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The Journal of Clinical Pediatric... Jan 2023Local anesthesia is performed in dentistry before clinical procedures to avoid pain. Children can show fear at the sight of the needle and pain at its insertion. To make... (Randomized Controlled Trial)
Randomized Controlled Trial
Local anesthesia is performed in dentistry before clinical procedures to avoid pain. Children can show fear at the sight of the needle and pain at its insertion. To make local anesthesia more comfortable, the use of computer-controlled local anesthetic delivery (CCLAD) systems has been developed to control the flow rate of the anesthetic solution injected through the needle. The aim of the present research is to evaluate and compare the discomfort felt by patients using a traditional syringe and the CCLAD system SleeperOne®, by considering pain, size sensation, bitterness, and vomit. 30 patients were included in the study and randomly assigned to traditional anesthesia or CCLAD. After injection, patients were assessed for the abovementioned outcomes. A Visual Analogue Scale (VAS) from 0 to 10 scores was used. As far as pain is concerned, statistically lower mean values were found in the Trial group ( < 0.05). Instead, concerning size, bitterness and vomit perceptions, no statistically significant differences were found between the groups ( > 0.05). Linear regressions were calculated considering technique, quadrant, dental arch, tooth, dentition, sex, and age as independent variables. The technique has shown to have a significant influence on pain ( < 0.05), with lower values for SleeperOne® device. Pain resulted significantly influenced by the type of dentition ( < 0.05), with higher scores for deciduous one. Moreover, perceived pain decreased with the increase of the age of patients ( < 0.05). At last, bitterness perception scores resulted to be higher for primary first molars ( < 0.05). SleeperOne® device seems to be a valid support for the reduction of pain related to anesthetic injection, especially in children. Further studies should evaluate CCLADs' uses combined with lidocaine preanesthetic as well as with conscious sedation through nitrous oxide in order to determine possible synergistic effects between these procedures.
Topics: Humans; Child; Anesthesia, Local; Syringes; Anesthetics, Local; Lidocaine; Pain; Anesthesia, Dental; Pain Perception
PubMed: 36627224
DOI: 10.22514/jocpd.2023.002 -
Brazilian Journal of Anesthesiology... 2020Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether... (Review)
Review
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.
Topics: Anesthesia, Conduction; Anesthesia, Local; COVID-19; Coronavirus Infections; Humans; Pandemics; Pneumonia, Viral; Postoperative Period
PubMed: 32600800
DOI: 10.1016/j.bjan.2020.05.002 -
American Journal of Surgery May 2021Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than...
BACKGROUND
Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults.
METHODS
This is a retrospective review of 97,437 patients in the Veterans Affairs Surgical Quality Improvement Program who had open inguinal hernia surgery under local or general anesthesia. Outcomes included 30-day postoperative complications, operative time, and recovery time.
RESULTS
Our cohort included 22,333 (23%) Veterans who received local and 75,104 (77%) who received general anesthesia. Mean age was 62 years. Local anesthesia was associated with a 37% decrease in the odds of postoperative complications (95% CI 0.54-0.73), a 13% decrease in operative time (95% CI 17.5-7.5), and a 27% shorter recovery room stay (95% CI 27.5-25.5), regardless of age.
CONCLUSIONS
Using local rather than general anesthesia is associated with a profound decrease in complications (equivalent to "de-aging" patients by 30 years) and could significantly reduce costs for this common procedure.
Topics: Age Factors; Aged; Anesthesia Recovery Period; Anesthesia, General; Anesthesia, Local; Female; Hernia, Inguinal; Hospitals, Veterans; Humans; Male; Middle Aged; Operative Time; Retrospective Studies; Texas; Treatment Outcome; Veterans
PubMed: 32896372
DOI: 10.1016/j.amjsurg.2020.08.024 -
The Journal of International Advanced... Jul 2022This study describes the efficacy of cochlear implantation under local anesthesia with conscious sedation with dexmedetomi- dine in adult patients and proposes a method...
Adult Cochlear Implantation Under Local Anesthesia and Conscious Sedation with Dexmedetomidine: Efficacy and a Method to Interact with the Conscious and Cooperative Patient.
BACKGROUND
This study describes the efficacy of cochlear implantation under local anesthesia with conscious sedation with dexmedetomi- dine in adult patients and proposes a method to communicate with the conscious and cooperative patient intraoperatively. This less invasive anesthetic procedure is suitable for patients with comorbidities preventing general anesthesia.
METHODS
Unilateral cochlear implantation with Oticon Medical systems was performed in 10 adult patients with comorbidities preventing general anesthesia. Classical cochlear implantation was performed under local anesthesia and conscious sedation with dexmedetomidine. Cue cards were used to support intraoperative dialogue. Outcome measures were intraoperative adverse events, patient perceptions, as well as post- operative completions measured with a questionnaire.
RESULTS
The procedure was successful for all 10 patients. Dexmedetomidine lead to rapid and successful conscious sedation and no case of high blood pressure or aggravation of comorbidities was noted. Stapedial reflex measurements led to reliable thresholds. The usage of the cue cards was successful: patients were able to read the cue cards and thereby the medical team could inform the patients of surgical progress and ask the patients questions.
CONCLUSION
Cochlear implantation and intraoperative dialogue with the conscious and cooperative patient is possible. The main advantage of the anesthetic procedure is the reduction in intra- and postoperative complications. Further, expected benefits include a less invasive procedure, the conscious state of the patient which enables the recording of auditory perception, and the absence of nonauditory percepts such as facial nerve stimulation during implant stimulation, a shorter surgical duration, and lower-associated costs.
Topics: Adult; Anesthesia, General; Anesthesia, Local; Cochlear Implantation; Conscious Sedation; Dexmedetomidine; Humans
PubMed: 35894523
DOI: 10.5152/iao.2022.20005 -
Contrast Media & Molecular Imaging 2021In order to avoid the psychological harm caused by pain to patients, in this study, the application effect of computer-assisted local anesthesia in patient surgery was... (Randomized Controlled Trial)
Randomized Controlled Trial
In order to avoid the psychological harm caused by pain to patients, in this study, the application effect of computer-assisted local anesthesia in patient surgery was studied. In this method, 72 patients with hypertension, 35 males and 37 females, aged 53-83 years, with an average age of 70.8 ± 1.3 years, were selected for appointment tooth extraction in the department of stomatology from January to December 2014. All patients were booked for tooth extraction by ECG monitoring. Patients who were contraindicated for tooth extraction, had a history of mental illness, and had used antianxiety drugs and sedatives within 1 week before surgery were excluded. Patients were randomly divided into two groups according to their ID numbers: observation group, 36 cases, and control group. Painless oral local anesthesia injection instrument was used for local anesthesia injection. In the control group, 36 patients were injected with local anesthesia by traditional manual injection. The results showed that 86.11% of patients in the observation group had decreased anxiety scores after anesthesia, while only 13.88% of patients in the control group had decreased anxiety scores. Among patients with decreased anxiety scores, 80.65% in the observation group became nondental anxiety compared with 28.57% in the control group. Computer-assisted oral local anesthesia can effectively control dental anxiety and relieve the pain and discomfort of local anesthesia injection, and improve patient satisfaction, conducive to the smooth nursing work.
Topics: Aged; Aged, 80 and over; Anesthesia, Local; Computers; Female; Humans; Injections; Male; Middle Aged; Tooth Extraction
PubMed: 34867116
DOI: 10.1155/2021/8643867 -
Urology Journal Apr 2022This study aimed to examine the short and long-term complications of thermocautery-assisted circumcisions with local anesthesia done in a sterile environment in...
PURPOSE
This study aimed to examine the short and long-term complications of thermocautery-assisted circumcisions with local anesthesia done in a sterile environment in operating room conditions, accompanied by literature.
MATERIALS AND METHODS
The participants who consecutively underwent thermocautery-assisted circumcision with local anesthesia from June 2018 to May 2019 included in the study. They were one month-17 years old, same ethnic origin, in same location. The age groups were compared in terms of complications.
RESULTS
The participant age and surgical duration means were 4.89 ± 2.08 (30 days-17 years) years old and 7.484 ± 1.524 (5-20 minutes) minutes, respectively. Complications were observed in fifty-three participants or 2.9% of the whole observation set. The participants under intervals of one six months and over 6 years of age had significantly lowered complication rates when compared to the other participants, and this comparison was statistically significant (P = 0.001).
CONCLUSION
The study results demonstrated that circumcision with thermocautery after local anesthesia viable, reliable, and effective method. It can be assumed that circumcisions in males especially may be effective in 1-6 months, and over 6 years of age. Parents choose this method because it is more appropriate and eliminates the risk of general anesthesia.
Topics: Anesthesia, General; Anesthesia, Local; Circumcision, Male; Humans; Male; Retrospective Studies
PubMed: 35466390
DOI: 10.22037/uj.v19i.6748 -
Turkish Journal of Medical Sciences Feb 2021To compare the subjective level of pain in patients who underwent an ultrasound-guided percutaneous liver biopsy (PLB) after either pericapsular anesthesia (PA) or... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND/AIM
To compare the subjective level of pain in patients who underwent an ultrasound-guided percutaneous liver biopsy (PLB) after either pericapsular anesthesia (PA) or subcapsular anesthesia (SA), based on the numeric rating scale (NRS).
MATERIALS AND METHODS
A total of 323 patients, mean age 51, range 21–82 years; 160 (49.5%) male, referred to the Interventional Radiology Clinic of Kocaeli University Faculty of Medicine for image-guided PLB, between June 2019 and May 2020 were included and randomized into two groups by anesthetic type; the first (n = 171) consisted of patients undergoing SA while the second (n = 152) included patients undergoing PA. The intensity of pain at 0, 1, and 6 h after PLB was evaluated between the groups using NRS.
RESULTS
At hours 0, 1, and 6, the median [range] NRS scores in the subcapsular and pericapsular groups were 2 [1–2] versus 3 [2–4] (P < 0.001), 1 [0–1] versus 1 [1–2] (P < 0.001), and 0 [0–0] versus 1 [0–1] (P < 0.001), respectively. Subgroup analysis revealed that the patients who underwent the subcostal procedure with subcapsular anesthesia reported the lowest pain scores and intercostal procedure with pericapsular anesthesia reported the worst pain scores for each time point: 0 h 1 [1–2] versus 3 [3–4], P < 0.001; 1 h 1 [0–1] versus 1 [1–2], P < 0.001; and 6 h 0 [0–0] versus 0 [0–1], P < 0.001, respectively.
CONCLUSION
Subcapsular anesthesia is a well-tolerated procedure compared to a pericapsular procedure. Furthermore, the application of a subcapsular anesthetic with a subcostal approach was reported to result in the lowest pain and greatest patient comfort.
Topics: Anesthesia, Local; Biopsy, Needle; Diagnostic Self Evaluation; Female; Humans; Image-Guided Biopsy; Liver; Liver Diseases; Male; Middle Aged; Outcome Assessment, Health Care; Pain Measurement; Pain, Postoperative; Pain, Procedural; Ultrasonography, Interventional
PubMed: 32967413
DOI: 10.3906/sag-2006-346 -
Anesthesia Progress 1992Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects: a decrease in the peak plasma concentration of the local anesthetic agent,... (Review)
Review
Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects: a decrease in the peak plasma concentration of the local anesthetic agent, increase in the duration and the quality of anesthesia, reduction of the minimum concentration of anesthetic needed for nerve block, and decrease of blood loss during surgical procedures. The addition of a vasoconstrictor to a local anesthetic may also have detrimental effects. A review of the literature indicates that vasoconstrictor concentrations in local anesthetics marketed for dental use in the United States are not always optimal to achieve the purposes for which they are added. In most cases, a reduced concentration of vasoconstrictor could achieve the same goal as the marketed higher concentration, with less side-effect liability.
Topics: Amides; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Blood Loss, Surgical; Drug Interactions; Humans; Ropivacaine; Vasoconstrictor Agents
PubMed: 8250339
DOI: No ID Found -
Medicina Oral, Patologia Oral Y Cirugia... May 2012To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. (Clinical Trial)
Clinical Trial Comparative Study
OBJECTIVE
To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques.
MATERIAL AND METHOD
A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded.
RESULTS
A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009).
CONCLUSIONS
Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques.
Topics: Adolescent; Adult; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Child; Female; Humans; Injections; Jaw; Male; Middle Aged; Prospective Studies; Single-Blind Method; Young Adult
PubMed: 22143716
DOI: 10.4317/medoral.17512 -
BMC Anesthesiology Aug 2020Arteriovenous fistulae (AVF) are the hemodialysis access modality of choice for patients with end-stage renal disease. However, they have a high early failure rate. Good... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Arteriovenous fistulae (AVF) are the hemodialysis access modality of choice for patients with end-stage renal disease. However, they have a high early failure rate. Good vascular access is essential to manage long-term hemodialytic treatment, but some anesthesia techniques directly affect venous diameter as well as intra- and post-operative blood flow. The main purpose of this meta-analysis was to compare the results of regional and local anesthesia (RA and LA) for arteriovenous fistula creation in end-stage renal disease.
METHODS
We conducted a systematic review and meta-analysis to synthesize evidence from 7 randomized controlled trials (565 patients) and 1 observational study (408 patients) with the aim of evaluating the safety and efficacy of RA versus LA in surgical construction of AVF.
RESULTS
Pooled data showed that RA was associated with higher primary patency rates than LA (odds ratio [OR], 1.88; 95% confidence interval [CI]: 1.24-2.84; P = 0.003; I = 31%). Additionally, brachial artery diameter was significantly increased in the RA versus LA group (mean difference [MD], 0.83; 95% CI: 0.75-0.92; P < 0.001; I = 97%) and the need for intra- as well as post-operative pain killers was significantly less (RA, P = 0.0363; LA, P = 0.0318). Moreover, operation duration was significantly reduced using RA versus LA (MD, - 29.63; 95% CI: - 32.78 - -26.48; P < 0.001; I = 100%).
CONCLUSIONS
This meta-analysis suggests that RA is preferable to LA in patients with end-stage renal disease in guaranteeing AVF patency and increasing brachial artery diameter.
Topics: Anesthesia, Conduction; Anesthesia, Local; Arteriovenous Shunt, Surgical; Humans; Kidney Failure, Chronic; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome
PubMed: 32867692
DOI: 10.1186/s12871-020-01136-1