-
Urology Journal Mar 2020To evaluate the efficacy of caudal regional anesthesia and local anesthesia methods in prostate biopsy applied under transrectal ultrasonography. Matherials and Methods:... (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparison of the Efficacy of Local Anesthesia Methods and Caudal Regional Anesthesia in Prostate Biopsy Applied Under Transrectal Ultrasonography: A Randomized Controlled Study.
PURPOSE
To evaluate the efficacy of caudal regional anesthesia and local anesthesia methods in prostate biopsy applied under transrectal ultrasonography. Matherials and Methods: This prospective study included a total of 160 patients randomly separated into 4 equal groups as intrarectal local anesthesia (IRLA), periprostatic local anesthesia (PPLA), combined local anesthesia (IRLA+PPLA), and caudal regional anesthesia (CRA). The patients were evaluated using the pain scores on a visual analog scale.
RESULTS
The pain score during anesthesia induction was significantly higher in the CRA group than in the IRLA and IRLA+PPLA groups (p<0.001). The pain score during entry of the probe to the rectum and movement was significantly lower in the CRA group than the IRLA groups (p=0.014). The pain score on penetration of the needle to the prostate and at 30 mins after the biopsy was significantly higher in the IRLA group (p<0.001). At 2 hours after the biopsy, the pain score in the CRA group was significantly lower than IRLA groups (p=0.015).
CONCLUSION
The PPLA alone can be applied more quickly than CRA, causes less pain during the application, and has similar efficacy in reducing pain during and after the prostate biopsy procedure.
Topics: Aged; Anesthesia, Conduction; Anesthesia, Local; Humans; Image-Guided Biopsy; Male; Middle Aged; Prospective Studies; Prostate; Rectum; Treatment Outcome; Ultrasonography, Interventional
PubMed: 32207137
DOI: 10.22037/uj.v0i0.5503 -
Andrology Jan 2019Surgical sperm retrieval, requiring local anesthetic injection, is the most frequent surgical procedure in male infertility. However, needle phobia is common and may... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Surgical sperm retrieval, requiring local anesthetic injection, is the most frequent surgical procedure in male infertility. However, needle phobia is common and may contribute to negative experiences or refusal of procedures employing needle injection.
OBJECTIVES
The aim of this study was to compare the acceptability, safety, and efficacy of needle-free jet anesthetic technique (MadaJet) with conventional needle injection for surgical sperm retrievals in patients with azoospermia.
MATERIALS AND METHODS
This single-blind randomized controlled trial (RCT) was included of 59 participants who underwent surgical sperm retrievals. Patients were randomly assigned to the needle-free jet (n = 29) or needle injection (n = 30) groups prior to undergoing the surgery. The primary endpoint was the pain score.
RESULTS
Baseline characteristics were comparable between the two groups. The safety and adverse outcomes were also not statistically significant difference (p > 0.05). The pain score in patients using needle-free jet was significantly lower than that in patients using needle injection (p < 0.05). Patients in MadaJet group had a significantly lower discomfort score during (p < 0.001) and after (p = 0.01) injection than those in the needle injection group. However, there was no significant difference in the fear score (before, during, and after) of MadaJet and needle injection (p = 0.98, p = 0.74, and p = 0.94, respectively). The mean time to onset of anesthesia was much shorter in the MadaJet group as compared with needle injection (10 ± 4 vs. 157.5 ± 71 s, p < 0.001). However, the duration of anesthesia in patients using MadaJet was shorter compared with those using needle injection (44 ± 13 vs. 63 ± 26 min, p < 0.001).
CONCLUSION
In conclusion, for local anesthesia in patients undergoing surgical sperm retrieval, MadaJet produces less pain and discomfort with quicker time to onset and offset of anesthesia compared with conventional needle injection.
Topics: Adult; Anesthesia, Local; Azoospermia; Humans; Injections, Jet; Male; Needles; Sperm Retrieval; Young Adult
PubMed: 30407744
DOI: 10.1111/andr.12557 -
BMC Ophthalmology Jun 2022To compare the efficacy and safety of trans-sub-Tenon's ciliary nerve block anesthesia and transcutaneous retrobulbar anesthesia in patients undergoing pars plana... (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To compare the efficacy and safety of trans-sub-Tenon's ciliary nerve block anesthesia and transcutaneous retrobulbar anesthesia in patients undergoing pars plana vitrectomy (PPV).
METHODS
A prospective, randomized, double-blinded clinical trial was conducted at Zhongda Hospital, Affiliated with Southeast University, from February 2021 to October 2021. Patients undergoing PPV were randomly allocated into two groups: the trans-sub-Tenon's anesthesia group (ST group) and the retrobulbar anesthesia group (RB group) in the ratio of 1:1. The ST group received 2 ml ropivacaine through the Tenon capsule to the retrobulbar space, while the RB group received 2 ml ropivacaine via transcutaneous retrobulbar injection. Visual analog score (VAS) was used to evaluate pain during the whole process, including during anesthesia implementation, intraoperatively and on the first day after the operation. Movement evaluation (Brahma scores) and anesthesia-related complications were also noted.
RESULTS
Finally, a total of 120 patients were included in the study (60 in the ST group and 60 in the RB group). There were no significant differences in baseline patient characteristics or surgical features between the two groups. The VAS pain scores for anesthesia implementation were 0.52 ± 0.47 in the ST group and 1.83 ± 0.87 in the RB group (P < 0.001). The VAS scores during the operation were 0.53 ± 0.49 in the ST group and 1.48 ± 1.02 in the RB group (P < 0.001) and those on the first day after the operation were 0.37 ± 0.38 in the ST group and 0.81 ± 0.80 in the RB group (P = 0.002). No patients required supplemental intravenous anesthesia intraoperatively. The Brahma movement scores were 0.70 ± 1.64 in the ST group (scores ranging from 0 to 8) and 2.38 ± 3.15 in the RB group (ranging from 0 to 12) (P = 0.001). Forty-two patients in each group received laser photocoagulation during surgery. Fifteen patients (36%) in the ST group could not see the flashes of the laser, compared to 8 patients (19%) in the RB group (P = 0.087). No serious sight-threatening or life-threatening complications related to anesthesia were observed in either group.
CONCLUSIONS
For PPV, trans-sub-Tenon's ciliary nerve block anesthesia was more effective in controlling pain than transcutaneous retrobulbar anesthesia during the whole surgery process, including during anesthesia implementation, intraoperatively and on the first day after the operation. Additionally, it could achieve better effect of akinesia and was relatively safe. Trans-sub-Tenon's anesthesia could be considered an alternative form of local anesthesia during vitreoretinal procedures.
TRIAL REGISTRATION
The study protocol has been registered at ChiCTR.org.cn on February 2021 under the number ChiCTR2100043109 .
Topics: Anesthesia, Local; Anesthetics, Local; Humans; Pain; Prospective Studies; Ropivacaine; Vitrectomy
PubMed: 35773662
DOI: 10.1186/s12886-022-02507-7 -
European Annals of Otorhinolaryngology,... Sep 2014Cochlear implantation has become a routine procedure for patients with hearing loss. In some patients, general anesthesia might be contraindicated due to multiple...
INTRODUCTION
Cochlear implantation has become a routine procedure for patients with hearing loss. In some patients, general anesthesia might be contraindicated due to multiple co-morbidities. We describe a successful protocol for cochlear implantation under local anesthesia with light sedation.
CASE REPORT
An 81-year-old patient presented with profound sensorineural hearing loss. Her past medical history revealed ischemic coronaropathy, managed by stenting. After multidisciplinary evaluation and clear adapted information to the patient, surgery was performed under local anesthesia with light sedation and monitored anesthesia care. The procedure lasted 70 min, and was without incident and under good conditions for the surgeon. During the intervention, the patient was comfortable. No nausea or vomiting was noted. The postoperative period was smooth and uneventful.
CONCLUSION
We find local anesthesia with light sedation a good alternative to general anesthesia for patients where general anesthesia is contraindicated. An experienced surgical and anesthesiology team is essential to shorten the duration of the procedure.
Topics: Aged, 80 and over; Anesthesia, Local; Cochlear Implantation; Female; Humans; Monitoring, Physiologic
PubMed: 24703001
DOI: 10.1016/j.anorl.2012.12.006 -
Medicine Aug 2021Traditionally, TAVR (Transcatheter Aortic Valve Replacement) has been performed under general anesthesia (GA). Thus GA facilitates the use of TEE (Transesophageal...
BACKGROUND
Traditionally, TAVR (Transcatheter Aortic Valve Replacement) has been performed under general anesthesia (GA). Thus GA facilitates the use of TEE (Transesophageal echocardiography), and the use of TEE is an important means to improve the quality of cardiac surgery and reduce postoperative complications. However, GA was also associated with prolonged mechanical ventilation, longer hospitalization and intensive care unit hours, and the need for positive inotropic agents. With increasing clinical experience and advances in transcatheter techniques, transfemoral TAVR may also be feasible under local anesthesia (LA). Studies have shown that LA can avoid hemodynamic fluctuations caused by general anesthesia and lung damage caused by positive pressure ventilation, and can also reduce medical costs.
METHODS
Two researchers independently read the titles and abstracts of the literature obtained. After excluding the studies that did not meet the inclusion criteria, they read through the full text of the remaining literatures to determine whether they truly met the inclusion criteria. When two researchers disagree on the included literature, the third researcher decides whether to include it or not. For literature with incomplete data, contact the author via email for unpublished data. The included studies were assessed by two researchers for the risk of bias, and cross-checked. Stata16.0 was used for meta-analysis. Heterogeneity was assessed by χ2 test and I2 quantification. Pooled analysis was performed by random effects model. Sensitivity analysis was performed by excluding references one by one. We will perform subgroup analysis based on data conditions.
RESULTS
In this study, high quality evidence was provided by selecting local anesthesia and general anesthesia during transfemoral transcatheter aortic valve replacement for patients with primary arterial stenosis.
CONCLUSION
Local anesthesia provides anaesthetic-guided sedation that does not require intubation and is safe and effective. Local anesthesia may be a better alternative to TAVR under general anesthesia.
ETHICS AND DISSEMINATION
The study does not require ethical approval.
INPLASY REGISTRATION NUMBER
INPLASY202170078.
Topics: Anesthesia, General; Anesthesia, Local; Aortic Valve Stenosis; Femoral Artery; Humans; Length of Stay; Postoperative Complications; Randomized Controlled Trials as Topic; Retrospective Studies; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Meta-Analysis as Topic; Systematic Review as Topic
PubMed: 34449511
DOI: 10.1097/MD.0000000000027085 -
Journal of the American Veterinary... Dec 2022To evaluate the anesthetic and cardiopulmonary effects of ketamine-dexmedetomidine combined with local anesthesia, associated or not in the postoperative period with...
OBJECTIVE
To evaluate the anesthetic and cardiopulmonary effects of ketamine-dexmedetomidine combined with local anesthesia, associated or not in the postoperative period with different doses of atipamezole, for orchiectomy in cats.
ANIMALS
24 healthy cats.
PROCEDURES
Cats received ketamine (7 mg/kg) combined with dexmedetomidine (10 µg/kg) IM, and 1 mL of saline (group KDSAL), 25 µg/kg (group KDAT25), or 50 µg/kg (group KDAT50) of atipamezole IV, postoperatively. All cats received local anesthesia (2 mg/kg of lidocaine) intratesticular and SC. Physiologic variables were recorded at baseline and at time points during anesthesia. Ketamine rescue dose (1 mg/kg) was recorded. The quality of recovery, the degree of sedation, and side effects were evaluated postoperatively.
RESULTS
2 cats received a single additional bolus of ketamine to perform local anesthesia. Heart rate was lower in KDSAL, KDAT25, and KDAT50 during anesthesia, compared with baseline. Hypertension was observed intraoperatively in all groups. The time to head up, pedal reflex regained time, time to sternal recumbency, and time to standing were shorter in KDAT25 and KDAT50 compared to KDSAL. Lower sedation scores were assigned sooner to KDAT25 and KDAT50 than KDSAL. All groups resulted in low recovery quality scores and no side effects.
CLINICAL RELEVANCE
At the doses used, ketamine-dexmedetomidine combined with local anesthesia allowed the performance of orchiectomy. Rescue dose of ketamine for performing local anesthesia may be required. This combination can result in hypertension. Both atipamezole doses shortened the anesthetic recovery, without differences among them, and side effects.
Topics: Male; Cats; Animals; Ketamine; Dexmedetomidine; Orchiectomy; Anesthesia, Local; Anesthetics; Postoperative Period; Hypertension; Cat Diseases
PubMed: 36459451
DOI: 10.2460/javma.22.10.0437 -
The Cochrane Database of Systematic... Jul 2015Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body. It involves infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective, safer anaesthesia for cataract surgery than retrobulbar block.
OBJECTIVES
The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications.
SEARCH METHODS
In the previous version of our review, we searched the databases until December 2007. In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (March 2015); MEDLINE (1960 to March 2015); and EMBASE (1980 to March 2015).
SELECTION CRITERIA
We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the included studies used varied methods for reporting the outcomes. We performed a subgroup analysis for globe akinesia.
MAIN RESULTS
We included six trials involving 1438 participants. Three of the six trials had adequate sequence generation while all the trials had unclear allocation concealment There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block.
AUTHORS' CONCLUSIONS
There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery measuring acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare for both types of block.
Topics: Anesthesia, Local; Cataract Extraction; Humans; Nerve Block; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 26133124
DOI: 10.1002/14651858.CD004083.pub3 -
Medicine Aug 2023The aim of this study was to clarify or determine any possible association between pain reports with a visual analogue scale (VAS) and a figures based scale. This...
The aim of this study was to clarify or determine any possible association between pain reports with a visual analogue scale (VAS) and a figures based scale. This research was a preliminary study aimed at developing a new pain scale without any verbal description. Healthy Japanese patients aged 20 to 39 years who received anesthetic injections for mandibular third molar extraction at our department were enrolled. Regarding pain from dental local anesthetic injections, we recorded figures selected by participants (among options of a circle, triangle, square, bar, and cross), and VAS scores. Overall, 29 men and 31 women participated in the study. Pain caused by local dental anesthesia tended to remind both men and women of the triangle among the suggested figures. Furthermore, patients who chose a cross also reported higher VAS scores than those who chose other figures. Acute pain caused by local dental anesthesia was associated with triangles, and patients who selected a cross were associated with higher VAS scores. The results of this study provide clinicians with important information for dental practice, and could prove useful in developing new pain scales.
Topics: Male; Humans; Female; Anesthesia, Local; Molar, Third; Pain Measurement; Anesthetics, Local; Tooth Extraction; Acute Pain; Anesthesia, Dental
PubMed: 37543810
DOI: 10.1097/MD.0000000000034598 -
British Journal of Anaesthesia Oct 1974
Topics: Anesthesia, Local; Humans
PubMed: 4621189
DOI: 10.1093/bja/46.10.707 -
American Journal of Surgery Sep 2021Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of...
BACKGROUND
Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty.
METHODS
We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications.
RESULTS
In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38-0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13-21% with local.
CONCLUSIONS
Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.
Topics: Aged; Aged, 80 and over; Anesthesia, General; Anesthesia, Local; Databases, Factual; Elective Surgical Procedures; Female; Frail Elderly; Frailty; Hernia, Inguinal; Herniorrhaphy; Humans; Incidence; Male; Postoperative Complications; Veterans
PubMed: 33504434
DOI: 10.1016/j.amjsurg.2021.01.026