Anesthetic Spray Research Articles

Lidocaine spray vs mepivacaine local infiltration for suturing 1st/2nd grade perineal lacerations: a randomised controlled non-inferiority trial

BackgroundPerineal lacerations are a very common complication of post-partum. Usually, the repair of 1st and 2nd-grade lacerations is performed after the administration of local anesthesia. Despite the great relevance of the problem, there are only a few studies about the best choice of local anesthetic to use during suturing. We performed a randomised controlled trial to evaluate the efficacy and safety of the use of a local anesthetic spray during the suturing of perineal lacerations in the post-partum.MethodsWe compared the spray with the standard technique, which involves the infiltration of lacerated tissues, using the NRS scale. 136 eligible women who had given birth at University Hospital of Udine were enrolled and randomly assigned to receive nebulization of Lidocaine hydrochloride 10% spray (experimental group) or subcutaneous/submucosal infiltration of mepivacaine hydrochloride (control group) during suturing of perineal laceration.ResultsThe lacerations included 84 1st-grade perineal traumas (61.7%) and 52 2nd-grade perineal traumas (38.2%). All the procedures were successfully completed without severe complications or serious adverse reactions. There were no statistically significant differences between the two groups in terms of blood losses or total procedure time. Moreover, there were no statistically significant differences in terms of NRS to none of the intervals considered. Regarding the application of the spray in the B group, in 36 cases (52.9%) it was necessary to improve the number of puffs previously supposed to be sufficient (5 puffs). Just in 3 cases, an additional injection was necessary (4.4%).ConclusionsOur study demonstrates that lidocaine spray alone can be used as a first line of local anesthetic during the closure of I-II-grade perineal lacerations, as it has comparable efficacy to mepivacaine infiltration.Trial registrationThe trial was recorded on https://clinicaltrials.gov. Identification number: NCT05201313. First registration date: 21/01/2022. Unique Protocol ID: 0042698/P/GEN/ARCS.

Comparison of Mucosal Vibration and Topical Anesthetic Spray for Pain Reduction during Local Anesthesia in Young Adults: A Randomized Controlled Clinical Trial

Comparison of Mucosal Vibration and Topical Anesthetic Spray for Pain Reduction during Local Anesthesia in Young Adults: A Randomized Controlled Clinical Trial

Hysteroscopic Lysis of Complex Uterine Adhesions After Interventional Radiology-Guided Access

To demonstrate a novel surgical technique using hysteroscopic lysis of adhesions after interventional radiology (IR)-guided access in patients with severe intrauterine adhesions and challenging uterine access. This video illustrates the technique of the safe division of intrauterine adhesions after IR-guided access. Conventional hysteroscopic adhesiolysis might be inadequate or risky in cases of severely narrowed or obstructed uterine flow tract, possibly resulting in incomplete adhesiolysis, false passages, or uterine perforation. This video presents 2 cases from a tertiary center involving a multidisciplinary team of a reproductive surgeon and an interventional radiologist. The first case involves a 38-year-old with severe Asherman syndrome, who experienced unsuccessful attempt to treat adhesions that was complicated by a false passage. The second case involves a 39-year-old with recurrent severe Asherman syndrome and a history of unsuccessful attempts at hysterosalpingogram and conventional hysteroscopic lysis of adhesions. In the IR suite, the patient was put in a lithotomy position on the fluoroscopy table. A vaginal speculum was inserted exposing the cervix. The procedure was performed using intravenous sedation and topical anesthetic spray applied to the cervix. Using fluoroscopy, a balloon cannula was inserted through the cervix, followed by contrast injection to assess uterine access. If there is no route, transvaginal ultrasound-guided needle cannulation of the main portion of the uterine cavity would be performed, approximating as closely as possible to the expected route of the cervical canal. A guidewire followed by a locked loop catheter was advanced through adhesions into the uterine cavity. The catheter was left protruding from the cervix to guide the hysteroscope. The patient was then transferred to the operating room for the hysteroscopic procedure. Under the guidance of the intrauterine catheter, the adhesions were carefully lysed using cold scissors. The endometrial cavity and tubal openings were inspected to ensure complete adhesiolysis and exclusion of any other copathologies. IR guidance can provide a safe and effective approach to hysteroscopic lysis of adhesions in patients with challenging intrauterine adhesions and difficult uterine access, such as patients with severe Asherman syndrome, intractable cervical stenosis, uterine wall agglutination, previous adhesiolysis failure, marked fixed retroverted retroflexed uteri, and previous false passage or uterine perforation.

Development of Herbal Topical Anesthetic Mucoadhesive Spray for oral Cavity using Customer-Centric Approach

The use of herbal medicines is increasing globally due to consumer perceptions and scientific research. The limited availability of herbal medications and a lack of effective topical anesthetics have driven the development of new products using a customer-centric strategy. This study aimed to present a novel herbal topical anesthetic mucoadhesive spray development using the New Product Development (NPD) process though three steps: the idea concept of the product, prototype development, and consumers’ acceptance evaluation, involving key stakeholders-consumers and healthcare professionals. Multiple research methods were implemented, including qualitative, quantitative, and scientific methods, in each step. The findings showed insights gathered through in-depth interviews about the product needs of stakeholders. Multiple regression analysis showed that price, attitude, and social value significantly positively influenced consumer purchase intentions, while attitude influenced healthcare professionals' prescribing intentions. Consequently, the prototype was developed based on consumer needs. The results of the acceptance evaluation phase indicated high consumer acceptance of the herbal topical anesthetic mucoadhesive spray. The entire journey of the new product development process in this study enhances our understanding of customer-centric approaches in product development and can be applied to generate market-driven innovations that meet the needs of the target market. Doi: 10.28991/HEF-2023-04-03-02 Full Text: PDF

EFFECTIVENESS OF LOCALANAESTHESIA SPRAY VS SUPRA PERIOSTEAL INFILTRATION IN MOBILE ANTERIOR / POSTERIOR TEETH – A COMPARATIVE STUDY.

Objectives – To compare the Effectiveness of local Anesthesia spray vs supraperiosteal Inltration in mobile anterior or posterior teeth – a comparative study Methods– The study is an observational study and is being carried out in outpatient section of Department of Oral and Maxillofacial Surgery of a tertiary care hospital in Kelambakkam. 20 individuals diagnosed with periodontal pathologies in opposing quadrants that presents as Grade III mobility are advised for extraction as treatment plan. One Group will receive 10% lidocaine spray around the periapical and periodontal areas. Second Group will receive supraperiosteal Inltration. Pain tolerance will be recorded while performing the dental extraction at 3, and 5 minutes and at end of the procedure. The pain tolerance between the teeth that was extracted by administration of local anaesthetic spray and with those receiving supraperiosteal inltrations will be compared. Readings of the two groups will be recorded and subjected to statistical analysis. The extraction procedure will be performed by a single operator. The study is single blinded. Results – There is a signicant difference in the efcacy of 10% lignocaine spray and Supraperiosteal Inltration as in controlling pain during extraction of tooth, in adults Conclusion: The efcacy of supraperiosteal Inltration was superior compared to 10% lignocaine spray respectively. The patients who received supraperiosteal inltration perceived less pain during extraction of tooth when compared to patients who received 10% lignocaine spray. There is a signicant difference in the efcacy of 10% lignocaine spray and Supraperiosteal Inltration as in controlling pain during extraction of tooth, in adults. Hence, we advocate the use only of an inltration prior to any dental extraction.

Air filtration mitigates aerosol levels both during and after endoscopy procedures.

Upper gastrointestinal endoscopies are aerosol-generating procedures, increasing the risk of spreading airborne pathogens. We aim to quantify the mitigation of airborne particles via improved ventilation, specifically laminar flow theatres and portable high-efficiency particulate air (HEPA) filters, during and after upper gastrointestinal endoscopies. This observational study included patients undergoing routine upper gastrointestinal endoscopy in a standard endoscopy room with 15-17 air changes per hour, a standard endoscopy room with a portable HEPA filtration unit, and a laminar flow theatre with 300 air changes per hour. A particle counter (diameter range 0.3μm-25μm) took measurements 10cm from the mouth. Three analyses were performed: whole procedure particle counts, event-based counts, and air clearance estimation using post-procedure counts. Compared to a standard endoscopy room, for whole procedures we observe a 28.5x reduction in particle counts in laminar flow (p < 0.001) but no significant effect of HEPA filtration (p = 0.50). For event analysis, we observe for lateral flow theatres reduction in particles >5μm for oral extubation (12.2x, p < 0.01), reduction in particles <5μm for coughing/gagging (6.9x, p < 0.05), and reduction for all sizes in anesthetic throat spray (8.4x, p < 0.01) but no significant effect of HEPA filtration. However, we find that in the fallow period between procedures HEPA filtration reduces particle clearance times by 40%. Laminar flow theatres are highly effective at dispersing aerosols immediately after production and should be considered for high-risk cases where patients are actively infectious or the supply of personal protective equipment is limited. Portable HEPA filers can safely reduce the fallow time between procedures by 40%.

Retrospective Chart Review: The Feasibility of a Self-Administered Nasal Spray Targeting the Sphenopalatine Ganglion (SPG) in Treatment of Chronic Migraine.

Objective: To describe the results of a self-administered anesthetic nasal spray developed to target the sphenopalatine ganglion (SPG) for the acute and preventive treatment of chronic migraine. Background: The SPG is a known migraine treatment target that may be anesthetized via minimally invasive in-office procedures. Historically, various noninvasive selfadministered intranasal anesthetic formulations have been developed for the treatment of migraine, with some studies suggesting implication of the SPG mechanism, however, this has needed further development and data on efficacy has been mixed and inconclusive. During COVID-19 pandemic clinic closures, we noticed a substantial need for improved at-home therapies for our university headache center patients with chronic migraine. Methods: We developed a compounded anesthetic nasal spray utilizing upward force and a supine delivery positioning with the aim of better targeting the SPG. Patients were instructed to use this treatment once per month as prevention and, additionally, up to four times per month as need acutely. Retrospective chart review was performed. Physician clinical judgment of patient reports was used to assign a dichotomous conclusion of the usefulness of such treatment for patients at an interval of 3 months (preventive effect) and acutely (acute effect). Adverse effects were also reviewed. Results differentiate treatment response in medication overuse headache (MOH) and peripartum subgroups as well. Results: 52 out of 66 (79%) patients reported improvement in overall headache frequency or intensity at 3 month follow up (preventive effect). 40 out of 53 (75%) patients who using the treatment acutely reported improvement in headache intensity (acute effect). Of the 6 patients also with MOH, 5 (83%) reported preventive effect and 4 (67%) reported acute effect. Of the 9 patients who were also peripartum, all 9 (100%) reported preventive effect and 8 (89%) reported acute effect. No significant adverse effects were reported. Conclusion: A self-administered nasal spray developed to target the SPG may be an effective and safe therapy for the acute and preventive treatment of chronic migraine. This delivery method suggests safe and potentially successful blockade of the SPG at home. Further developments in non-invasive intranasal techniques are warranted.

An up-to-date overview of the pharmacotherapeutic options for premature ejaculation

ABSTRACT Introduction Premature ejaculation (PE) is a sexual dysfunction of unknown etiology affecting a substantial number of males and deteriorating sexual health and quality of life of the patient and his partner. Treatment still remains challenging; however, pharmacotherapy is considered the mainstay of therapy with behavioral and psychosexual interventions being particularly important as adjudicate procedures, within the context of a holistic approach. Areas covered The authors review the literature on the available medications for PE, both officially registered and non-registered. Currently, only dapoxetine and an anesthetic spray containing lidocaine and prilocaine (Fortacin™) are officially approved, with the rest being used off-label. Herein, updated data regarding the efficacy and safety of the pharmaceutical agents are presented. Expert opinion On-demand dapoxetine is reportedly efficacious and safe in treating lifelong PE and is the first medication to be approved for this purpose. Fortacin has also shown considerable efficacy and may be reliably used on-demand. Phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be effective in the treatment of PE and are therefore recommended either as monotherapy or combined with other therapies (i.e. dapoxetine). Adverse events of any therapy should be taken under consideration. Physicians should encourage patients to discuss their needs and expectations and grade any improvement of their condition with treatment.

Rupture of an epidural filter connector during bolus administration of local anesthetic: a case report

BackgroundEpidural catheters are routinely placed for many surgical procedures and to treat various pain conditions. Known complications arising from epidural catheter equipment malfunction include epidural pump failure, epidural catheter shearing, epidural catheter connector failure, epidural filter connector cracking, and loss-of-resistance syringe malfunction. Practitioners need to be aware of these potentially dangerous complications and take measures to mitigate the chances of causing significant patient harm. We report on the complete breakage of an epidural filter connector during epidural bolus administration of local anesthetic by hand with a syringe.Case presentationA B. Braun Perifix® epidural catheter was placed in a 73-year-old male scheduled for radical prostatectomy. During the operation, a continuous infusion of local anesthetic was administered through the epidural catheter in addition to general endotracheal anesthesia. At the conclusion of surgery and after extubation, the patient endorsed incisional pain. The epidural filter connector broke in half as a bolus of local anesthetic was administered by hand with a syringe. The local anesthetic sprayed widely throughout the room as the fragmented epidural filter connector became a projectile object that recoiled and struck the patient.ConclusionsThis incident placed the patient and surrounding healthcare providers at substantial risk for injury and infection from the fractured epidural filter connector becoming a projectile object and from the local anesthetic spray. The most plausible cause of this event was from a large amount of pressure being applied to the filter connector. This may have occurred by excessive force being applied by hand to the syringe, by the presence of a clogged filter, or by the catheter being kinked or blocked proximal to the filter. Being aware of this deleterious complication and potentially modifying existing epidural bolus techniques, such as using smaller syringes with less applied force and checking all epidural components vigilantly prior to and during bolus administration, can help anesthesia providers deliver the safest possible care to patients with epidural catheters.

Inhaling muscle spray: A rising trend of abuse.

Ethyl chloride was popular as an inhalant recreational drug in the 1980s. It is easily available in pharmacies as well as sold online as a topical anesthetic spray for pain relief. In recent times, its use is gaining popularity again among the youth as an inhalant drug due to its neuro-stimulatory effects. To avoid the risks associated with use of illegal drugs, and ease of availability of ethyl chloride without restrictions, there is a rising trend to use it as a “substitute” drug of abuse. In this paper, we try to highlight to the critical care and emergency physicians that majority of these cases present with predominant neurological symptoms, with occasional involvement of the cardiovascular system. The diagnosis of ethyl chloride poisoning is primarily clinical and supportive care is the mainstay of treatment, along with subsequent counseling. Ethyl chloride abuse should be considered as a differential diagnosis in young patients presenting with predominant neurological symptoms. Alongside raising public awareness, the manufacturers and retail distributors of these products have an important role to play in reducing the risk of abuse.

Acute migraine anesthetic nasal spray treatment during the COVID-19 pandemic (1779)

Acute migraine anesthetic nasal spray treatment during the COVID-19 pandemic (1779)

Does The Use of Ethyl Chloride Improve Patient-Reported Pain Scores With Negative Pressure Wound Therapy Dressing Changes? A Prospective, Randomized Controlled Trial.

Negative pressure wound therapy (NPWT) is commonly used for surgical incisions and large wounds, particularly in the context of trauma. Research has shown that patients report that the most painful aspect of NPWT is related to foam dressing changes. This study aimed to determine whether topical use of the vapocoolant anesthetic ethyl chloride would impact patient-reported pain during these procedures. This study was a single-blinded, placebo-controlled randomized trial in patients who were undergoing NPWT foam dressing change following surgery performed by the orthopedic trauma team. A total of 100 patients were randomized to receive ethyl chloride topical anesthetic spray or placebo (tissue culture grade water) during dressing change. The outcome measure specified prior to enrollment was a mean decrease in patient-reported pain of 1.7 points using a numeric rating scale. Baseline and procedural characteristics were collected to investigate contributions to patient-reported pain. We hypothesized that the use of ethyl chloride would decrease patient reported pain scores. Significantly more females were randomized to the receive vapocoolant; remaining baseline and procedural characteristics were similar between groups. The median time for NPWT drape removal was 2.0 minutes in both groups (p = 0.66). The postprocedural pain reported by patients was significantly lower in the experimental group compared with placebo (median, 5.0 vs. 7.0; p = 0.03). Multivariate analysis adjusting for potential confounders showed treatment group to be the strongest predictor of postprocedure pain (p = 0.002). Additionally, a generalized linear model suggests that treatment group was the strongest predictor of change in pain score as reported by patients prior to and immediately following dressing change. Use of vapocoolant spray during NPWT dressing change for orthopedic trauma wounds and surgical incisions was feasible and resulted in significant reduction in patient-reported pain associated with the procedure. Therapeutic, Level I.

Topical Treatment of Premature Ejaculation: The Rise of Anesthetic Spray Formulations?

Topical anesthetics are one of the first line therapeutical options for men with premature ejaculation (PE). Real-life PE management often involves a range of interventions including systemic drug treatments (such as off-label and on-label selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, phosphodiesterase-5 inhibitors (PDE5Is)), topical anesthetic creams and sprays, and behavioral approaches. Among them, on-demand dapoxetine and lidocaine/prilocaine spray formulations are the only approved treatment options for lifelong PE. The earliest strategy to treat PE was based on the use of topical anesthetic agents. The rationale behind the use of anesthetics is that by reducing the glans penis sensitivity, the spinal and cerebral input of sexual arousal impulses may also be reduced. Oral SSRI proved to be effective to treat PE, but their high rate of side effects limit treatment adherence and both short and long term follow up data are lacking. Conversely, topical anesthetics have proved to increase ejaculatory latency, control, and sexual satisfaction in couple affected by PE with limited rates of adverse events. In this context, we aimed to perform a narrative review to summarize the most recent findings regarding the use of topical treatments for PE.

Introduction of Transnasal Endoscopy to a Scottish District General Hospital.

Esophagogastroduodenoscopy can be uncomfortable and distressing with many patients opting for conscious sedation over topical local anesthetic spray. Transnasal endoscopy is an alternative and we sought to assess how easily it could be introduced to a district general hospital and how acceptable patients found it. Selected patients requiring diagnostic endoscopy were offered transnasal endoscopy with topical nasal anesthetic by clinicians new to transnasal endoscopy but competent at esophagogastroduodenoscopy. Postal feedback questionnaires were used to assess comfort, distress, recollection of periprocedural consultation, and overall experience (visual analog scale 1-10). A total of 213 transnasal endoscopy procedures were undertaken with 207 completed successfully (97.2%). Two patients (0.9%) had self-limiting epistaxis and no patient required admission. One hundred (47%) questionnaires were returned including 98 from those with completed transnasal endoscopy. Thirty-three (33%) had previous esophagogastroduodenoscopy and 28 (85%) reported a preference for transnasal endoscopy. Fifty-eight patients (59%) found transnasal endoscopy comfortable (visual analog scale >6) with 17 reporting discomfort (visual analog scale <5). Seventeen patients found the procedure distressing (visual analog scale >6) but 70 (73%) did not (visual analog scale <5). Eighty-four patients (85.7%) had clear recollection of their procedure (visual analog scale >6) and overall satisfaction was reported as good (visual analog scale >6) by 94.7%. Transnasal endoscopy can be adopted by clinicians competent with conventional esophagogastroduodenoscopy with expectation of high procedure completion rate and low complication rate. Our patients reported high levels of satisfaction with few reporting distress. Perhaps as a consequence, most patients had a clear recollection of their procedure.

Comparison of the Effectiveness between 5% Eutectic Mixture of Local Anesthetic Cream and Ethyl Chloride Spray Applied on the Skin Prior to Intravenous Cannulation

Background: Since the patients scheduled for an endoscopic procedure had been unhappy with pain during intravenous cannulation. Objective: To compare the effectiveness between 5% eutectic mixture of local anesthetic cream and ethyl chloride spray applied on the skin prior to the procedure. Materials and Methods: One hundred eighty-six patients were randomized equally into three groups, A: 5% eutectic mixture of local anesthetic cream, B: ethyl chloride spray, and C: placebo. Then a nurse used a 22-gauge (22G) needle catheter to administer a cannula. Five minutes after the intravenous cannulation, a co-researcher assessed the patient’s pain perception and satisfaction as well as the nurse’s difficulty in performance by means of a numeric rating scale. Results: One hundred seventy-six patients completed the present study. Participants having the anesthetic cream and spray application as well as the placebo expressed their pain scores as 1.7±1.3, 1.6±1.2, and 2.2±1.3, respectively. Therefore, patients applied with local anesthetics had significantly less pain perception than those with the placebo (p=0.039); however, scores were not different between the anesthetic cream and the spray groups. Conclusion: Patients scheduled for an endoscopic procedure did not showed significant pain relief with either the 5% eutectic mixture of local anesthetic cream or the ethyl chloride spray. Keywords: 5% eutectic mixture of local anesthetic cream, Ethyl chloride spray, Endoscopic surgery, Intravenous cannulation, Pain

Fentanyl vs dexmedetomidine nebulization as adjuvant to lignocaine: A comparative study during awake flexible fiberoptic bronchoscopy

Background and aimsFlexible fiberoptic bronchoscopy is used to diagnose diseases of the tracheobronchial tree and to obtain samples. Methods used for awake flexible fiberoptic bronchoscopy (FFB) to anaesthetize the airway include local anaesthetic nebulization, gargles, lozenges, sprays, and airway blocks. The aim is to compare the effect of fentanyl and dexmedetomidine nebulization as an adjuvant to lignocaine during awake FFB. MethodsNinety patients were recruited and were randomized into 3 groups. Group I Patients were nebulised with a mixture of 4% lignocaine 4 ml and fentanyl 2 μg/kg, Group II with a mixture of 4% lignocaine 4 ml and dexmedetomidine 1 μg/kg, and Group III with 4% lignocaine 4 ml and saline. ResultsCough score was lower in Group II (1.6 ± 0.67) than Group I (2.5 ± 0.68) and Group III (2.7 ± 0.59). This difference between Group II and the rest of the group was highly significant (P < 0.001). Patients of Group II also had better satisfaction scores (1.40 ± 0.56) when compared to Group I (1.90 ± 0.71) and Group III (2.43 ± 0.57). Patients in Group II were more comfortable (1.23 ± 0.43) than Group I (1.63 ± 0.49) and Group III (1.87 ± 0.34) (P < 0.001). ConclusionDexmedetomidine as an adjuvant to lignocaine nebulization provides a better condition for bronchoscopy than fentanyl or lignocaine alone.

Single-use lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical spray; can it now be employed as a multi-use atomiser?

This study investigated the risk of contamination of lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution after modification of the application technique. This paper reports a prospective basic sciences study involving 22 study samples and 1 control sample of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients using a modified application technique. The modification involves keeping the nozzle (actuator) pressed down whilst withdrawing the spray to at least 30 cm (1 ft) from the patient, before releasing the nozzle (actuator) and subsequently reapplying the spray. Three of the 23 samples confirmed bacterial growth in the bottle contents, but there was no growth in any of the samples from the pump. These bacteria are considered to be contaminants. There is a potential to use the lidocaine hydrochloride 5 per cent w/v and phenylephrine hydrochloride 0.5 per cent w/v topical solution as a multi-use spray by changing the actuator between patients. This would have significant beneficial cost implications without the attendant infection control risk.

Role and Adverse Effects of Premedication for Reducing Pain and Discomfort during Fiberoptic Nasal Pharyngoscopy and Laryngoscopy

INTRODUCTION: Fiberoptic nasal endoscopy is a common procedure. Pretreatment with many drugs has been tried to decrease discomfort and pain related to the procedure. It was our effort to study whether they are effective in reducing pain and discomfort of the procedure.&#x0D; MATERIAL AND METHODS: It was a four-armed triple blind randomized controlled trial. Block randomization was done. Four arms were pretreated with placebo, decongestant spray, local anesthetic spray, and combination of decongestant and local anesthetic spray. Discomfort of pretreatment, discomfort of the procedure, pain due to procedure, ease of procedure and adverse effects were recorded by visual analogue score and analyzed by non-parametric tests. P value less than 0.05 was considered statistically significant.&#x0D; RESULTS: There were 40 participants in each wing making a total of 160. There were 79 males and 89 females. Discomfort of pretreatment was significantly higher is groups treated with lidocaine spray alone or in combination (p&lt;0.001). Discomfort due to procedure was lowest in group pretreated with placebo (p=0.009) and pain was comparable throughout the groups (0.15).The procedure of nasal endoscopy was easiest in group pretreated with decongestant spray (p=0.02). Adverse effect was highest in form of burning sensation and pain in groups treated with lidocaine (p&lt;0.001).&#x0D; CONCLUSION: Lidocaine spray caused a lot of discomfort in form of pain and burning sensation and was not able to decrease pain or discomfort, alone or in combination with decongestant, related to fiberoptic nasal endoscopy. Decongestant, however, made the procedure easier.

Comparative Effect of Topical Local Anaesthetic Spray &amp; Gel in the Reduction of Pain on Periodontal Probing in Individuals with Untreated Chronic Periodontitis

INTRODUCTION: The experience of pain during dental procedures is a concern to many individuals. In periodontal practice, the first meet between the patient and the periodontist is usually a periodontal examination.&#x0D; AIM: The present study aims to compare the efficacy of local anaesthetic gel &amp; spray in the reduction of pain on periodontal probing in a group of individuals with untreated chronic periodontitis.&#x0D; MATERIALS AND METHODS: Thirty participants meeting the inclusion criteria were included in the study and had full-mouth periodontal probing done at six sites per tooth. The participants were divided into 2 groups: Group I;15 patients with LOX 2% gel and Group II;15 patients were assessed with lignocaine spray. Intragroup comparison was done using paired t-test and Analysis of Variance was done for inter group comparison.&#x0D; RESULTS: The pre and post VAS score of the two groups over the periods were recorded of 2 minutes &amp; 5 minutes. In Group I, the mean VAS at 2 min decreases comparatively from the base-line &amp; remained lower significantly at 5 min as compared to the baseline. In contrast, in Group II, it decreased comparatively at 2 minutes but increases at 5 minutes and reaches almost the baseline value.&#x0D; CONCLUSION: For early pain relief, study found LOX 2% gel more effective than lignocaine spray in the of untreated chronic periodontitis.

Methods of pain control during endometrial biopsy: A systematic review and meta-analysis of randomized controlled trials.

To review effectiveness of methods for reducing pain during endometrial biopsy. PubMed, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched for randomized controlled trials that examined effectiveness of pain control methods for endometrial biopsy. Risk of bias was assessed from sequence generation, allocation concealment, blinding, incomplete outcome data and selective outcome reporting. Heterogeneity was examined from forest plot, statistical tests of homogeneity, and I2 statistic. For meta-analysis of pain scores, weighted mean difference with 95% confidence interval (CI) were estimated. Twenty-six studies were included in the review. Marginally significant reduction in the pain score during the procedure in participants with intrauterine lidocaine relative to control was observed (mean difference [MD] -1.31, 95% confidence interval [CI] -2.70 to 0.09, P = 0.07). Subgroup analysis showed that in studies that used low-pressure suction devices, intrauterine lidocaine was associated with statistically significant reduction in pain during the procedure (MD -2.22, 95% CI -3.72 to -0.73, P = 0.004). There was a significantly lower pain score during biopsy in the anesthetic spray group compared to control (MD -0.96, 95% CI -1.53 to -0.39, P = 0.001). Significant heterogeneity on types of intervention and outcome measures among studies that examined paracervical block and nonsteroidal anti-inflammatory drugs (NSAID) was observed. However, paracervical block and NSAID were associated with significant pain reduction compared to placebo in most of the related studies. Intrauterine anesthetics, anesthetic cervical spray, paracervical block and oral NSAID provide effective pain control during endometrial biopsy.