Injection Discomfort Research Articles

Postoperative quality of recovery comparison between ciprofol and propofol in total intravenous anesthesia for elderly patients undergoing laparoscopic major abdominal surgery: A randomized, controlled, double-blind, non-inferiority trial

Study objectivesWe conducted a non-inferiority study to assess the postoperative quality of recovery (QoR) in elderly patients receiving ciprofol or propofol total intravenous anesthersia(TIVA)after elective laparoscopic major abdominal surgery, with QoR-15 scores as the main measure. DesignA prospective, double-blind, randomized non-inferiority trial was conducted in the theater, post-anesthesia care unit (PACU), and the ward. Participants144 elderly patients (age ≥ 65 years) were randomly assigned to either the ciprofol group or the propofol group. InterventionsThe ciprofol group received continuous infusion of ciprofol with remifentanil, and the propofol group received infusion of propofol with remifentanil. Outcome measuresThe primary outcome was the QoR-15 on the first postoperative day (POD1), assessed in both intention-to-treat and per-protocol populations, with the mean difference between groups compared to a non-inferiority threshold of −8. Additional assessments included QoR-15 scores on POD2, 3, and 5 for both analysis sets. Other evaluated perioperative value factors included hemodynamic parameters and injection discomfort in the intention-to-treat analysis. A linear mixed model was utilized to examine the impact of group-time interactions on hemodynamic data and QoR-15. Main resultsThe QoR-15 scores on POD1 in the ciprofol group were non-inferior to those in the propofol group both in intention-to-treat set (mean [95 %CI], 95.9[93.7–98.2] vs. 95.6 [93.3–97.8]; mean difference [95 % CI], 0.4 [−2.8–3.5]; P<0.001 for noninferiority) and per-protocol set (mean [95 %CI], 96.7 [94.4–99.0] vs. 95.7 [93.4–98.0]; mean difference [95 % CI], 1.0 [−2.2–4.3]; P<0.001 for noninferiority). Comparable outcomes were noted on postoperative days 2, 3, and 5 following the procedure in both analysis sets. Additionally: compared with propofol group, the occurrence of injection pain was lower (2.8 % vs. 27.8 %, P < 0.001); the hypotension was less frequent (33.3 % vs. 54.2 %, P = 0.012); the bradycardia was more common (38.9 % vs. 23.6 %, P = 0.048). ConclusionsCiprofol is not inferior to propofol in QoR. Ciprofol can be suitably administered to elderly patients undergoing elective laparoscopic major abdominal surgery.

Effect of adding sodium bicarbonate 8.4% to local anesthesia on pain during upper canine infiltration.

Alkalization of local anesthetics may have an impact on alleviating the injection pain by buffering these solutions with sodium bicarbonate. The present study aimed to evaluate the pain during local anesthetic buccal infiltration for the maxillary canines after adding sodium bicarbonate 8.4% during local anesthesia. A buffered 2% lidocaine with 1:80,000 epinephrine and sodium bicarbonate 8.4% was used for one site, and an unbuffered 2% lidocaine with 1:80,000 epinephrine was used for the other site at the same appointment. Two groups of volunteers (15 male and 15 female) participated. Each participant received 0.6 mL of the anesthetic solution. Injection discomfort was assessed using a visual analog scale. 73% and 93% of patients in group 1 experienced pain in sites A and B, respectively, during the injection, whereas 80% and 100% of patients in group 2 experienced pain in sites A and B, respectively, during the injection. Both groups showed a significant difference in pain scores between the two injected sites (P ˂ 0.01). Upper canine infiltration anesthesia with buffered lidocaine and epinephrine with sodium bicarbonate has less pain during injection than when unbuffered lidocaine with epinephrine is used.

Reducing injection discomfort in dermatology outpatient clinics.

Reducing injection discomfort in dermatology outpatient clinics.

Does lidocaine reduce pain intensity during corticosteroid injection? A double-blind randomized controlled equivalence trial.

Of the strategies considered to limit the discomfort of corticosteroid injection, one is to inject without lidocaine to reduce the total volume and avoid acidity. In a Bayesian trial, adults receiving corticosteroid injections were randomized to receive 0.5 mL of triamcinolone with or without 0.5 mL of lidocaine. Serial analysis was performed until a 95% probability of presence or absence of a 1.0-point difference in pain intensity on the 0-10 Numerical Rating Scale was reached. Injections with lidocaine were associated with a median of 2.4-point lower pain intensity during injection with a 95% probability of at least a 1-point reduction. The 95% probability was confirmed in 90% of the repeated analysis (36/40). Lidocaine is associated with lower immediate pain intensity during corticosteroid injection for hand and wrist conditions.Level of evidence: I.

Delayed emergence after general anesthesia using remimazolam for induction agent in laparoscopic cholecystectomy: a case report

Remimazolam’s ultrashort-acting properties, including reduced injection discomfort, minimal impact on respiratory and cardiovascular functions and rapid metabolism, have garnered significant attention in the field of anesthesia. However, despite its widespread acclaim, we encountered an unusual case in which a patient without hepatic or renal impairment experienced unexpected delays in regaining consciousness following a single intravenous induction dose of remimazolam. The patient, a 63-year-old undergoing laparoscopic cholecystectomy for gallbladder stones, had preoperative tests revealing atrial fibrillation and a reduced ejection fraction observed in an echocardiogram. Anesthesia induction included the administration of remimazolam (0.3 mg/kg), sufentanil and rocuronium. The surgery proceeded uneventfully and was maintained with desflurane and sufentanil. However, after the surgery, the patient experienced delayed emergence from anesthesia. Opioid overdose was ruled out, and we suspected a metabolic delay associated with remimazolam. In response to this suspicion, we administered flumazenil, which promptly restored consciousness and normal breathing. Subsequent post-anesthetic observation revealed no complications, and the patient was discharged two days after surgery. This case highlights the significant delayed emergence phenomenon linked to remimazolam, even when administered as a bolus. Instances of delayed emergence following remimazolam administration underscore the complexities in anesthesia responses, emphasizing the importance of vigilant clinical monitoring and the need for ongoing research in this area.

Novel dental anaesthetic and associated devices: a scoping review protocol

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In oral health, local anaesthesia is crucial for managing pain and discomfort. Typically, anaesthesia is administered by injecting an anaesthetic solution using a needle and syringe. However, new technologies have been created to aid oral health therapists in reducing pain and discomfort during local anaesthesia administration. The purpose of this study is to analyse and investigate alternate local anaesthetic delivery systems, such as current equipment, technologies, and associated devices that help reduce injection discomfort. In addition, information gaps and limitations of existing studies will be highlighted to guide future studies. The protocol for scoping available evidence, mapping key concepts, and identifying gaps for future research is detailed in this manuscript.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) Manual for Evidence Synthesis guidelines were used to create this protocol. Six electronic databases such as MEDLINE, CINAHL, AMED, Dentistry and Oral Science Source, and Scopus, and two other search engines, Google and Google Scholar, will be searched for all relevant primary and secondary studies, grey literature, and other sources relating to new technologies have been developed to assist dentists in providing reduced pain and discomfort when administering local anaesthesia. Two reviewers will independently evaluate the sources retrieved using the eligibility criteria defined by the Population Concept, and Context (PCC) framework. To track the number of identified, included, and excluded sources, a PRISMA-ScR flowchart will be used. A data extraction table will display the extracted data and variables. The synthesised results will be accompanied by narrative explanations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings of this review will be summarised to aid in identifying limitations in existing research and provide guidance and recommendations for future research for health professionals.&lt;/p&gt;

O17 - Two versus four sterile water injections for managing back pain in labour

The efficacy and safety of sterile water injections to manage labour back pain was demonstrated in recent clinical trials. Varying the number of injections used in the procedure from four to two has been cited as a means of possibly reducing the injection pain while maintaining analgesic effect. However, it is not known if the pain relief provided by two sterile water injections is the same as that from the usual four injections, or if fewer injections results in a decrease in injection discomfort. The aim of this trial was to determine if the pain relief experienced by participants receiving two water injections would be clinically equivalent to four. We conducted a multicenter randomised controlled equivalence trial in which 238 women in labour with a Visual Analogue Scale pain score (VAS) of 70 millimetres (mm) (0= no pain; 100= worst pain imaginable) were randomised to two or four sterile water injections. The primary outcome was pain measured on a VAS at 30 minutes post treatment. A clinically relevant a-priori margin of equivalence was set at ±10 mm difference in VAS scores. Secondary outcomes included the likelihood of achieving an at least 30% and 50% reduction in pain, birth and neonatal outcomes. Clinical equivalence was not demonstrated. Both techniques achieved an at least 30% reduction in pain in over 75% of participants though duration of effect was longer in the four injection group. There was no difference in other birth related secondary outcomes. Four injections provided a margin of benefit over two injections in level and duration of analgesia. Four injections remains the technique of choice though two injections still provided significant pain relief and would be suitable where it was not possible or desirable to provide four.

Local Anesthesia in Interventional Radiology.

Interventional radiology is an evolving field that treats a variety of diseases. Local anesthetics is an important component of pain management during interventional radiologic procedures. It is highly effective and generally safe for routine procedures. However, local anesthetics can be associated with painful initial injection, allergic reactions, and rare but potentially devastating systemic toxicities. Recent evidence has shown that buffered solution and warm local anesthetics may reduce injection discomfort and improve clinical efficacy. Sensible safety practices and prompt recognition/treatment of the systemic toxicity are of paramount importance to provide safe local anesthesia. Interventional radiologists should be familiar with the basic pharmacology, common local anesthetics, optimizing strategies, complications, and management to provide safe and effective local anesthesia for patients.

Patient with hypogonadism and infertility successfully treated with clomiphene citrate

We described 59-year-old men with history of secondary/tertiary hypogonadism, without primary hypothyroidism, elevated prolactin or hemochromatosis with structurally intact hypothalamo- hypophyseal (HT-HP) axis who was diagnosed in 2017. He was treated by different physicians with Testosterone intramuscular injections, hCG intramuscular injections and combination of hCG and FSH intramuscular injections. The patients wanted to have another child and this is why his therapy was changed from testosterone to hCG and later on to hCG and FSH injections three times a week by his urologist. Although his testosterone levels increased his semen analysis showed oligospermia. The patient was not very compliant with his Testosterone, hCG/hCG and FSH injections, because of the discomfort of intramuscular injections. This is why we started the patient from the therapy with hCG and FSH intramuscularly to Clomiphene citrate (CC) 25 mg per mouth every other day in 2021. After eight months therapy with CC the patient semen analysis normalized, Total and Free testosterone levels normalized, LH and FSH increased, his libido, morning erections improved and his erectile dysfunction resolved. Most importantly for the patient his wife become pregnant. With this case we emphasize the role of Clomiphene citrate in treating male hypogonadism if the patients desire fertility.

A comparison of pretreatment with lignocaine versus dexmedetomidine in prevention of etomidate induced myoclonus- A randomised comparative trial

Etomidate is a short-acting non-barbiturate intravenous anesthetic with rapid induction and rapid awakening. It is frequently utilized in clinical practice, especially for patients with an unstable cardiovascular system, due to its minimal influence on hemodynamics and respiratory depression. However, Etomidate might cause side effects during anaesthetic induction, such as injection discomfort, phlebitis, hemolysis, and myoclonus. This study was, therefore, conducted in order to compare the pre-treatment with lignocaine versus dexmedetomidine in deterrence of myoclonus resulting from Etomidate.60 patients were allocated randomly into two study groups. Each group comprising 30 patients. Patients in GroupI received injection Lignocaine (1 mg/kg)and Group II received injection Dexmedetomidine (0.5μg/kg) in 10 ml of normal saline over 10 min followed by Etomidate injection (0.3 mg/kg) over 30 s. Patients were observed for 2 minutes for occurrence of myoclonus and the intensity and time of occurrence was noted by a person blinded to the drug used.In our study, 90% patients were myoclonus grade zero, followed by 6.7%, 3.3% and no one of myoclonus grade one, two and three in dexmedetomidine group at 1 min. 60.0%, 10.0%, 13.3% and 16.7% patients had grade zero, one, two, three of myoclonus respectively in lignocaine group at 1 min. 80.0% patients were myoclonus grade zero, followed by 13.3%, 3.3%, 3.3% of patients had myoclonus grade one, two, three respectively in dexmedetomidine group at 2mins. 53.3%, 10.0%, 16.7%, 20.0% patients were myoclonus grade zero, one, two and three respectively in lignocaine group at 2mins. On the whole 46.7% patients in lignocaine group developed Myoclonus; but 20.0% in dexmedetomidine group shows the myoclonus.We conclude that the prevalence of Etomidate-induced myoclonus was significantly decreased in patients who were pre-treated with dexmedetomidine in comparison with lignocaine.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

A Review of Current Literature of Interest to the Office-Based Anesthesiologist.

Application Effect of Computer-Assisted Local Anesthesia in Patient Operation.

In order to avoid the psychological harm caused by pain to patients, in this study, the application effect of computer-assisted local anesthesia in patient surgery was studied. In this method, 72 patients with hypertension, 35 males and 37 females, aged 53–83 years, with an average age of 70.8 ± 1.3 years, were selected for appointment tooth extraction in the department of stomatology from January to December 2014. All patients were booked for tooth extraction by ECG monitoring. Patients who were contraindicated for tooth extraction, had a history of mental illness, and had used antianxiety drugs and sedatives within 1 week before surgery were excluded. Patients were randomly divided into two groups according to their ID numbers: observation group, 36 cases, and control group. Painless oral local anesthesia injection instrument was used for local anesthesia injection. In the control group, 36 patients were injected with local anesthesia by traditional manual injection. The results showed that 86.11% of patients in the observation group had decreased anxiety scores after anesthesia, while only 13.88% of patients in the control group had decreased anxiety scores. Among patients with decreased anxiety scores, 80.65% in the observation group became nondental anxiety compared with 28.57% in the control group. Computer-assisted oral local anesthesia can effectively control dental anxiety and relieve the pain and discomfort of local anesthesia injection, and improve patient satisfaction, conducive to the smooth nursing work.

Glucose-responsive oral insulin delivery platform for one treatment a day in diabetes

Glucose-responsive oral insulin delivery platform for one treatment a day in diabetes

Comparison of Local Ice Packs with Local Anaesthetics for Decreasing the Pain of Injection during a Dental Procedure

Aim: To evaluate the efficacy of different possible and non-pharmacological techniques in eliminating the discomfort of local anaesthesia injection during dental procedures.&#x0D; Introduction: Dental anxiety and fear of needles are one of the most common problems seen by dental practitioners; several methods are currently used to lower the discomfort of local anaesthesia injection during dental procedures. The desensitization of injection sites is one of the recommended strategies. Among chemical anaesthetic topical agents that are effective but might have allergic side effects, using some non-pharmacological and safe techniques might be useful.&#x0D; Materials and Methods: Randomly chosen patients receiving LA underwent pre-injection intervention that included heat, cold and pressure. This was compared with a control of no pre-injection intervention. Pain score in ice and LA spray pre-injection intervention. It clearly shows that the pain levels in the LA spray technique are higher than those in the Ice technique.&#x0D; Results: Comparing the pain score of ice as a pre-injection intervention between males and females it was found that males have lower pain scores than females.&#x0D; Conclusion: This study shows a significant advantage of the non-pharmacological method over the pharmacological method. Hence further research could help standardize ice application pre-injection for a more nontoxic and natural method of reducing pain during an LA injection. It can also prove beneficial when LA does not work due to an acidic environment.

Patient-Reported Outcomes, Experiences and Satisfaction with Weekly and Monthly Injectable Prolonged-Release Buprenorphine.

IntroductionProlonged-release buprenorphine (PRB), administered by weekly or monthly injection, for opioid dependence (OD) treatment offers the potential to address some limitations of oral therapy including stigma, difficulty in achieving consistent appropriate dosing, risk of diversion of medications, risk of overdose, and continuing use of other drugs. Patient-reported outcomes (PRO) and experiences are important in the evaluation of OD therapy success. This work aimed to document PRO during PRB therapy to guide future treatment decision-making.MethodsQualitative interviews were completed with people on PRB OD treatment. Twenty individuals from four treatment services in England and Wales were asked to participate. A structured interview was developed guided by a person with OD lived experience. Interviews were transcribed, coded and analyzed using iterative categorization.ResultsFifteen of 20 individuals approached agreed to participate, and 14 completed interviews. The average age of participants was 42 (range 33–54) years, 13 males and 1 woman, the history of problematic opioid use was 14 years (3–25 years), time in treatment was 7 years (1–20 years), and duration on treatment with PRB was 4 months (range 1–8 months). Participants reported treatment experiences leading to coding of 277 unique comments: therapy effectiveness (77% indicated a benefit of, or satisfaction with, PRB therapy, 7% neutral/general, 16% indicated concern or questions about PRB therapy), convenience (81% benefit, 7% neutral/general, 12% concern), and overall satisfaction (81% benefit, 3% neutral/general, 16% concern). Reported benefits include cravings reduction of 10 (71%), self-care improvement of 10 (71%), relationships improvement of 9 (64%), resources management of 6 (43%), positive outlook on life of 12 (86%). Participants reported a range of positive personal experiences; challenges reported included temporary injection discomfort at treatment initiation.DiscussionIn this small, focused population, there was generally a positive level of treatment satisfaction with PRB. These experiences provide insights to explain potential treatment benefit to others and are useful in guiding therapy choices for others in the future.

State of the art review: oral and nasal vitamin B12 therapy in the elderly.

The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by 'PubMed' and 'Scholar Google' search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the 'Cochrane Library' and the 'ISI Web of Knowledge'. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from 'CARE B12' research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study.

To study the discomfort and fear associated with maxillary infiltration injections when using a combination of external cold and a commercially available vibrating device. A total of 60 children aged 7years old participated in this split mouth randomised crossover study. The control intervention comprised of the administration of 1.8ml of 2% lidocaine with 1:100,000 adrenaline using a 24mm 30 gauge needle, while the test intervention used external cold and a commercially available vibrating device in addition to the control protocol. The heart rate of the child at the time of injection was used as an objective measure and the Wong-Baker pain scale was used as a subjective measure of the child's discomfort. The face, limbs, arms, cry and consolability (FLACC) scale was used to record the child's pain as perceived by the dentist. Children reported a significantly lower Wong-Baker score and the operators observed a significantly lower heart rate and FLACC scores in the test visit than the control visit. Combining external cold with vibrating devices might be effective in reducing discomfort and fear in children undergoing infiltration dental analgesia. NCT02675387.

Systematic Review and Pragmatic Clinical Approach to Oral and Nasal Vitamin B12 (Cobalamin) Treatment in Patients with Vitamin B12 Deficiency Related to Gastrointestinal Disorders.

The objective of this review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin) treatment in gastrointestinal (GI) disorders. Relevant articles were identified by PubMed and Google Scholar systematic search, from January 2010 and June 2018, and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the Cochrane Library and the ISI Web of Knowledge. Data gleaned from reference textbooks and international meetings were also used, as was information gleaned from commercial sites on the web and data from CARE B12 research group. For oral vitamin B12 treatment, 4 randomized controlled trials (vs. intramuscular), 4 narrative and 4 systematic reviews, and 13 prospective studies fulfilled our inclusion criteria. These studies concerned patients with vitamin B12 deficiency related to: food-cobalamin malabsorption (n = 6), Biermer’s disease (n = 3), veganism or vegetarianism (n = 1), total gastrectomy after Roux-en-Y gastric bypass (n = 2) and Crohn’s disease (n = 1). Four prospective studies include patients with vitamin B12 deficiency related to the aforementioned etiologies, except veganism or vegetarianism. The systematic present review documents that oral vitamin B12 replacement, at a daily dose of 1000 μg (1 mg), was adequate to normalize serum vitamin B12 levels and cure main clinical manifestations related to vitamin B12 deficiency, in GI disorders, and thus, with safety profile. For nasal vitamin B12 treatment, only one preliminary study was available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 (except in patients presenting with severe neurological manifestations). Oral vitamin B12 treatment avoids the discomfort, contraindication (in patients with anticoagulation), and cost of monthly injections.

Cryogenic Numbing to Reduce Injection Discomfort during Indocyanine Green Lymphography.

Cryogenic Numbing to Reduce Injection Discomfort during Indocyanine Green Lymphography.

Novel Somatostatin Receptor Ligands Therapies for Acromegaly.

Surgery is considered the treatment of choice in acromegaly, but patients with persistent disease after surgery or in whom surgery cannot be considered require medical therapy. Somatostatin receptor ligands (SRLs) octreotide (OCT), lanreotide, and the more recently approved pasireotide, characterized by a broader receptor ligand binding profile, are considered the mainstay in the medical management of acromegaly. However, in the attempt to offer a more efficacious and better tolerated medical approach, recent research has been aimed to override some limitations related to the use of currently approved drugs and novel SRLs therapies, with potential attractive features, have been proposed. These include both new formulation of older molecules and new molecules. Novel OCT formulations are aimed in particular to improve patients’ compliance and to reduce injection discomfort. They include an investigational ready-to-use subcutaneous depot OCT formulation (CAM2029), delivered via prefilled syringes and oral OCT that uses a “transient permeability enhancer” technology, which allows for OCT oral absorption. Another new delivery system is a long-lasting OCT implant (VP-003), which provide stable doses of OCT throughout a period of several months. Finally, a new SRL DG3173 (somatoprim) seems to be more selective for GH secretion, suggesting possible advantages in the presence of hyperglycemia or diabetes. How much these innovations will actually be beneficial to acromegaly patients in real clinical practice remains to be seen.