Conventional Local Anesthesia Research Articles

Assessment of the Efficiency for Anesthesia of Two Agents in Teeth Removal: A Split-Mouth Research

ABSTRACT Aim: This study was intended to assess and relate the clinical anesthetic effectiveness of tramadol hydrochloride and lidocaine. Methodology: A clinical randomized split-mouth study was piloted among 40 patients who were otherwise healthy but needed to have their maxillary first premolars extracted bilaterally for orthodontic reasons were considered in the research. In each subject on one side (quadrant) of the arch 1.8 milliliters of lidocaine was given and on other side of the arch 1.8 milliliters of tramadol was given. On the basis of a list that was prepared by a computer, the randomization was done and the sides (quadrant) of the arches were decided for all the subjects, and the injections were given as local infiltration. Results: Lidocaine was found to be statistically more effective for overall anesthesia duration, despite the fact that there was no significant variance between the two drugs at the time when anesthetic effect began to take effect. Tramadol was found to be statistically more efficient than lidocaine when compared to the anesthetic activity at the 5th minute before extraction. Tramadol was found to be statistically more successful than lidocaine for both the patient’s degree of satisfaction and the rate at which wounds healed. Conclusion: Based on the findings of this research, it appears that tramadol and epinephrine could be used as a substitute to conventional local anesthetics during extractions of maxillary first premolar teeth during oral-maxillofacial surgery.

A Randomised Split-Mouth Clinical Trial to Assess the Efficacy of Oroquiver: An Affordable Vibrotactile Device for Dental Injections

Introduction: Injection pain is a common concern among patients, including those receiving dental injections. Local Anaesthesia (LA) is a crucial procedure in dentistry to ensure painless treatment. Vibration stimuli have shown promise in raising the pain threshold, managing orofacial pain, musculoskeletal pain, and relieving dental pain. However, many vibrotactile devices available in the market are not affordable for common dentists. Aim: To compare pain perception in patients undergoing bilateral extractions using OroQuiver-assisted LA administration versus conventional LA administration. Materials and Methods: A randomised split-mouth clinical trial was conducted with 17 patients undergoing simultaneous bilateral extractions. LA was administered with and without OroQuiver on the right and left-sides, respectively. Pain assessment was performed using Wong Baker’s Facial Rating Scale and a questionnaire sheet comparing patient comfort following LA administration on both sides. Results: There was a significant difference in the Visual Analog Scale (VAS) score for pain experienced during LA injections using the vibrotactile device (4.29±1.1) compared to the conventional method (7.2±1.5). None of the patients reported discomfort with the device. The device reduced anxiety towards dental injections in 14 patients, and 16 patients indicated they would recommend the device to others. Conclusion: OroQuiver effectively reduced injection-related pain regardless of the type of nerve block administered. It is a costeffective, easily maneuverable, feasible, sterilizable, and reusable device that effectively reduces LA injection-related pain.

Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study.

There is a dearth of studies to assess the effectiveness of cryotherapy as a possible adjuvant in anesthesia. Therefore, this study aimed to compare the impact of pretreatment intraoral ice packs, application of Endo-ice, and a combination of Endo-ice and intrapulpal ice sticks use on the effectiveness of pulpal anesthesia as an adjunct in the management of pain and dental anxiety in mandibular second molars with symptomatic irreversible pulpitis (SIP) against traditional inferior alveolar nerve block (IANB) technique. The randomized controlled double-blind clinical study comprised of 200 subjects within the age group of 20-45 years with SIP involving mandibular second molars and divided into four groups of 50 each. Conventional IANB was administered in group 1. Intraoral compact ice packs, Endo-ice, and combined use of Endo-ice and intrapulpal ice sticks were employed following conventional IANB in groups 2, 3, and 4, respectively. The intensity of pain and anxiety before and after the intervention was documented using Heft-Parker visual analog scale (HP-VAS) and Corah's Dental Anxiety Scale-Revised (DAS-R). The average age of the overall study sample was 30.8±2.08 years, and the differences in age and gender distribution were found to be statistically insignificant. The mean HP-VAS scores on access opening and pulpectomy, using ANOVA paired with Tukey's post hoc multiple comparison tests were evaluated to be statistically highly significant (p<0.001). The greatest reduction in HP-VAS score was observed in group 4 receiving combined use of both Endo-ice and intrapulpal ice sticks. While the pretreatment DAS-R score was determined to be statistically insignificant between groups, group 1 subjects had the highest DAS-R score postoperatively (p<0.001). The effectiveness of pulpal anesthesia was found to be 84%, 96%, 92%, and 98% for groups 1 through 4, respectively, and demonstrated a statistically significant difference. The combined use of Endo-ice and intrapulpal ice sticks used as an adjuvant to local anesthesia (LA) was found to be significantly effective in lowering pain compared to the control groups in molars with SIP. Cold administration before and during the procedure was more effective than conventional LA in lowering intraoperative anxiety. Furthermore, the use of Endo-ice and intrapulpal cold after IANB significantly improves the effectiveness of pulpal anesthesia in mandibular second molars with SIP.

Efficacy of Sodium Bicarbonate-Buffered Local Anesthetic Solution in Cases Requiring Bilateral Maxillary Premolar Orthodontic Extraction: A Comparative Split-Mouth Study.

Aims and objectives This study was carried out to evaluate the efficacy of 8.4% sodium bicarbonate-buffered local anesthetic solution and conventional local anesthetic in patients requiring bilateral maxillary orthodontic extractions in terms of pain on injection, onset of action, and duration of action. Methods 102 patients requiring bilateral maxillary orthodontic extractions were included in the study. Buffered local anesthetic was administered on one side while conventional local anesthesia (LA) was administered on the other side. Pain on injection was measured using a visual analogue scale, while onset of action was measured by probing the buccal mucosa after 30 seconds of administration and duration of action was measured by the time after which the patient experienced pain or took a rescue analgesic. The data was statistically analyzed to determine the significance. Results The pain during injection was found to be lesser at sites where buffered local anesthetic was administered (mean visual analogue scale (VAS) score = 2.4) as compared to conventional local anesthetic(mean VAS score = 3.9). The onset of action was faster with buffered local anesthetic(mean value = 62.3 seconds) as compared to conventional local anesthetic (mean value = 157.16 seconds). Lastly, the duration of action was found to be longer for buffered local anesthetic group (mean value = 225.65 minutes) as compared to conventional local anesthetic (mean value = 187 minutes). Conclusion 8.4% sodium bicarbonate-buffered local anesthetic was found to be more efficient than conventional local anesthetic in terms of reduction in pain on injection as well as faster onset and longer duration of action.

Analgesic efficacy of modified thoracoabdominal nerves block through the perichondrial approach in laparoscopic cholecystectomy: A retrospective study with propensity analysis.

Modified thoracoabdominal nerves block through the perichondral approach (M-TAPA) was recently reported to provide broad analgesia with only a single injection of local anesthetics (LA) on each side. However, the effectiveness of M-TAPA in laparoscopic cholecystectomy (LC) is not often reported. We retrospectively evaluated the analgesic efficacy of M-TAPA in patients who underwent LC and compared it with conventional LA infiltration (LAI) by calculating the propensity score. The primary outcome was the frequency of analgesic use after surgery. Although there was no difference in the frequency of analgesic use within 48 hours (P=.063), there was significantly less analgesic use 24-48 hours after surgery in the TAPA group (P=.02). Intraoperative remifentanil administration also significantly decreased in the TAPA group (P < .001). We found that pre-incisional M-TAPA may have an advantage over LAI with respect to analgesia on postoperative day 1.

Evaluation of the effectiveness of photobiomodulation therapy as an alternative method to local anesthesia injection in pediatric dentistry.

The idea of receiving local anesthesia (LA) via an injection is a major source of dental fear and anxiety. In children, dental anxiety is considered the main reason for avoiding dental treatments. Moreover, there are potential complications during/after LA administration. Thus, it is necessary to search for painless, low-risk, and nonpharmacological anesthetic approaches. This study was performed to evaluate the effectiveness of photobiomodulation (PBM) therapy as an alternative method to LA injection for conventional restorative treatments in pediatric patients. This was a split-mouth randomized clinical study. The study included 15 children between 6 and 12 years old. Each child had 2 similar contralateral caries lesions in the first permanent molars in the same jaw, total (30) teeth. For each child, one tooth was treated under conventional LA injection and the other was treated under PBM-based anesthesia. The Wong-Baker's Faces Pain Scale was used for reporting the pain and discomfort levels at the end of the treatments. Data statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. Mann-Whitney U-test was used to compare between the groups. The PBM-based anesthesia group recorded a mean pain score of 2.27 ± 1.28. The conventional LA group recorded a mean pain score of 1.73 ± 0.7. The difference between the groups was not statistically significant (P = 0.168). PBM-based anesthesia may be an optional alternative to LA injection for conventional restorative treatments in children with dental anxiety, needle phobia, or special needs, and it deserves further studies and improvement.

The feasibility of needleless jet injection versus conventional needle local anesthesia during dental procedures: a systematic review.

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad's scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

The Effect of an Audiovisual Distraction Method on 6-10-Years Old Children’s Behavior During Dental Treatment: A Clinical Trial

Objective: Management of uncooperative and anxious children during dental treatment is a major problem in pediatric dentistry. This study was designed to assess the effect of an audiovisual distraction method in minimizing the fear and anxiety of the child patient during dental treatment. &#x0D; Methods: A randomized clinical trial with a parallel design was carried out on 40 children aged between 6 and 10 years to ascertain the efficacy of the audiovisual (virtual reality eyeglasses) distraction method in reducing children's dental anxiety during local anesthetic administration. Forty children were randomly divided into two groups; the control group (conventional local anesthesia injection alone) and the study group (conventional local anesthesia injection combined with audio-visual virtual reality eyeglasses). The pain experience and anxiety were assessed using a combination of measures: visual analog scale (child self-report) &amp; visual analog scale (parent report), pulse rate and oxygen saturation SpO2 (physiological), and behavior assessment performed using (Frankl’s behavior rating scale and Houpt’s scale). &#x0D; Results: All 40 children completed the study. A highly significant reduction in the child’s anxiety and pain experienced in the audiovisual distraction group was seen as reported by the visual analog scale (p &lt; 0.001) and Houpt scale (p &lt; 0.003). In contrast, pulse rate and spo2 showed no statistically significant difference between the two groups. &#x0D; Conclusions: Audiovisual distraction method offers an effective distraction tool for alleviating the pain and unpleasantness that arises while administering local anesthesia in dental treatment.

Interaction Between Ropivacaine and a Self-Assembling Peptide: A Nanoformulation for Long-Acting Analgesia.

IntroductionRopivacaine as a conventional local anesthetic has been used more and more frequently in the treatment of postoperative pain, but its analgesic effect can only last for several hours. In order to fulfill the clinic requirement for long-term analgesia, a long-acting ropivacaine nanocrystal formulation was fabricated through the interaction between ropivacaine and a self-assembling peptide.MethodsTransmission electron microscopy, dynamic light scattering, circular dichroism and fluorescence spectrometry were used to examine the structural changes caused by the interaction between ropivacaine and the peptide. Scanning electron microscopy, dynamic light scattering, Fourier transform infrared spectrometry, X-ray diffraction and optical microscopy were used to characterize the ropivacaine-peptide nanocrystal. In vitro drug release and pharmacokinetics study were conducted to evaluate the slow-release profile of the nanocrystal formulation. A rodent cutaneous trunci muscle reflex model was used to evaluate the nociceptive blockade effects, and histological analysis was used to evaluate the local toxicity. A rodent plantar incisional pain model was used to evaluate the analgesic effect.ResultsSoluble ropivacaine monomers interacted with the Q11 peptide through π-π stacking and remolded its self-assembling structure, leading to the formation of drug/peptide nanoparticles which could be mineralized to form drug/peptide nanocrystals by adjusting the pH. Under physiological condition, the nanocrystals could release free ropivacaine slowly. As evaluated in rodent models, the anesthetic and analgesic effects of this formulation were significantly extended without causing toxicity.ConclusionBased on the interaction between ropivacaine and Q11, a controllable biomineralization process could be induced to obtain homogeneous nanocrystals, which could be used as an injectable long-acting analgesic formulation. This crystallization strategy utilizing the peptide-drug interaction also provided a promising pathway to fabricate long-acting formulations for many other small molecular drugs.

The Effect of Commonly Used Local Anesthetic on Bacterial Growth.

Liposomal bupivacaine (LB) has emerged as a superior form of local anesthetic across numerous surgical subspecialties. The purpose of this study is to evaluate the ex-vivo antimicrobial effects of LB in comparison with traditional local anesthetics. A standardized inoculum of bacteria commonly associated with surgical site infection was inoculated into a suspension of 1% lidocaine, 0.25% bupivacaine, Exparel (proprietary liposomally packaged 1.3% bupivacaine), and normal saline as a growth control. In all five bacteria tested, the medium inoculated with traditional local anesthetics reduced growth to a greater degree than LB-inoculated plates. Both conventional local anesthetics reduced the growth of all bacteria when compared with the control with the exception of methicillin-susceptible Staphylococcus aureus growth in bupivacaine. LB-inoculated plates had equivalent growth to the control in all plates with the exception of Escherichia coli plates which demonstrated superior growth. The results of this simple ex-vivo model suggest that the liposomal packaging of bupivacaine may decrease this local anesthetic's innate antibacterial properties.

A randomized controlled trial of three different local anesthetic methods for minor hand surgery.

Purpose: Hemostasis and local anesthetic injection are essential for minor hand surgeries under local anesthesia (LA). Wide awake local anesthesia no tourniquet (WALANT) became popular for achieving hemostasis without a tourniquet. However, a recent study reported that injection is more painful than tourniquet use in minor hand surgery. Therefore, this study aimed to compare three LA methods that differ according to injection and hemostasis, namely, the combination of a tourniquet and buffered lidocaine solution (CTB), WALANT, and conventional LA. Methods: This randomized prospective single-center study included 169 patients who underwent minor hand surgery between 2017 and 2020. We randomly allocated the patients to each group and recorded the pain and anxiety score during the surgery, as well as satisfaction after the surgery. Results: Pure lidocaine injection was significantly more painful than buffered lidocaine and WALANT solution injection (p < 0.001). Local anesthesia injection was significantly more painful than tourniquet use in all groups (p < 0.001). The intraoperative anxiety score was significantly lower in the CTB group than in the conventional LA and WALANT groups (p < 0.001). The satisfaction score was significantly higher in the CTB and WALANT groups than in the conventional LA group (p < 0.001). Conclusion: CTB for minor hand surgery under LA is associated with less injection pain and patient anxiety. The tourniquet is tolerable without much pain and waiting time. Thus, CTB in minor hand surgery is a good alternative to WALANT and conventional LA.

New peripheral nerve blocks and local anesthetics.

To describe current developed regional blocks, their indications and clinical use. Furthermore, describe new local anesthetics recently introduced and the new agents in pipeline. There are multiple new blocks recently developed with the introduction of ultrasound to regional anesthesia and studies demonstrate effect in different surgical procedures. However, majority of the studies do not compare with gold standard and are relatively small to change clinical practice. Some of these blocks are: erector spinae plane block, infiltration between the popliteal artery and capsule of the posterior knee, pectoral nerve blocks, quadratus lumborum and transversus abdominis plane block. New local anesthetics and adjuvants have been developed in recent years. However, the studies with even with the oldest one introduced Exparel is currently questioned, large future studies are needed to determine efficacy and safety profile and compared with conventional local anesthetics. New regional block techniques and new local anesthetics have been introduced recently. However, the efficacy/safety and comparison to conventional techniques and local anesthetics are still needed. Future studies must focus on prolonging analgesia with least invasive regional technique and compare new local anesthetics with current ones.

Jet or conventional local anaesthesia? A randomized controlled split mouth study.

To compare the efficacy, acceptance and preference of conventional infiltration technique with a needleless jet anaesthetic device (Comfort-In). Non-fearful healthy adult volunteers, aged 19-40 years, were recruited in the Dental School of Aristotle University of Thessaloniki, Greece. Intact maxillary premolars were selected for local anaesthesia. Both techniques were applied sequentially with 35 min time gap on either buccal side on the same day by the same operator. The quadrant and the order of administration were randomly assigned using an online randomization generator. Immediately after administration, at 1, 3, 5, 10, 15, 20, 25 and 30 min, pulp vitality and soft tissue pain reaction tests were performed. Each participant was asked 6 questions in order to assess acceptance. At the end of the session, at 24 h and 7 days, all participants were asked to report any adverse events and their preference. In 63 volunteers who were successfully followed, 63 teeth received conventional local infiltration and 63 the Comfort-In. Both techniques presented with similar anaesthetic efficacy at 1, 3, 5, 10 and 15 min, whereas the conventional technique was more efficacious at 20 min (p < 0.005). Both presented similar acceptance apart from higher pain/discomfort during administration of Comfort-In (p = 0.002). Significantly higher preference was reported for the conventional technique immediately after the session, at 24 h and at 7 days (p < 0.0005); 19 (30.2%) reported the presence of ecchymosis or lacerations at the Comfort-In site as opposed to 5 (7.9%) with the conventional method (p < 0.0001). Both techniques showed similar effectiveness. Conventional infiltration was preferred to needleless anaesthesia by non-fearful adult volunteers and was associated with less adverse events. This study enhances the advantages of conventional local anaesthesia. ISRCTN17400733.

Needle-free anesthesia: clinical efficacy of a mucoadhesive patch for atraumatic anesthesia in dental procedures.

This study showcases the clinical efficacy of mucoadhesive patches designed for the buccal delivery of lidocaine and prilocaine hydrochlorides (1:1, 30 mg/patch). Such patches were developed for needle-free pre-operative local anesthesia in dentistry, aiming at mitigating the use of infiltrative anesthesia for medium-complexity clinical procedures. The patches were manufactured encompassing drug-release, mucoadhesive and backing layers, all prepared through film casting using biocompatible materials. Fifty-eight (n = 58) adult patients (65% women and 35% men) were randomly selected and included in a one-arm open clinical prospective cohort study. The average age of the subjects was of 50 years. The majority (59%) of the subjects, mostly women (82%), reported needle-phobia or anxiety due to dental procedures, which was assessed through a questionnaire approved by the ethical council for human use in research. The patches were positioned in the gingival region of the teeth involved in the procedure (86% on the maxillary and 14% on the mandibular bone). Two anesthetic patches were applied on each patient: one in the vestibular region and another in the palate/lingual portion, and these patches remained attached to the placement sites throughout the procedures. Concerning the dental procedures performed, 40% were cavity preparations and dental restorations of medium cavities; 29% staple facilities; 10% gingival retractions; 9% subgingival scrapings; 3% gingivalplasties; 3% supragingival preparations; 3% occlusal adjustments; and 2% subgingival preparations. In 90% of the cases, it was not necessary to complement with conventional infiltrative local anesthesia during the procedures. Patients did not report any discomfort or side effect during or after the administration of the patches. Among the cases in which there was the need for complementation, 50% were cavity preparations and dental restorations; 33% supragingival preparations; and 17% gingivoplasties. The complementary anesthesia volume was of 0.63 ± 0.23 mL and women corresponded to 83% of the participants who needed such intervention. Furthermore, in most cases, the patch was capable of initiating the anesthesia within a short time frame (5 minutes) and reaching the maximum anesthetic effect within 15 and 25 min, lasting at least 50 min. Undesirable side effects were not reported either 2 h after the administration or within the 6-month follow-up. Therefore, the anesthetic patches developed provide needle-free, painless, safe, and patient/dentist-friendly advances in performing routine medium-complexity dental procedures.

Comparison of tumescent local anesthesia vs normal anesthesia technology in upper blepharoplasty in Asian women.

Blepharoplasty is the most common type of plastic surgery, used to improve most of the eyelid skin sag caused by aging. In the past, local infiltration anesthesia was widely used in blepharoplasty. Tumescent local analgesia (TLA) is safe and reliable method for anesthesia, even children can use this method. This research aimed to systematically compare the differences between conventional local infiltration anesthesia and TLA in blepharoplasty. One hundred and seventy-eight bilateral upper blepharoplasty patients participated in this research. Visual analog scale (VAS) was employed to evaluate the postoperative pain in the patients. Periorbital appearances are based on light photography and judged by both medical and nonmedical panel. The use of TLA decreased the surgery duration but had no influence on the other surgery characteristics of upper blepharoplasty. Using TLA for anesthesia in bilateral upper blepharoplasty generated less pain than using local infiltration anesthesia. At day 7 after upper blepharoplasty, the rate of generation of both ecchymosis and erythema in normal anesthesia (NA) side were higher than in TLA side. The satisfaction of patients after upper blepharoplasty was not influenced by the use of different anesthesia methods. Compared with the normal anesthesia technology, the use of TLA in the upper blepharoplasty shortened the surgery duration, alleviated the postoperative pain, and mitigated the generation of ecchymosis and erythema. So, TLA is suitable for the performance of anesthesia in blepharoplasty.

A Prospective Randomized Study to Assess the Quality of Life in Post-Operative Recovery Phase in Patients Undergoing Surgery for Isolated Vertically Undisplaced Mandibular Parasymphysis Fracture Using Twin Mix Solution.

Trauma is a major cause for facial fractures commonly encountered by maxillofacial surgeons. Mandible is commonly involved in facial trauma resulting in an isolated fracture or associated with other facial bones due to its prominent location in the facial skeleton. This study was undertaken to investigate the quality of life (QoL) post-operatively in patients diagnosed with undisplaced parasymphysis fracture who underwent open reduction and internal fixation (ORIF) under local anesthesia (LA) using the twin mix (TM) solution. A prospective randomized clinical study was conducted among 40 patients aged between 20-55years requiring ORIF for unilateral vertically undisplaced parasymphysis fracture under LA. Group A patients (n = 20) received conventional LA solution with adrenaline, and Group B patients (n = 20) received freshly prepared TM solution for their surgical intervention as a day care procedure. Various parameters such as jaw function, ability to masticate and labialis activity (lower lip pout) were assessed. The data were collected and analyzed applying student's t test, Shapiro-Wilk test using SPSS software. All the 20 patients in Group B who received TM solution exhibited better jaw function and mouth opening with a mean score of (±SD) of 4.55 (±0.944). They also exhibited reduced difficulty in mastication and ability to purse the lower lip on third post-operative day as compared to the patients in Group A. No complications were observed among the patients post-operatively in both the groups of this study. TM solution proves to be superior as compared to the conventional LA solution as the former offers an improved clinical outcomes enhancing the QoL post-operatively in patients undergoing ORIF for undisplaced parasymphysis mandibular fracture.

A randomized controlled trial of minor hand surgeries comparing wide awake local anesthesia no tourniquet and local anesthesia with tourniquet

IntroductionEpinephrine and sodium bicarbonate (NaHCO3) used in wide-awake local anesthesia no tourniquet (WALANT) affect many areas such as hemostasis, injection pain, anesthetic effect and others. However, few clinical trials have focused on injection pain and the duration of anesthetic effect, and no prospective studies have reported the benefits of WALANT post operation. This study compared WALANT with conventional local anesthesia with tourniquet in minor hand surgeries, and aimed to answer following questions: (1) Does WALANT have enough benefits for injection pain and duration of anesthetic effect?; (2) How does WALANT affect postoperative management (such as postoperative pain and use of analgesics)?; (3) How satisfied are the patients with the surgery? HypothesisWe hypothesized that WALANT had advantages in injection pain, duration of anesthetic effect, and postoperative management compared to conventional local anesthesia. Materials and methodsThe present study is designed as a randomized prospective one center study. This study included 185 patients who received surgical treatment for the diagnosis of carpal tunnel syndrome, trigger finger, or de Quervain's disease between 2017 and 2019. We randomly allocated the patients to either the WALANT group or the conventional group. We inquired and recorded patients’ injection pain, duration of anesthetic effect, postoperative pain, the use of analgesics, and satisfaction with the surgery. ResultsThe injection pain was significantly lower in the WALANT group in all procedures (p<0.001). The duration of anesthetic effect was significantly longer in the WALANT group in all procedures (p<0.001). As for the postoperative management of all procedures, the pain score was significantly lower in the WALANT group until the first day after surgery, with the biggest difference at 6hours after surgery. The use of analgesics was significantly lower in the WALANT group until the second day after surgery. Satisfaction with surgery was significantly higher in the WALANT group in all procedures: A1 pulley release (p=0.026), 1st extensor retinaculum (p=0.045), and carpal tunnel release (p=0.003). DiscussionOur study showed better results in WALANT than in the conventional method, with no tourniquet pain, lower injection pains, longer anesthetic duration, and less postoperative pain. It provided patients with great satisfaction. In addition, WALANT has the potential benefits of no time limit due to tourniquet pain and long anesthetic effect. Therefore, WALANT is comfortable and cost effective, and could be a good alternative to conventional local lidocaine anesthesia. Level of evidenceII.

Un essai contrôlé randomisé comparant l’anesthésie locale sur malade éveillé sans garrot et l’anesthésie locale avec garrot pour les chirurgies mineures de la main

IntroductionEpinephrine and sodium bicarbonate (NaHCO3) used in wide-awake local anesthesia no tourniquet (WALANT) affect many areas such as hemostasis, injection pain, anesthetic effect and others. However, few clinical trials have focused on injection pain and the duration of anesthetic effect, and no prospective studies have reported the benefits of WALANT post operation. This study compared WALANT with conventional local anesthesia with tourniquet in minor hand surgeries, and aimed to answer following questions: (1) Does WALANT have enough benefits for injection pain and duration of anesthetic effect? (2) How does WALANT affect postoperative management (such as postoperative pain and use of analgesics)? (3) How satisfied are the patients with the surgery? HypothesisWe hypothesized that WALANT had advantages in injection pain, duration of anesthetic effect, and postoperative management compared to conventional local anesthesia. Materials and methodsThe present study is designed as a randomized prospective one center study. This study included 185 patients who received surgical treatment for the diagnosis of carpal tunnel syndrome, trigger finger, or de Quervain's disease between 2017 and 2019. We randomly allocated the patients to either the WALANT group or the conventional group. We inquired and recorded patients’ injection pain, duration of anesthetic effect, postoperative pain, the use of analgesics, and satisfaction with the surgery. ResultsThe injection pain was significantly lower in the WALANT group in all procedures (p<0.001). The duration of anesthetic effect was significantly longer in the WALANT group in all procedures (p<0.001). As for the postoperative management of all procedures, the pain score was significantly lower in the WALANT group until the first day after surgery, with the biggest difference at 6hours after surgery. The use of analgesics was significantly lower in the WALANT group until the second day after surgery. Satisfaction with surgery was significantly higher in the WALANT group in all procedures: A1 pulley release (p=0.026), 1st extensor retinaculum (p=0.045), and carpal tunnel release (p=0.003). DiscussionOur study showed better results in WALANT than in the conventional method, with no tourniquet pain, lower injection pains, longer anesthetic duration, and less postoperative pain. It provided patients with great satisfaction. In addition, WALANT has the potential benefits of no time limit due to tourniquet pain and long anesthetic effect. Therefore, WALANT is comfortable and cost effective, and could be a good alternative to conventional local lidocaine anesthesia. Level of evidenceII.

Light-triggered release of conventional local anesthetics from a macromolecular prodrug for on-demand local anesthesia

An on-demand anesthetic that would only take effect when needed and where the intensity of anesthesia could be easily adjustable according to patients’ needs would be highly desirable. Here, we design and synthesize a macromolecular prodrug (P407-CM-T) in which the local anesthetic tetracaine (T) is attached to the polymer poloxamer 407 (P407) via a photo-cleavable coumarin linkage (CM). P407-CM-T solution is an injectable liquid at room temperature and gels near body temperature. The macromolecular prodrug has no anesthetic effect itself unless irradiated with a low-power blue light emitting diode (LED), resulting in local anesthesia. By adjusting the intensity and duration of irradiation, the anesthetic effect can be modulated. Local anesthesia can be repeatedly triggered.

Transversus Abdominis Plane Block versus Wound Infiltration with Conventional Local Anesthetics in Adult Patients Underwent Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background How to effectively control the postoperative pain of patients is extremely important to clinicians. Transversus abdominis plane (TAP) block is a novel analgesic method reported to greatly decrease postoperative pain. However, in many areas, there still exists a phenomenon of surgeons using wound infiltration (WI) with conventional local anesthetics (not liposome anesthetics) as the main means to decrease postoperative pain because of traditional wisdom or convenience. Here, we compared the analgesic effectiveness of the two different methods to determine which method is more suitable for adult patients. Materials and methods. A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TAP block and WI without liposome anesthetics in adult patients were performed. Frequently used databases were extensively searched. The main outcomes were postoperative pain scores in different situations (at rest or during movement) and the time until the first use of rescue analgesics. The secondary outcomes were postoperative nausea and vomiting (PONV) incidence and patient satisfaction scores. Results Fifteen studies with 983 participants met the inclusion criteria and were included in the present study. The heterogeneity in the final analysis regarding the pain score was low to moderate. The major results of the sensitivity analysis were stable. WI had the same analgesic effect as TAP block only at the one-hour postoperative time point (mean difference = −0.32, 95% confidence interval (-0.87, 0.24), P = 0.26) and was associated with a shorter time until the first rescue analgesic and poorer patient satisfaction. Conclusion TAP block results in a more effective and steady analgesic effect than WI with conventional local anesthetics in adult patients from the early postoperative period and obtains higher patient satisfaction.