RESUMEN

BACKGROUND: Venipuncture is one of the most commonly performed medical procedures in paediatric care, but it can also be one of the most painful and distressing experiences for patients. Finding effective strategies to manage pain and fear associated with venipuncture is crucial for improving the paediatric patient experience and promoting positive health outcomes. This study aimed to evaluate the efficacy of a combined approach using a topical analgesic cream (TKTX cream) and a distraction technique (Trace Image and Colouring for Kids-Book, TICK-B) in reducing pain intensity and fear levels in children undergoing venipuncture procedures. METHODS: We conducted this randomised controlled trial among 176 children aged 6-12 years undergoing venipuncture. Participants were randomly assigned to four groups: TICK-B, TKTX cream, TICK-B+TKTX cream and a control group. Pain and fear were measured using the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale. The study was carried out from 20 February 2024 to 1 June 2024 at the emergency unit of Heevi paediatric teaching hospital in the Kurdistan region of Iraq. In the intervention groups, TICK-B was applied for 2-3 min before needle insertion, and TKTX cream was applied 20 min before the venipuncture procedure. All outcome measures were evaluated 2-3 min after the completion of the venipuncture procedure. RESULTS: The combined TICK-B (colouring book) and TKTX cream (topical anaesthetic) intervention was the most effective in reducing both pain intensity (mean score 2.80 vs 7.24 in the control, p<0.001) and fear levels (mean score 0.93 vs 2.83 in the control, p<0.001) during and after venipuncture procedures compared with individual interventions and control. CONCLUSIONS: The combined TICK-B distraction and TKTX cream topical anaesthetic intervention was the most effective in reducing pain intensity and fear during and after venipuncture in children, providing a practical strategy for healthcare providers to optimise needle procedure management. TRIAL REGISTRATION NUMBER: NCT06326125.

Asunto(s)

Ansiedad , Manejo del Dolor , Flebotomía , Humanos , Flebotomía/efectos adversos , Niño , Masculino , Femenino , Manejo del Dolor/métodos , Ansiedad/terapia , Ansiedad/etiología , Ansiedad/prevención & control , Dimensión del Dolor , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Dolor/psicología , Dolor/prevención & control , Dolor/etiología , Dolor/tratamiento farmacológico , Combinación Lidocaína y Prilocaína , Resultado del Tratamiento , Irak

RESUMEN

BACKGROUND & AIMS: Chronic migraine poses a global health burden, particularly affecting young women, and has substantial societal implications. This study aimed to assess the efficacy of Greater Occipital Nerve Block (GONB) in individuals with chronic migraine, focusing on the impact of local anesthetics compared with placebo. METHODS: A meta-analysis and systematic review were conducted following the PRISMA principles and Cochrane Collaboration methods. Eligible studies included case-control, cohort, and randomized control trials in adults with chronic migraine, adhering to the International Classification of Headache Disorders, third edition (ICHD3). Primary efficacy outcomes included headache frequency, duration, and intensity along with safety assessments. RESULTS: Literature searches across multiple databases yielded eight studies for qualitative analysis, with five included in the final quantitative analysis. A remarkable reduction in headache intensity and frequency during the first and second months of treatment with GONB using local anesthetics compared to placebo has been reported. The incidence of adverse events did not differ significantly between the intervention and placebo groups. CONCLUSION: The analysis emphasized the safety and efficacy of GONB, albeit with a cautious interpretation due to the limited number of studies and relatively small sample size. This study advocates for further research exploring various drugs, frequencies, and treatment plans to enhance the robustness and applicability of GONB for chronic migraine management.

Asunto(s)

Trastornos Migrañosos , Bloqueo Nervioso , Humanos , Bloqueo Nervioso/métodos , Enfermedad Crónica , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Resultado del Tratamiento

RESUMEN

INTRODUCTION: surgical pain is managed with multi-modal anesthesia in total knee arthroplasty (TKA). It is dubious whether including local infiltrative anaesthesia (LIA) before wound closure provides adequate pain control and decreases morbidity. MATERIAL AND METHODS: this was a retrospective conducted to assess postoperative pain control, morbidity index, and opioid consumption in 116 patients who underwent TKA and were divided into two groups based on LIA (Modified Ranawat Regimen) or normal saline infiltration in the wound. RESULTS: the mean NRS score was significantly lower in LIA group (3.2) as compared to the control group (3.9) in the first 24 hours. Functional milestones were relatively achieved earlier in LIA group but the values were not significant. Tramadol consumption was remarkably higher in the control group as compared to LIA group on day 1 and 2. As per the morbidity index the mean score on day one was 16.18 and 23.40 which decreased to 6.37 and 9.21 by day three in LIA and control group respectively indicating morbidity has decreased but more so in LIA group. CONCLUSION: our study concludes that use of modified cocktail regimen in the knee effectively decreased morbidity with excellent to good results, declining NRS score, minimal rescue analgesia requirement, early ambulation with better safety.

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INTRODUCCIÓN: el dolor quirúrgico se trata con anestesia multimodal en la artroplastia total de rodilla (ATR). Es dudoso que incluir anestesia local infiltrativa (LIA) antes del cierre de la herida proporcione un control adecuado del dolor y disminuya la morbilidad. MATERIAL Y MÉTODOS: se realizó una retrospectiva para evaluar el control del dolor posoperatorio, el índice de morbilidad y el consumo de opioides en 116 pacientes sometidos a ATR y se dividieron en dos grupos según el LIA (régimen de Ranawat modificado) o la infiltración de solución salina normal en la herida. RESULTADOS: la puntuación media NRS fue significativamente menor en el grupo LIA (3.2) en comparación con el grupo control (3.9) en las primeras 24 horas. Los hitos funcionales se alcanzaron relativamente antes en el grupo LIA, pero los valores no fueron significativos. El consumo de tramadol fue notablemente mayor en el grupo de control en comparación con el grupo de LIA los días 1 y 2. Según el índice de morbilidad, la puntuación media el día uno fue 16.18 y 23.40, que disminuyó a 6.37 y 9.21 en el día tres en el grupo de LIA y control, respectivamente, lo que indica que la morbilidad ha disminuido, pero más en el grupo LIA. CONCLUSIÓN: nuestro estudio concluye que el uso de un régimen de cóctel modificado en la rodilla disminuyó efectivamente la morbilidad con resultados excelentes a buenos, una disminución de la puntuación NRS, un requisito mínimo de analgesia de rescate y una deambulación temprana con mayor seguridad.

Asunto(s)

Anestésicos Locales , Artroplastia de Reemplazo de Rodilla , Dolor Postoperatorio , Humanos , Estudios Retrospectivos , Artroplastia de Reemplazo de Rodilla/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Femenino , Masculino , Persona de Mediana Edad , Anciano , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Centros de Atención Terciaria , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestesia Local/métodos , Resultado del Tratamiento , Tramadol/administración & dosificación , Tramadol/uso terapéutico , Dimensión del Dolor

RESUMEN

Labor epidural analgesia (LEA) is associated with increased maternal body temperature; however, the responsible mechanism is unknown. Recent studies suggest that changes in EA affect the incidence of fever and that epidural sufentanil supplementation enhances analgesia and reduces the amount of local anesthetic. The aim of this study was to evaluate the effect of different concentrations of sufentanil combined with ropivacaine on intrapartum fever during delivery. We performed a retrospective study comparing maternal fever rates in patients receiving labor analgesia between December 2018 and January 2019. Each patient receiving different concentrations of sufentanil in their EA received either proposal H (0.08% ropivacaine + 0.4 µg/mL sufentanil) or proposal L (0.08% ropivacaine + 0.2 µg/mL sufentanil), with the same nulliparous status. The primary outcome of this study was the incidence of intrapartum maternal fever, which was defined as any temperature ≥ 38°C during labor using Fisher exact test. Secondary outcome measures included visual analog scale (VAS) pain scores, birth events, and neonatal outcomes. We observed a perinatal fever incidence rate of 11.7% in the group receiving proposal L, while the incidence rate was 19.8% in the group receiving proposal H (P = .001). Five hours after administration, the average body temperature of the puerpera decreased significantly in the proposal L group compared with proposal H group. In addition, treatment with 0.2 µg/mL sufentanil provided satisfactory pain relief during labor, shortened the first stage of labor and total labor time, reduced oxytocin use, and had no significant adverse effects on neonatal outcomes. EA may increase the risk of intrapartum epidural-associated fever. Compared with the 0.4 µg/mL sufentanil group, the 0.2 µg/mL sufentanil group can provide better analgesia and improve maternal fever. These retrospective results highlighted the importance of prospective and mechanistic studies of maternal fever associated with intraspinal analgesia.

Asunto(s)

Analgesia Epidural , Anestésicos Locales , Fiebre , Ropivacaína , Sufentanilo , Humanos , Sufentanilo/administración & dosificación , Sufentanilo/efectos adversos , Sufentanilo/uso terapéutico , Femenino , Ropivacaína/administración & dosificación , Ropivacaína/uso terapéutico , Embarazo , Estudios Retrospectivos , Adulto , Fiebre/epidemiología , Fiebre/prevención & control , Analgesia Epidural/métodos , Analgesia Epidural/efectos adversos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Analgesia Obstétrica/métodos , Analgesia Obstétrica/efectos adversos , Trabajo de Parto/efectos de los fármacos , Dimensión del Dolor , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Incidencia

RESUMEN

OBJECTIVE: Greater occipital nerve (GON) blockade injections can be used to prevent episodic and chronic cluster headaches. In recent studies, prophylactic treatment has been used in addition to the GON blockade. In this study, we aimed to elucidate the effect of GON blockade on the attack frequency, pain intensity, and duration in patients diagnosed with chronic cluster headaches. PATIENTS AND METHODS: The demographic characteristics of 30 patients who received GON blockade along with acute attack treatment, short- and long-term prophylactic treatment for cluster headache, and 24 patients who received only acute attack treatment, short- and long-term prophylactic treatment, before blockade treatment, in the 1st week and 1st month after blockade were investigated. Attack frequency, attack duration, and visual analog scale (VAS) variables were compared. RESULTS: We evaluated the VAS score, daily attack frequency, and duration of pain attacks after repeated GON blockade and found a statistically significant difference in the VAS score, daily attack frequency, duration of pain attacks, average values of the treatment, and time interaction of pain intensity in the group in which GON blockade was applied in the 1st week and 1st month compared to the pre-treatment period (p<0.01), (p<0.01), (p=0.044). CONCLUSIONS: Regarding the outcomes of this research, GON blockade provided significant improvement in pain frequency, attack duration, and VAS score in the period from attack treatment to the start of long-term prophylaxis treatment and one month after treatment, without the need to switch to different prophylaxis treatments. Therefore, GON blockade may be a preferable and reliable treatment option.

Asunto(s)

Cefalalgia Histamínica , Bloqueo Nervioso , Humanos , Cefalalgia Histamínica/terapia , Cefalalgia Histamínica/tratamiento farmacológico , Bloqueo Nervioso/métodos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Dimensión del Dolor , Resultado del Tratamiento , Nervios Espinales/efectos de los fármacos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico

RESUMEN

Objective: To evaluate studies related to pain management associated with arteriovenous fistula cannulation among children. METHODS: The systematic review comprised literature search on Embase, ProQuest, Science Direct, Scopus, SpringerLink and Wiley Online databases for studies published in English between 1998 and 2021. The search used key words, including pain management OR analgesia AND child OR paediatric AND haemodialysis OR dialysis AND arteriovenous fistula OR arteriovenous fistula cannulation OR fistula needle OR arteriovenous fistula insertion OR needle insertion. The quality of the studies was evaluated using the Joana Briggs Institute checklist. General characteristics of the and pain outcomes were noted. RESULTS: Of the 2,877 studies initially identified, 8(0.27%) were analysed; 7(87.5%) quasi-experimental and 1(12.5%) randomised controlled trial. Overall, there were 283 participants aged 6-18 years. The strategies used for reducing arteriovenous fistula puncture-related pain among children undergoing haemodialysis included cryotherapy, lidocaine agents, virtual reality (VR), guided visualisation, balloon inflation, aromatherapy, and other programmed distractions. The strategies had a positive effect on reducing arteriovenous fistula cannulation-related pain among children. Conclusion: Non-pharmacological pain management is an easier, simpler, inexpensive and more effective method of atraumatic care among children undergoing haemodialysis.

Asunto(s)

Derivación Arteriovenosa Quirúrgica , Manejo del Dolor , Diálisis Renal , Humanos , Diálisis Renal/efectos adversos , Diálisis Renal/métodos , Niño , Derivación Arteriovenosa Quirúrgica/efectos adversos , Manejo del Dolor/métodos , Cateterismo/métodos , Adolescente , Crioterapia/métodos , Realidad Virtual , Lidocaína/uso terapéutico , Anestésicos Locales/uso terapéutico , Dolor Asociado a Procedimientos Médicos/etiología , Dolor Asociado a Procedimientos Médicos/prevención & control

RESUMEN

The dose-response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3-12 years (American Society of Anesthesiologists grade I-II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg-1], B [1 mg kg-1], C [1.5 mg kg-1], and D [2 mg kg-1]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006.

Asunto(s)

Lidocaína , Náusea y Vómito Posoperatorios , Tonsilectomía , Humanos , Tonsilectomía/efectos adversos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/efectos adversos , Niño , Masculino , Preescolar , Femenino , Náusea y Vómito Posoperatorios/prevención & control , Adenoidectomía/efectos adversos , Relación Dosis-Respuesta a Droga , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico

RESUMEN

OBJECTIVE: Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. METHODS: One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA). RESULTS: In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. CONCLUSION: Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

Asunto(s)

Anestésicos Locales , Ibuprofeno , Lidocaína , Diente Molar , Pulpitis , Diente Primario , Humanos , Niño , Pulpitis/terapia , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Ibuprofeno/administración & dosificación , Ibuprofeno/uso terapéutico , Femenino , Masculino , Preescolar , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Pulpectomía/métodos , Bloqueo Nervioso/métodos , Mandíbula , Administración Oral , Dimensión del Dolor/métodos , Resultado del Tratamiento

RESUMEN

OBJECTIVE: This study aimed to compare the effectiveness of lidocaine with magnesium sulphate in patients undergoing root canal treatment following irreversible pulpitis. METHODS: A total of 86 patients were randomised to receive 1.8 ml of 2% lidocaine replaced with 0.2 ml of 10% magnesium sulphate with 1: 80,000 epinephrine (n=43) as MGS group and 1.8 ml of 2% lidocaine with 1: 80,000 epinephrine (n=43) as LDC group. Preoperative visual analogue scale (VAS) pain scores were record-ed. Patients were instructed to report any perioperative pain felt during the access cavity preparation and when introducing the first patency file (#10 k) in the root canal and perioperative VAS recorded. RESULTS: The success rate of the inferior alveolar nerve block (IANB) was higher in the MSG group. The mean+-SD of perioperative pain was 0.16+-0.37 in the MSG group and 3.13+-0.77 in the LDC group. The MGS group produced better anaesthetic efficacy with a p-value of 0.01. CONCLUSION: Based on the results, adding 10% magnesium sulphate to 2% lidocaine increased the effective-ness of IANB in patients with symptomatic irreversible pulpitis of mandibular molar teeth.

Asunto(s)

Anestésicos Locales , Lidocaína , Sulfato de Magnesio , Nervio Mandibular , Bloqueo Nervioso , Pulpitis , Humanos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/farmacología , Sulfato de Magnesio/administración & dosificación , Sulfato de Magnesio/uso terapéutico , Bloqueo Nervioso/métodos , Femenino , Masculino , Adulto , Método Doble Ciego , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Dimensión del Dolor/métodos , Adulto Joven , Resultado del Tratamiento , Persona de Mediana Edad

RESUMEN

Fascia iliaca compartment block (FICB) reduces opioid consumption and pain scores after total hip arthroplasty (THA), and has recently been widely applied. We investigated whether FICB could also reduce postoperative bleeding. One hundred and fifteen consecutive patients who underwent elective THA under general anesthesia over 5 months were retrospectively analyzed. They were divided into 2 groups: the FICB group received an epinephrine-mixed FICB procedure and the control group did not receive any block. Using the hematocrit measured at 4 different time points (preoperative and 1, 24, and 48 hours after surgery), the estimated blood loss (EBL) was calculated for 3 different time periods (0-1, 1-24, 24-48 hours after surgery). EBL at 1 to 24 hours (226 vs 398 mL, P = .008) was significantly lower in the FICB group than in the control group. Additionally, the number of packed red cell (PRC) units transfused per patient over 48 hours was 0.38 units in the FICB group, which was significantly lower than the 0.70 units used in the control group (P = .040). Epinephrine-mixed FICB in THA has the potential to reduce postoperative bleeding in the first 24 hours after surgery as well as reduce PRC transfusion requirements.

Asunto(s)

Artroplastia de Reemplazo de Cadera , Epinefrina , Bloqueo Nervioso , Hemorragia Posoperatoria , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Epinefrina/administración & dosificación , Estudios Retrospectivos , Masculino , Femenino , Anciano , Hemorragia Posoperatoria/prevención & control , Hemorragia Posoperatoria/etiología , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Fascia/inervación , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Vasoconstrictores/uso terapéutico , Vasoconstrictores/administración & dosificación , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología

RESUMEN

Background and Objectives: Surgical wound analgesia has been analyzed in many studies, but few have focused on its relationship with inflammatory markers. As such, we aimed to determine the influence of analgesic surgical wound infiltration in open colorectal surgery on the seric levels of pro- and anti-inflammatory markers and the associated efficacy in postoperative pain control. Materials and Methods: Forty patients who underwent open colorectal surgery were prospectively randomized: group 0, epidural analgesia; group 1, intravenous analgesia (control), group 2, preincision and prelaparoraphy infiltration; and, group 3, prelaparoraphy infiltration. Wound infiltration was performed with ropivacaine. We analyzed the levels of IL-6 and IL-10 cytokines before and 6 h after surgery and their correlation with pain scores. Results: The postoperative Il-6 levels were significantly lower in group 0 than in the control (p = 0.041). The postoperative Il-10 levels were significantly higher in group 3 (p = 0.029) than in the control. Six hours after the operation, the pain scores were significantly lower in all groups than in the control (p = 0.005, p = 0.022, and p = 0.017 for groups 0, 2, and 3, respectively). Pain scores were significantly correlated with Il-10 levels in group 2 (p = 0.047); in group 3, IL-10 levels directly correlated with those of Il-6 (p = 0.026). Conclusions: The analgetic effect of preincisional and prelaparoraphy analgetic infiltration was efficient. The analgetic infiltration of the surgical wound prior to closure stimulates both the inflammatory activator and regulator interleukins.

Asunto(s)

Dolor Postoperatorio , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Proyectos Piloto , Anciano , Interleucina-10/sangre , Interleucina-10/análisis , Ropivacaína/uso terapéutico , Ropivacaína/administración & dosificación , Estudios Prospectivos , Citocinas/sangre , Interleucina-6/sangre , Interleucina-6/análisis , Cirugía Colorrectal/métodos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Dimensión del Dolor/métodos , Adulto , Herida Quirúrgica/tratamiento farmacológico , Herida Quirúrgica/complicaciones , Analgésicos/uso terapéutico , Analgesia Epidural/métodos

RESUMEN

OBJECTIVES: To present data on the effectiveness of corticosteroid injections (CSI) in reducing symptom scores for musculoskeletal conditions in patients treated in an NHS primary care CSI service. The data will also examine whether adding local anaesthetic to the corticosteroid preparation affects the overall patient outcomes in symptom scores. METHODS: A Patient-reported outcomes (PRO) questionnaire was used to collect data. Patients were asked to complete the questionnaire post-CSI. Patients were asked to rate their symptoms on a score of 0-6 before and after their injection. Data were calculated using standard deviation and paired t-test to assess the effectiveness of CSI in reducing symptom scores. RESULTS: Overall, 172 patients (79.6%) reported an improvement in symptomatology post CSI. Improvements were seen across all injection sites. Of those taking medication for their symptoms, 73 patients (55.7%) reported that they were able to reduce their medication. Data did not suggest that adding local anaesthetic to the injectate resulted in better patient outcomes. Post-injection symptom scores were statistically similar across all clinicians. CONCLUSION: 83.7% of patients experienced a reduction in symptom scores post injection. Adding lidocaine to the injectate preparation did not result in any statistically significant improvement in patient outcome. Over half of the participants were able to reduce their medication post injection, which demonstrates this is a highly effective primary care service for treatment/management of some MSK conditions.

Asunto(s)

Corticoesteroides , Enfermedades Musculoesqueléticas , Atención Primaria de Salud , Humanos , Femenino , Masculino , Persona de Mediana Edad , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Adulto , Anciano , Medición de Resultados Informados por el Paciente , Resultado del Tratamiento , Inyecciones Intraarticulares , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Encuestas y Cuestionarios , Inyecciones

RESUMEN

BACKGROUND AND OBJECTIVES: General practitioners excise many suspected skin cancers using local anaesthetics such as lignocaine, but the relationships between the dose and volume of the local anaesthetic and wound complications are unclear. This pilot study considers an association between the dose and volume and complications. METHOD: An audit was conducted of patient records from two time periods: one before and one after an education intervention. Data extracted included lignocaine (volume and dose), wound complications (dehiscence and infection) and the demographics of patients and clinicians. RESULTS: Both the dose and volume of lignocaine administered were significantly associated with complication rates (P=0.0084 and P=0.0209, respectively). In the post-intervention period, clinician behaviour changed, with a reduction in the volume and dose of lignocaine administered (P<0.001 and P<0.001, respectively) without episodes of inadequate analgesia. DISCUSSION: This pilot study reported a relationship between lidocaine dose and volume and rates of complications. Shortcomings of this study limit attribution of findings to clinical practice. However, the results justify further rigorous research.

Asunto(s)

Anestésicos Locales , Lidocaína , Neoplasias Cutáneas , Humanos , Lidocaína/efectos adversos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Proyectos Piloto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Anestésicos Locales/uso terapéutico , Neoplasias Cutáneas/cirugía , Masculino , Femenino , Persona de Mediana Edad , Anciano , Cicatrización de Heridas/efectos de los fármacos , Adulto

RESUMEN

AIM: This study aimed to assess the feasibility and effectiveness of the pectoral nerves (PECS) II block in facilitating cardiac implantable electronic device (CIED) insertion in a sample of 120 patients, with a focus on the percentage of cases completed without additional intraoperative local anesthesia. METHODS: PECS II blocks were performed on the left side using ultrasound guidance in all 120 patients. Feasibility was assessed by the proportion of cases completed without the need for extra intraoperative local anesthetic. Secondary outcomes included the amount of additional local anesthetic used, intraoperative opioid requirements, postoperative pain scores, time to first postoperative analgesia, analgesic consumption, patient satisfaction, and block-related complications. RESULTS: Of the 120 patients, 78 (65%) required additional intraoperative local anesthetic, with a median volume of 8.2 mL (range 3-13 mL). Fifteen patients (12.5%) needed intraoperative opioid supplementation. Nine patients (7.5%) required postoperative tramadol for pain relief. In total, 98 patients (81.7%) reported high satisfaction levels with the procedure. CONCLUSIONS: The PECS II block, when combined with supplementary local anesthetic, provided effective postoperative analgesia for at least 24 h in 120 patients undergoing CIED insertion. While it did not completely replace surgical anesthesia in most cases, the PECS II block significantly contributed to a smoother intraoperative experience for patients.

Asunto(s)

Desfibriladores Implantables , Bloqueo Nervioso , Nervios Torácicos , Humanos , Masculino , Femenino , Anciano , Bloqueo Nervioso/métodos , Persona de Mediana Edad , Dolor Postoperatorio/tratamiento farmacológico , Marcapaso Artificial , Estudios de Factibilidad , Resultado del Tratamiento , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Satisfacción del Paciente/estadística & datos numéricos , Ultrasonografía Intervencional/métodos , Anciano de 80 o más Años

RESUMEN

OBJECTIVE: This study evaluates intratympanic lidocaine's efficacy and safety for tinnitus relief in sudden sensorineural hearing loss (SSNHL) patients. METHODS: In a double-blind randomized controlled trial, 100 SSNHL patients with unilateral tinnitus received either intratympanic lidocaine or saline plus usual care. Treatment impact was assessed at 1 and 3 months using the Tinnitus Handicap Inventory, subjective visual analog scale, pure-tone audiometry. RESULTS: The lidocaine group demonstrated significant tinnitus relief according to the Tinnitus Handicap Inventory and visual analog scale, without pure-tone audiometry improvement or serious adverse events throughout the study period. CONCLUSION: Intratympanic lidocaine provides a safe, efficacious treatment option for SSNHL tinnitus. Further studies should refine the dosage and delivery parameters because of SSNHL's heterogenous nature.

Asunto(s)

Anestésicos Locales , Audiometría de Tonos Puros , Pérdida Auditiva Sensorineural , Pérdida Auditiva Súbita , Inyección Intratimpánica , Lidocaína , Acúfeno , Humanos , Acúfeno/tratamiento farmacológico , Método Doble Ciego , Masculino , Femenino , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Persona de Mediana Edad , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Adulto , Resultado del Tratamiento , Pérdida Auditiva Súbita/tratamiento farmacológico , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Anciano

RESUMEN

INTRODUCTION: Obesity patients undergoing laparoscopic bariatric surgery (LBS) are frequently encountered perioperative adverse events related to opioids-based anaesthesia (OBA) or opioids-free anaesthesia (OFA). While modified opioid-sparing anaesthesia (MOSA) has been shown to lower the occurrence of adverse events related to OBA and OFA. This study is to assess the efficacy of MOSA in enhancing the recovery quality among individuals undergoing LBS. METHODS AND ANALYSIS: A single-centre, prospective, double-blind, randomised controlled trial is conducted at a tertiary hospital. A total of 74 eligible participants undergoing elective LBS will be recruited and randomly allocated. Patients in the MOSA group will receive a combination of low-dose opioids, minimal dexmedetomidine, esketamine and lidocaine, while in the OBA group will receive standard general anaesthesia with opioids. Patients in both groups will receive standard perioperative care. The primary outcome is the quality of recovery-15 score assessed at 24 hours after surgery. Secondary outcomes include pain levels, anxiety and depression assessments, gastrointestinal function recovery, perioperative complication rates, opioid consumption and length of hospital stay. ETHICS AND DISSEMINATION: Ethical approval has been provided by the Ethical Committee of Yan'an Hospital of Kunming City (approval No. 2023-240-01). Eligible patients will provide written informed consent to the investigator. The outcomes of this trial will be disseminated in a peer-reviewed scholarly journal. TRIAL REGISTRATION NUMBER: The study protocol is registered at https://www.chictr.org.cn/ on 19 December 2023. (identifier: ChiCTR2300078806). The trial was conducted using V.1.0.

Asunto(s)

Analgésicos Opioides , Cirugía Bariátrica , Laparoscopía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Analgésicos Opioides/uso terapéutico , Anestesia General/métodos , Anestésicos Locales/uso terapéutico , Anestésicos Locales/administración & dosificación , Cirugía Bariátrica/métodos , Dexmedetomidina/uso terapéutico , Método Doble Ciego , Ketamina/uso terapéutico , Laparoscopía/métodos , Tiempo de Internación/estadística & datos numéricos , Lidocaína/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

RATIONALE: Dopa-responsive dystonia (DRD) is a rare autosomal dominant hereditary disorder with a prevalence of 0.5 per million population. The disease is characterized by onset of dystonia in childhood, progressive aggravation of the dystonia with diurnal fluctuation, and complete or near complete alleviation of symptoms with low-dose oral levodopa. The incidence of DRD is low, and only a few publications have described this disorder connected with anesthesia. PATIENT CONCERNS: We present a case involving a pregnant woman with DRD who continued levodopa/benserazide throughout the pregnancy. The perioperative anesthesia management was described. We used chloroprocaine 3% for epidural anesthesia during cesarean section. DIAGNOSES: Dopa-responsive dystonia. INTERVENTIONS: Levodopa/benserazide. OUTCOMES: In summary, levodopa/benserazide was continued throughout our patient's pregnancy with a good obstetric outcome, and chloroprocaine was safely used in epidural anesthesia without deterioration of her dystonic symptoms. LESSONS: Chloroprocaine was safely used in epidural anesthesia without deterioration of her dystonic symptoms.

Asunto(s)

Anestesia Epidural , Anestésicos Locales , Cesárea , Trastornos Distónicos , Procaína , Humanos , Femenino , Embarazo , Procaína/uso terapéutico , Procaína/administración & dosificación , Procaína/análogos & derivados , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Adulto , Anestesia Epidural/métodos , Trastornos Distónicos/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Anestesia Obstétrica/métodos

RESUMEN

BACKGROUND: Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery. METHODS: We used PRISMA 2020 and a measurement tool to assess systematic reviews 2 guidelines to conduct this review. The random-effects model was adopted using Review Manager Version 5.4 for pooled estimates. RESULTS: We retained 24 eligible RCTs involving 1705 patients (862 patients in the intraperitoneal instillation group and 843 patients in the control group). The intraperitoneal instillation group reduced total opioid consumption during the first 24 hours postoperatively (MD = -21.93 95% CI [-27.64, -16.23], P < .01), decreased pain scores at different time (4 hours, 8 hours, 12 hours and 24 hours), shorter the hospital stay (MD = -0.20 95% CI [-0.36, -0.05], P < .01), reduced the postoperative shoulder pain (MD = 0.18 95% CI [0.07, 0.44], P < .01), and decreased postoperative nausea and vomiting (MD = 0.47 95% CI [0.29, 0.77], P < .01). CONCLUSION: Intraperitoneal instillation of ropivacaine appears to be an effective component of multimodal pain management strategies following laparoscopic digestive surgery, significantly reducing opioid consumption and improving postoperative recovery markers. Despite these promising results, additional high-quality trials are needed to confirm the efficacy and safety of this approach. REGISTRATION: The registration number at PROSPERO was CRD42021279238.

Asunto(s)

Anestésicos Locales , Laparoscopía , Manejo del Dolor , Dolor Postoperatorio , Ensayos Clínicos Controlados Aleatorios como Asunto , Ropivacaína , Ropivacaína/administración & dosificación , Ropivacaína/uso terapéutico , Humanos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Laparoscopía/efectos adversos , Laparoscopía/métodos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Manejo del Dolor/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Tiempo de Internación/estadística & datos numéricos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/efectos adversos , Dimensión del Dolor

RESUMEN

BACKGROUND: The research aimed to assess the effectiveness of inside-out anterior quadratus lumborum (QL3) block and local wound infiltration in managing postoperative pain and total morphine dosage following kidney transplantation. METHODS: In this prospective, randomized, double-blind study; 46 end-stage renal disease patients undergoing kidney transplantation were randomly allocated into 2 groups: a QL group (n = 23) receiving 20 mL of 0.25% bupivacaine using the ultrasound-assisted inside-out technique before wound closure, while the local wound infiltration (LA) group (n = 23) receiving the same dose around the surgical wound and drain at the time of skin closure. The primary outcome measure was the numerical pain rating scale, with secondary outcomes including amount of morphine consumption at various postoperative time points (2nd, 4th, 6th, 12th, 18th and 24th hours). RESULTS: Patients in the QL group had significantly lower numerical rating scale scores at the 2nd and 4th hours, both at rest and during movement (P < .05). Although pain scores at rest and during movement at later time points were lower in the QL group compared to the LA group, these differences were not statistically significant. Cumulative morphine consumption at postoperative 4th, 6th, 12th, 18th and 24th hours was significantly lower in the QL group (P < .05). No patients experienced complications from the QL3 block. CONCLUSION: Ultrasound-assisted inside-out QL3 block significantly reduced postoperative pain levels at the 2nd and 4th hours, both at rest and during movement, and led to a reduction in cumulative morphine consumption from the 4th hour postoperatively, and persisting throughout the 24-hour period.

Asunto(s)

Analgésicos Opioides , Anestésicos Locales , Trasplante de Riñón , Morfina , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Masculino , Método Doble Ciego , Femenino , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Trasplante de Riñón/métodos , Trasplante de Riñón/efectos adversos , Persona de Mediana Edad , Estudios Prospectivos , Bloqueo Nervioso/métodos , Morfina/administración & dosificación , Morfina/uso terapéutico , Adulto , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Bupivacaína/administración & dosificación , Dimensión del Dolor , Fallo Renal Crónico/terapia , Manejo del Dolor/métodos , Ultrasonografía Intervencional/métodos

RESUMEN

INTRODUCTION: Thoracotomy procedures can result in significant pain and cause nausea/vomiting. Glucocorticoids have anti-emetic and analgesic effects due to their anti-inflammatory and nerve-blocking properties. This study investigates the additive effect of local dexamethasone with bupivacaine as sole analgesic medication through a peripleural catheter after thoracotomy. METHOD: The study was conducted as a randomized control trial on 82 patients. Participants were allocated to receive either 2.5 mg/kg of bupivacaine plus 0.2 mg/kg of dexamethasone or 2.5 mg/kg of bupivacaine plus the same amount of normal saline as placebo through a 6 French peripleural catheter implemented above the parietal pleura and beneath the musculoskeletal structure of the chest wall. The primary outcome was the severity of pain 24 h after the operation in the visual analogue scale (VAS) score. Secondary outcomes were the incidence of nausea/vomiting, opioid consumption for pain control, and incidence of any adverse effects. RESULTS: A total of 50 participants were randomized to each group, and the baseline characteristics were similar between the groups. Median of VAS score (6 (3-8) vs. 8 (6-9), p < 0.001), postoperative opioid consumption (9 (36%) vs. 17 (68%) patients, p=0.024), and median length of hospital stay (4 (3-8) vs. 6 (3-12) days, p < 0.001) were significantly lower in the dexamethasone group. However, postoperative nausea/vomiting (p=0.26 for nausea and p=0.71 for vomiting) and surgical site infection (p = 0.55) were similar between the two groups. CONCLUSION: In thoracotomy patients, administering local dexamethasone + bupivacaine through a peripleural catheter can reduce postoperative pain, analgesic consumption, and length of hospital stay. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT20220309054226N1, registration date: 3/21/2022.

Asunto(s)

Anestésicos Locales , Bupivacaína , Dexametasona , Dolor Postoperatorio , Toracotomía , Humanos , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Toracotomía/efectos adversos , Toracotomía/métodos , Masculino , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & control , Femenino , Bupivacaína/administración & dosificación , Persona de Mediana Edad , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Método Doble Ciego , Manejo del Dolor/métodos , Náusea y Vómito Posoperatorios/epidemiología , Adulto , Dimensión del Dolor/métodos , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anciano , Quimioterapia Combinada