Relative Analgesia Research Articles

Opiate prescription after hip and knee arthroplasty: a retrospective cohort study.

Excessive opiate analgesia in relation to orthopaedic surgery is associated with morbidity and mortality. Pre-operative use of opiates is associated with higher post-operative use. There is little information about opiate prescribing practices in relation to elective total joint arthroplasty (TJA) in New Zealand rural centres. The aims of this study were to describe opiate use before, immediately after and 1 year after TJA, and to compare prescribing practices with local guidelines. A retrospective cohort study of elective primary hip and knee arthroplasties was conducted between January 2018 and April 2019. Opiate use was evaluated from clinical records and from electronic prescribing records and described in morphine milligram equivalents (MME) with a particular focus on pre-operative and post-operative periods, and use after 1 year. In the study period, 199 patients underwent 203 joint arthroplasties. Of these, data from 157 patients were analysed. Patient data were not analysed because of unavailable files (N=20), non-elective procedures (N=11), bilateral arthroplasties (N=4), deaths (N=4) and incomplete information (N=3). Pre-operative opiates were used by 92 (59%) patients, of whom 70 (76%) were not using opiates after 1 year. There were 126 (80%) patients who were discharged with opiate prescriptions and the vast majority, 121 (96%), did not receive discharge prescriptions that conformed to local guidelines. Despite undergoing joint arthroplasty, about one quarter of patients who had been prescribed opiates before the operation were still receiving opiates after 1 year. There was poor compliance with local guidelines.

Use of Combined Relative Analgesia and Local Anesthesia for Children

Use of Combined Relative Analgesia and Local Anesthesia for Children

LARAGA – Pharmacological behaviour management in paediatric dentistry in the UK

While non-pharmacological behaviour management plays an important role in paediatric dentistry, it is not the solution for all children and a proportion will still require an adjunctive pharmacological approach such as local anaesthetic, relative analgesia or general anaesthetic (LA-RA-GA). Paediatric conscious sedation at Newcastle Dental Hospital (NDH) is distinctive in that RA is provided by both the Child Dental Health (CDH) and Sedation (SED) departments. The primary aim of this study was to evaluate the outcomes of the NDH paediatric sedation service and analyse the effect of various confounding factors involved in treatment. This cross-sectional analysis forms part of a retrospective service evaluation of the inhalation sedation service provided by Newcastle Dental Hospital. Anonymised data were collected on 200 patients attending NDH (100 CDH, 100 SED) between September 2019 and March 2020. Data were cleaned manually and analysed using descriptive statistics, exploratory analysis with chi-squared tests and multivariable analyses (logistic regression) to identify any factors associated with failed RA appointments. Overall success for the NDH paediatric inhalation sedation service was 90.5%; CDH %/n = 89%, SED %/n = 92. There was a significant association between a failed RA appointment and no RA experience, a mother attending as chaperone and patients being under six years old. The odds of failure in an afternoon appointment were 1.6 times higher than a morning appointment, and girls were 1.5 times more likely than boys to have a failed RA appointment. Dental treatment under combined RA and LA is a successful technique for managing mild-to-moderately anxious paediatric patients. Careful patient selection, based on patient cooperation at the initial consultation, alongside an episode of acclimatisation, may help increase treatment success rates. • Careful patient selection, based on patient cooperation at the initial consultation, is important when deciding if conscious sedation is appropriate for a patient. • Acclimatisation, via non-invasive treatment under conscious sedation, may play a crucial role in assessing suitability for more invasive treatment in the future. • Pharmacological behaviour management in paediatric dentistry exists along a spectrum, in which non-pharmacological management plays a pivotal role.

Linear Discriminant Analysis for Investigating Differences in Upper Body Movement Symmetry in Horses before/after Diagnostic Analgesia in Relation to Expert Judgement.

Simple SummaryIdentifying the anatomical structures involved in causing pain and an associated lameness in a horse typically requires assessment in straight lines and circles and using regional administration of local anesthetic drugs (diagnostic analgesia). Visual assessment of changes in movement are affected by bias, i.e., expected changes influence decisions. Quantitative measurements with inertial sensors aim at removing this bias. The current study is aimed at investigating how a specific data-driven method, linear discriminant analysis (LDA), may be useful for aiding veterinary decision making about perceived changes in lameness. Changes in movement data after diagnostic analgesia and expert judgements from 53 lame horses were used to study (a) the accuracy of LDA-based decision making, (b) differences between straight-line and circular movement and (c) which commonly used movement features are most useful in this context. Accuracy was comparatively low and varied considerably between 36% and 57%, indicating considerable overlap between movement symmetry data of the diagnostic analgesia categories. The best data-driven separation between categories was observed when the limb in which perineural anaesthesia had been performed was on the inside of the circle (on hard ground for forelimb and on soft ground for hindlimb diagnostic analgesia). Movement features of all three landmarks (head, withers, pelvis) were important for data-driven classification, emphasizing the complexity of the movement pattern changes after diagnostic analgesia observed in lame horses.Diagnostic analgesia and lunging are parts of the equine lameness examination, aiding veterinarians in localizing the anatomical region(s) causing pain-related movement deficits. Expectation bias of visual assessment and complex movement asymmetry changes in lame horses on the lunge highlight the need to investigate data-driven approaches for optimally integrating quantitative gait data into veterinary decision-making to remove bias. A retrospective analysis was conducted with inertial sensor movement symmetry data before/after diagnostic analgesia relative to subjective judgement of efficacy of diagnostic analgesia in 53 horses. Horses were trotted on the straight and on the lunge. Linear discriminant analysis (LDA) applied to ten movement asymmetry features quantified the accuracy of classifying negative, partial and complete responses to diagnostic analgesia and investigated the influence of movement direction and surface type on the quality of the data-driven separation between diagnostic analgesia categories. The contribution of movement asymmetry features to decision-making was also studied. Leave-one-out classification accuracy varied considerably (38.3–57.4% for forelimb and 36.1–56.1% for hindlimb diagnostic analgesia). The highest inter-category distances (best separation) were found with the blocked limb on the inside of the circle, on hard ground for forelimb diagnostic analgesia and on soft ground for hindlimb diagnostic analgesia. These exercises deserve special attention when consulting quantitative gait data in lame horses. Head and pelvic upward movement and withers minimum differences were the features with the highest weighting within the first canonical LDA function across exercises and forelimb and hindlimb diagnostic analgesia. This highlights that movement changes after diagnostic analgesia affect the whole upper body. Classification accuracies based on quantitative movement asymmetry changes indicate considerable overlap between subjective diagnostic analgesia categories.

Physiological Effects, Psychomotor Analysis, Cognition, and Recovery Pattern in Children Undergoing Primary Molar Extractions under Nitrous Oxide Sedation Using Two Different Induction Techniques: A Split-mouth Randomized Controlled Clinical Trial.

Nitrous oxide inhalation sedation (NOIS) has been in use as a tool for pharmacological behavior modification and relative analgesia (RA) for well over 170 years now since its discovery in 1844 by the American Dentist Horace Wells. Advantages include raising of the pain reaction threshold, alteration of both pain sensitivity and pain reaction, reduction of fatigue, and time awareness that helps to handle stress and lengthy appointments. In addition, the most important clinical consequences of Nitrous Oxide (N2O) pharmacokinetics are rapid induction and recovery, reversibility, titrability, and adjustability. The goal of the current investigation was to analyze the safety aspects of nitrous oxide sedation. It was carried out on 25 patients within the age group 7-10 years requiring extractions of two primary molars in each patient. Split-mouth design was followed, with the first extraction done under traditional slow induction while the second extraction was done following the rapid induction technique of NOIS. N2O was studied for its physiological effects, psychomotor analysis was done, cognition and recovery patterns were analyzed utilizing the two different induction techniques. Based on the results obtained, it was found that N2O is a very safe and useful drug that delivers a comfortable patient for dental treatment.How to cite this articleKhinda V, Rao D, Sodhi SPS, et al. Physiological Effects, Psychomotor Analysis, Cognition, and Recovery Pattern in Children Undergoing Primary Molar Extractions under Nitrous Oxide Sedation Using Two Different Induction Techniques: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S131-S137.

Exploring patients’ experiences of analgesia after major lower limb amputation: a qualitative study

ObjectivesTo explore patient experiences, understanding and perceptions of analgesia following major lower limb amputation.DesignQualitative interview study, conducted as part of a randomised controlled feasibility trial.SettingParticipants were recruited from two general...

Conscious sedation, general anaesthesia for patients with special needs

This study aimed to identify indications for dental treatment under general anaesthetic (GA) and conscious sedation for adult patients with special needs in public dental clinics and recommend pathways to provide safe and effective care. Following ethics approval from relevant institutions (Approval No: EC00172; Reference No: 49013), de-identified data was collected and analysed from relevant hospital record software, dental record software and patient paper charts. A total of 444 patients (> 18 years old) who underwent 607 conscious sedation or GA treatment sessions (1st January 2015 -31st December 2018) were included. Treatment was provided by specialists in Special Needs Dentistry (SND) or postgraduate students in SND or general dentists. Overall, 395 of the 444 patients (89.0%) had conditions that affected their dental management, with the most common being medical conditions (87.4%), followed by intellectual disability (74.7%), physical disability (33.6%) and psychiatric conditions (16.8%). Statistically significant differences were seen between patient cohorts treated using relative analgesia (RA), intravenous (IV) sedation and GA for multiple parameters including elements of medical complexity. Using public dental cost parameters, RA was the most cost-effective and clinically efficacious. The study showed under-utilisation of RA and IV sedation compared to GA for patients with special needs, although RA was superior for clinical productivity. Referrals for patients with special needs should be triaged by SND team members (specialists or postgraduate students), to determine the appropriate modality for care (behaviour management/conscious sedation/GA) by clinicians within their scope of practice.

Pain perception using a computer-controlled anaesthetic delivery system in paediatric dentistry: A review.

In paediatric dentistry it is essentials to reduce axiety and fear induced by local anaesthetic injection, in order to obtain patient's cooperation and achieve a successful treatment. Hence, this review is aiming to primary evaluate pain perception in paediatric patients when using a computer-controlled local anaesthetic delivery system (C-CLADS) compared to traditional injection. A database literature search was conducted on both MEDLINE and Cochrane Central Register of Controlled Trials and a data extraction table was created to perform a critical evaluation of each scientific article. The primary results were the perception of pain during anaesthesia and the patient's behaviour, the secondary the amount of anaesthetic required and its duration over time. In the review were included 7 clinical studies regarding paediatric patients where split-mouth designs or group division were used. The age range was between 5 and 17 years old. Pain and fear parameters were measured by visual analogue scales, behavioural scales, heart rate and satisfaction questionnaires. Substantial heterogeneity between clinical trials was observed, which led to difficult comparison. Computerised devices have proved to be interesting in reducing pain during anaesthesia, improving the approach to the paediatric patient. It is advisable to conduct research with anxious subjects and patients under the age of 4, because no evidence has been found in the literature. It is recommended to conduct further research with anxious subjects and patients below the age of 4, where Relative Analgesia by Langa or pharmacological anxiolysis are frequently used.

EJPD Impact Factor 2020: An extraordinary success!

The European Journal of Paediatric Dentistry (EJPD) has reached the extraordinary Impact Factor of 1.5 (Journal Citation Reports 2020 Release), passing in few years from 0.421 in 2015, when Luigi Paglia became Editor in Chief, taking over the Journal after Giuliano Falcolini. EJPD is the official journal of the Italian Society of Paediatric Dentistry (SIOI), but its scientific value and diffusion made it an authoritative reference source not only in Europe, but also worldwide. This is the result of the great work and commitment of the Editorial Board, composed by national and international experts, with the collaboration of the Managing Director Giuseppe Marzo and of the editorial staff. The prominent position that EJPD has gained in the international ranking of dental journals, where the top tier is dominated by those that mainly focus on adult patients, rewards its constant pursue of excellence of the scientific approach, giving at the same time great importance to articles dealing with everyday practice. This is the reason why the papers published in the EJPD are so rich in images. Communication through images is paramount for the current generation and generations to come. Digital diagnostic instruments and advanced treatments, 3D technologies, the current concepts of aerosol and no aerosol technique, together with the progress in the field of new dental materials, like bioactive cements for paediatric restorations or new biocompatible technopolymers (milled or 3D printed) for dentofacial orthopaedics and orthodontics are areas of great interest. We believe that our Journal should pay special attention to papers that take into account the overall health and wellness of the child using safe and efficient preventive, therapeutic or comfort techniques (laser, ozone, relative analgesia, caries diagnosis with transillumination, etc), also considering the importance of environmental conditions and promoting the collaboration with other specialists, with a focus on special need patients. EJPD also aims at guiding young paediatric dentists-graduating from postgraduate schools and residency programmes in paediatric dentistry-with a more comprehensive approach to the practical aspects of the profession, while striving to become the global scientific reference point of maternal and child oral care, defending them from the attractive flatteries of the predatory journals.

The self-perceived role of sedation-trained dental nurses within a Community Dental Service: a qualitative study.

Background Dental nurses trained in assisting with relative analgesia with nitrous oxide (RA) play an important role in patient care. Provision of RA is a service provided in the Community Dental Service based in Doncaster, Barnsley and Rotherham.Aim To explore how sedation-trained dental nurses perceive their role within a Community Dental Service, and to explore what motivates them and how they feel changes could enhance the provision of care.Methods Twelve nurses who had experience of assisting with RA for at least one year in three community clinics in a South Yorkshire-based Community Dental Service were recruited and undertook a semi-structured interview. All interviews were transcribed verbatim and subsequent thematic analysis of the manuscripts was undertaken.Results Five major themes were identified: 1) motivation; 2) role; 3) training and continuing professional development; 4) pressures on the service; and 5) service enhancements.Conclusion Within this qualitative study, the dental nurses perceived that they had a crucial role in patient and parent behavioural management and keeping the patient safe during treatment. Helping patients to accept planned dental treatment gave them significant job satisfaction. Overall, this study has shown that they feel that they have a crucial role in assisting with RA treatment.

Point-of-Care Ultrasound to Assess Gastric Content in Pediatric Emergency Department Procedural Sedation Patients.

There is debate regarding the timing of procedural sedation and analgesia (PSA) in relation to fasting status. Point-of-care ultrasound (POCUS) provides the ability to measure gastric content and is being used as a surrogate for aspiration risk in anesthesia. We sought to evaluate the gastric content of pediatric emergency department (PED) patients undergoing PSA using POCUS. We performed a prospective observational study using a convenience sample of pediatric patients undergoing PSA between July 1, 2018, and June 30, 2019. Following a brief history, gastric content was measured using POCUS in both supine and right lateral decubitus positions at 2-hour intervals until the time of PSA. Qualitative content and calculated volume were classified based on the Perlas Model of anesthesia "Risk" assessment. Ninety-three patients were enrolled with 61.3% male and mean age of 6.5 years. Gastric content was determined in 92 patients. There were 79.3% that had "high risk" content at the time of PSA, with a median fasting time of 6.25 hours and no serious adverse events. Fasting duration had a weak to moderate ability to predict "risk" category (area under the curve = 0.73), with no patient (n = 17) who underwent multiple evaluations awaiting PSA progressing from "high" to "low risk." The majority of PED patients undergoing PSA at our institution had "high risk" gastric content with no clinically significant change occurring during serial evaluations. This calls into question the utility of delaying PSA based upon fasting status and lends support to a more comprehensive risk-benefit approach when planning pediatric PSA.

Comparative study of epidural labour analgesia and programmed labour analgesia in relation to effect on ambulation and interventions required at a tertiary hospital

Comparative study of epidural labour analgesia and programmed labour analgesia in relation to effect on ambulation and interventions required at a tertiary hospital

Comparative study of epidural labour analgesia and programmed labour analgesia in relation to fetal and maternal outcome

Comparative study of epidural labour analgesia and programmed labour analgesia in relation to fetal and maternal outcome

Inhalation sedation – looking forward to the digital age

As we progress into the 21st century, Janet Pickles suggests it is good to reflect on the origins of the modern inhalation sedation (or relative analgesia) machine

Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry.

ABSTRACTBackgroundMany studies were conducted to assess the benefit/risk of equimolar mixture of oxygen and nitrous oxide (EMONO), but evaluating the appetite associated to its use is now getting very little attention in the literature. The purpose of this study was to investigate the effects present, felt, and sought during care by the child related with the 50% nitrous oxide/oxygen (EMONO) sedation used in pediatric dentistry.Materials and methodsAll patients in consultation with the Dental Service of Nantes hospital and in need of EMONO were included in the study. In this prospective single-center study, the effects present, felt, and sought during care by the child and the assessment of EMONO appreciation were recorded. The presence of clear signs that the child was trying to extend the duration of the EMONO use was also sought.ResultsOnly 62% of the patients were presented with an anxiolytic effect, and 40% relative analgesia. Both effects were associated in 33% of children. Over the 76 patients assessed, 12 attempted to extend the duration of the EMONO use (16%). After a bivariate statistical analysis, none of the variables appeared significantly associated with the extension of the EMONO use duration.ConclusionThe significant proportion of patients who have prolonged the EMONO use seems to indicate a real attraction for nitrous oxide. This is the first study to evaluate nitrous oxide appreciation on a child.How to cite this articlePrud’homme T, Allio A, Dajean-Trutaud S, et al. Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry. Int J Clin Pediatr Dent 2019;12(5):429–436.

Medically induced labor: Epidural analgesia and women's perceptions of pain in early labor.

INTRODUCTIONApproximately 25% of all deliveries in Denmark are medically induced, typically characterized by more intense uterine contractions. The aim of this paper is to investigate the differences in the administration of epidural analgesia and pain experience between spontaneous and medically induced labor in nulliparous and multiparous women.METHODSThis is a prospective case-controlled study of 100 participating women in labor. The primary outcome was the timing of administration of epidural analgesia, by delivery progression and frequency. Pain scores were indicated by the McGill Pain Questionnaire and the duration of pain was also notified.RESULTSIn nulliparous and multiparous women, medically induced labor was associated with earlier administration of epidural analgesia in relation to the onset of labor pain, compared to women with a spontaneous onset of labor (10.4 vs 26.10 hours, p=0.0). There was a trend, however not statistical, in the use of epidural analgesia in relation to delivery progression, assessed as dilation of the cervix (3 cm vs 4.5 cm, p=0.07) and towards higher frequency for medically induced labor (51.5% vs 32.8%, p=0.07). In nulliparous women, a reduced period of labor pain was shown in medically induced deliveries compared to spontaneous deliveries (9.30 vs 19.00 hours, p=0.03). However, no significant differences in experienced pain were shown (Score: 28.70 vs 29.60, p=0.194).CONCLUSIONSEpidural analgesia was administered earlier, and duration of experienced pain was shorter in medically induced labor, in comparison to spontaneous deliveries. However, the experienced pain was not different, possibly explained by a more intense labor process.

Nitrous oxide analgesic effect on children receiving restorative treatment on primary molars.

Pain experienced during dental treatment increases the risk of developing dental anxiety in children who will became anxious adults, avoiding dental care. It is therefore essential to provide pain-free dental treatment. The strongest fears are often associated with injections: being able to successfully complete painless restorative treatment without the need for local anesthesia injection is therefore an important goal. Nitrous oxide administration by means of Langa's Relative Analgesia (RA) technique has been demonstrated to have both sedative and bland analgesic properties: the mechanism by which N2O exerts its analgesic effects is now understood. The purpose of this study was to test the analgesic effectiveness of Nitrous Oxide used in the RA technique as the only analgesic agent for restorative treatment of primary molars presenting caries lesions without pulp involvement. Ninety patients aged between 3.2 and 9.4 years, 38 males and 52 females, ASA I and II, were included in the study. One hundred and thirty-four restorations were completed on primary molars with caries lesions without pulp involvement (1/3 to 2/3 into dentin): 72 restorations were completed on 48 patients under RA in the Study Group and 62 restorations were performed on 42 patients under RA and local anaesthesia (LA) in the Control Group. At the end of each session, the perception of pain experienced during treatment was rated by each patient using the Wong-Baker FACES® Pain Rating Scale. No statistical difference on self-reported pain perception was seen in the Study Group (treatment under RA) and in the Control Group (treatment under RA plus LA administration). The results also showed no significant difference in pain sensation between males and females; age as well as gender did not affect the results between groups. Nitrous oxide as used in the Langa's RA technique is effective in providing a sufficient analgesic outcome during restorations of primary molars when there is no pulp involvement, with no need for LA supplement.

Impacto del manejo perioperatorio en el pronóstico oncológico del cáncer de mama no metastásico. Un paradigma de futuro

IntroductionRecurrent disease or metastases are the main cause of death from breast cancer. ObjectivesTo assess the influence of perioperative and postoperative anaesthetic and analgesic techniques on the appearance of recurrences and breast cancer prognosis. Material and methodsA literature search was conducted for studies that assessed perioperative and postoperative anaesthetic technique and analgesia in relation to the oncological prognosis of breast cancer. ResultsWe identified 146 studies and selected 9 studies for a full text reading. DiscussionThe ability of tumour cells to escape patient immunity is the key to the development of metastases. Patient immunosuppression and perioperative inflammatory mediators could be involved in recurrence. ConclusionThe use of opioids, inhalational anaesthesia and the anaesthetic technique seem to have a negative influence on prognosis. However, there are currently only animal on in vitro studies on this topic.

A 'happy-air' alternative to general anaesthetic?

Does relative analgesia with nitrous oxide reduce the number of general anaesthetic sessions and dental loss?2018; 224: 429-433 http://dx.doi.org/10.1038/sj.bdj.2018.215.

Does relative analgesia with nitrous oxide reduce the number of general anaesthetic sessions and dental loss?

Does relative analgesia with nitrous oxide reduce the number of general anaesthetic sessions and dental loss?