Additional Local Anesthesia Research Articles

Pectoral Nerve Block II for Cardiac Implantable Electronic Devices.

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. 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. 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. 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.

The effect of spermatic cord block on reducing the risk of vagal reflex during microsurgical subinguinal varicocelectomy: A randomized trial

PurposeThis study aimed to compare the risk of vagal reflex during microsurgical subinguinal varicocelectomy (MSV) under general anesthesia (GA) with or without additional local anesthetic (LA) spermatic cord block (SCB). MethodA single-center randomized controlled trial was conducted between January 2022 and June 2023.300 patients with left-sided grade Ⅲ varicocele were randomly divided into two groups: SCB group (n = 153) and control group (n = 147)（computer-generated random numbers list）. During MSV under GA, the SCB group was given of ropivacaine for SCB before pulling the spermatic cord, while the control group was directly lifted. The primary outcome was the reduction in the lowest heart rate in the SCB group as compared with the control group during spermatic cord traction (SCT). Secondary outcomes included the reduction in the lowest blood pressure in the SCB group as compared with the control group; and the reductions in the lowest heart rate and lowest blood pressure as compared with baseline during SCT. The number of times that surgery and medications were suspended because of symptomatic reflex bradycardia was also recorded. Adverse events were also recorded as secondary outcomes. ResultFive patients in the SCB group and 10 patients in the CG were excluded. The lowest heart rate and systolic blood pressure during SCT in the SCB group and the control group were significantly lower than the baseline values (P < 0.05). However, the decrease in the SCB group (70-73bpm VS 108–115 mmHg) was milder than that of the control group（66–72 bpm VS 105–114 mmHg）(P < 0.05). The number of surgeries and medication pauses due to symptomatic reflex bradycardia during surgery was significantly lower in the SCB group (2 VS 1) than in the control group (9 VS 7) (P < 0.05). ConclusionSCB can effectively reduce the vagal reflex caused by pulling the spermatic cord during MSV, and reduce the risk of anesthesia and surgery.

0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period

Background3% chloroprocaine (CP) has been reported as the common local anesthetic used in pregnant women undergoing urgent cesarean delivery during labor analgesia period. However, 0.75% ropivacaine is considered a promising and effective alternative. Therefore, we conducted a randomized controlled trial to compare the effectiveness and safety of 0.75% ropivacaine with 3% chloroprocaine for extended epidural anesthesia in pregnant women.MethodsWe conducted a double-blind, randomized, controlled, single-center study from November 1, 2022, to April 30, 2023. We selected forty-five pregnant women undergoing urgent cesarean delivery during labor analgesia period and randomized them to receive either 0.75% ropivacaine or 3% chloroprocaine in a 1:1 ratio. The primary outcome was the time to loss of cold sensation at the T4 level.ResultsThere was a significant difference between the two groups in the time to achieve loss of cold sensation (303, 95%CI 255 to 402 S vs. 372, 95%CI 297 to 630 S, p = 0.024). There was no significant difference the degree of motor block (p = 0.185) at the Th4 level. Fewer pregnant women required additional local anesthetics in the ropivacaine group compared to the chloroprocaine group (4.5% VS. 34.8%, p = 0.011). The ropivacaine group had lower intraoperative VAS scores (p = 0.023) and higher patient satisfaction scores (p = 0.040) than the chloroprocaine group. The incidence of intraoperative complications was similar between the two groups, and no serious complications were observed.ConclusionsOur study found that 0.75% ropivacaine was associated with less intraoperative pain treatment, higher patient satisfaction and reduced the onset time compared to 3% chloroprocaine in pregnant women undergoing urgent cesarean delivery during labor analgesia period. Therefore, 0.75% ropivacaine may be a suitable drug in pregnant women undergoing urgent cesarean delivery during labor analgesia period.Clinical trial number and registry URLThe registration number: ChiCTR2200065201; http://www.chictr.org.cn, Principal investigator: MEN, Date of registration: 31/10/2022.

AG-920 (Articaine) Ophthalmic Solution: A Masked, Active-Controlled Evaluation of Its Local Anesthetic Efficacy and Safety in Pediatric Patients.

Purpose: The safety and efficacy of a novel topical ocular anesthetic (AG-920 sterile ophthalmic solution, 8%) was previously evaluated in adults. For both clinical and regulatory purposes, this new agent was evaluated in children. Methods: This was a Phase 3, randomized, active-controlled, single-masked, parallel-group design study in healthy pediatric subjects performed at a private practice retina clinic in the United States. The safety and anesthetic efficacy of AG-920 was compared with proparacainehydrochloride ophthalmic solution 0.5% in 60 children undergoing ophthalmic examinations. The primary efficacy endpoint was whether the investigator was able to perform the eye examination. Results: In all subjects in each treatment group, the investigator was able to perform the eye examination without additional local anesthetic. There were no adverse events reported in this study. In both the study eye and fellow eye, there were no notable changes after dosing, and both treatment groups were similar. All external eye exams in all subjects in both treatment groups were normal. Conclusions: In this pediatric population aged 7 months to >11 years, AG-920 was therapeutically equivalent to marketed proparacaine with respect to having an ophthalmic examination performed without needing additional local anesthetic. Further, AG-920 was well tolerated, and there were no clinically significant safety findings.

Monitored epidural catheter placement-ultrasound-guided neurostimulation-aided thoracic catheter placement via caudal route for perioperative analgesia in neonatal thoracotomies: A technical feasibility study.

In this case series, we investigated the feasibility of combining ultrasound and neurostimulation for inserting a stimulating epidural catheter in the thoracic epidural space through the caudal route in neonates. Twelve neonates undergoing tracheo-oesophageal fistula repair under general anaesthesia were studied. The catheter was visible on ultrasound as a hyperechoic dot in the epidural space. Inadvertent high placement was identified in two neonates with neurostimulation, in whom the catheter was withdrawn to the thoracic epidural space, and the position was confirmed on ultrasound. A 0.5 ml/kg bolus dose of 0.125% bupivacaine injected through the epidural catheter was imaged in real-time in the epidural space. Block was effective in 10 neonates; two needed an additional local anaesthetic (LA) bolus. To conclude, ultrasound with neurostimulation facilitates accurate positioning of the caudally placed epidural catheter to the mid-thoracic level in neonates.

PECS II block for cardiac implantable electronic device insertion: A pilot study.

Some truncal blocks could provide adequate surgical anesthesia and postoperative analgesia in cardiac implantable electronic devices (CIED) insertion. The aim of this study was to evaluate the feasibility of the pectoral nerves (PECS) II block for CIED insertion. PECS II blocks were performed on the left side using the ultrasound-guided single injection technique in all patients. The primary outcome for feasibility was the percentage of the cases completed without intraoperative additional local anesthesia. Secondary outcomes were the amount of intraoperative additional local anesthetic, intraoperative opioid requirement, postoperative pain scores, first requirement for postoperative analgesia, postoperative analgesic consumption, patient satisfaction, and block-related complications. Of the total 30 patients, 19 (63.3%) required intraoperative additional local anesthetic. The median (IQR [range]) volume of the additional local anesthetic used was 7 (4-10 [2.5-12]) mL. Two patients needed additional IV analgesics in the first 24h postoperatively. No statistically significant differences were determined between the patients requiring and not requiring intraoperative additional local anesthetic in respect of age, gender, duration of surgery, block performance time, and hospital stay. A total of 26 (86.6%) patients reported a high level of satisfaction with the procedure. PECS II block for cardiac electronic implantable device insertion provides effective postoperative analgesia for at least 24h. Although PECS II block alone could not provide complete surgical anesthesia in the majority of the patients, when combined with supplementary local anesthetic, contributes to a smooth intraoperative course for patients.

Comparative Evaluation of the Anesthetic Efficacy of 1% Chloroprocaine Vis-a-vis 2% Lignocaine with Adrenaline (1:80,000) in Third Molar Surgery.

To evaluate the anesthetic efficacy of 1% chloroprocaine in comparison to 2% lignocaine hydrochloride and adrenaline (1:80,000) in third molar surgery. A randomized single-blind trial comprising of 30 healthy patients requiring bilateral extraction of impacted lower third molars with similar difficulty index was undertaken. A test dose was administered to all patients with subdermal infiltration of 1% chloroprocaine with 0.5ml. A classic inferior alveolar and long buccal nerve block was given using 1% chloroprocaine 2ml on one side and 2% lignocaine hydrochloride 2ml with adrenaline on the other side. The time to onset and duration of action were noted. Pain during the surgical intervention, need for additional local anesthetic solution during the surgical intervention and the hemodynamic changes associated with the administration of the drugs were monitored. Chloroprocaine had an early onset of action with a mean of 1.17 ± 0.55min as compared to lignocaine 4.2 ± 0.48min. Patients administered with lignocaine experienced less postoperative pain compared with chloroprocaine since the duration of action of chloroprocaine was lesser than that of lignocaine. Additional amount of LA was required when chloroprocaine was administered as compared to lignocaine. Chloroprocaine alone did not cause any appreciable changes in the hemodynamics, but lignocaine with adrenaline caused a transient increase in arterial pressure and heart rate 2min following the administration. It was also observed that more blood was lost following chloroprocaine administration than with lignocaine. Chloroprocaine has a rapid onset of action and short duration of action with minimal effects on the hemodynamic changes than lignocaine. Considering the fact that it is a safe drug with no effects of the cardiovascular system it can be advocated that Chloroprocaine can be used as an effective local anesthetic agent for performing oral and maxillofacial surgical interventions of short duration.

A fracture of the catheter tube occurred during the radial artery puncture, likely attributed to additional local anesthesia.

A fracture of the catheter tube occurred during the radial artery puncture, likely attributed to additional local anesthesia.

A Multimodal Approach to Analgesia in Anorectal Surgery

Аim: Evaluation of methods for pain prevention and pain reduction after anorectal surgery at all stages of treatment based on publications found in available databases.Key points. Most anorectal diseases are benign and do not affect life expectancy, meanwhile about 40 % of the population suffer from it. Mainly anorectal disorders affect middle-aged people reducing their life quality. At the same time many articles aimed at studying only postoperative anesthesia. 2 researchers independently searched for articles published in Medline, Scopus, Cochrane, Web of Science, E-library databases using keywords. A total of 54 publications were included. A multimodal approach should include the pain prevention during pre-, intra- and postoperative periods. Acetaminophen is recommended for pain reduction according to the dosing protocols. Acetaminophen combined with other systemic analgesics is advisable for patients with severe pain. The opioids use is justified only for moderate-severe postoperative pain. Metronidazole and lidocaine with nitroglycerin ointment/ nifedipine/сorticosteroids effectiveness has been proven for local postoperative anesthesia. Prophylactic use of antibiotics and bowel preparation do not reduce postoperative pain. Stool softeners are recommended for reducing postoperative pain severity. Additional local anesthesia such as nerve blockade or infiltration anesthesia is recommended for all patients. Modern minimally invasive treatment methods of hemorrhoid are associated with less severe postoperative pain.Conclusion. The recommended scheme of multimodal anesthesia for patients after anorectal surgery is shown on Fig.1. Further studies are needed to evaluate preoperative anesthesia effectiveness, the feasibility of the perioperative flavonoids use, as well as comparisons of various minimally invasive treatment methods of anorectal diseases.

Literature Review for Office-Based Anesthesia

Literature Review for Office-Based Anesthesia

Risk factors for insufficient ultrasound-guided supraclavicular brachial plexus block

PurposeUltrasound-guided supraclavicular brachial plexus block (SCBPB) is performed by surgeons for upper limb anesthesia; however, certain patients need additional local anesthesia. This study aimed to identify risk factors for additional local anesthetic injection requirements.MethodsIn total, 269 patients receiving ultrasound-guided SCBPB were enrolled. Patient age, sex, body mass index, anesthetic drug dose, surgeon expertise (hand surgeon or resident), tourniquet time, comorbidities (diabetes mellitus and mental disorders), and preoperative blood pressure representing anxiety were compared between the additional local anesthesia and no additional local anesthesia groups matched for background using propensity scores. Receiver operating characteristic analysis was performed to determine risk factor cut-off values with the highest predictive potential.ResultsOf 269 patients, 41 (15.2%) required additional intraoperative local anesthesia. Among surgical sites, elbow surgery showed the highest prevalence of the need for additional local anesthesia (17/41, 41%). A high body mass index and high systolic blood pressure before surgery were identified as risk factors for additional intraoperative local anesthesia requirement. Furthermore, systolic blood pressure > 170 mmHg (area under the curve, 0.66) predicted the need for intraoperative local anesthesia with 36% sensitivity, 89% specificity, 37.5% positive predictive value, and 88.6% negative predictive value. The median systolic blood pressure was significantly greater in patients requiring additional local anesthesia than in those not requiring it [151 (139–171) mmHg vs. 145 (127–155) mmHg; P = 0.026].ConclusionElbow surgery, obesity, and high systolic blood pressure (> 170 mmHg) before surgery are predictive of additional intraoperative local anesthesia requirement.Level of EvidencePrognostic Level III

Anesthesia care in the interventional neuroradiology suite: an update.

The scope of procedures conducted by neurointerventionalists is expanding quickly, with lacking consensus over the best anesthesia modality. Although the procedures involve all age groups, the interventions may be complex and lengthy and may be provided in hospitals currently not yet familiar with the field. Here we review current literature addressing elective outpatient neurointerventional procedures and aim to provide an update on the management of intervention-specific crises, address special patient populations, and provide key learning points for everyday use in the neurointerventional radiology suite. Various studies have compared the use of different anesthesia modalities and preinterventional and postinterventional care. Monitored anesthesia care is generally recommended for elderly patients, whereas children are preferably treated with general anesthesia. Additional local anesthesia is beneficial for procedures, such as percutaneous kyphoplasty and vascular access. Combining different anesthetic modalities is a valuable approach in the neurointerventional radiology suite. More interventional and patient population-specific studies are needed to improve evidence-based perioperative management.

MP30-19 THE RAKAI SCORE: A NOVEL TOOL FOR PAIN MEASUREMENT DURING EARLY INFANT MALE CIRCUMCISION WITH THE SHANGRING

You have accessJournal of UrologyCME1 May 2022MP30-19 THE RAKAI SCORE: A NOVEL TOOL FOR PAIN MEASUREMENT DURING EARLY INFANT MALE CIRCUMCISION WITH THE SHANGRING Aaron Brant, Christina Sze, Jeffrey Johnson, Spyridon Basourakos, Quincy Nang, Stephen Kiboneka, Joseph Kagayi, Alice Christensen, Mark Barone, Marc Goldstein, Kaylee Ho, Karla Ballman, Philip Li, Godfrey Kigozi, and Richard Lee Aaron BrantAaron Brant More articles by this author , Christina SzeChristina Sze More articles by this author , Jeffrey JohnsonJeffrey Johnson More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Quincy NangQuincy Nang More articles by this author , Stephen KibonekaStephen Kiboneka More articles by this author , Joseph KagayiJoseph Kagayi More articles by this author , Alice ChristensenAlice Christensen More articles by this author , Mark BaroneMark Barone More articles by this author , Marc GoldsteinMarc Goldstein More articles by this author , Kaylee HoKaylee Ho More articles by this author , Karla BallmanKarla Ballman More articles by this author , Philip LiPhilip Li More articles by this author , Godfrey KigoziGodfrey Kigozi More articles by this author , and Richard LeeRichard Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Measurement of pain in infants can be challenging due to an inability to communicate level of discomfort directly. Therefore, providers are forced to rely on secondary proxies for discomfort, resulting in a nonspecific or inaccurate measurement. In this study, we present the use of the novel Rakai scale for the measurement of pain during early infant circumcision (EIMC) using ShangRing (SR) in our recent clinical trials in Uganda, Tanzania, and Kenya. METHODS: Male infants aged 0 – 60 days were brought to 14 sites in Kenya, Tanzania, and Uganda by a parent or legally appointed representative for SR EIMC from February to December 2020. Infants with congenital genitourinary anomalies, bleeding diatheses, or allergy to local anesthetics were excluded. Topical anesthesia was administered, with additional local injectable anesthesia given if needed. Infants were scored on both the nine-point Rakai scale during SR placement (Table 1) as well as the seven-point Neonatal Infant Pain Scale (NIPS) post-operatively. RESULTS: Rakai and NIPS scores were completed for 1,690 of 1,691 infants (99.9%) who underwent SR placement. The mean procedure time was 10.1 minutes (standard deviation (STD): 5.3). Additional injectable anesthesia was needed for 44 infants (2.6%). Mean Rakai Score was 3.6 of 9 (STD: 2.6). The highest scored portion of the procedure was “skin adjustment with the ring in place” (mean 0.52 of 1), and the lowest scored portion was “placement of hemostats” (mean 0.24 of 1). Severe Rakai Score (>6 of 9) was recorded in 303 infants (17.9%). Mean NIPS Score was 0.3 of 7 (STD: 0.8), with “flexed or extended arms” the highest scored portion (mean 0.06 of 1). A severe NIPS score (≥5 of 7) was recorded in 8 infants (0.5%). CONCLUSIONS: In a large prospective study of male newborn infants undergoing SR placement, the Rakai Score captured infant pain at each step of the procedure with a higher rate of severe pain detection than the NIPS score administered post-operatively. Thus, the Rakai score may be superior to pre-existing tools such as the NIPS score for pain measurement during SR EIMC due to its detection of intraprocedural pain with more significant detection of severe pain. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e486 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Christina Sze More articles by this author Jeffrey Johnson More articles by this author Spyridon Basourakos More articles by this author Quincy Nang More articles by this author Stephen Kiboneka More articles by this author Joseph Kagayi More articles by this author Alice Christensen More articles by this author Mark Barone More articles by this author Marc Goldstein More articles by this author Kaylee Ho More articles by this author Karla Ballman More articles by this author Philip Li More articles by this author Godfrey Kigozi More articles by this author Richard Lee More articles by this author Expand All Advertisement PDF DownloadLoading ...

Triple Versus Single Application of Lidocaine, Epinephrine, and Tetracaine for Laceration Repair in Children.

Lidocaine (4%), epinephrine (0.1%), and tetracaine (0.5%) topical gel (LET) is a safe and effective method of providing anesthesia for laceration repair. Some patients, however, require additional infiltrated local anesthetic. We sought to determine if 3 applications of LET 10 minutes apart (triple LET) result in lower pain scores with suturing than one application for 30 minutes (single LET). We performed a randomized single-blind controlled trial of pediatric emergency department patients 7 to 17 years old with simple lacerations requiring sutures. Patients received either triple or single LET, and the first suture was placed or attempted within 15 minutes of removing the LET. Visual analog pain score on a 100-mm scale was obtained by a blinded nurse. Pain scores between groups were compared using the Wilcoxon rank sum test. Forty-eight patients were enrolled: 21 for single LET and 27 for triple LET. Mean visual analog pain scale (VAS) score for single LET patients was 16 (SD, 17; range, 0-48), and that for triple LET patients was 16 (SD, 24; range, 0-95), with the difference not significant at 0.37 (95% confidence interval, -11.9 to 12.6). There was no significant difference in requirement for additional anesthesia between single LET (4 of 21 [19%]) and triple LET (5 of 27 [19%]) patients. Lidocaine (4%), epinephrine (0.1%), and tetracaine (0.5%) topical gel every 10 minutes for 3 applications was not superior in anesthetic efficacy to applying it once for 30 minutes.

A Randomized Controlled Trial of Virtual Reality in Awake Minor Pediatric Plastic Surgery Procedures.

Virtual reality has been used to alleviate pain and anxiety in a variety of medical procedures. The authors sought to explore the effects of virtual reality in common awake minor plastic surgery procedures where children may experience discomfort. A randomized controlled trial compared virtual reality to standard-of-care distraction among children aged 6 to 16 years undergoing awake minor plastic surgery procedures at a quaternary children's hospital. Primary outcome was change in Faces Pain Scale-Revised pain score, and secondary outcomes included change in Venham Situational Anxiety Scale score, procedure duration, administration of local anesthetic, and pain/anxiety management satisfaction. Mean pain and anxiety scores were similar in both groups (p = 0.60 and p = 0.18, respectively), and procedure duration was shorter with virtual reality (22 minutes versus 29 minutes; p = 0.002). Duration remained shorter in a linear regression model accounting for procedure type (p = 0.01). Similar proportions of children received additional local anesthetic after the initial dose (virtual reality, n = 6; standard of care, n = 9; p = 0.19) and median pain management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.41). Median anxiety management satisfaction was similar (virtual reality, 9 of 10; standard of care, 9 of 10; p = 0.05). Younger children reported more "fun" than older children with virtual reality (p = 0.02). Surgeons reported interest "using virtual reality again" in 83 percent of cases. The use of virtual reality for awake pediatric plastic surgery reduced procedure time but not pain or anxiety compared to standard of care in children aged 6 to 16 years. Virtual reality was safe and well-liked and should be considered as an additional tool. Increased efficiency may allow more cases to be performed. Therapeutic, II.

Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial.

BackgroundThe study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic.MethodsIn this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed.ResultsProcedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study.ConclusionsVR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

The Efficacy of Pectoralis Nerve Blockade in Breast Reductions: A Prospective Randomized Trial.

Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumption in patients undergoing mastectomies, but the effectiveness of these blocks in breast reductions has not been established. This trial aims to evaluate the efficacy of Pecs blocks (I and II) on perioperative pain management in patients undergoing breast reductions. Thirty-six patients were enrolled in the randomized controlled trial divided into 2 groups. The treatment group (n = 16) received general anesthesia plus postinduction ultrasound-guided Pecs blocks. The control group (n = 20) received general anesthesia alone. The primary outcomes measured were perioperative narcotic requirements, need for postoperative antiemetics, pain scores, and length of time in the operating room (OR). We measured patient and procedural risk factors including pedicle/skin excision patterns, concurrent liposuction, weight of resection, and additional local anesthesia. Risk factors as well as outcomes were analyzed using Fischer exact and t tests. No statistically significant difference was shown between the group receiving the Pecs blocks and the control with regard to narcotic requirements, pain scores, and need for antiemetics. Patients undergoing Pecs blocks had a significantly higher OR time before incision (P = 0.0073). Patient and procedural risk factors were well balanced (P > 0.41). Pectoralis nerve blocks may be a valuable component of a multimodality pain regimen; however, when performed as a solitary adjunct, they do not seem to decrease perioperative narcotic requirements, pain scores, or the need for antiemetic medication in patients undergoing breast reductions. In addition, postinduction Pecs blocks significantly increase OR times.

Local anesthetic added to spinal anesthesia; does it stabilize stress hormones after inguinal herniorrhaphy?: A randomised controlled trial

BackgroundElective inguinal hernia repair is a common minor surgery. Early postoperative mobilization without inflammatory related complication is desired. MethodsIn this randomized controlled trial study 48 adult males were enrolled who experienced elective inguinal hernia repair under spinal anesthesia. Subjects were categorized in 2 groups with equal 24 members in each including patients received local anesthetic (2 mg kg−1 of bupivacaine 0.5%) in addition to spinal anesthesia and controlled who had spinal anesthetic with local placebo injection. Plasma cortisol and prolactin concentration were obtained 1 h before and 3 h after operation. To evaluate severity of postoperative pain the visual analogue scale(VAS) was applied. We also measured the total dosage of analgesic requirement among patients. ResultsData showed that spinal anesthesia alone was followed by increasing plasma concentration of either cortisol or prolactin postoperatively (P < 0.01). Findings according to investigate severity of pain implied on that local anesthesia could make more postoperative comfort for patients with inguinal herniorrhaphy(P < 0.001). Therefore, analgesic requirement in patients who were equipped by additional local anesthesia also decreased(P < 0.001). ConclusionsWe concluded that adding local anesthetic to basic spinal anesthesia during inguinal herniorrhaphy could induce to either lower stress hormones plasma concentration or decrease pain and need for analgesic postoperatively.

Ultrasound-guided supraclavicular nerve block for implantable port catheters: Does it show a significant difference in pain control?

Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients (p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 (p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] (p > 0.05). The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.

Tangential Excision of Rhinophyma with the Disposable Razor Blade: Simple and Cost Efficient with Aesthetically Good Results.

Medical therapies for rhinophyma have been described but these only delay progression. Therefore, surgery is the method of choice. Plenty of modalities have been described including cold-knife surgery, electrosurgery, hydrosurgery, laser-assisted treatments, and dermabrasion.Settings and Design:In this two-center study, patients’ charts and photodocumentation were analyzed retrospectively.Materials and Methods:Surgery was performed under general anesthesia with an additional local anesthesia of the affected areas of the nose. We removed the hypertrophic tissue in thin layers with a sterile disposable razor blade under constant visual control of the underlying cartilage and adnexal structures. A dressing with Mepithel and gauzes was applied. Patients presented weekly to monitor the wounds. Follow-up was 1 year.Results:From 2016 to 2019, nine male patients with rhinophyma underwent surgical therapy at AGAPLESION Markus Hospital, Frankfurt am Main, Germany and at the Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Austria. The mean age of the patients was 66 years. Mean time to complete re-epithelization equaled 31.5 days. No recurrences were noted within the follow-up period of 1 year. Patients’ satisfaction was very high. Only one patient had hypertrophic scars at the wing of the nose and another one developed a superficial fistula without connection to the nasal cavity.Conclusion:To the best of our knowledge, this is the first case series describing the use of a disposable razor blade for rhinophyma treatment supporting its efficiency described in previous anecdotal publications. We can highly recommend the technique, as it is cost-efficient and simple and provides excellent aesthetic results.