injuries may be handled in the emergency department without referral to a hand surgery specialist. We would like to give some recommendations on how to treat the most frequent injuries like lesions to the nail and nailbed, fingertip amputation as well as burns, infections and bites. But first, we highlight the different methods of local anesthesia and discuss the use of a tourniquet or vasoconstriction with adrenalin - WALANT - instead.


Assuntos
Mordeduras e Picadas , Traumatismos dos Dedos/diagnóstico , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/cirurgia , Traumatismos da Mão/terapia , Anestesia Local , Mãos , Humanos , Unhas/lesões , Torniquetes
7.
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
8.
Tokai J Exp Clin Med ; 45(3): 108-112, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901896

RESUMO

A 33G, 12-mm needle broke and entered the soft tissue in a 60-year old man. Panoramic X-ray imaging and cone-beam computed tomography (CT), which we performed a few hours after the breakage, revealed the needle in the soft tissue of the lower right mandibular molar. We immediately made an incision in the buccal gingiva of the lower right mandibular molar under local anesthesia and attempted to remove the needle but could not locate it. Thereafter, we adopted a watch-and-wait approach, as the patient had no subjective symptoms. Nine months later, we confirmed via CT that the needle had migrated subcutaneously to the right side of the neck. Two months later, we identified its location using C-arm fluoroscopy and removed it under general anesthesia. This report is a rare case and we are the first to document the subcutaneous migration of a fractured needle.


Assuntos
Corpos Estranhos , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/cirurgia , Gengiva , Mandíbula , Pescoço , Agulhas/efeitos adversos , Anestesia Dentária , Anestesia Local , Tomografia Computadorizada de Feixe Cônico , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Medicine (Baltimore) ; 99(39): e22394, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991462

RESUMO

OBJECTIVE: We perform this protocol for randomized controlled trial to compare the efficacy of intrathecal morphine and local infiltration anesthesia (LIA) in the treatment of the postoperative pain after total knee replacement (TKR). METHODS: This is a randomized controlled, single center trial which was performed from March 2019 to March 2020. This trial is conducted according to the SPIRIT Checklist of randomized researches. It is authorized via the Ethics Committee of Beijing Friendship Hospital (2019-P2-050-01). Eighty participants who undergo TKR were randomized into 2 groups. Intrathecal morphine group: 0.1 mg of the morphine was intrathecally injected, and the spinal anesthetic was injected at the same time in the group LIA; In the LIA group: the knee joint was infiltrated with epinephrine, ketorologic acid and ropivacaine in the process of operation, and the identical mixture was injected 2 bolus through the intraarticular catheter after operation. The main outcome variables were the visual analog scale and the consumption amount of opioid every 6-hour interval within 2 days postoperatively. The secondary outcome variables were the side effects associated with opioid, the length of hospital stay, motion range, and the loss of blood collected by the closed suction drainage. All the required analyses were carried out via applying the SPSS for Windows Version 19.0. RESULTS: The clinical outcome variables between groups were shown in . CONCLUSION: This protocol will provide the evidence on which technique can achieve better analgesia after TKR.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia Local , Artroplastia do Joelho/efeitos adversos , Morfina/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Humanos , Injeções Espinhais , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Medicine (Baltimore) ; 99(36): e21971, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899035

RESUMO

BACKGROUND: The purpose of this meta-analysis was to comprehensively collect randomized controlled trials (RCTs) to assess the clinical efficacy of intrathecal morphine (ITM) versus local infiltration analgesia (LIA) in the treatment of total knee and hip arthroplasty patients. METHODS: Relevant studies were identified from the Embase, PubMed, Cochrane Library, Web of Science, Wanfang, and Chinese National Knowledge Infrastructure (CNKI) databases. We also reviewed the references of all identified articles to identify additional studies. For each study, we assessed the risk ratio (RR), weighted mean difference (WMD), and corresponding 95% confidence interval (95% CI) to synthesize outcomes. Meta-analysis was performed with Stata 12.0 software. RESULTS: We included 13 studies with 942 patients for meta-analysis. LIA significantly decreased the pain value with rest or mobilization until 72 hours (P < .05). LIA significantly decreased cumulative morphine consumption by 13.52 mg. Moreover, the length of hospital stay was lower in the LIA group than in the ITM analgesia group. Finally, LIA significantly reduced morphine-related complications (nausea and vomiting, pruritus, and respiration depression). CONCLUSIONS: LIA was an effective approach for relieving postoperative pain and reducing postoperative consumption of morphine compared with ITM in total knee and hip arthroplasty patients.


Assuntos
Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Morfina/administração & dosagem , Anestesia Local , Humanos , Injeções Espinhais , Tempo de Internação , Dor Pós-Operatória/prevenção & controle
11.
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
12.
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
13.
PLoS One ; 15(8): e0236624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760093

RESUMO

PURPOSE: To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia. METHODS: Prospective, single-center, randomized study. Patients scheduled for PPV for macular hole (MH) or epiretinal membrane (ERM) at the Retina and Vitreous Section of the Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo were randomly assigned to one of two groups in a 1:1 allocation ratio. Patients assigned to Group ST received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2-4 ml of 1% ropivacaine. Patients assigned to PB received peribulbar anesthesia with 4-6 ml of 1% ropivacaine. After PPV, patients in both groups were asked to rate the level of pain they felt during the entire procedure (including anesthesia administration and PPV) by pointing at a 0-100 Visual Analogue Pain Scale (VAS). Data regarding demographics, patient characteristics and surgical features were also collected. RESULTS: Fifty-four patients were enrolled in the study (26 in Group ST and 28 in Group PB). Baseline characteristics, including age, gender, and presence of comorbidities, were similar in both groups. The surgery performed was PPV alone in 10 and 14 patients in the ST and PB groups, respectively, and combined phacoemulsification and PPV in 16 and 14 patients in the ST and PB groups, respectively (p = 0.39, Pearson). Surgery duration (mean ± SD minutes) was similar in the two groups (62 ± 12 for ST and 70 ± 20 for PB, p = 0.09, t-Test). No patients needed supplemental topical or intravenous anesthesia during surgery. No sight- or life-threatening complication was observed in either group. VAS score was significantly lower in the ST compared to the PB group (median (interquartile range) was 1 (2.25-0) in the ST group compared to 11.5 (29.75-5) in the PB group, p< 0.0001, Wilcoxon). CONCLUSION: In this study of patients who underwent PPV for MH or ERM, topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia. Compared to peribulbar anesthesia which is administered with a sharp needle, sub-Tenon anesthesia administered with a blunt cannula may be associated with a reduced risk of such adverse events as globe perforation, retrobulbar hemorrhage, and inadvertent injection of anesthesia into the optic nerve sheath.


Assuntos
Anestesia Local , Anestésicos Locais , Injeções/métodos , Lidocaína , Ropivacaina , Vitrectomia , Idoso , Feminino , Humanos , Injeções Intraoculares/métodos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Estudos Prospectivos
14.
J Am Acad Orthop Surg ; 28(15): e642-e650, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732655

RESUMO

Trigger finger (TF) is one of the most common causes of hand disability. Immobilization of TF with a joint-blocking orthosis has been demonstrated to effectively relieve pain and improve function. The efficacy of steroid injections for TF varies based on the number of affected digits and the clinical severity of the condition. Up to three repeat steroid injections are effective in most patients. When conservative interventions are unsuccessful, open surgical release of the A1 pulley effectively alleviates the subjective and objective manifestations of TF and currently remains the benchmark procedure for addressing TF. Although several studies have emerged suggesting that a percutaneous approach may result in improved outcomes, this technique demands a learning curve that may predispose patients to higher risk of procedure-related complications. There is no role for preoperative antibiotics in patients who undergo elective soft-tissue procedures of the hand. WALANT anesthesia has gained popularity because it has been associated with improved patient outcomes and a clear cost savings; however, proper patient selection is critical. Similar to other soft-tissue hand procedures, TF surgery rarely necessitates a postoperative opioid prescription.


Assuntos
Procedimentos Ortopédicos/métodos , Dedo em Gatilho/cirurgia , Corticosteroides/administração & dosagem , Adulto , Anestesia Local/economia , Anestesia Local/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Tratamento Conservador , Redução de Custos , Mãos/cirurgia , Humanos , Imobilização/métodos , Injeções Intralesionais , Curva de Aprendizado , Procedimentos Ortopédicos/economia , Procedimentos Ortopédicos/educação , Dedo em Gatilho/diagnóstico , Dedo em Gatilho/terapia
15.
Anaesth Intensive Care ; 48(4): 277-288, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32777929

RESUMO

Strabismus correction surgery is the most common eye operation in children. Adults have approximately a 4% lifetime risk of developing strabismus. Current treatment options include pharmacological injection of botulinum toxin or bupivacaine, conventional corrective surgery, adjustable suture surgery and minimally invasive surgery. Repeated surgery is common as each operation has a 60%-80% chance of successful correction. The benefits of early surgical correction in large-angle strabismus in children outweigh the risks of anaesthesia. General anaesthesia is suitable for patients of all age groups, for complicated or repeated surgery, and bilateral eye procedures. Regional ophthalmic block reduces the incidence of oculocardiac reflex and emergence agitation, and provides postoperative analgesia, but requires a cooperative patient as many experience discomfort. Topical anaesthesia has been used in pharmacological injection, minimally invasive surgery, uncomplicated conventional strabismus surgery and some adjustable suture strabismus surgery. Its use, however, is only limited to cooperative adult patients. Prophylactic antiemesis with both ondansetron and dexamethasone is recommended, especially for children. A multimodal analgesia approach, including paracetamol, intravenous non-steroidal anti-inflammatory drugs, topical local anaesthetic and minimal opioid usage, is recommended for postoperative analgesia, while a supplementary regional ophthalmic block is at the discretion of the team.


Assuntos
Anestésicos , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo , Adulto , Anestesia Local , Bupivacaína , Criança , Humanos , Estrabismo/cirurgia
16.
Georgian Med News ; (303): 58-63, 2020 Jun.
Artigo em Russo | MEDLINE | ID: mdl-32841182

RESUMO

The aim of research - to assess the feasibility and effectiveness, of the intraosseous method of anesthesia, with the Quick Sleeper injection system on the toothless area of ​​the alveolar bone during dental implantation. Clinical and physiological studies were conducted to study the features of performing intraosseous anesthesia on the site of alveolar bone adentia in the absence of the usual anatomical topographic landmarks. New computer technologies, as well as modern methods of patient examination and observation were used. The results of the analysis confirmed the advantages of intraosseous anesthesia compared with alternative methods of local anesthesia during dental implantation. The advantages of the intraosseous method of anesthesia are characterized, the features of conducting, the anatomical guidelines have been indicated for an effective intraosseous anesthesia in the area of ​​the alveolar bone adentia, during dental implantation.


Assuntos
Anestésicos Locais/uso terapêutico , Infusões Intraósseas , Anestesia Local , Implantação Dentária , Humanos , Injeções
17.
Acta Odontol Scand ; 78(6): 474-480, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32730719

RESUMO

OBJECTIVE: We introduced a humanoid robot for the use of techno-psychological distraction techniques in children aged 4-10 to reduce their anxiety and improve their behaviour during dental treatment. MATERIALS AND METHODS: Two hundred children (98 boys, 102 girls; mean age: 6.5 ± 1.66 years) appointed for first time for dental caries were included and randomly divided into two groups [N = 100 for each group; RG: Robot Group (accompanied by the robot), CG: Control Group (without robot accompaniment)]. Half of the children were treated under local anaesthesia (infiltration anaesthesia) (n = 50 within each group) and half of the children were treated without any local anaesthesia (n = 50 within each group) within each group. The success rate of the new robotic distraction technique was evaluated by using Parental Corah Dental Anxiety Scale, Facial Image Scale (FIS), physiological pulse rate and Frankl Behaviour Rating Scale (FBRS). RESULT: Pulse rates, which measured during treatment and after treatment, were statistically higher in CG than in RG (p < .05). After dental treatment, the FIS score was significantly higher in CG than RG (p < .05). 88.3% of the children in RG stated that they wanted the robot to be with them at the next treatment session. CONCLUSIONS: Robotic technology can successfully help in coping with dental anxiety and stress, and helps children to behave better in dental office.


Assuntos
Ansiedade ao Tratamento Odontológico , Robótica , Anestesia Local , Criança , Pré-Escolar , Cárie Dentária , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Robóticos
18.
Zhongguo Gu Shang ; 33(7): 659-61, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32700491

RESUMO

OBJECTIVE: To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome. METHODS: From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function. RESULTS: Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair. CONCLUSION: Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.


Assuntos
Síndrome do Túnel Carpal , Adulto , Anestesia Local , Feminino , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória , Vigília
19.
Rev Bras Anestesiol ; 70(2): 159-164, 2020.
Artigo em Português | MEDLINE | ID: mdl-32600800

RESUMO

Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the postoperative period and provides safety to pati ents and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.


Assuntos
Anestesia por Condução/métodos , Anestesia Local/métodos , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Anestesia por Condução/efeitos adversos , Anestesia Local/efeitos adversos , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão , Período Pós-Operatório
20.
Clin Ter ; 171(4): e335-e339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614368

RESUMO

Awake fiberoptic intubation (AFOI) is mandatory to manage difficult airways. Superior laryngeal nerve block (SLNB) could reduce risks and improve patient comfort. The aim of this study is to assess the procedural comfort of SLNB during AFOI in a population of patients undergoing upper airway oncological surgery. Forty patients were randomized into two groups and were treated with continuous infusion of remifentanil, topic anesthesia and intercricoid block. In the study group (=20), SLNB was performed with lidocaine (L-SLNB); in the control group (n=20) SLNB was performed using saline (S-SLNB). AFOI was more comfortable in the L-SLNB group compared to S-SLNB patients [FOICS ≤ 1 in 18 patients (90%) L-SLNB; 2 (10%) S-SLNB (P <0.001)]. Intubation was faster in L-SLNB (47.45 ±15.38 sec) than S-SLNB (80.15 ±37.91 sec) (p <0.001). The SLNB procedure during AFOI is a safe and comfortable procedure in a population of patients undergoing upper airways surgery. Time to intubation was shorter in L-SLNB than in S-SLNB.


Assuntos
Obstrução das Vias Respiratórias/terapia , Intubação Intratraqueal , Nervos Laríngeos , Bloqueio Nervoso , Obstrução das Vias Respiratórias/cirurgia , Anestesia Local , Constrição Patológica , Feminino , Tecnologia de Fibra Óptica/métodos , Humanos , Intubação Intratraqueal/métodos , Lidocaína , Masculino , Pessoa de Meia-Idade , Vigília
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