Infiltration Anesthesia Research Articles

СVII level сervical ESP-block at the surgical treatment of a neck tumor: clinical case

BACKGROUND: Еrector spinae plane (ESP) block at the level of СVII under ultrasound navigation control can be technically feasible and successfully used in surgical interventions in the topographic area above the level of the seventh cervical vertebra, which is the upper anatomic boundary for the m. erector spinae. At the same time, the available information on the clinical use of posterior cervical plane blockades, which also includes the ESP block, during surgical interventions in the cervical dorsal region is rather scarce.
 CLINICAL CASE DESCRIPTION: We present a clinical case of removal of a large benign tumor localized on the posterior surface of the neck in a patient who had a serious concomitant endocrine and cardiovascular pathology, using bilateral ESP-blockade, which was performed at the level of СVII under the control of ultrasound navigation in combination with local infiltration anesthesia directly in the area of the skin incision. The peculiarities of this case include the absence of ESP-block potentiation with general anesthetics, preservation of the patient’s consciousness during the surgical intervention, stable hemodynamics and good indices of gas metabolism in combination with the absence of any pain sensations, as well as satisfactory condition of the patient and his early activation in the postoperative period.
 CONCLUSION: The presented clinical case demonstrates the possibility of using ESP-block at the level of CVII in volumetric surgical intervention on the dorsal surface of the neck as the method of choice.

General anesthesia with local infiltration reduces urine retention rate and prolongs analgesic effect than spinal anesthesia for hemorrhoidectomy.

Postoperative pain and complications pose significant challenges following a hemorrhoidectomy. Attaining effective anesthesia with minimal complications is crucial. The ideal anesthesia method for ambulatory hemorrhoidectomy remains uncertain. This study aimed to investigate whether the combination of general anesthesia plus local infiltration (GAL) is associated with lower complications and reduced pain compared to spinal anesthesia (SA) in the context of hemorrhoidectomy. This retrospective single-center cohort study, conducted in a tertiary medical center in East Asia, evaluated excisional hemorrhoidectomies performed between January 1, 2017, and March 31, 2023, utilizing GAL or SA. Data on the six most common complications-pain, constipation, acute urine retention (AUR), bleeding, nausea, and headache-were extracted from medical records. A total of 550 hemorrhoidectomies were included: 220 in the GAL group and 330 in the SA group. Patient characteristics were comparable between the two groups. The AUR rate was significantly lower in the GAL group compared to the SA group (15.5% vs. 32.1%, P < 0.001). Although the proportion of pain scores ≥4 did not differ significantly between the GAL and SA groups (36.2% vs. 39.8%, P = 0.429), the pain score curve indicated a stable trend. Overall, the GAL group exhibited a lower rate of adverse effects (56.9% vs. 67.4%, P = 0.023). There were no significant differences in the rates of other complications and emergency department readmission between the GAL and SA groups. GAL emerges as a favorable choice for anesthesia in hemorrhoidectomy, demonstrating a lower incidence of urine retention and a prolonged analgesic effect in multiple hemorrhoidectomies. These findings support the conclusion that GAL represents an optimal anesthetic method for enhancing the postoperative experience in patients undergoing hemorrhoidectomy.

The Impact of Ultrasound-Guided Subcostal Transversus Abdominis Plane (SCTAP) Block on Postoperative Pain Relief in a Patient Undergoing Cholecystectomy: A Case Report

Introduction: Handling post-operative pain in cholecystectomy requires several considerations, especially in terms of pain management. Various multimodal analgesia strategies to optimize postoperative pain control include epidural catheter placement, intravenous opioids, and the recently introduced ultrasonography (USG)-guided subcostal transversus abdominis plane (SCTAP) block. This case report aims to describe the postoperative analgesic effectiveness of ultrasound-guided SCTAP block in a patient undergoing open cholecystectomy.&#x0D; Case presentation: A 57 year old female patient with a diagnosis of multiple cholelithiasis, cholecystitis, was planned to undergo cholecystectomy, under general anesthesia and SCTAP block, with an ultrasound probe placed under the costal margin, the transversus abdominis muscle fascia was identified and local anesthetic infiltration laterally with bupivacaine plain 0.25 % 20 ml each on the left and right sides. Postoperatively, the patient returned to the room and received oral analgesics without opioids for pain management.&#x0D; Conclusion: Ultrasound-guided SCTAP blocks provide effective postoperative analgesia, reduce the need for postoperative analgesics, while supporting recovery after open cholecystectomy.

Evaluation of early effectiveness of local infiltration anesthesia with compound betamethasone in total knee arthroplasty

To evaluate the early effectiveness of local infiltration anesthesia (LIA) with compound betamethasone in total knee arthroplasty (TKA). The clinical data of 102 patients with knee osteoarthritis who were treated by TKA and met the selection criteria between May 2022 and March 2023 were retrospectively analyzed. They were divided into control group and study group according to whether LIA preparation was added with compound betamethasone, with 51 cases in each group. There was no significant difference of baseline data, such as age, gender, body mass index, operative side, preoperative range of motion (ROM), Knee Society Score (KSS), white blood cell (WBC), and hematocrit between the two groups ( P>0.05). The intraoperative total blood loss and hidden blood loss were recorded, and WBC was recorded on the 1st, 2nd, and 3rd days after operation. Pain was assessed by visual analogue scale (VAS) score on the 1st, 2nd, and 3rd days after operation and morphine intake milligrames equivalent within 48 hours after operation. Passive ROM, maximum extension and flexion angles of knee joint were measured on the 3rd day after operation; the early postoperative complications were recorded. There was no significant difference in total blood loss and hidden blood loss between the two groups ( P>0.05). The postoperative pain levels in both groups were relatively mild, and there was no significant difference in VAS scores in the first 3 days after operation and in morphine intake milligrams equivalent within 48 hours after operation between the two groups ( P>0.05). The WBC in the first 3 days after operation was significantly improved in both groups ( P<0.05). The WBC in the study group was significantly higher than that in the control group on the 1st and 2nd days after operation ( P<0.05), but there was no significant difference between the two groups on the 3rd day after operation ( P>0.05). On the 3rd day after operation, the maximum extension angle of knee joint in the study group was smaller than that in the control group, while the maximum flexion angle and passive ROM of knee joint in the study group were larger than those in the control group, and the differences were significant ( P<0.05). There were 6 cases of fever and 17 cases of deep venous thrombosis in the control group, and 1 case and 14 cases in the study group, respectively. There was no poor wound healing and periprosthetic joint infection in the two groups, and there was no significant difference in the incidence of complications between the two groups ( P>0.05). The application of compound betamethasone in LIA during TKA is a safe and optimal strategy to promote the early postoperative rehabilitation of patients.

Trexit: A “Clean” Withdrawal from Transrectal Prostate Biopsies – Prospective Results of In-office Freehand Transperineal Biopsies Under Local Anaesthesia

Introduction: Prostate biopsy (PB) may be performed by either the transrectal (TR) or transperineal (TP) approach. Cancer detection rates seem to be comparable between the two approaches. However, evidence suggests a reduced infection risk and a higher detection of tumours localised in the anterior zone of the prostate with the TP route. TP-PB is currently recommended as a first-line procedure for the diagnosis of prostate cancer (PCa) whenever available. We sought to report the initial results of in-office freehand TP-PB under local anaesthesia in the outpatient setting. Methods: We conducted a prospective study with consecutive sampling with data from men submitted to TP-PB from Sep/2019 to Sep/2021, in a tertiary care centre. A questionnaire was carried out to appraise the pain related to the procedure on a pain numerical rating scale from 0 to 10. Presenting PSA, biopsy result and characteristics and complications that motivated a visit to the emergency department–ED – until 1 month after the PB were analysed. Antibiotic (AB) prophylaxis was not provided to any of the patients undergoing TP-PB. TP-PB was performed under local anaesthesia by freehand method. Results: A hundred and eight (108) patients underwent TP-PB. The mean age was 66±9 years old. The median presenting PSA was comparable in patients with positive and negative PB results (7.7 ng/mL, p=0.11). Overall, 67/108 (62%) patients had PCa diagnosed. Clinically significant (cs) PCa (ISUP=2) was diagnosed in 42/67 (63%) patients. The TP approach allowed the diagnosis of anterior zone PCa in 61% (41/67) of the patients (anterior zone csPCa in 63% of these), 7% (5/67) had exclusively anterior zone pathological findings. Complications leading to an ED visit were recorded in only one patient. Patients reported only mild levels of discomfort related to the anaesthesia infiltration (3±3) and to the introduction of the US transducer (3±3). Globally, the patients ascribed a pain of 3±3 to the entire procedure. Conclusion: Freehand TP-PB under local anaesthesia, without AB prophylaxis, is a well-tolerated and safe procedure, feasible as an outpatient procedure. TP-PB provides an easy access to the anterior zone of the prostate allowing for the diagnosis of previously missed PCa.

Experimental study of local anesthetic and antiarrhythmic activities of fluorinated ethynylpiperidine derivatives.

The chemical structure of piperidine has a unique ability to combine with other molecular fragments. This fact makes it possible to actively use it as an effective basis for the creation of new drug-like substances. Thus, the aim of the current investigation was to study the acute toxicity, local anesthetic potency, and antiarrhythmic activity of the two new synthesized piperidine derivatives under laboratory codes LAS-286 and LAS-294 (local anesthetic substances). The Bulbring & Wajda animal model and method of determining the nociception threshold during electrical stimulation was used to investigate the action of the substance during infiltration anesthesia. An antiarrhythmic activity was observed by the aconitine-induced rat arrhythmia model. Additionally, these compounds were studied in relation to molecular docking to delineate the structure-activity relationships. The tested piperidine derivatives had a low toxicity in the subcutaneous and intravenous administration routes. The experimental results showed a higher prolonged and pronounced local anesthetic activity for LAS-286 at a 0.5% concentration, compared to the reference preparations. The low dosage of 0.1 mg/kg of LAS-294 demonstrated a pronounced preventive antiarrhythmic effect in 90% of cases on the development of mixed arrhythmia, caused by aconitine. The results of molecular docking confirmed a higher binding affinity of the tested piperidines with the Nav1.4 and Nav1.5 macromolecules. The results of the present study are very promising, because these piperidines have shown a high biological activity, which can suggest a potential therapeutic application in the future.

Retrospective comparison of articaine buccal infiltration and lidocaine intraosseous anesthesia in carious mandibular molars.

It is vital to identify more efficient anesthesia techniques for the restorative or endodontic treatment of mandibular molars. Both articaine buccal infiltration anesthesia (ABI) and lidocaine inferior alveolar nerve block anesthesia (LIANB) may not provide profound anesthesia, necessitating supplementary anesthesia. This study aimed to investigate whether lidocaine intraosseous lidocaine intraosseous anesthesia (LIO) is more suitable than ABI as primary anesthesia for caries treatment of mandibular molars. This study retrospectively analyzed patients treated for advanced caries according to the International Caries Detection and Assessment System (ICDAS) 5 and 6. The study involved 48 patients, split evenly between those receiving ABI and LIO, and examined the anesthesia success rate, pain during anesthesia, onset time, duration, and post-anesthesia lower lip numbness using Chi-square and Independent T-tests. In the ABI group, 17 patients (70.8%) did not require additional anesthesia, whereas all 24 patients (100%) in the LIO group did not require additional anesthesia (P < 0.001). ABI was associated with significantly higher pain during anesthesia, slower onset time, and longer duration of anesthesia than LIO. There was no significant difference in post-anesthesia lower lip numbness between the two methods. Intraosseous anesthesia using lidocaine is more effective for treating severe caries in the mandibular molars because of its higher success rate, decreased pain during anesthesia, faster onset, and shorter recovery time.

Comparison of Inferior Alveolar Nerve Block and Infiltration Anesthesia Techniques for Pain Control in Primary Mandibular Molar Extractions in pediatric patients

Comparison of Inferior Alveolar Nerve Block and Infiltration Anesthesia Techniques for Pain Control in Primary Mandibular Molar Extractions in pediatric patients

Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis.

This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success. A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression. Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030]. The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.

Combined impact of local anaesthetic infiltration through wound catheter and epidural analgesia following surgical hepatectomy: a meta-analysis.

A meta-analysis was performed to examine the effects of wound catheter (WC) local anaesthetic infiltration (LAI) and epidural analgesia (EA) in open hepatectomy (OH). A systematic literature review was performed, which found 350 subjects with OH at the baseline of the studies; 159 of them were treated with WC local anaesthetic infiltration, and 191 used EA. WC LAI substantially reduced the functional recovery time (MD = -0.64; 95% CI, -1.02 to -0.26, p < 0.001) and increased the pain score on the second postoperative day (MD = 0.25; 95% CI: 0.10-0.40, p < 0.001) compared to EA in OH patients. WC LAI did not vary from EA in OH patients in second postoperative opiate use (MD = -14.86; 95% CI: -32.88 to 3.16, p = 0.11) or overall complication rate (OR = 0.66; 95% CI: 0.41-1.04, p = 0.07). WC LAI showed a non-significant difference in opiate consumption on the second postoperative day and in the overall complication rate, compared with EA, but it showed a lower functional recovery time and higher pain score.

Modified thoracoabdominal nerves block through perichondrial approach for laparoscopic cholecystectomy.

A new block, namely, modified thoracoabdominal nerves block through perichondrial approach, is administered below the costal cartilage. We sought to compare the analgesic efficacy of the modified thoracoabdominal nerves block through perichondrial approach block with local anesthetic infiltration at the port sites in an adult population who underwent laparoscopic cholecystectomy. Patients who will undergo laparoscopic cholecystectomy were randomized to receive bilateral ultrasound-guided modified thoracoabdominal nerves block through perichondrial approach blocks or local anesthetic infiltration at the port insertion sites. The primary outcome was the total amount of tramadol used in the first 12 h postoperatively. The secondary outcomes were total IV tramadol consumption for the first postoperative 24 h and visual analog scale scores. The modified thoracoabdominal nerves block through perichondrial approach group had significantly less tramadol use in the first 12 h postoperatively (p<0.001). The modified thoracoabdominal nerves block through perichondrial approach group's visual analog scale scores at rest (static) and with movement (dynamic) were significantly lower compared with the port infiltration group (p<0.05). Patients who received modified thoracoabdominal nerves block through perichondrial approach block had significantly less analgesic consumption and better pain scores than those who received port-site injections after laparoscopic cholecystectomy.

Ultrasound-guided Supraclavicular Brachial Plexus Block with Ropivacaine in Basilic Vein Transposition Surgery for Chronic Renal Failure Patients: An Interventional Study

Introduction: Basilic Vein Transposition surgery (BVT) is preferred under ultrasound-guided supraclavicular brachial plexus block, which provides excellent and safe anaesthesia in Chronic Renal Failure (CRF) patients. Ropivacaine, with a shorter elimination half-life than bupivacaine and better pharmacokinetics, is a safer option as a local anaesthetic agent in CRF. Aim: To assess the onset and duration of sensory and motor blockade with 20 mL of 0.5% ropivacaine in ultrasound-guided supraclavicular block and the need for additional local infiltration at the surgical site for BVT. Materials and Methods: In present interventional study conducted in the Department of Anaesthesiology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India, 25 American Society of Anaesthesiologists (ASA) III/IV CRF patients, aged 18-80 years, who underwent BVT surgery, were included from December 2021 to November 2022. A 20 mL dose of 0.5% ropivacaine was administered to these patients via ultrasound-guided supraclavicular block. The surgeon performed local infiltration with 10 mL of lignocaine at the T2 dermatomal area in all patients. Descriptive statistics were calculated for age, weight, ASA status, onset and duration of sensory and motor blockade, and the need for additional local infiltration. Results: The mean age and mean weight of the patients were 52 years and 57.68 kg, respectively. Total 17 were male and eight were female, while 23 were ASA III and two were ASA IV. After administering the supraclavicular block, the mean onset of sensory and motor blockade was 9±2.3629 and 13.16±2.6721 minutes, respectively. The mean duration of sensory and motor blockade was 612.8±132.815 and 522.8±121.124 minutes, respectively. All patients required local site infiltration (10 mL of 1% lignocaine-Adrenaline) as the T2 dermatome is usually spared by the supraclavicular block. Three patients required additional local anaesthetic infiltration. Conclusion: Minimising the concentration and volume of local anaesthetic drugs without compromising efficacy is challenging, particularly in BVT, where the incision is extensive and performed under supraclavicular BPB in high-risk CRF patients. The anaesthesia practice of using a low volume of 0.5% ropivacaine in BPB under ultrasound guidance, along with local anaesthetic infiltration with 1% lignocaine with adrenaline at the T2 dermatome, can serve this purpose without any complications.

Analgesia strategy for inguinal hernia repair in children: a systematic review and network meta-analysis of randomized clinical trials based on regional blocks.

Despite its acknowledged benefits, the selection of an optimal regional block for analgesia pediatric hernia surgery remains a subject of debate. This study endeavored to conduct a network meta-analysis and systematic review of randomized clinical trials, aiming to amalgamate insights from both direct and indirect comparisons concerning the analgesic effectiveness and safety of various regional blocks post-inguinal hernia repair in children. A comprehensive literature search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library up to 12 November 2022 by two independent reviewers, employing a standardized protocol. The inclusion criteria encompassed randomized trials focusing on children undergoing inguinal hernia repair utilizing either local infiltration analgesia or regional analgesia. The primary outcomes assessed were pain scores at 2, 6, and 24 h post-operation. The initial search yielded 281 records relating to 1,137 patients. The analysis of ranking probability indicated that Paravertebral Block (PVB) holds the highest likelihood (88% and 48%) of being the most effective in alleviating pain at 2 h and 6 h post-surgery. Trans vs. Abdominis Plane Block (TAPB) emerged as the superior choice for mitigating pain (83%) and decreasing morphine consumption (93%) at 24 h following the operation. Local Anesthetic Infiltration (LAI) was identified as the most effective in shortening the hospital stay, with a 90% probability. Regional anesthesia significantly enhances postoperative pain management in pediatric inguinal hernia repair surgery. For short-term postoperative pain relief, PVB emerges as the most effective technique. Meanwhile, TAPB provides more prolonged analgesia. Although TAPB does not exhibit a pronounced advantage in short-term analgesia, its simplicity and the absence of a need for a special position render it a viable option. However, the interpretation of these results should be approached with caution due to the presence of limited data and heterogeneity. PROSPERO (CRD42022376435; www.crd.york.ac.uk/prospero).

Discovering a rare cause for backache – A case report in Bertolotti syndrome

Bertolotti syndrome is one of the rare causes of chronic backache in all age groups. It is caused by an abnormally enlarged transverse process called “mega-apophysis” articulating with the sacrum or ileum leading to altered biomechanics of the spine.A 16-year-old school-going girl with Castelli’s type II A was managed successfully with steroid and local anesthetic infiltration into the pseudoarticulation. An internet-based literature survey was conducted and the results were analyzed. 12 studies that describe the treatment modality of bertolotti syndrome were found.The local infiltration of steroid and anesthetic agents can be used to diagnose or treat this entity. Recurrence of symptoms following infiltration deserved excision of mega-apophysis.

Effect of Different Methods of Anesthesia on Surgically Created Arteriovenous Fistula

Aim of the study was to determine the advantages of peripheral nerve blocks (PNB) versus local infiltration anesthesia (LIA) in the formation of arteriovenous fistula (AVF) surgically created for hemodialysis treatmentType of study: prospective non-randomized study. Approved by the ethics committee of JLF UK in Martin.Type of workplace: clinical workplace of a university hospital.Material and method. The cohort of patients (N=40) who required arteriovenous fistula (AVF) creation was divided into 2 groups, 20 patients each: patients operated under peripheral nerve blockade and patients operated under local infiltration anesthesia. The preserved function of the fistula was monitored 24 hours, 6 weeks and one year after the operation, without revision. Patient inclusion criteria included: age 19–75 years, ASA 3–4, weight 40–120 kg, BMI up to 40. Statistical treatment of data included Mann-Whitney exact test, Fisher's test, t-test, Shapiro–Wilk normality test.Results. After 24 hours, all fistulas created with peripheral nerve blockade were functional whereas only 90% developed under local infiltration anesthesia remained functional (P&gt;0.05 between groups). However, after 6 weeks, 80% of fistulas created under peripheral nerve block were functional, compared to 50% of functional fistulas created in patients under local infiltration anesthesia (P=0.048). One year after surgery, the difference remained as a trend since 55% of fistulas created under peripheral nerve block remained functional while only 35% of fistulas created in patients receiving local infiltration anesthesia were functional without complications (P=0.097).Conclusion. In our study, the peripheral nerve block anestesia seem superior in term of improved survival of created fistula compared to local infiltration anesthesia.

Novel Techniques for Musculoskeletal Pain Management after Orthopedic Surgical Procedures: A Systematic Review.

Effective postoperative pain management is critical for recovery after orthopedic surgery, but often remains inadequate despite multimodal analgesia. This systematic review synthesizes evidence on innovative modalities for enhancing pain control following major orthopedic procedures. Fifteen randomized controlled trials and comparative studies evaluating peripheral nerve blocks, local anesthetic infiltration, cryotherapy, transcutaneous electrical stimulation, adjunct medications, and other techniques are included. Thematic analysis reveals that peripheral nerve blocks and local anesthetic infiltration consistently demonstrate reduced pain scores, opioid consumption, and side effects versus conventional analgesia alone. Oral multimodal medications also show promise as part of opioid-sparing regimens. Adjunctive approaches like cryotherapy, music, and dexmedetomidine require further research to optimize protocols. Despite promising innovations, critical knowledge gaps persist regarding comparative effectiveness, optimal interventions and dosing, combination strategies, cost-effectiveness, and implementation. High-quality randomized controlled trials using standardized protocols are essential to guide the translation of enhanced multimodal regimens into clinical practice. This review provides a framework for pursuing research priorities and advancing evidence-based postoperative pain management across orthopedic surgeries.

Does Local Infiltration of Anesthesia Reduce Port-site Pain in Gynecological Laparoscopic Surgeries? A Pilot Study.

The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic surgeries and to compare it with those receiving placebo and to evaluate the additional analgesic requirement in the first 24 h after surgery. A prospective interventional study was conducted on 60 women scheduled for benign gynecological laparoscopic surgeries. Patients were randomized into two groups using an alternative sequential method of allocation. Approval from the Institute's Ethics Committee was sought. Informed written consent was taken from all the patients. All laparoscopic surgeries were performed under general anesthesia. Double-blinding was done. A VAS with a 10 cm vertical score ranging from "no pain" to "worst possible pain" was used to assess the postoperative pain when the patient awakened in the operating room (2 h after surgery), then after 6 and 24 h. The primary outcome measured was pain perception by the patient (as VAS scores), and the secondary outcome was the need for additional analgesia. Comparison of both groups with the VAS score shows P > 0.001, i.e., nonsignificant in all the groups. Additional analgesics were required in 56% of the patients in the intervention group and 60% of the patients in the control group; however, 44% and 40% of the patients from the intervention and control groups, respectively, do not require any additional analgesic in the postoperative period. The local infiltration of bupivacaine does not significantly reduce the port-site postoperative pain in gynecological laparoscopic surgeries.

PAIN ASSOCIATED WITH INTRAOSSEOUS ANESTHESIA WITH QUICKSLEEPER AND POST-OPERATIVE CONDITION OF THE PERFORATION SITE

Purpose: The aim of the study is to determine the pain during intraosseous anesthesia (IA) with the Quicksleeper and the post-operative state of the perforation site. Materials and methods: The subjects of the study were 58 patients who underwent successful intraosseous analgesia, indicated with treatment of caries or irreversible pulpitis of mandibular first and second molars. The Visual Analogue Scale was used to assess the pain during the perforation of the compact bone and during the infiltration of anesthetic solution into the cancellous bone. All 58 patients were followed up at the 24th hour and on the 7th day after the manipulation, and the following parameters were evaluated: condition of the perforation site and presence of palpation pain. Results: Only 10 patients registered mild pain during perforation of compact bone and 8 – during anaesthetic infiltration. At 24 hours after IA, 12 patients registered mild pain, 6 patients registered moderate pain at the perforation site. On the 7th day, we established mild pain in 4 patients. After IA a reactive inflammatory process was registered in 27% of the cases at 24 hours, while on the 7th day, the inflammatory reaction was registered in only 6% of the cases. Conclusion: The intraosseous system Quicksleeper allows painless perforation of the compact bone and infiltration of the anesthetic solution into the cancellous bone due without risk of serious post-operative complications at the site of anesthesia.

Administration of Spinal Anesthesia in the Jack-knife Prone Position for Anorectal Surgeries

At the institution, anorectal surgeries are often done in prone-jackknife position, under Monitored Anesthesia Care (MAC) combined with either local infiltration or intrathecal spinal anesthesia. The traditional technique for spinal anesthesia is done with 0.75% hyperbaric Bupivacaine in a sitting position and the patient remains in this position for 10-15 minutes before turning into a prone jackknife position for the surgery. The other approach for spinal anesthesia is done while patient is already in a jackknife prone position and using 0.25% hypobaric Tetracaine, former technique is easier than the latter however demands a longer knife-to-skin time and patients are potentially prone for more hemodynamic instability. In this case series, three male adults who underwent anorectal surgery in the jackknife position with jack-knife position for spinal anesthesia and mild MAC has been described. The operating time was more efficient, the perioperative course and recovery were uneventful. Patient and staff satisfactions were encouraging and promising for the jackknife spinal anesthesia technique. A short acting hyperbaric local anesthetic will further enhance efficiency by shortening recovery and discharge time.

#54 : Patient Tolerability of Local Anesthesia Infiltration of the Vaginal Wall and Parietal Peritoneum During Oocyte Retrieval for Minimal Simulation In-Vitro Fertilization (IVF)

Background and Aims: Oocyte retrieval is a brief and minimally invasive procedure occasionally performed under anesthesia due to pain caused by the aspirating needle puncturing the vaginal skin and ovarian capsule during its manipulation within the ovary. Despite different techniques and regimens examined, there is no conclusion on the preferred method for anesthesia and pain relief for these procedures. The purpose of this retrospective cross-sectional study was to assess patient tolerability of local anesthesia for oocyte retrieval. Method: Patients undergoing minimal stimulation IVF were included. The average age of the women was 38.51 ± 4.402 (min. 28, max. 49). 3 ml of 2% lidocaine infiltration was done at the vaginal wall and parietal peritoneum just before oocyte retrieval. Participants rated pain levels at three events: during oocyte aspiration (“intra-op”), right after oocyte retrieval (“post-op”), and 15 minutes post-OPU. The pain scale used ranged from 0 to 10, with 0 being “No pain” and 10 being “Worst pain imaginable”. Results: The average time duration of oocyte retrieval was 7.54 ± 4.57. The average number of follicles aspirated was 4.77 ± 4.04 and the average number of eggs retrieved was 3.62 ± 3.213. Average pain ratings were as follows: Intra-op: 4.152 ± 2.757 S.D. (min. 0, max. 10); 15-min post-OPU: 2.848 ± 2.662 (min. 0, max. 9), and Discharge: 1.711 ± 2.017 (min. 0, max. 8), respectively. There was significant difference in the average pain felt by patients at the three events (p&lt;0.001). According to 55 out of 99 participants who willingly answered the survey, 90.9% were willing to use the same sedation method again. Conclusion: Vaginal wall and parietal peritoneum local anesthesia infiltration helps in making the procedure tolerable for the patient.