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Clinical Neurophysiology Practice 2022Stimulated skin wrinkling test (SSW) has been launched as a non-invasive diagnostic procedure. However, no normative age dependent values have been reported that can be...
OBJECTIVE
Stimulated skin wrinkling test (SSW) has been launched as a non-invasive diagnostic procedure. However, no normative age dependent values have been reported that can be applied in clinical practice. The objectives of the study were to (1) collect age-dependent normative values according to the 5-point scale assessment for the SSW, to (2) determine reliability scores for the obtained norm values, and to (3) introduce a new digital method for SSW assessment, the Digit Wrinkle Scan© (DWS©) for detection of wrinkles in a more quantitative manner.
METHODS
Firstly, 82 healthy participants were included, divided in 5 age groups. The participants underwent SSW using lidocaine and prilocaine topical cream. Secondly, 35 healthy participants were included to test whether the DWS© could be a novel manner to assess the grade of wrinkling quantitatively. We determined the inter-observer reliability of both methods. Also, the intra-observer reliability was calculated for the DWS©.
RESULTS
We found a decrease in normative values over age. The inter-observer reliability of assessment by the 5-point scale method was moderate after SSW (Cohen's k: 0.53). Results of the DWS© indicate that total wrinkle length per mm showed moderate to good agreement for the 4th and 5th digits after SSW, and a low agreement for the other digits.
CONCLUSIONS
Age-dependent normative values were obtained according to the 5-point scale, but its clinical application is doubtful since we found a moderate inter-observer reliability. We introduced the DWS© as a possible new method in order to quantify the grade of wrinkling.
SIGNIFICANCE
We found unsatisfactory reliability scores, which hampers its usefulness for clinical practice.
PubMed: 35434427
DOI: 10.1016/j.cnp.2022.03.005 -
Saudi Journal of Anaesthesia 2022Pain relief of epidural anesthesia in cesarean delivery is difficult. EMLA, a eutectic mixture of lidocaine and prilocaine, is effective for pain reduction during...
BACKGROUND
Pain relief of epidural anesthesia in cesarean delivery is difficult. EMLA, a eutectic mixture of lidocaine and prilocaine, is effective for pain reduction during venipuncture and superficial surgery. However, its effectiveness during epidural insertion is not well elucidated. The aim of this randomized, double-blind study was to evaluate the efficacy of EMLA for epidural insertion in elective cesarean delivery.
METHODS
With Institutional Review Board approval and written patients' informed consent, forty-two ASA physical status 2 patients (aged 23-45) scheduled for elective cesarean section were included in this study. The patients were randomized to applied ELMA (EMLA group) or placebo cream (Placebo group) about one hour prior to anesthesia. Pain during skin infiltration with 1% mepivacaine and subsequent insertion of Tuohy needle was assessed immediately after each procedure. The presence of patient's response with physical withdrawal on both procedures was recorded. Statistical analysis was performed using Mann-Whitney test and Fisher's exact test. A value of < 0.05 was considered significant.
RESULTS
Median VAS values on skin infiltration and on insertion of Tuohy needle did not differ between groups. The incidence of patient's response with physical withdrawal on skin infiltration was not different between groups. However, that on insertion of Tuohy needle was significantly lower in EMLA group than in Placebo group (0%, 21%).
CONCLUSIONS
EMLA cream could not reduce the pain during epidural insertion.
PubMed: 35431754
DOI: 10.4103/sja.sja_728_21 -
JPMA. the Journal of the Pakistan... Feb 2022The development of methaemoglobinaemia due to prilocaine, which is used for local anaesthesia, is a rare, life-threatening, but well-known side effect. The development...
The development of methaemoglobinaemia due to prilocaine, which is used for local anaesthesia, is a rare, life-threatening, but well-known side effect. The development of this side-effect in a pregnant patient with chronic kidney disease can lead to foetal distress. The case presented here is of a 21-year old pregnant female with chronic kidney disease who required haemodialysis in the 22nd week of pregnancy due to the progression to end-stage kidney disease. During haemodialysis, a right jugular tunneled double-lumen catheter was inserted using prilocaine as the local anaesthetic. Prilocaine-induced methaemoglobinaemia was diagnosed. In the 24-hour follow-up, the methaemoglobin level decreased to normal with oxygen supply of 10-15 L/min, 2 units of erythrocyte suspension and accompanying haemodialysis.
Topics: Adult; Anesthesia, Local; Anesthetics, Local; Female; Humans; Methemoglobinemia; Pregnancy; Prilocaine; Renal Insufficiency, Chronic; Young Adult
PubMed: 35320195
DOI: 10.47391/JPMA.3072 -
Turkish Journal of Urology Jul 2021Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for patients with renal and ureteral calculi. Even though the procedure is less invasive...
Extracorporeal Shock Wave Lithotripsy (ESWL) is one of the treatment options for patients with renal and ureteral calculi. Even though the procedure is less invasive compared to others, pain caused by the procedure is a major concern. Several studies recommended the use of either local or systemic analgesia with varying results. We aimed to compare the use of local anesthetics and systemic analgesics from randomized controlled trials evaluating pain management during ESWL. A systematic search adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis protocol was performed in theMedline, ScienceDirect, and Cochrane library databases. The bias was evaluated using the Cochrane risk of bias tool. Mean difference (MD) was used to analyze continuous outcomes. A total of seven studies were obtained. The topical anesthesia used was eutectic mixture of local anesthetic cream and xylocaine gel. In contrast, the local injection anesthesia used was subcutaneous prilocaine and intracutaneous sterile water injection. The systemic analgesics used were intramuscular and oral forms of sodium diclofenac. There is no significant difference between the visual analogue scale results between the local and systemic groups (P> .05). The differences in ESWL frequency were also insignificant (P > .05). Additional analgesics supplementation (MD 8.44, 95% CI 2.28-14.61, P¼ .007) and the duration of the procedure (MD 1.39, 95% CI 0.21-2.56, P¼ .02) were significantly lower in the local group. Local anesthesia in ESWL shows a similar degree of pain and frequency but has a shorter duration and fewer analgesics supplementation than systemic analgesics.
PubMed: 35118950
DOI: 10.5152/tju.2021.21143 -
Journal of Anesthesia, Analgesia and... Jan 2022Local anesthesia is the most used anesthetic technique for inguinal hernia repair, despite its unpredictability. Selective spinal anesthesia with a short-term local...
Selective spinal anesthesia with hyperbaric prilocaine provides better perioperative pain control than local anesthesia for ambulatory inguinal hernia repair without affecting discharging time: a randomized controlled trial.
PURPOSE
Local anesthesia is the most used anesthetic technique for inguinal hernia repair, despite its unpredictability. Selective spinal anesthesia with a short-term local anesthetic guarantees rapid recovery, predictable duration and low incidence of side effects. We tried to assess the efficacy of this neuraxial technique in ambulatory setting.
METHODS
One hundred thirty-two ASA I-III, aged > 18 patients scheduled for inguinal hernia repair have been randomized into two groups receiving unilateral spinal anesthesia with 40 mg of hyperbaric prilocaine (group A) or local anesthesia with mepivacaine (group B).
PRIMARY ENDPOINT
intraoperative and post-operative NRS. Other outcomes: sensory block onset, need for opiates and deep sedation, surgery duration, and time to discharge.
RESULTS
Group A: intraoperative NRS was 0 in 100% of patients; post-operative maximum NRS was > 3 in 12.12% of patients. Group B: mean intraoperative NRS was 4; mean post-operative NRS was 2.5. Spinal anesthesia resulted superior in controlling both intraoperative and post-operative pain (p < 0.00001; p = 0.008). Mean time of the motor block resolution in group A was 98 ± 2 min. Mean time to discharge was not significantly different between groups. Surgical time was significantly different between the two groups (mean time of 37 ± 3.2 min group A; 54 ± 6 min group B-p < 0.00001).
CONCLUSION
Spinal anesthesia group patients had significantly less pain than local anesthesia group, both intraoperatively and post-operatively, without differences in time to discharge, incidence of complications and with improvement of surgical time. More randomized controlled trials are needed to confirm this hypothesis.
TRIAL REGISTRATION
NCT05136534 . Registered November 29, 2021-Retrospectively registered.
PubMed: 37386519
DOI: 10.1186/s44158-022-00034-x -
European Endodontic Journal Dec 2021The aim of this study was to compare the success rate of anaesthesia with 3% prilocaine and felypressin (0.03 IU/mL) in maxillary first and second molar teeth with...
OBJECTIVE
The aim of this study was to compare the success rate of anaesthesia with 3% prilocaine and felypressin (0.03 IU/mL) in maxillary first and second molar teeth with irreversible pulpitis.
METHODS
The study population was 159 patients (53 males, 106 females) who had maxillary first or second molar teeth with irreversible pulpitis (84 first molars, 75 second molars). A buccal infiltration of 3% prilocaine with 0.03 IU/mL felypressin was used as the primary anaesthetic technique. In addition to using a categorised pain score, sound, eye movement and body motion were considered signs of anaesthesia efficacy. The data were analysed with independent t and Chi-square tests. Significance was set at α=0.05.
RESULTS
Overall, the success rate was 56.6% in maxillary molars, 53.6% in maxillary first molars, and 60% in maxillary second molars. There was no statistically significant difference between maxillary first and second molars in terms of anaesthesia success rate (P>0.05). The overall success rate of intraligament supplementary injections was 50%, and intrapulpal supplementary injections was 97.91%. No significant difference was found between maxillary first and second molars in terms of the success rate of the supplemental techniques (P>0.05).
CONCLUSION
No significant difference was found between maxillary first and second molars in terms of anaesthesia success rate when 3% prilocaine with 0.03 IU/mL felypressin was used as an anaesthetic solution for the infiltration injection.
Topics: Anesthesia, Dental; Anesthetics, Local; Female; Humans; Male; Molar; Prilocaine; Pulpitis
PubMed: 34967341
DOI: 10.14744/eej.2021.74755 -
South Asian Journal of Cancer Sep 2021Bone marrow aspiration although being a common procedure is associated with significant pain and its reduction remains an unmet need. We evaluated the use of tramadol...
A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain.
Bone marrow aspiration although being a common procedure is associated with significant pain and its reduction remains an unmet need. We evaluated the use of tramadol and eutectic mixture of local anesthetics (prilocaine plus lignocaine) (EMLA) for reducing the severity of pain. In this pilot study, we compared the addition of either tramadol 50 mg per oral (T) or EMLA local application (E) or no intervention (L) in addition to the usual procedure of local infiltration with lignocaine 2% before bone marrow aspiration and biopsy (BMAB) in adults suspected/confirmed with malignancy. Both, tramadol and EMLA were administered 1 hour prior to the procedure. Primary end point was reduction in pain intensity with these interventions compared with local infiltration alone. Pain was assessed using numerical FACES pain scale, a visual analogue scale. Secondary end points were to see the effect on pre procedure apprehension and to find out the other factors associated with increased pain related to the procedure. A total of 300 patients were included in the study, 100 each in tramadol (T), EMLA (E), and only lignocaine local infiltration (L) arms, respectively. The mean pain intensity on the visual scale was significantly lower in the tramadol arm (T, E, L-3.4, 4.4, 4.7, respectively) ( < 0.0005). There was a significant reduction in percentage of patients who experienced moderate/severe pain (four or more) in the tramadol arm (T, E, L-45, 77, 82%, respectively) ( < 0.0005). Duration of procedure >10 minutes, body mass index >30, ECOG (Eastern Oncology Group) performance status ≥3, and age >50 years were positively correlated with more pain. Leukemia patients experienced significantly more pain compared with patients with lymphoma and other solid malignancies. Tramadol was well tolerated. No significant effect on pre-procedure apprehension was noted in any of the arms. Tramadol appears to have a preventive effect on bone marrow aspiration/biopsy-associated pain and appears to be well tolerated, whereas EMLA was not associated with such an effect. Larger studies may be done to ascertain the same.
PubMed: 34938684
DOI: 10.1055/s-0041-1731904 -
Brazilian Oral Research 2021This study showcases the clinical efficacy of mucoadhesive patches designed for the buccal delivery of lidocaine and prilocaine hydrochlorides (1:1, 30 mg/patch). Such... (Randomized Controlled Trial)
Randomized Controlled Trial
This study showcases the clinical efficacy of mucoadhesive patches designed for the buccal delivery of lidocaine and prilocaine hydrochlorides (1:1, 30 mg/patch). Such patches were developed for needle-free pre-operative local anesthesia in dentistry, aiming at mitigating the use of infiltrative anesthesia for medium-complexity clinical procedures. The patches were manufactured encompassing drug-release, mucoadhesive and backing layers, all prepared through film casting using biocompatible materials. Fifty-eight (n = 58) adult patients (65% women and 35% men) were randomly selected and included in a one-arm open clinical prospective cohort study. The average age of the subjects was of 50 years. The majority (59%) of the subjects, mostly women (82%), reported needle-phobia or anxiety due to dental procedures, which was assessed through a questionnaire approved by the ethical council for human use in research. The patches were positioned in the gingival region of the teeth involved in the procedure (86% on the maxillary and 14% on the mandibular bone). Two anesthetic patches were applied on each patient: one in the vestibular region and another in the palate/lingual portion, and these patches remained attached to the placement sites throughout the procedures. Concerning the dental procedures performed, 40% were cavity preparations and dental restorations of medium cavities; 29% staple facilities; 10% gingival retractions; 9% subgingival scrapings; 3% gingivalplasties; 3% supragingival preparations; 3% occlusal adjustments; and 2% subgingival preparations. In 90% of the cases, it was not necessary to complement with conventional infiltrative local anesthesia during the procedures. Patients did not report any discomfort or side effect during or after the administration of the patches. Among the cases in which there was the need for complementation, 50% were cavity preparations and dental restorations; 33% supragingival preparations; and 17% gingivoplasties. The complementary anesthesia volume was of 0.63 ± 0.23 mL and women corresponded to 83% of the participants who needed such intervention. Furthermore, in most cases, the patch was capable of initiating the anesthesia within a short time frame (5 minutes) and reaching the maximum anesthetic effect within 15 and 25 min, lasting at least 50 min. Undesirable side effects were not reported either 2 h after the administration or within the 6-month follow-up. Therefore, the anesthetic patches developed provide needle-free, painless, safe, and patient/dentist-friendly advances in performing routine medium-complexity dental procedures.
Topics: Adult; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Female; Humans; Male; Middle Aged; Prilocaine; Prospective Studies; Treatment Outcome
PubMed: 34932660
DOI: 10.1590/1807-3107bor-2021.vol35.0131 -
Anesthesia Progress Dec 2021The aim of this study was to investigate the changes in pulpal blood flow (PBF) and pulpal oxygen tension (PpulpO2) after injecting local anesthetics with...
OBJECTIVE
The aim of this study was to investigate the changes in pulpal blood flow (PBF) and pulpal oxygen tension (PpulpO2) after injecting local anesthetics with vasoconstrictors.
METHODS
Under general anesthesia, male Japanese White rabbits were injected with 0.6 mL of 2% lidocaine with 1:80,000 epinephrine (LE) or 3% propitocaine (prilocaine) with 0.03 IU felypressin (PF) at the apical area of the lower incisor.
RESULTS
Relative to baseline, PBF and PpulpO2 significantly decreased 5 minutes after LE or PF injection as compared with saline. The decrease in PBF was significantly lower in the LE group than in the PF group. Although the LE group had a larger decrease in PpulpO2 relative to baseline than the PF group did, that difference was not significant. PBF and PpulpO2 recovered to baseline faster in the PF group than in the LE group.
CONCLUSION
The injection of local anesthetic solutions containing vasoconstrictors (LE or PF) transiently caused significant decreases in PBF that resulted in significant decreases in PpulpO2. The recovery of PpulpO2 was faster than PBF regardless of the vasoconstrictor used.
Topics: Anesthesia, Dental; Anesthetics, Local; Animals; Dental Pulp; Epinephrine; Lidocaine; Male; Oxygen; Rabbits; Vasoconstrictor Agents
PubMed: 34911066
DOI: 10.2344/anpr-68-02-09 -
International Journal of Clinical... 2021Pediatric patients are apprehensive regarding having dental treatment mainly because of painful local anesthetic (LA) injections. Various techniques like transcutaneous...
Comparative Evaluation of the Effectiveness of Different Pain-alleviating Methods before Local Anesthetic Administration in Children of 6 to 12 Years of Age: A Clinical Study.
BACKGROUND AND AIM OF THE STUDY
Pediatric patients are apprehensive regarding having dental treatment mainly because of painful local anesthetic (LA) injections. Various techniques like transcutaneous electrical nerve stimulation (TENS), topical anesthetic agents, and vibrator device are introduced to reduce discomfort before LA administration. Therefore, the present study aimed to compare and evaluate the effectiveness of TENS, 2% lignocaine gel, eutectic mixture of lignocaine and prilocaine (EMLA), and vibrating device before LA injections in alleviating pain in pediatric patients.
MATERIALS AND METHODS
Sixty healthy children aged 6 to 12 years who required LA injections for dental procedures were selected and divided into four groups with 15 patients in each group. Wong-Baker's facial pain rating scale (WBFPRS) and face, legs, activity, cry, and consolability scale (FLACC) are used for pain perception which are tabulated, and statistically analyzed.
RESULTS
The test results demonstrated that the TENS group has shown the least mean WBFPRS and FLACC score, followed by vibrator devices, EMLA gel, and lignocaine gel.
CONCLUSION
The newly introduced TENS apparatus showed encouraging results, hence can be used as a safe and reliable technique to be used in pediatric dentistry.
HOW TO CITE THIS ARTICLE
Patil SB, Popali DD, Bondarde PA, Comparative Evaluation of the Effectiveness of Different Pain-alleviating Methods before Local Anesthetic Administration in Children of 6 to 12 Years of Age: A Clinical Study. Int J Clin Pediatr Dent 2021;14(4):447-453.
PubMed: 34824494
DOI: 10.5005/jp-journals-10005-1998