Generalized paralysis provoked by local lidocaine injection

Objectives:Os trigonum (OT) syndrome involves an accessory bone at the posterior talus crowding the tarsal tunnel and is frequently described in performance athletes, such as dancers, cheerleaders, and gymnasts. When reaching terminal plantarflexion as such athletes frequently do, OT can cause painful impingement of the posterior ankle. A low-lying flexor hallucis longus (FHL) muscle belly may aggravate symptoms. Local anesthetic injection is used as a diagnostic measure and initial intervention, with >80% immediate symptom resolution, and is preferred to casting. Surgical excision of OT also results in symptom resolution. We aimed to describe short-term pain relief of pediatric patients undergoing an injection of the OT and evaluate the relationship between several patient factors and progression to surgery. Methods:Retrospective review at one institution was conducted of patients with diagnosis codes for OT syndrome between 2014 and 2023. We collected demographics, treatment details, injection content (lidocaine with or without betamethasone), post-injection symptom relief, and radiographic measurements: regional maturity (distal tibial physeal status), musculotendinous junction (MTJ) distance from end of tibia to end of FHL muscle belly (Figure 1), relative MTJ- ratio of MTJ distance to the distance from tibia to tarsal tunnel, axial area of the FHL muscle belly or tendon at the midpoint of OT, and volume of OT. Volume of OT was calculated by multiplying OT length on the axial slice by OT area on the sagittal slice (Figure 2). Injections and surgeries were performed by one pediatric sports medicine specialist and two orthopaedic surgeons.Results:76 patients (59 female) with OT syndrome of mean age 13.9 ± 2.5 years were enrolled. 24 patients (26 ankles) underwent injections for OT. 17 patients (18 ankles) underwent surgical removal of OT. No patient or treatment factors that were collected were significantly related to post-injection symptom relief (p>0.05) (Table 1). Advancement to surgery is significantly related to FHL MTJ distance, relative FHL MTJ distance, the relative position of the OT against the talus, FHL muscle belly presence at the midpoint of the OT, distal tibial physeal status, gender, and whether the patient is a performance athlete (Table 2). The odds of advancement to surgery are significantly affected by FHL MTJ distance and relative FHL MTJ distance (p=0.009 OR=1.02, p=0.008 OR=1.13), but not by the initial level of relief from injection (p=0.453). Conclusions:Given the high prevalence of OT syndrome among performance athletes and the frequent use of plantarflexion in such activities, it is important for clinicians to understand the relationship between patient factors and level of relief from injection to the OT. Our results suggest that size and position of OT, physeal status, gender, being a performance athlete, sports participation, age, and presence of steroid with lidocaine injection are not related to immediate symptom relief from OT injection. This suggests that local lidocaine injection is effective across all patients. Because performance athletes rely heavily on the FHL when they bear weight on a plantarflexed ankle on demi-pointe and pointe, it is important for clinicians to understand the influence of the FHL on OT treatment. Our results suggest that FHL location and size are not related to immediate symptom relief from OT injection. Furthermore, initial level of relief from local injection does not predict likelihood of advancing to surgery. A more distal FHL MTJ location and a more inferior OT are significantly related to advancement to surgery. These factors may be associated with more severe symptoms, indicating that a low-lying FHL muscle belly and more inferior OT are used by providers as an indication for surgery. Gender and being a performance athlete, who are predominantly female, are each significantly related to progression to surgery for symptomatic OT. Patients who rely heavily on their ankles for their primary activity, such as performance athletes, may have more persistent OT symptoms indicating a need for surgery. Clinicians may consider these factors when determining treatment plans for pediatric and adolescent patients with OT syndrome.

Despite the growing popularity of aesthetic procedures, procedural pain remains a major concern among patients. Topical numbing cream and local anesthetic injection are widely used to manage discomfort and reduce pain; however, their relative effectiveness in cannula-based facial treatments remains a subject of ongoing debate. The aim of the study was to compare the anesthetic efficacy of BLT cream (benzocaine 20%, lidocaine 10%, and tetracaine 4%) and 1% lidocaine local injection in patients undergoing cannula-based facial aesthetic treatments. Retrospectively, 29 females underwent 2 separate treatment sessions, each using a different anesthetic method. Pain intensity was assessed using a self-reported numerical pain rating scale, and patients were asked to indicate their preferred method upon completion of the second treatment session. Mean pain scores were compared using paired samples t-test, and patient preference was analyzed using frequency and percentage distributions. A P-value of <.05 was considered statistically significant. Of the 29 patients enrolled, 28 patients were included in the final analysis. The mean pain score with BLT cream was 5.07 ± 0.40 (95% CI, 4.24-5.90), compared with 3.04 ± 0.32 (95% CI, 2.38-3.69) with 1% lidocaine injection. The difference was statistically significant (P = .0001), with a mean difference of 2.03. Most patients reported a preference for 1% lidocaine injection over topical cream for future treatments. In this preliminary study, local injection of 1% lidocaine provides significantly better pain control than BLT cream during cannula-based facial treatments, with higher patient preference. Injectable anesthesia may be a more effective option for enhancing patient comfort in aesthetic practice. Level of Evidence: 3 (Therapeutic).

Objective To investigate the application efficacy of disposable circumcision stapler with compound lidocaine cream combined with lidocaine injection in the circumcision. Methods From September 2013 to November 2014, 120 cases (11 cases of redundant prepuce phimosis patients), were divided into disposable circumcision suture group (S group, 60 cases) and conventional circumcision (T group, 60 cases), two groups had no statistically significant difference at patient age and wrapping case (6 cases phimosis of S group, 5 cases phimosis of T group)(P>0.05. Patient's age ranged from 11 to 49 years. 30 patients in each group were treated with lidocaine cream combined with lidocaine injection, and another 30 patients were treated with a local anesthetic lidocaine injection. Comparisons were conducted among the four groups on the operation time, anesthesia, intraoperative and postoperative pain score, blood loss and postoperative complications, postoperative appearance satisfaction, wound healing time. Results For the disposable circumcision stapler with lidocaine cream combined with lidocaine injection group, disposable circumcision stapler with lidocaine injection group, sleeve circumcision with lidocaine cream combined with lidocaine injection group and sleeve circumcision with lidocaine injection group, the operation time was (5.3±1.5)min, (4.9±1.4)min, (31.6±3.4)min, (32.0±3.3)min respectively, blood loss was (0.6±0.4)ml, (0.8±0.5)ml, (6.9±2.4)ml, (7.5±2.1)ml respectively, narcotic pain score was 0.6±0.6, 3.2±3.9, 2.5±1.0, 0.5±0.6, intraoperative pain score was 0.8±0.9, 1.4±0.8, 2.2±1.1, 3.1±1.1, postoperative 24 h pain score was 1.6±0.9, 2.2±0.8, 2.6±1.3, 4.4±1.1, postoperative 48h pain score was 0.7±0.6, 0.8±0.9, 2.4±0.8, 2.8±0.7, wound healing time was (13.7±1.5)d, (13.5±1.7)d, (14.2±1.3)d, (14.1±1.6)d, the rate of postoperative complications was 6.6% (2/30), 10.0%(3/30), 26.6%(8/30), 33.4%(10/30), satisfaction rate of appearance was 93.4%(28/30), 96.7%(29/30), 70.4%(22/30), 80.0%(24/30). Compared with sleeve circumcision with lidocain injection group, disposable circumcision stapler with lidocaine cream combined with lidocaine injection had a shorter operation time, less pain, less bleeding, higher appearance satisfaction rate and lower incidence of complications (P 0.05). Conclusion Application of the disposable circumcision stapler with lidocaine cream combined with lidocaine injection on circumcision is safe and has got better clinical outcomes. Key words: Redundant prepuce; Disposable circumcision suture device; Compound lidocaine cream; Lidocaine injection

Objective: To explore the effects of local injection of epinephrine and lidocaine on postoperative pain and bleeding in children undergoing tonsillectomy. Methods: Sixty-eight children who underwent a tonsillectomy in our hospital from March 2019 to October 2020 were selected. The children were randomly divided into two groups of 34 cases each. The observation group received local anesthetic injections of lidocaine and the control group received local anesthetic injections of epinephrine. The postoperative pain, operation time, blood pressure changes, and intraoperative blood loss of the two groups of children were observed and analyzed. Results: The postoperative pain, operation time, and intraoperative blood loss scores of the children in the observation group were 4.36 ± 0.69, 0.36 ± 0.09, and 39.36 ± 1.78 respectively, which were significantly better than those of the children in the control group (P &lt; 0.05) at 5.36 ± 0.77, 0.79 ± 0.05, and 45.36 ± 1.56, respectively. The systolic blood pressure and diastolic blood pressure of the observation group 3 minutes before surgery and 180 minutes after surgery were no different from those of the control group (P &gt; 0.05). Conclusion: Local injection of epinephrine and lidocaine effectively relieved postoperative pain and reduced bleeding in children undergoing tonsillectomy as compared to epinephrine alone.

Objective: The current treatment strategy for piriformis syndrome includes rehabilitation, symptomatic relief and local injection with either corticosteroid or botulinum toxin. Blind injection is sometimes used, as are CT-guided or electromyography-guided injection techniques. We report our local experience in treating piriformis syndrome with sono-guided corticosteroid injection. Methods: We enrolled 29 patients with piriformis syndrome whose initial symptoms were not relieved after medical treatment. They then received sono-guided local corticosteroid and lidocaine injection. Instead of traditional localization using anatomical landmarks, we used ultrasound to directly visualize the piriformis muscle and perform sono-guided local injection. The outcome was measured using a Likert pain scale. The pre-treatment pain score was recorded for every patient. During the six-month follow-up, the minimal pain score achieved was recorded for each patient as the post-treatment pain score. The Wilcoxon rank sum test was used to evaluate the difference between pre-treatment and post-treatment Likert pain scales. Results: Of the 29 patients with piriformis syndrome, 12 were male (41.4%), and 17 were female (58.6%). The ages of the patients ranged from 22 to 89 years, and the mean age was 59.1. The average pre-treatment and post-treatment pain scores were 7.7 ± 1.7 and 1 ± 2.8, respectively, which showed a statistically significant improvement (p＜0.001). In all, 65.5% of the patients had more than 50% reduction of pain. None of the 29 patients had complications after the treatment.Conclusion: Local corticosteroid injection guided by ultrasound is a safe and effective treatment modality for piriformis syndrome.

Effects of lidocaine on nipple attachment and home orientation by rat pups

A randomised placebo-controlled clinical trial on the efficacy of local lidocaine injections and oral citalopram for the treatment of complex regional pain syndrome

Background: Intrauterine contraceptive device (IUCD) is one of the most common contraception methods. In a survey of female Fellows of the American College of Obstetricians and Gynecologists, the prevalence of personal IUCD use was >20-fold higher than among women in the general population. In statistical terms, The IUCD is used by approximately 15% of reproductive-aged women in developing countries and 8% in developed countries. Aim of work: To compare the safety and efficacy of different local lidocaine preparations (spray, cream and injection) for reducing pain associated with IUCD insertion. Patients and Methods: This is a prospective randomized clinical trial. The study was conducted at Ain Shams University Maternity hospital at family planning outpatient clinic during the period between December 2017 and June 2018. Results: Results proved that lidocaine 10% spray application to the cervix during IUCD insertion effectively reduce pain felt during stages of IUCD insertion and is good option for reduction of pain associated with IUCD insertion in compared with lidocaine injection or cream. Conclusion: Our study demonstrated that local lidocaine spray 10% is effective in control of pain associated with IUCD insertion when compared with lidocaine cream or injection because its application is easy and rapid, while lidocaine injection can also reduce pain but injection itself is painful that makes it unfavorable method.

Background: Intrauterine contraceptive device (IUCD) is one of the most common contraception methods. In a survey of female Fellows of the American College of Obstetricians and Gynecologists, the prevalence of personal IUCD use was >20-fold higher than among women in the general population. In statistical terms, The IUCD is used by approximately 15% of reproductive-aged women in developing countries and 8% in developed countries. Aim of work: To compare the safety and efficacy of different local lidocaine preparations (spray, cream and injection) for reducing pain associated with IUCD insertion. Patients and Methods: This is a prospective randomized clinical trial. The study was conducted at Ain Shams University Maternity hospital at family planning outpatient clinic during the period between December 2017 and June 2018. Results: Results proved that lidocaine 10% spray application to the cervix during IUCD insertion effectively reduce pain felt during stages of IUCD insertion and is good option for reduction of pain associated with IUCD insertion in compared with lidocaine injection or cream. Conclusion: Our study demonstrated that local lidocaine spray 10% is effective in control of pain associated with IUCD insertion when compared with lidocaine cream or injection because its application is easy and rapid, while lidocaine injection can also reduce pain but injection itself is painful that makes it unfavorable method.

The aim of this study was to explore the efficacy of transcutaneous electrical nerve stimulation (TENS) with locally injected cobalamin in relieving pain and improving activities of daily living in patients with postherpetic neuralgia. Ninety patients (≥50 yrs old) with postherpetic neuralgia with a pain score of 4 or greater were randomized to receive TENS and local injections of cobalamin or lidocaine or a combination of cobalamin and lidocaine for 8 wks. Treatment efficacy was assessed on the basis of worst pain severity, global impression of change, activities of daily living, and quality-of-life. Time × group interaction, group differences, and time effect on worst pain at each follow-up point were statistically significant (P < 0.05) among the groups. In the group receiving TENS and local injection of cobalamin and in the group receiving TENS with a combination of cobalamin and lidocaine, the mean ± SD pain scores were 4.0 ± 1.4 and 4.1 ± 1.2 at endpoint, 28 and 26 patients achieved pain reduction of 30% or greater, and 14 and 10 perceived worst pain of 3 or less, respectively. The activities of daily living and quality-of-life data at the study endpoint showed significant benefits in the group receiving TENS and local injection of cobalamin and in the group receiving TENS and a combination of cobalamin and lidocaine (P < 0.05). In the group receiving TENS and local injection of lidocaine, the mean ± SD pain score was 6.1 ± 1.2 at the endpoint relative to baseline (P < 0.05), and only six patients achieved pain reduction of 30% or greater. TENS in combination with local cobalamin injection has a significant analgesic effect.

Injury of a spinal nerve or dorsal root ganglion (DRG) during selective spinal nerve blocks is a potentially serious complication that has not been adequately investigated. Our hypothesis was that local anesthetic injection into these structures may result in an inflammatory response and hyperalgesia. We evaluated inflammatory and behavioral responses after injection of 4 microL lidocaine or saline into the L5 spinal nerve or DRG of rats after partial laminectomy. Behavioral testing was performed before and after surgery to examine hyperalgesia in response to nociceptive mechanical stimulation of the foot. DRGs were harvested and stained, and rings of immunoreactive glial cells around neurons were counted. Animals demonstrated hyperalgesia on the ipsilateral paw up to 4 days after lidocaine injection into the DRG but not after injection into the spinal nerve. The number of glial fibrillary acid protein immunopositive glial cell rings, which represent activation of satellite cells, significantly increased in DRGs after injection of lidocaine into either the DRG or the spinal nerve. The number of glial fibrillary acid protein-positive cells in the lidocaine-injected group was significantly larger than in the saline-injected group. Sporadic OX-42 immunopositive cells, which represent activated microglia, were also seen in lidocaine-injected DRGs. Testing for Pan-T expression, which labels activated T lymphocytes, showed no positive cells. Lidocaine injection into the DRG may produce hyperalgesia, possibly due to activation of resident satellite glial cells. In a clinical setting, local anesthetic injection into the DRG should be avoided during selective spinal nerve blocks.

A randomized controlled crossover trial: Lidocaine injected at a 90-degree angle causes less pain than lidocaine injected at a 45-degree angle

BackgroundThe present study aimed to evaluate the efficacy of local lidocaine injections into the myofascial trigger points (TPs) located at the pericranial muscles in patients with episodic tension-type headache (ETTH).MethodsThe study included 108 patients with frequent ETTH that were randomized into 4 groups. One injection of saline (NaCl 0.9%) was administered to group 1 (n = 27), 1 injection of lidocaine (0.5%) was administered to group 2 (n = 27), group 3 (n = 27) received 5 injections of saline (NaCl 0.9%), and group 4 (n = 27) received 5 injections of lidocaine (0.5%); on alternate days 2 mL for each muscle was injected into the frontal, temporal, masseter, sternocleidomastoid, semispinalis capitis, trapezius and splenius capitis muscles bilaterally. The frequency of painful days per month (FPD) and the patients’ visual analogue scales (VAS) were evaluated before treatment, and 2, 4 and 6 months after treatment.ResultsMean age of the patients was 36.28 ± 9.41 years (range: 18–54 years). FPD scores improved significantly in group 2, 3 and 4 at 2 months posttreatment compared to pre- treatment (all P < 0.05), and also VAS scores improved significantly in group 2 and 4 at 2 months posttreatment (P < 0.05) but this improvement insisted at the 6 month only in group 4. Group 2 had better VAS and FPD than group 1 only at 2. and 4. months after treatment (for VAS P < 0.0121, P = 0.0232; for FPD P = 0.0003, P = 0.0004, respectively). Group 4 had better scores than group 3 at the 2., 4. and 6. months after treatment in both parameters (all P < 0.05). Group 2 had better scores than group 1 in FPD at the 2. and 4. months posttreatment (P = 0.0003, P = 0.0004, respectively), but not at the 6. month.ConclusionLocal lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH.

Introduction:Different methods have been proposed for the reduction of the pain caused by the injection of local anesthetics. This study aimed to evaluate the effect of skin cooling on reduction of pain associated with local injection of lidocaine buffered with sodium bicarbonate. Methods:This randomized controlled trial included 108 adult patients with arm/forearm wounds who referred to the emergency departments. Participants were randomly allocated to two equal groups. Patients in both groups received subcutaneous injection of buffered lidocaine. In the intervention group, an ice cube measuring 2 × 2 × 2 cm (at 0 ° C) in sterile gloves were placed on the wound for 2 minutes before the injection of buffered lidocaine. The primary outcome was severity of pain during lidocaine injection using a visual analog scale (VAS).Results:One hundred and eight patients were enrolled in the study, 54 in each group. There was no statistically significant difference in age (p = 0.777), sex (p = 0.466), and length of laceration (p = 0.410) between the two groups. The pain scores during lidocaine injection were significantly lower in the intervention group compared to control group (2.39 ± 1.14 vs 4.26 ± 0.94, p < 0.001).Conclusions:Skin cooling prior to the injection of local anesthetics can significantly reduce the pain caused by local anesthetic infiltration

This study explored the efficacy of local methylcobalamin injection in relieving pain and improving the quality of life among subjects with subacute herpetic neuralgia. A single-center, randomized controlled trial of local methylcobalamin injection was performed. Ninety-eight subjects (age, ≥ 50 years) with unilateral, dermatomal pain ≥ 4 related to herpes zoster on the torso lasting for 30 days after onset of rash were enrolled. Subjects were randomized to receive local methylcobalamin injection (N = 33), oral methylcobalamin (N = 33), or subcutaneous 1.0% lidocaine injection (N = 32) for 4 weeks. Worst pain severity, global impression of change, continuous spontaneous pain, paroxysmal pain, allodynia, paresthesia, interference with activities of daily living, and quality of life were assessed after 28-day treatment period. Time per group interaction and group difference on overall pain at each follow-up point were statistically significant (P < 0.001) among groups. In the injected methylcobalamin group, the overall pain (P < 0.001), continuous spontaneous pain (P < 0.05), paroxysmal pain (P < 0.05), and allodynia (P < 0.05) revealed a significant effect at each follow-up point as compared with the other groups. Twenty subjects achieved pain reduction ≥ 50%, 24 perceived worst pain ≤ 3, 24 stopped using analgesics at end point; activities of daily living and quality of life improved significantly as compared with the other groups (P < 0.001). Although both of the other groups showed a significant response after the 14-day treatment (P < 0.001) compared with the baseline, oral methylcobalamin did not provide any significantly pain relief (P > 0.05). Local methylcobalamin injection was not only efficacious in relieving pain, but also appears to be tolerable and a potential choice of treatment for subacute herpetic neuralgia.