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The Cochrane Database of Systematic... Aug 2015Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Local anaesthesia for cataract surgery can be provided by sub-Tenon's or topical anaesthesia. Both techniques offer possible advantages. This review, which originally was published in 2007 and was updated in 2014, was undertaken to compare these two anaesthetic techniques.
OBJECTIVES
Our objectives were to compare the effectiveness of topical anaesthesia (with or without intracameral local anaesthetic) versus sub-Tenon's anaesthesia in providing pain relief during cataract surgery. We reviewed pain during administration of anaesthesia, postoperative pain, surgical satisfaction with operating conditions and patient satisfaction with pain relief provided, and we looked at associated complications.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE (last search in November 2014) and the reference lists of published articles. We looked for conferences abstracts and trials in progress and placed no constraints on language or publication status.
SELECTION CRITERIA
We included all randomized studies that compared sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.
DATA COLLECTION AND ANALYSIS
We assessed trial quality and extracted data in the format allowing maximal data inclusion.
MAIN RESULTS
We included eight studies in this updated review but could retain in the analysis only seven studies on 742 operated eyes of 617 participants. Two cross-over trials included 125 participants, and five parallel trials included 492 participants. These studies were published between 1997 and 2005. The mean age of participants varied from 71.5 years to 83.5 years. The female proportion of participants varied from 54% to 76%. Compared with sub-Tenon's anaesthesia, topical anaesthesia (with or without intracameral injection) for cataract surgery increases intraoperative pain but decreases postoperative pain at 24 hours. The amplitude of the effect (equivalent to 1.1 on a score from 0 to 10 for intraoperative pain, and to 0.2 on the same scale for postoperative pain at 24 hours), although statistically significant, was probably too small to be of clinical relevance. The quality of the evidence was rated as high for intraoperative pain and moderate for pain at 24 hours. We did find differences in pain during administration of local anaesthetic (low level of evidence), and indications that surgeon satisfaction (low level of evidence) and participant satisfaction (moderate level of evidence) were less with topical anaesthesia. There was not enough evidence to say that one technique would result in a higher or lower incidence of intraoperative complications compared with the other.
AUTHORS' CONCLUSIONS
Both topical anaesthesia and sub-Tenon's anaesthesia are accepted and safe methods of providing anaesthesia for cataract surgery. An acceptable degree of intraoperative discomfort has to be expected with either of these techniques. Randomized controlled trials on the effects of various strategies to prevent intraoperative pain during cataract surgery could prove useful.
Topics: Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Cataract Extraction; Female; Humans; Male; Nerve Block; Pain; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 26308931
DOI: 10.1002/14651858.CD006291.pub3 -
PeerJ 2023Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia.
METHODS
The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023.
RESULTS
Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81-1.14]; = 0.65; I= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [-0.54-8.16]; = 0.09; I= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86-12.79]; < 0.0001; I= 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia.
CONCLUSIONS
Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.
Topics: Humans; Anesthesia, Local; Anesthetics, Local; Pain; Injections; Pain Measurement
PubMed: 37520252
DOI: 10.7717/peerj.15734 -
Scientific Reports May 2021Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored... (Comparative Study)
Comparative Study
Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.
Topics: Aged; Aged, 80 and over; Anesthesia, General; Anesthesia, Local; Female; Fractures, Compression; Humans; Kyphoplasty; Male; Middle Aged; Operative Time; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 34045557
DOI: 10.1038/s41598-021-90621-9 -
The British Journal of Ophthalmology May 1998
Topics: Anesthesia, Local; Anticoagulants; Cataract Extraction; Humans; Warfarin
PubMed: 9713076
DOI: 10.1136/bjo.82.5.589a -
Indian Journal of Ophthalmology Jul 2023: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon...
BACKGROUND
: A good anesthesia not only makes the patient comfortable during surgery, but also has a huge impact on the postoperative recovery. It also makes the operating surgeon carry out each step of the surgery precisely and beautifully. The art of giving a good local anesthesia is to be learnt and practiced not only by anesthetists, but also by the practicing ophthalmologists.
PURPOSE
: This video gives an overview of anatomy in terms of the nerve supply of the orbit, the surface marking, and the techniques of giving regional and nerve blocks.
SYNOPSIS
: In this video, we describe the anatomy, the surface marking, the technique of regional anesthesia including peribulbar, retrobulbar, and subtenon blocks and of nerve blocks, specifically of facial, frontal nerve and its branches, infraorbital, nasociliary, infratrochlear, and dorsal nasal nerves, with their application in ocular plastic surgery.
HIGHLIGHTS
: This video highlights the essence of providing appropriate and good anesthesia so that the surgeon works in an optimal field with maximum comfort to the patients. Video link https://youtu.be/h8EgTMQAsyE.
Topics: Humans; Anesthetics, Local; Anesthesia, Local; Nerve Block; Ophthalmologic Surgical Procedures; Orbit
PubMed: 37417157
DOI: 10.4103/IJO.IJO_1366_23 -
Anesthesiology Jul 2018
Review
Topics: Anesthesia, Local; Anesthesiology; Animals; Humans; Internship and Residency
PubMed: 29916905
DOI: 10.1097/ALN.0000000000002318 -
Journal of Cosmetic Dermatology Apr 2022Limited dilute lidocaine infiltration facilitates a comfortable procedure and a rapid recovery process following a novel intervention for reduction of cellulite....
BACKGROUND
Limited dilute lidocaine infiltration facilitates a comfortable procedure and a rapid recovery process following a novel intervention for reduction of cellulite. Infiltration of dilute lidocaine has many other practical applications in dermatologic surgery.
OBJECTIVES
This article describes a safe, effective technique for local infiltration of limited volume dilute lidocaine anesthesia in a cellulite reduction procedure.
METHODS
The limited dilute lidocaine technique was utilized in studies of a novel device designed to reduce the appearance of cellulite by focal release of fibrous septa in a minimally invasive procedure. No sedation was used. A small (27- to 30-gauge) needle was used to deliver anesthesia to the entry sites. Then, a 20-gauge spinal needle was tunneled under the skin in the superficial plane to manually deliver anesthetic along the advancement pathway of the device and marked cellulite targets.
RESULTS
During the initial studies, the mean delivered anesthesia volume was 357.2 ml (range, 250-525 ml) or 18.7 mg/kg (range, 11.1-28.4 mg/kg). The mean anesthesia time was 16 min (range, 8-32 min). The mean number of cellulite depressions treated was 19.8 (range, 11-34). Adverse events were closely monitored, and there were no signs of toxicity in any study patients. There were very low levels of discomfort; all patients reported the procedure was tolerable. This technique facilitates a time-efficient procedure and minimizes weeping of excess fluid during recovery.
CONCLUSIONS
When administered with care and skill, the limited dilute anesthesia technique is a safe, effective approach for local anesthesia with many practical applications in dermatologic surgery.
Topics: Anesthesia, Local; Anesthetics, Local; Cellulite; Humans; Lidocaine
PubMed: 35113474
DOI: 10.1111/jocd.14825 -
BMJ Open Sep 2017We conducted a systematic review and meta-analysis to identify the potential favourable effects of local anaesthesia plus sedation (LAS) compared with general... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVES
We conducted a systematic review and meta-analysis to identify the potential favourable effects of local anaesthesia plus sedation (LAS) compared with general anaesthesia (GA) in transcatheter aortic valve implantation (TAVI).
METHODS
Electronic databases (PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials) and the reference lists of eligible publications were screened for randomised controlled trials (RCTs) and observational studies published between 1 January 2006 and 26 June 2016 that compare LAS to GA in an adult study population undergoing TAVI. We conducted study quality assessments using the Cochrane risk of bias tool and structured the review according to PRISMA. A meta-analysis calculating the pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) under the assumption of a random-effects model was performed. Statistical heterogeneity was evaluated using the I² statistic and Cochran's Q-test.
RESULTS
After database screening, one RCT and 19 observational studies were included in the review. We found no differences between LAS and GA in terms of 30-day mortality, in-hospital mortality and other endpoints that addressed safety and complication rates. LAS was associated with a shorter ICU and hospital stay and with lower rates of catecholamine administration and red blood cell transfusion. New pacemaker implantations occurred more frequently under LAS. The overall conversion rate from LAS to GA was 6.2%.
CONCLUSION
For TAVI, both LAS and GA are feasible and safe. LAS may have some benefits such as increased haemodynamic stability and shorter hospital and ICU stays, but it does not impact 30-day mortality. Since there is a paucity of randomised trial data and the findings are mainly based on observational study data, this review should be considered as a hypothesis-generating article for subsequent RCTs that are required to confirm the potential favourable effects we detected for LAS.
REGISTRATION NUMBER
CRD42016048398 (PROSPERO).
Topics: Anesthesia, General; Anesthesia, Local; Aortic Valve Stenosis; Conscious Sedation; Hospital Mortality; Humans; Length of Stay; Postoperative Complications; Transcatheter Aortic Valve Replacement
PubMed: 28951409
DOI: 10.1136/bmjopen-2017-016321 -
Swiss Dental Journal 2015A large variety of local anaesthetics is widely used in dental clinic. Cautious application is essential in order to avoid adverse events of potentially lethal nature....
A large variety of local anaesthetics is widely used in dental clinic. Cautious application is essential in order to avoid adverse events of potentially lethal nature. The objective of this article is to present an overview of the mechanisms and to underline potentially lethal adverse effects and contraindications. The knowledge of specific side effects is vital in daily practice. An overview on specific products is accessible on www.kompendium.ch, however users have to be aware of the fact that this source may be incomplete.
Topics: Anesthesia, Dental; Anesthesia, Local; Contraindications; Humans; Risk Factors
PubMed: 25592063
DOI: 10.61872/sdj-2015-01-05 -
BMC Health Services Research Nov 2023Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite the benefits attributed to the use of local anesthesia (LA) for open hemorrhoidectomy (OH) in developed countries, this technique is still not considered as the first line technique in low-income countries such as Uganda; therefore, we aimed at comparing the cost of OH under LA versus Saddle block among patients with 3rd or 4th degree hemorrhoids.
METHODS
This trial was conducted from December 2021 to May 2022 among patients with primary uncomplicated 3rd or 4th degree hemorrhoids. The operating time, and direct costs in (US$) including medical and non-medical were recorded. We analysed the cost in the two groups (local anesthesia versus saddle block) using SPSS version 23.0.
RESULTS
Findings of fifty-eight patients were analysed including 29 participants per group. There was a significant difference in operating time and cost among the two groups (p < 0.05). The mean operating time was 15.52 ± 5.34(SD) minutes versus 33.72 ± 11.54 min for OH under LA and SB respectively. The mean cost of OH under LA was 57.42 ± 8.90 US$ compared to 63.38 ± 12.77US$ in SB group.
CONCLUSION
The use of local anesthesia for OH was found to have less operating time with high-cost effectiveness. Being affordable, local anesthesia can help to increase the turnover of patients who would otherwise wait for the availability of anesthesia provider. Policy makers should emphasize its applicability in low-income settings to help in the achievement of 2030 global surgery goals.
TRIAL REGISTRATION
Pan African Clinical Trials Registry, PACTR202110667430356. Registered on 08/10/2021.
Topics: Humans; Anesthesia, Local; Anesthesia, Spinal; Costs and Cost Analysis; Hemorrhoidectomy; Hemorrhoids; Pain, Postoperative; Double-Blind Method
PubMed: 37993912
DOI: 10.1186/s12913-023-10290-4