Anesthetic Cream Research Articles

Acute cortisol and behavior of dairy goat kids administered local anesthesia, topical anesthesia or systemic analgesia prior to cautery disbudding

Cautery disbudding of goat kids causes thermal burns and tissue destruction, which results in acute and post-operative pain and negatively affects animal welfare. The objectives of this study were to evaluate acute cortisol concentrations and behavioral responses associated with (1) injecting a lidocaine ring block prior to cautery disbudding and comparing this to saline injections and (2) pain mitigation strategies (lidocaine ring block, topical eutectic mixture of local anesthetics (EMLA) cream, oral meloxicam) on cautery disbudded dairy goat kids. Sixty doe kids were allocated to one of six treatments: (1) disbudding without pain relief (DB), (2) a ring block using 1% lidocaine (DBLA) 20 min before disbudding, (3) saline injection (DBSA) 20 min before disbudding, (4) oral meloxicam 60 min before disbudding (DBMEL), (5) EMLA cream rubbed into the buds 60 min before disbudding (DBEM) and (6) handled but not disbudded (HAND). Blood was sampled pre- (-20 and -5 min) and post-treatment (15 and 30 min) to assess plasma cortisol concentrations and behavior during treatment was recorded using video cameras to assess rump movements, tail shakes and vocalizations (values presented as number/treatment). DBLA and DBSA kids showed elevated cortisol above baseline 5 min pre-disbudding (after injections) (P ≤ 0.01), which was no different to cortisol 15 min post-disbudding (P > 0.05). Rump movements and tail shakes of DBLA (5.5 ± 0.8 and 6.9 ± 1.2) and DBSA kids (5.6 ± 0.8 and 7.2 ± 1.2) were no different to those of DB kids (P > 0.10). Cortisol was elevated from baseline for 30 min post-disbudding for DBEM kids and DBMEL kids (P ≤ 0.05). Rump movements, tail shakes and vocalizations of DBEM (5.7 ± 0.8, 6.3 ± 1.2 and 11.1 ± 1.6) and DBMEL kids (5.3 ± 0.8, 8.0 ± 1.2 and 9.1 ± 1.6) were no different to those of DB kids (P > 0.05). HAND kids showed no change in cortisol over time (P > 0.10) and performed fewer rump movements, tail shakes and vocalizations than all treatments (P ≤ 0.01). In conclusion, lidocaine injection using a ring block appears to cause more pain than handling alone and may not reduce pain associated with cautery disbudding; therefore, a lidocaine ring block may not be a useful pain mitigation strategy for disbudding dairy goat kids. There was no evidence that meloxicam reduced acute pain and EMLA cream may have intensified the pain associated with disbudding. Further research on efficacious pain mitigation strategies for cautery disbudding of dairy goat kids is required.

Reducing Pain During Emergency Arterial Sampling Using Three Anesthetic Methods: A Randomized Controlled Clinical Trial.

Taking a sample of arterial blood is widely reported as a cause of significant pain. To compare three anesthetic methods with standard practice (no anesthesia) to establish which was the most effective in reducing pain caused by radial artery puncture in patients requiring an arterial blood gas test in the emergency department (ED). A randomized controlled trial was conducted to compare the effectiveness between anesthetic cream, cryoanalgesia, and subcutaneous mepivacaine in reducing pain caused by radial artery puncture in ED patients. After comparing perceived pain during arterial puncture, the lowest median score was obtained in the mepivacaine group (1 interquartile range 0.6-1.3) and the highest median score in the control group (5 interquartile range 4.0-7.0). When comparing the control group with the three intervention groups, the Kruskal-Wallis test showed that mepivacaine (p=0.023) and cryoanalgesia (p=0.012) were associated with significantly lower pain scores. The anesthetic cream (p=0.861) intervention group did not produce a statistically significant median difference compared with the control group. The results of this study encourage the use of anesthetic methods like cryoanalgesia or mepivacaine for their proven effectiveness in reducing or eliminating pain during arterial puncture.

Efficacy of lidocaine 7 %, tetracaine 7 % self-occlusive cream in reducing MAL-cPDT-associated pain in subjects with actinic keratosis: A randomized, single-blind, vehicle-controlled trial (The "3P-Trial").

Conventional photodynamic therapy (cPDT) is considered a very effective treatment of actinic keratosis (AK) lesions. However, its use is limited by the fact that this procedure could be very painful. The use of topical anesthetics such as tetracaine or lignocaine/prilocaine has shown disappointing results in term of pain reduction. A self-occlusive topical 7% lidocaine/7% tetracaine anesthetic cream (LT-C) approved by the FDA to provide local topical anesthesia in adults undergoing superficial dermatological procedures is available. There are no data regarding its pain reducing effect during cPDT. We perform a prospective, randomized, single-blind, two-center trial (The 3P-Trial) to assess the pain reduction effect of LT-C versus vehicle in subjects with AK undergoing cPDT. Fifty AK subjects (74 ± 10 years, 32 men, 18 women) with on average 17 lesions were enrolled after their written informed consent. Eight subjects presented also a total of 16 basal cell carcinoma lesions. Twenty-five were randomized to LT-cream, applied 1 h before the Methyl amino levulinate (MAL)-cPDT session and 25 to cream vehicle. The main outcome was the patient-assessed evaluation of pain score during and just after the conclusion of cPDT session (mean of the two values) using a 10-point visual analog scale (VAS). The cPDT session (LED Red light 630 nm) was performed with a duration of 6 ± 2 min with a standard fluence of 37 J/cm2. All treated lesions were prepared by gentle superficial curettage. All the randomized subjects concluded the trial. The mean ± SD of VAS score in vehicle group was 6.2 ± 2.7 (95 % CI of the mean: 5.0-7.5). In the group treated with LT-cream the VAS score was 3.3 ± 1.9 (95 % CI of the mean: 2.5-4.1). The active cream reduced the VAS score by 47 %. Median values of pain VAS score in the active group was reduced by 60 % in comparison with vehicle group (3.0 vs 7.5). The difference between the two groups was statistically significant (p = 0.0009; Mann-Whitney test). The 3P-trial has demonstrated that the preventive application of the self-occlusive lidocaine 7%-tetracaine 7% cream is very effective in reducing the procedure-associated pain during MAL-cPDT for the treatment of AK lesions.

Implementation Effectiveness of a Parent-Directed YouTube Video ("It Doesn't Have To Hurt") on Evidence-Based Strategies to Manage Needle Pain: Descriptive Survey Study.

BackgroundDespite the availability of high-quality evidence and clinical practice guidelines for the effective management of pediatric pain, this evidence is rarely used in practice for managing children’s pain from needle procedures such as vaccinations. Parents are generally unaware of pain management strategies they can use with their children.ObjectiveThis study aimed to develop, implement, and evaluate the implementation effectiveness of a parent-directed YouTube video on evidence-based strategies to manage needle pain in children.MethodsThis was a descriptive study. Analytics were extracted from YouTube to describe video reach. A Web-based survey was used to seek parent and health care professional (HCP) feedback about the video. The 2-minute 18-second video was launched on YouTube on November 4, 2013. In the video, a 4-year-old girl tells parents what they should and should not do to help needles hurt less. The key evidence-based messages shared in the video were distraction, deep breathing, and topical anesthetic creams. A group of parents (n=163) and HCPs (n=278) completed the Web-based survey. Measures of reach included number of unique views, country where the video was viewed, sex of the viewer, and length of watch time. The Web-based survey assessed implementation outcomes of the video, such as acceptability, appropriateness, penetration, and adoption.ResultsAs of November 4, 2018 (5 years after launch), the video had 237,132 unique views from 182 countries, with most viewers watching an average of 55.1% (76/138 seconds) of the video. Overall, both parents and HCPs reported strong acceptance of the video (ie, they liked the video, found it helpful, and felt more confident) and reported significant improvements in plans to use distraction, deep breathing, and topical anesthetic creams.ConclusionsThis parent-directed YouTube video was an acceptable and appropriate way to disseminate evidence about the procedure of pain management to a large number of parents.

Nonsurgical facial tightening after a fractional noninsulated microneedling radiofrequency treatment in Asians

AbstractBackgroundAs our previous three‐dimensional (3D) volumetric investigations have shown, noninsulated microneedle radiofrequency (NIMNRF) with 2.5‐mm penetration depth needles can induce long‐lasting tightening effects. However, further tightening effects for deeper tissues were sometimes required. The objective of this study was to investigate the efficacy of a novel fractional NIMNRF treatment strategy with 5.0‐mm penetration depth needles.Materials and MethodsTwenty Asian patients underwent full facial skin tightening using a sharply tapered NIMNRF applicator with a novel fractionated pulse mode. Patients received from 500 to 1000 pulses of 80 to 110 ms duration at a power of 10 to 14 W and a 1.5‐ to 5.0‐mm penetration depth. A topical anesthetic cream was applied before treatment. 3D volumetric assessments were performed at 6 months after the treatment. Patients rated their satisfaction using a 5‐point scale at each follow‐up.ResultsObjective assessments with superimposed 3D color images showed a significant volumetric reduction in lower two‐thirds of the face for all patients. About 85% of the patients were either “satisfied” or “very satisfied” with the treatment results. Side effects were mild and included a slight burning sensation and mild erythema that were minor and transitory. Posttreatment hyperpigmentation was not present, neither were other complications.ConclusionsThe advantages of the novel fractional NIMNRF treatment are the high potency of facial tightening effects, and reduction of discomfort and side effects. Taken together, these characteristics facilitate the ability to give repeated treatments and provide an alternative or adjunct treatment for patients with improved results.

Snodgrass vs Snodgraft operation to repair the distal hypospadias in the narrow urethral plate

Using the Snodgraft technique in patients with urethral plate less than 8mm to repair distal hypospadias is still debatable. Some authors assume that augmentation may be beneficial. We aimed to compare the outcomes of the Snodgrass vs Snodgraft procedure in patients with a narrow urethral plate less than 8mm. This prospective randomized study included 60 children who had been treated by the Snodgrass or Snodgraft procedure for repair of distal penile hypospadias with narrow urethral plate from March 2017 to September 2018. They were randomized into two subgroups. Group 1 (30 patients) underwent tubularized incised plate urethroplasty, whereas the second group (30 patients) underwent the Snodgraft procedure by using the inner prepuce. Operative details, postoperative period, and complications were reported and statistically analyzed using IBM SPSS software package version 20.0. The operative time was longer for patients who underwent the Snodgraft procedure: 78 (55-95) and 110 (80-140) minutes in groups 1 and 2, respectively. In group 1, there was one case of meatal stenosis which was resolved by urethral dilation using the local anesthetic cream in the outpatient clinic. In addition, there was another case of distal penile fistula. In group 2, there was a case of complete wound disruption and another of distal penile fistula. There was no significant difference in the complication rate in any group. The operative time was longer in group 2 than in group 1 but with comparable outcomes. The Snodgraft procedure is not superior to the Snodgrass operation in the narrow healthy urethral plate.

Pressure-and dose-controlled, needle-free, transcutaneous pneumatic injection of botulinum neurotoxin-A for the treatment of primary axillary and palmoplantar hyperhidrosis.

Botulinum neurotoxin (BoNT) effectively downregulates the secretion of eccrine sweat glands in patients with axillary and palmoplantar primary hyperhidrosis (PH). To demonstrate the efficacy and safety of pressure- and dose-controlled, needle-free, transcutaneous pneumatic injection (TPI) of BoNT-A for treating axillary and palmoplantar PH. Needleless TPI-BoNT-A treatments were delivered on the axillary or palmoplantar skin at a pneumatic pressure of 2.05 bars and an injection volume of 0.08mL/shot. The efficacy thereof was assessed by evaluating starch-iodine test results and Hyperhidrosis Disease Severity Scale (HDSS) scores. At baseline, median HDSS scores were 3 (IQR, 3-4) for axillary lesions and 4 (IQR, 3.5-4) for palmoplantar lesions. Median HDSS scores at 1month after TPI-BoNT-A treatment significantly decreased to 1 (IQR, 1-1.75) for axillary lesions (P<.001) and 1 (IQR, 1-2) for palmoplantar lesions (P<.001). Median global improvement scale scores were 4 (IQR, 3.25-4) for axillary PH and 3 (IQR, 2.5-4) for palmoplantar PH (P>.05). In all patients, pain was tolerable during treatments for both axillary and palmoplantar PH after the application of topical anesthetic cream. Pressure- and dose-controlled, needle-free, BoNT delivery effectively and safely decreased sweating in axillary and palmoplantar skin.

A Randomized Controlled Trial of Three Noninvasive Analgesic Techniques for the Prevention of Pain During Facial Injections.

Injections are associated with a certain amount of pain, the tolerance of which can vary between individuals. With regard to noninvasive pain control techniques in subcutaneous injections, few studies with adequate levels of evidence and design quality exist to support any specific analgesic method. In this study, we evaluated the efficacy of 3 noninvasive analgesic techniques (cold, anesthetic cream, and vibration) during subcutaneous forehead injections in 100 healthy volunteers. This randomized, single-blind, controlled trial comprised 100 healthy volunteers. Every patient received 4 forehead injections of 0.1 mL physiological saline through 29G needles after 1 of 3 noninvasive analgesic techniques (cold, vibration, or anesthetic cream) or control treatment was applied to each injection site. The results were evaluated through a survey that included a visual analog scale for pain measurements. All analgesic methods demonstrated better pain control than the no-treatment arm (P < 0.001), of which vibration performed better than the other analgesic techniques (P < 0.015 vs cold and P < 0.015 vs anesthetic cream). No differences were observed between cold and anesthetic cream. The average amount of pain per injection in males was higher than in females (P < 0.014). Vibration analgesia effected significantly better pain control than cold and anesthetic cream. Nevertheless, the choice of anesthetic method should be adapted to the preferences and experiences of each patient to optimize pain control in procedures that involve subcutaneous injections.

Management of pain at arteriovenous fistula puncture: Cryotherapy versus lidocaine/prilocaine.

Pain at arteriovenous fistula (AVF) puncture is common in hemodialysis (HD) patients. The purpose of our work is to determine its frequency, to evaluate the efficiency of two techniques: anesthetic cream (Emla™) and cryotherapy, and to compare their efficiency. A prospective and interventional analytical study of HD patients was conducted in our structure. We included all patients with pain at AVF puncture. We evaluated the pain intensity using a visual analogue scale before and after our intervention: Emla™ cream during three consecutive HD sessions, then cryotherapy (ice cubes placed in latex gloves, during 5 min, directly applied on the puncture sites) during three consecutive HD sessions. The statistical analysis was performed using the Epi Info software. Eighty-four patients are undergoing HD in our structure, of which 32 (38%) report pain at AVF puncture. The mean value of the visual analog scale before the puncture was 7.19 ± 1.95 (4-10). Pain decrease was statistically significant for both techniques. Comparative analysis of the two techniques revealed a significant reduction in pain in favor of cryotherapy (P 0.001). The analgesic effect has been proved for both techniques. Cryotherapy provides higher efficiency, with fewer constraints, and could be proposed for the management of pain at AVF puncture.

Methemoglobinemia Secondary to Herbal Products.

Dear Editor, We read with interest the recent article by Al-Qahtani et al. regarding methemoglobinemia in a young boy.[1] We would like to discuss few other essential points that we believe to be important for Saudi J Med Med Sci readers to have a comprehensive understanding of this topic.[23] While there seems to be a good temporal correlation between Ferula asafoetida ingestion and the development of methemoglobinemia in the case reported, we still strongly recommend that in such cases, a comprehensive workup should be performed to rule out congenital methemoglobinemia. In young patients, we should be very cautious and always consider congenital methemoglobinemia before labeling them as a case of acquired methemoglobinemia. We recommend genetic testing for cytochrome b5 reductase deficiency and hemoglobin (Hb) M to ensure that in such cases, the child is free from any genetic perturbations that can put him/her at risk for the recurrence of methemoglobinemia in future.[4] Hb M is a special variant in which heme iron can undergo auto-oxidation, resulting in methemoglobinemia. The common Hb M variants are Hb M-Boston, Hb M-Iwate, Hb Auckland, Hb Chile, Hb M-Saskatoon and Hb M-Milwaukee. Food products such as frozen items may have high nitrate content, and there have been reports of clusters of cases with many family members developing methemoglobinemia because of frozen food consumption.[5] In addition, it should be noted that rarely used topical agents such as eutectic mixture of local anesthetic cream, e-cigarettes, contaminated water and other herbal medicines such as choy sum can lead to methemoglobinemia.[6] In the case reported by Al-Qahtani et al., it is unclear why the patient had anemia of 10.4 g/dl and leukocytosis of 24,000/mm. Did the authors look for hemolysis in this case and what was the likely explanation of the high white blood cell count? Getting a serum lactate dehydrogenase and other hemolytic panel such as serum haptoglobin, direct antiglobulin test and peripheral blood smear would be beneficial to rule out concomitant hemolysis that can be associated with methemoglobinemia.[7] The family history is very relevant in this case, as rightly explained by Al-Qahtani et al.[1] As per the history provided, both the brothers of the infant had glucose-6-phosphate dehydrogenase (G6PD) deficiency. However, we recommend that the parents should also be checked for this deficiency. In case of a male boy, there is a 50% chance of having a G6PD deficiency if the mother is a carrier. Therefore, genetic testing of parents is mandatory to predict the likelihood of transmitting the condition to children. Methylene blue (MB) is the drug of choice in the management of methemoglobinemia. In the case reported by Al-Qahtani et al., MB was not given for the fear that he may be positive for G6PD deficiency given the strong family history. This patient was critically sick and mechanically ventilated. We are not sure about the logistic resources at the author’s medical center, but a rapid fluorescent spot test for G6PD deficiency is now readily available, which can confirm G6PD deficiency in as early as a few minutes.[8] This patient was not given either MB or vitamin C and instead was successfully treated with hyperoxic ventilation. This is a great learning case, but we wish to reinforce the fact to the readers that MB should be the first choice and all efforts should be made to check the G6PD status so that patients are not denied the standard of care. It should also be noted that in addition to MB and ascorbic acid, other drugs such as riboflavin and cimetidine can be used to treat methemoglobinemia with variable outcomes.[3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Taking care of healthcare workers during COVID-19 pandemic: does plastic surgery have a role?

Background:The massive use of personal protective equipment is required by the medical and paramedical staff of the COVID-19 dedicated departments. This often causes painful pressure injuries. The aim of this study is to value the use of anesthetic cream and collagen veil masks for the treatment of pain. We also evaluated the possible psychological impact on healthcare workers involved in the emergency, which is currently a hot topic in the worldwide literature.Materials and Methods:We applied lidocaine idrochloride 5% cream and a collagen veil mask respectively before and after each work shift. We evaluated the improvement of pain symptoms through VAS assessments. We used a modified Maslach burnout inventory as well to evaluate the psychological impact of our treatments on healthcare workers.Results:A significant reduction of pain was detected within the first 3 days, but this was not significant over the long period (10 days). Otherwise, we saw a significant improvement of the psychological assessment (p<0,05).Conclusions:Parameters such as pain or psychological stress are not objective, but, anyway, our data show a reduction of pain due to continuative PPE wearing and a significant improvement of psychological wellness of healthcare workers from two different countries, a finding which should not be undervalued by all the health caregivers not directly involved in COVID-19 pandemic. (www.actabiomedica.it)

The use of lidocaine/prilocaine anesthetic cream for laser procedures in dermatology and cosmetology

The use of lidocaine/prilocaine anesthetic cream for laser procedures in dermatology and cosmetology

Effect of lidocaine cream analgesia for chest drain tube removal after video-assisted thoracoscopic surgery for lung cancer: a randomized clinical trial

Background and objectivesPain management makes an important contribution to good respiratory care and early recovery after thoracic surgery. Although the development of video-assisted thoracoscopic surgery (VATS) has led to improved...

Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy

ObjectiveTo evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. MethodsThis cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. ResultsOf the 124 patients included in the study, 56 (45.2%) experienced a pain level≤2. In the Group III a significantly greater proportion of patients were classified with a pain level score≤2, P<.001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). ConclusionThe results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP.

Sticky boundary to retain a thick layer of eutectic mixture of local anesthetics cream at surgical site for effective anesthesia

Topical anesthetic creams are widely used to provide local anesthesia in dermatologic surgery. To achieve the desired effect, a certain degree of penetration is required. This effect can be achieved by occlusion with a transparent dressing. However, the use of dressings for occlusion can lead to spillage of the cream, which can result in a poor anesthetic effect.1 The recommended dose of the drug is 1.5-2 g per 10 cm2 area of skin, which might not be retained under the occlusive dressing.2 Furthermore, because of poor drug diffusion, the effect of occlusion is poor in areas with physiologically thick skin, such as the feet and upper back, or in pathologically hyperkeratotic, acanthotic, or fibrosed skin.

혈액투석 환자의 동정맥루 천자 시 피부자극법과 국소마취크림 도포에 따른 통증과 심박변이도 비교

혈액투석 환자의 동정맥루 천자 시 피부자극법과 국소마취크림 도포에 따른 통증과 심박변이도 비교

Pain assessment and factors influencing pain during bone marrow aspiration: A prospective study.

Although bone marrow aspiration (BMA) is still considered a painful procedure, pain level remains poorly documented. We therefore conducted a prospective study intended to evaluate pain level in adult patients undergoing BMA at the sternal or iliac crest site to identify factors associated with pain. We enrolled a total of 448 patients who underwent 461 BMA and asked those patients to score their pain intensity after BMA using numerical pain rating scale (NPRS). The following factors: level of anxiety, quality of the information given to the patient, operator’s experience, and bone texture were recorded using a standardized questionnaire. The median NPRS score was 3.5 (IQR [2.0; 5.0]) the sternal site (n = 405) was associated with an increased median NPRS score (3.5 [2.0; 5.0]) compared to the iliac crest (n = 56, 2.5 [1.0; 4.0]; p<0.0001). For those patients who underwent sternal BMA, the median NPRS score was significantly lower when using lidocaine infiltration (p = 0.0159) as compared with no anesthetic use. Additionally there was no significant effect of anesthetic cream found. After multivariate analysis, the model of NPRS score at the sternal site included patient anxiety (p<0.0001) and the use of lidocaine infiltration (0.0378). This study underlines the usefulness of a comprehensive management including pain relief and efforts to reduce anxiety including appropriate information given to the patient during BMA.

Nitrous Oxide Reduces Pain Associated With Local Anesthetic Injections.

Local anesthetic injections can be painful and distressing. The aim of this study was to determine whether nitrous oxide, ice, vibration, or topical anesthetic improves analgesia for local anesthetic injections. A cohort study of 400 patients undergoing Mohs micrographic surgery with local anesthetic was conducted. Patients received no intervention (n = 200), ice (n = 50), topical anesthetic cream (n = 50), vibration device (n = 50), or nitrous oxide (n = 50). Pain was rated using the Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale. Without intervention, mean VAS was 4.2 and FACES was 4.6. Nitrous oxide was the most successful in reducing pain (mean VAS 1.6 vs. 4.2, P < .01, FACES 1.2 vs. 4.6, P < .01). Topical ice reduced pain (mean VAS 3.0 vs. 4.2, P < .01, FACES 3.0 vs. 4.6, P < .01). Vibration reduced pain (mean VAS 3.5 vs. 4.2, P < .01, FACES 3.6 vs. 4.6, P < .01). Higher pain scores were associated with age <50 (P = .02), male sex (P = .05), and surgery on the nose, lip, ear, or eyelid (P = .02). Nitrous oxide, ice, and vibration reduce injection pain. These interventions are especially useful for younger males undergoing surgery on the nose, lip, ear, or eyelid.

Anesthetic cream relieves pain after cryotherapy treatment of plantar and palmar warts.

Cryotherapy using liquid nitrogen is an effective and commonly used treatment for palmoplantar warts. However, pain can be a limiting factor in the effective use of cryotherapy. In this study, we found that a single application of anesthetic cream following cryotherapy treatment of warts reduced posttreatment pain and led to improved tolerability of the procedure.

THE EFFECTIVITY OF EUTECTIC MIXTURE OF LOCAL ANESTHETICS CREAM AS EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY ADJUVANT ANALGESIA IN SOETOMO GENERAL HOSPITAL

Objective: The Extracorporeal Shockwave Lithotripsy (ESWL) procedure is the first choice for kidney stone therapy with the size ≤20mm. One of the complications of ESWL is the pain. Pain control during ESWL is essential to maintain the focus point of ESWL and give enough time to achieve complete stone fragmentation. Until now there is still no data about the effectiveness of Eutectic Mixture of Local Anesthetics (EMLA) cream as an adjuvant analgesic for ESWL procedure in Soetomo Hospital Surabaya. To compare the onset of pain and ESWL Wong-Baker Pain Scale (WBPS) between the EMLA group and placebo group. Material &amp; Methods: The design of this study was a single-blind randomized control trial comparing the onset of pain and Wong Baker pain scale between the patient in EMLA group and placebo one. WBPS is assessed in minute 15, 30, 45, and 60 of ESWL sessions and 60 minutes post ESWL procedure. The results were analyzed with SPSS. Pain onset and differences of WBPS were tested by using independent T-test if the data is normally distributed and using Mann-Whitney test if the data is not normally distributed. Results: 10 patients were obtained in each group. The mean onset of pain in the EMLA group was longer than the mean onset of pain in the placebo group but statistically not significant (p&gt;0.05). The WBPS in the EMLA group was significantly lower compared with the placebo group in the 30, 45, and 60 minutes of ESWL (p&lt;0.05). Conclusion: EMLA cream application before ESWL was effective and safe as an adjuvant analgesic to reduce pain during ESWL.