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Burns & Trauma 2022Topical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There...
BACKGROUND
Topical local analgesic and anaesthetic agents have been used both pre- and immediately post-harvest on split-thickness skin graft (STSG) donor site wounds (DSW). There is no systematic review of their effectiveness in providing post-harvest analgesia, or of the possible toxic effects of systemic absorption. This study is designed to address the question of which agent, if any, is favoured over the others and whether there are any safety data regarding their use.
METHODS
Systematic literature review of randomised controlled trials of topical agents applied to STSG DSWs, with a view to providing analgesia. Studies identified via search of Cochrane and EBSCO databases. No restrictions on language or publication year. Primary outcomes: pain at the time of (awake) STSG, and post-harvest pain (up to first dressing change). Secondary outcome was serum medication levels relative to published data on toxic doses. Cochrane risk of bias assessment tool utilised in assessment of included studies. At least 2 reviewers screened and reviewed included studies. A narrative review is presented.
RESULTS
There were 11 studies meeting inclusion criteria. Overall methodological quality and patient numbers were low. Topical eutectic mixture of lidocaine and prilocaine pre-harvest affords good local anaesthesia in awake STSG harvesting. Topical bupivacaine (5 studies) or lidocaine (1 study) gave significantly better post-harvest anaesthesia/analgesia than placebo. Topical morphine performs no better than placebo. Topical local anaesthetic agents at reported doses were all well below toxic serum levels.
CONCLUSIONS
Topical local anaesthetics (lidocaine or bupivacaine) provide good analgesia, both during and after STSG harvest, at well below toxic serum levels, but there are no good data determining the best local anaesthetic agent to use. There is no evidence morphine performs better than placebo.
PubMed: 36133279
DOI: 10.1093/burnst/tkac020 -
Restorative Dentistry & Endodontics Aug 2022This study aimed to evaluate the effects of 5% lidocaine and 2.5% lidocaine/2.5% prilocaine topical anesthetic on pain during needle insertion and infiltration injection...
OBJECTIVES
This study aimed to evaluate the effects of 5% lidocaine and 2.5% lidocaine/2.5% prilocaine topical anesthetic on pain during needle insertion and infiltration injection in the labial mucosa of anterior maxillary teeth, and to assess the relationship between patients' anxiety and pain scores.
MATERIALS AND METHODS
The Modified Dental Anxiety Scale questionnaire was applied and recorded. Patients were randomly divided into 4 groups ( = 30), as follows: G1 group: 5% lidocaine and placebo for 1 minute, G2 group: 2.5% lidocaine/2.5% prilocaine and placebo for 1 minute, G3 group: 5% lidocaine and placebo for 3 minutes, and G4 group: 2.5% lidocaine/2.5% prilocaine and placebo for 3 minutes. Before the application of topical anesthesia, one side was randomly selected as the topical anesthesia and the contralateral side as the placebo. The pain levels were measured with Visual Analog Scale (VAS) immediately after needle insertion and injection and were compared. The correlation between anxiety and pain scores was analyzed.
RESULTS
Administration of 5% lidocaine for 1 minute had significantly higher pain scores for both insertion and infiltration injection than the other groups ( < 0.05). There was a significant moderate positive correlation between dental anxiety and the injection-induced VAS pain score in the placebo side in all groups ( < 0.05).
CONCLUSIONS
Topical anesthetics significantly reduced the pain caused by both needle insertion and injection pain in comparison to the placebo side. The pain scores of patients with dental anxiety were lower on the topical anesthesia compared to the placebo side.
TRIAL REGISTRATION
Thai Clinical Trials Registry Identifier: TCTR20201217002.
PubMed: 36090513
DOI: 10.5395/rde.2022.47.e25 -
Swiss Dental Journal Sep 2022When choosing local anesthetics, risk factors such as underlying diseases, use of other medications and allergies have to be taken into consideration. Systematic...
When choosing local anesthetics, risk factors such as underlying diseases, use of other medications and allergies have to be taken into consideration. Systematic complications might occur if a specific limit in the plasma concentration is exceeded. Articaine and prilocaine are metabolized extrahepatically. In case of an absolute contraindication for vasoconstrictors, the use of mepivacaine, bupivacaine or articaine is recommended.
Topics: Aged; Anesthetics, Local; Bupivacaine; Carticaine; Humans; Mepivacaine; Prilocaine
PubMed: 36052970
DOI: 10.61872/sdj-2022-09-03 -
Turkish Journal of Physical Medicine... Jun 2022This study aims to compare the efficacy of the wrist splint and the injection of corticosteroid, autologous blood, and hypertonic dextrose in the treatment of lateral...
Effects of splinting and three injection therapies (corticosteroid, autologous blood and prolotherapy) on pain, grip strength, and functionality in patients with lateral epicondylitis.
OBJECTIVES
This study aims to compare the efficacy of the wrist splint and the injection of corticosteroid, autologous blood, and hypertonic dextrose in the treatment of lateral epicondylitis (LE).
PATIENTS AND METHODS
A total of 120 patients (43 males, 77 females; mean age: 45.7±7.7 years; range, 18 to 65 years) diagnosed with LE between December 2013 and June 2015 were included in the study and randomized into four groups. The first group was administered 20 mg methylprednisolone acetate + 2 mL 2% prilocaine, the second group 2 mL venous blood + 0.5 mL prilocaine, and the third group 2 mL 30% dextrose + 0.5 mL prilocaine injections. A second injection was administered to the third group one month later. The fourth group was recommended to use only a wrist splint. Pre-treatment and post-treatment evaluations of the patients were carried out at one and six months by the Visual Analog Scale (VAS) in terms of pain, by Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire in terms of functional level, and by the Jamar dynamometer in terms of grip strength.
RESULTS
In all groups, VAS values at one and six months after treatment were found to be lower in comparison to baseline. Except for the splint group, a significant improvement was observed in all three injection groups in terms of grip strength and PRTEE values at six months compared to the baseline values. In the comparison of the groups, no significant difference was observed in terms of improvement in VAS scores and grip strength. While corticosteroid injection was significantly effective in terms of PRTEE pain, function, and total scores only at one month, the autologous injection was effective in terms of PRTEE function and total scores at only six months after treatment. There were no significant differences for splint and prolotherapy groups in terms of PRTEE scores.
CONCLUSION
Corticosteroid injection, autologous blood injection, and prolotherapy are effective and safe long-term methods in LE treatment.
PubMed: 35989952
DOI: 10.5606/tftrd.2022.8007 -
Acta Veterinaria Scandinavica Aug 2022A common and to some degree painful procedure in veterinary practice is to insert an intra-venous catheter. In both human and veterinary medicine, a topical mixture of...
A common and to some degree painful procedure in veterinary practice is to insert an intra-venous catheter. In both human and veterinary medicine, a topical mixture of lidocaine and prilocaine (EMLA cream) has shown to reduce the pain, however a period of 60 min between application and initiation of the procedure is recommended. This time lapse is not always suitable for clinical practise and a shorter time before anaesthetic effect is therefore desirable. Lidocaine has a shorter time lapse (1-3 min) when used on mucus membrane; however, the effect of lidocaine for desensitization of skin has shown variable results in humans. The aim of the study was to evaluate the effect of topical lidocaine spray 10% on the response to placement of venous catheters in dogs. Topical lidocaine spray 10% or NaCl 0.9% was administered prior to placing an intravenous catheter in the cephalic vein. A cross-over of treatment with 2 h wash out period was used before placing a catheter in the opposite cephalic vein. The procedure was video recorded and the dogs' responses were later scored by three persons blinded to treatment using a visual analogue scale. The VAS scores were normalised and the mean difference between treatments were compared using Wilcox signed-rank test. This study could not find a statistical difference between the treatments (P = 0.1763) and could conclude that no significant difference in response to intravenous catheterisation was found between application of NaCl 0.9% or lidocaine 10% prior to the procedure.
Topics: Anesthetics, Local; Animals; Catheterization; Dogs; Double-Blind Method; Humans; Lidocaine; Pain; Prilocaine; Sodium Chloride
PubMed: 35987686
DOI: 10.1186/s13028-022-00639-w -
Journal of Plastic, Reconstructive &... Sep 2022Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures.
OBJECTIVES
To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort.
METHODS
This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question.
RESULTS
Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS.
CONCLUSIONS
"Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low.
THE CLINICAL TRIAL REGISTRATION NUMBER
CRD42021260332 (PROSPERO).
Topics: Humans; Anesthesia, Local; Anesthetics, Local; Bicarbonates; Double-Blind Method; Epinephrine; Felypressin; Lidocaine; Network Meta-Analysis; Pain; Patient Comfort; Prilocaine
PubMed: 35961926
DOI: 10.1016/j.bjps.2022.06.058 -
The Journal of Dermatological Treatment Nov 2022The eutectic mixture of local anesthetics (EMLA) is an effective cutaneous anesthetic, although its application is time consuming and poses a risk of methemoglobinemia....
BACKGROUND
The eutectic mixture of local anesthetics (EMLA) is an effective cutaneous anesthetic, although its application is time consuming and poses a risk of methemoglobinemia. Currently, the efficacy of topical 10% lidocaine cream is unclear.
OBJECTIVE
To compare the onset, anesthesia depth, and duration of topical 10% lidocaine and EMLA cream.
METHODS
The randomized, split-body, comparative trial performed on 40 participants who received a topical 10% lidocaine cream or EMLA on forearms for 15-150 min. Pain was stimulated using a 21-gauge needle insertion and evaluated with the Verbal Pain Score. Adverse effects were recorded.
RESULTS
EMLA conferred significantly better efficacy than 10% lidocaine ( < .001). For acceptable pain at 4-mm depth, the minimal application times were 40.88 and 45.38 min of EMLA and 10% lidocaine creams, respectively. With 60/120-min application, the maximal needle-insertion depths with acceptable pain were 6.61/9.47 mm (EMLA) and 6.01/8.94 mm (10% lidocaine). EMLA's anesthetic effect showed an early increase after removal which was sustained for 60-90 min. Both creams caused adverse effects, with EMLA showing higher proportions, although the differences were statistically insignificant.
CONCLUSION
The efficacy of EMLA was superior to 10% lidocaine cream, especially regarding anesthesia onset and duration.
Topics: Humans; Lidocaine, Prilocaine Drug Combination; Prilocaine; Pain Measurement; Ointments; Lidocaine; Anesthetics, Local; Pain; Anesthesia
PubMed: 35920410
DOI: 10.1080/09546634.2022.2109566 -
Molecular Pharmaceutics Sep 2022Water is generally regarded as a universal plasticizer of amorphous drugs or amorphous drug-containing systems. A decrease in glass-transition temperature () is...
Water is generally regarded as a universal plasticizer of amorphous drugs or amorphous drug-containing systems. A decrease in glass-transition temperature () is considered the general result of this plasticizing effect. A recent study exhibits that water can increase the of amorphous prilocaine (PRL) and thus shows an anti-plasticizing effect. The structurally similar drug lidocaine (LID) might show similar interactions with water, and thus an anti-plasticizing effect of water is hypothesized to also occur in amorphous LID. However, the influence of water on the of LID cannot be determined directly due to the very low stability of LID in the amorphous form. It is possible to predict the of LID from a co-amorphous system of PRL-LID using the Gordon-Taylor equation. Interactions were observed between PRL and LID based on the deviations between the experimental s and the s calculated by the conventional use of the Gordon-Taylor equation. A modified use of the Gordon-Taylor equation was applied using the optimal co-amorphous system as a separate component and the excess drug as the other component. The predicted of fully hydrated LID could thus be determined and was found to be increased by 0.9 ± 0.7 K compared with the of water-free amorphous LID. It could be shown that water exhibited a small anti-plasticizing effect on LID.
Topics: Calorimetry, Differential Scanning; Glass; Lidocaine; Temperature; Transition Temperature
PubMed: 35876141
DOI: 10.1021/acs.molpharmaceut.2c00339 -
Veterinary Anaesthesia and Analgesia Sep 2022To compare 5% lidocaine ointment applied for 10 minutes before intravenous (IV) catheterization to a eutectic mixture of local anesthetics (2.5% lidocaine and 2.5%...
OBJECTIVE
To compare 5% lidocaine ointment applied for 10 minutes before intravenous (IV) catheterization to a eutectic mixture of local anesthetics (2.5% lidocaine and 2.5% prilocaine; EMLA) cream applied for 10 or 60 minutes prior and a water-based placebo for 60 minutes for successful marginal ear IV catheterization in rabbits.
STUDY DESIGN
Randomized, blinded, complete crossover, controlled trial.
ANIMALS
A total of 10 intact male, New Zealand White rabbits aged 4 months.
METHODS
After application of one of the treatments on the marginal ear vein, an operator unaware of the treatment attempted IV catheter placement. Successful IV catheterization was considered as a catheter inserted at the first attempt, safely secured, with appropriate patency. Generalized linear mixed models were developed to identify relevant predictors of successful catheter placement.
RESULTS
Ears that had EMLA cream applied 60 minutes before the catheterization attempt had more than 10 times the odds of successful catheter placement [odds ratio (OR)=10.75; 95% confidence interval (CI), 1.92-60.16; p < 0.008] compared with placebo. Both the application of EMLA cream or lidocaine ointment 10 minutes before the catheterization attempt resulted in approximately three times the odds of successful catheter placement compared with placebo, but were not statistically significant.
CONCLUSIONS AND CLINICAL RELEVANCE
Application of EMLA cream on the marginal ear vein 60 minutes before catheterization increases the chance of successful IV catheter placement in conscious rabbits.
Topics: Anesthetics, Local; Animals; Catheterization, Peripheral; Double-Blind Method; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Ointments; Prilocaine; Rabbits; Water
PubMed: 35871995
DOI: 10.1016/j.vaa.2022.06.004 -
JAAD Case Reports Jul 2022
PubMed: 35769194
DOI: 10.1016/j.jdcr.2022.05.028