Anesthetic Injection Research Articles

Comparison of Analgesic Efficacy between Bupivacaine with Dexamethasone versus Bupivacaine in Caudal Block for Pediatric Patients Undergoing Lower Abdominal Surgeries

Abstract Background Caudal analgesia is one of the most popular regional blocks in paediatric patients undergoing lower abdominal surgeries but with the drawback of short duration of action after single shot local anaesthetic injection. We evaluated whether caudal dexamethasone as an adjuvant to the Bupivacaine improves analgesic efficacy after paediatric lower abdominal surgeries. Aim of the Study The current study is conducted to evaluate the analgesic effect of dexamethasone when given caudally as an adjuvant to bupivacaine for children undergoing lower abdominal surgeries eg: open inguinal hernia repair, hypospidius, orchidopexy and circumcision surgeries. Methods Totally 60 patients of 1–3 years age group, American Society of Anaesthesiologists physical status I and II undergoing elective lower abdominal surgeries were randomly allocated to two groups in double-blind manner. Group B (the control group) received 1 ml/kg of 0.25% bupivacaine caudally for lower abdominal surgeries and 0.5 ml/kg for anal and penile surgeries and Group BD received 1 ml/kg of 0.25% bupivacaine for lower abdominal surgeries and 0.5 ml/kg for anal and penile surgeries, in which 0.1 mg/kg dexamethasone was added for caudal analgesia. Post operative pain by FLACC scale (faces, legs, activity, cry and consolability tool score), rescue analgesic requirement and adverse effects were noted for 24 h. Results Results were statistically analysed using KRUSKAL-WALLIS TEST. Pain scores measured at 4,8 and 12h post-operative, were lower in Group BD as compared to Group B Mean duration of analgesia in Group BD 1026±139,8 min and in Group B was 465,6± 79,2 min with P = 0.001. Rescue analgesic requirement was more in Group B as compared to Group BD. Adverse effects after surgery were comparable between the two groups. Conclusion Caudal dexamethasone added to bupivacaine is a good alternative to prolong post-operative analgesia with less pain score compared to caudal bupivacaine alone.

Impact of dexmedetomidine as an adjuvant to peribulbar anesthesia on the retinal vasculature in glaucoma patients: an optical coherence tomography angiography study

Objectives To assess Dexmedetomidine’s effect as an adjuvant to peribulbar anesthesia on the retinal vasculature in patients with glaucoma undergoing cataract extraction surgery via optical coherence tomography angiography (OCT-A). Participants Thirty-nine glaucoma participants planned for phacoemulsification were allocated into two groups. A 10 ml mixture of peribulbar anesthesia was administered to group I. This anesthetic mixture consisted of 4.5 ml of lidocaine 2% mixed with 4.5 ml of bupivacaine 0.5%,1 ml of dexmedetomidine (50 µg), and 150 IU hyaluronidase. Group II was administered a peribulbar anesthetic mixture consisting of 4.5 ml of lidocaine 2% combined with 4.5 ml of bupivacaine 0.5%,150 IU of hyaluronidase, and 1 ml of normal saline, totaling 10 ml. Optical coherence tomography angiography was used 10 mi before and 10 min after injection to scan optic disc total vessel density, foveal superficial deep capillary plexuses (DCP) density, radial peripapillary capillary network density, and total vessel density plus foveal avascular zone (FAZ) diameter. We also checked the intraocular pressure (IOP) before and 10 min after the anesthetic injection. Results After the administration of the peribulbar anesthetic, group II demonstrated a notably higher significance in the DCP fovea median percent change (–43.7%) compared with group I (-2%) (P<0.001). Additionally, group II experienced a considerably greater median percent change in DCP total density (–22.4%) postinjection compared to group I (–0.8%) (P value < 0.001). The postinjection median percent changes in foveal total vessel density and superficial vessel density were −16.2% and −56.8% in group II, and −1% and −2.4% in group I, respectively, with a P value less than 0.001. Moreover, following the injection, the median percentage change in the diameter of the foveal avascular zone was significantly higher in group II (–40.6%) than in group I (–2.3%) (P value < 0.001). Additionally, there was a noteworthy increase in the optic disc’s total vessel density and the median percentage shift in radial peripapillary capillary network density in group II (–13.1 and −13.7%, respectively) compared with group I (–1.2 and −1%, respectively, P value < 0.001). IOP before and after injecting the anesthesia was insignificantly different between the studied groups (P =0.198 and 0.069, respectively). Conclusion The addition of dexmedetomidine to the peribulbar anesthesia demonstrates a protective effect on the retinal microvasculature against the ischemic impact of anesthetic drugs with no significant effect on the IOP. This effect holds significant implications for glaucoma patients.

Adding Dexmedetomidine to Intra-articular Local Anesthetics Results in Prolonged Analgesia After Knee Arthroscopy: A Systematic Review and Meta-analysis

To assess the efficacy and safety of dexmedetomidine as an adjuvant to intra-articular (IA) injections of local anesthetics (LA) in adult patients undergoing knee arthroscopy. We searched MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing IA dexmedetomidine plus LA versus LA alone for knee arthroscopy in adults. We used the DerSimonian and Laird random-effects model for all outcomes and conducted a sensitivity analysis with the leave-one-out method, as well as a subgroup analysis for the type of LA. We used R version 4.1.2 for all statistical analyses. We included 16 RCTs encompassing 799 patients, of whom 49.8% received IA dexmedetomidine. In the pooled analysis, time to first analgesia rescue was prolonged in almost 4 hours with the use of dexmedetomidine (mean difference [MD] 229 minutes; P < .001). We found statistically significant differences favoring dexmedetomidine in pain scores at rest and movement throughout the first 2, 6, 12, and 24 hours postoperatively (P < .001). Although the MD ranged from -0.3 to -0.9 cm, corresponding to a 3% to 9% reduction in pain scores, this change is not clinically significant compared with the minimal clinically important difference (MCID). Additionally, the intervention group showed a statistically significant reduction in cumulative opioid consumption over 24 hours (MD -4.5 mg; P < .001). However, this reduction did not meet the threshold for the MCID. There was no difference between groups on the incidence of hypotension (P= .190), bradycardia (P= .430), and postoperative nausea and vomiting (P= .550). Adding dexmedetomidine to LA in IA injections for knee arthroscopy significantly extended analgesia duration. Additionally, it lowered pain scores and opioid use, although these effects did not reach the MCID. Furthermore, this addition did not increase the risk of adverse events. Level II, meta-analysis of Level I and II studies.

Comparative Evaluation of Pain Perception with Conventional and Septoject XL Needle in 6-8-year-old Children: A Randomized Controlled Trial.

To evaluate and compare pain perception with Septoject XL and conventional needles in 6-8 years old children. In this split-mouth randomized controlled trial, a single-blinded study, 24 children (6-8 years) were assigned at random to receive the local anesthetic (LA) injection for treatment needs either with Septoject XL or conventional needle for the first visit in one of the quadrants, while during the second visit in a different quadrant with the other one. Children's pain levels were assessed during each visit using an objective sound eye motor (SEM) scale and subjective Wong-Baker faces rating scale (FRS). The mean objective score rating using SEM for the conventional needle (3.8 ± 2.35) and Septoject XL needle (3.3 ± 2.01) was not found to be statistically significant among the two study groups Septoject XL or conventional needle (Z score-0.996, p = 0.3). Using the Wilcoxon test, the mean subjective rating score was not found to be statistically significant among the two study groups [Z score = 0.636 and p-value = 0.524, nonsignificant (NS)]. In the gender-wise comparison of male (n =15), (6.8667 ± 91548) and female (n = 9), (6.8889 ± 1.05409), NS mean ages of male and female study participants was observed (p = 0.873). Statistically, NS difference was observed in the pain perception while administration of LA using Septoject XL or conventional needle in 6-8-year-old children. This research can be useful in the selection of the gauge of the needle to be used while planning the treatment for different behavior groups.

Stenotrophomonas maltophilia Bloodstream Infection Outbreak in an Acute Care Hospital — Alameda County, California 2022–2023

Background: Stenotrophomonas maltophilia is an opportunistic pathogen found in healthcare settings. During April–September 2022, nine S. maltophilia bloodstream infections (BSIs) were identified among intensive care unit (ICU) patients at a hospital in Alameda County, California. Whole genome sequencing found isolates to be highly related. Despite implementation of infection prevention and control (IPC) interventions, four additional S. maltophilia BSIs were identified during June–September 2023. We investigated to identify risk factors for infection and stop transmission. Methods: We conducted a matched case-control study. A case was defined as S. maltophilia isolated from a blood culture from an ICU patient with a fever during April 2022–September 2023; control-patient subjects were patients admitted to the ICU during the same period with hospital stay greater than or equal to their matched case. Three control subjects were matched to each case. We extracted information on risk factors for infection from medical charts and observed IPC practices in hospital locations of interest. We collected environmental samples from the ICU, radiology unit, and emergency department. Results: Among 13 cases and 39 control subjects, patients exposed to iodinated contrast Omnipaque-300 (odds ratio [OR]: 5.7; 95% CI: 1.2–28.0), injectable propofol (OR: 12.2; 95% CI: 1.5–101.4), or fentanyl (OR: 9.2; 95% CI: 1.8–Inf.) were more likely to have a S. maltophilia BSI, compared with control-subjects. IPC deficiencies included improper cleaning and storage of medical equipment, including the contrast injection system, and patient care supplies. The outbreak strain of S. maltophilia was not isolated from environmental samples. Conclusions: Although a point-source was not identified, S. maltophilia was likely transmitted through improper IPC practices involving injectable contrast or anesthesia. Recommendations on proper cleaning and disinfection of the contrast injection system and proper storage, preparation, and administration of medications were made to reduce risk for contamination.

Evaluation of Efficacy and Cost-effectiveness of Outpatient Resection of Endometrial Pathologies in a University Hospital in the UK

ABSTRACT Objective: The objective of the study was to evaluate the efficacy of outpatient MyoSure procedures and their cost-effectiveness. Design: A retrospective analysis of patients who had outpatient MyoSure procedures from November 2019 to November 2020. Subjects and Methods: Data were collected retrospectively from electronic patient records (hysteroscopy reports, clinic notes, clinic letters, and histopathology results) from November 2019 to November 2020 and analyzed using Microsoft Excel and SPSS software. Results: Fifty-eight outpatient MyoSure procedures were performed from November 2019 to November 2020. The mean age was 53.13 years (22–81 years) and the mean body mass index was 29.65 kg/m2 (18–51 kg/m2). We found that our service has a success rate of 93.1% (54/58), a completion rate of 92.59% (50/58), and a discharge rate of 82.75% (48/58). The complete resection rate for polyps was 100% and for fibroids, it was 76.47%. When compared to the same procedure performed under general or regional anesthesia in a day surgery setting, an outpatient MyoSure procedure saves around 1117 GBP per procedure, for the Trust. We have compared data for the first 6 months to the following 6-month period. There were significant improvements in the success rate, completion rate, and discharge rate, also accompanied by a reduced complication rate. This is likely due to improved operators’ experience in performing the procedure, and also the increased use of local anesthetic injection and cervical dilatation. Conclusions: Outpatient MyoSure procedures are feasible, efficacious, safe, acceptable, and cost-effective. The use of local anesthetic and cervical dilation has been associated with improved success rates.

СПОСОБЫ ВЫПОЛНЕНИЯ МЕСТНОГО ПРОВОДНИКОВОГО ОБЕЗБОЛИВАНИЯ НА ВЕРХНЕЙ ЧЕЛЮСТИ (ЛИТЕРАТУРНЫЙ ОБЗОР)

Currently, both classical and improved methods of performing local conduction anesthesia on the upper jaw in the area of the infraorbital foramen are used in dental practice. Classical techniques for performing infraorbital anesthesia do not provide a wide area of anesthesia and the palatal surface of the alveolar process is not anesthetized, so an intraosseous method of administering an anesthetic in the area of the “crow’s foot” projection was proposed, but this method has the disadvantage of traumatizing the cortical plate of the alveolar process of the upper jaw in areas of intraosseous injection of local anesthetic. The Ushnitsky-Chakhov apparatus is used to perform infraorbital anesthesia using the extraoral method, but its use does not provide individualization of all parameters and structural features of the infraorbital canal, which often opens on the anterior surface of the body of the upper jaw with not one hole, but two or three, and therefore the clinical effectiveness of this type of pain relief in certain clinical cases is low. The variability of the anatomical and topographic parameters of the location of the infraorbital foramen, the structural features of the facial skeleton of each patient necessitates the search for new personalized methods of performing infraorbital anesthesia through individualization and the process of performing local conduction anesthesia by using a combination of x-ray and digital diagnostic methods, as well as the use of an individual navigation template that allows ensure the accuracy, safety and high clinical effectiveness of this method of conduction anesthesia when performing dental and other types of medical manipulations on the upper jaw.

Lateral atlanto-axial joint access using the C2 pedicle

Abstract Background Neck pain and headaches can arise from the lateral atlanto-axial (LAA) joint. This pain can be diagnosed with intra-articular injections of local anesthetic. A widely used technique for access to the lateral atlanto-axial joint uses a posterior approach, but this approach can be hazardous because of the proximity of the vertebral artery, the dural sac, and the C2 spinal nerve and dorsal root ganglion. Objective The objective was to describe and test a new technique for accessing the LAA joint that avoids structures that lie behind the joint. Interventions The new technique was described and tested for tolerance in 10 patients with unilateral suboccipital pain and tenderness over the LAA joint, along with evidence of LAA joint arthropathy on SPECT CT. The technique requires inserting a needle along a trajectory tangential to the dorsal surface of the C2 lamina. It involves obtaining a declined view of the C2 lamina and C2 pedicle. Conclusions In all cases, the C2 pedicle was easily identified and allowed the needle to pass asymptomatically underneath the neurovascular structures behind the joint. The tactile response of the lamina of C2 provided important feedback regarding needle depth caudal to the LAA joint.

Effect of epidural anesthesia on the optic nerve sheath diameter in patients with pre-eclampsia: a prospective observational study

IntroductionOptic nerve sheath diameter (ONSD) reflects intracranial pressure and is increased in pre-eclampsia. Administrating a significant volume of epidural solution into the epidural space can potentially increase ONSD. We investigated...

The corrected carotid artery flow time and carotid peak velocity variation do not predict spinal anesthesia-induced hypotension: A prospective observational study.

Study objectiveA common side effect of spinal anesthesia is spinal anesthesia-induced hypotension (SAIH). The preoperative prediction of SAIH may prevent hypotension-related complications. Carotid Doppler ultrasound enables non-invasive assessment of the corrected carotid flow time (ccFT) and the carotid peak velocity variation (ΔVpeakCCA). This study aimed to evaluate the ability of ccFT and ΔVpeakCCA to predict SAIH. DesignProspective, observational, single-center study. SettingOperating room. Participants42 patients presenting for elective surgery under spinal anesthesia. InterventionsAt the holding area, the ccFT and ΔVpeakCCA were assessed with carotid Doppler ultrasound by a novice and experienced sonographer. MeasurementsIn the operating room, the occurrence of hypotension was observed for 10 min after an intrathecal injection of local anesthetic. The area under the receiver-operating curve (AUROC) was determined for ccFT and ΔVpeakCCA. The correlation between ccFT or ΔVpeakCCA and the change in blood pressure was evaluated. The interobserver agreement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. Main resultsOf all patients, 43% experienced SAIH. The ccFT was 359 ± 30 ms in normotensive and 358 ± 18 ms in hypotensive patients (p = 0.91), while the ΔVpeakCCA was 7 [6–8] % in normotensive and 7 [6–11] % in hypotensive patients (p = 0.34). The AUROC was 0.52 [0.35–0.70] for ccFT and 0.59 [0.41–0.77] for ΔVpeakCCA. There was no correlation between the percentage change in blood pressure and the ccFT or ΔVpeakCCA. The ICC between sonographers was 0.93 [0.85–0.96], (p < 0.001) for ccFT and 0.76 [0.55–0.87], (p < 0.001) for ΔVpeakCCA. The bland-Altman analysis demonstrated acceptable accuracy and precision for ccFT. ConclusionsThe ccFT and ΔVpeakCCA do not predict the occurrence of SAIH. No correlation was found between these parameters and the percentage change in blood pressure after spinal anesthesia.

The use of laser photobiomodulation as pre-anesthetic tissue management technique in reducing injection pain in children

BackgroundOne of the main goals for pediatric dentists is to offer a painless anesthesia experience. Laser photobiomodulation is among the suggested strategies to decrease injection pain. So, this study aimed to assess the impact of laser photobiomodulation on local anesthesia (LA) injection pain in children and its effect on the efficacy of LA during pulpotomy and SSC procedures.MethodsThe research was carried out as a randomized controlled clinical trial with two parallel group design. It involved 64 cooperative healthy children, age range from 5 to 7 years, each having at least one maxillary molar indicated for pulpotomy. Children were randomly allocated to one of the two groups based on the pre-anesthetic tissue management technique used: test group received laser photobiomodulation, while control group received topical anesthetic gel. Pain during injection, pulpotomy, and SSC procedures was assessed using physiological measures (Heart Rate (HR)), subjective evaluation (modified Face-Pain‐Scale (FPS), and objective analysis (Sound‐Eye‐Motor scale (SEM)).ResultsA total of 64 children with mean age 6.23 ± 0.78 participated in this research. The mean HR scores were significantly lower in the laser PBM group during buccal and palatal infiltration injections. The SEM mean scores were significantly lower in the laser PBM group during both injections. For the FPS scale, the number of children who recorded satisfaction during injection was significantly higher in laser PBM group. There was no statistically significant difference in mean HR as well as in SEM and FPS scores between the two groups during pulpotomy and SSC procedures. Comparisons between the two study groups were performed using independent samples t- and Mann-Whitney U tests. Significance was set at p value < 0.05.ConclusionLaser photobiomodulation is a promising non-pharmacological pre-anesthetic tissue management technique in children that offered less painful injection compared to topical anesthetic gel without compromising the effectiveness of LA.Trial RegistrationClinicalTrials.gov Identifier: NCT05861154. Registered on 16/5/2023.Graphical

Prevalence of Dental Fear and Anxiety among School Children in Zawia City, Libya

Odontophobia, also known as dental fear and anxiety (DFA), is a type of phobia that can negatively affect the dental and oral health of people who experience it. This phobia has psychosocial characteristics that make it complex to address in dental practice. Dealing with dental fear is a challenging issue in dentistry for various reasons. Although this issue has been studied in children for quite some time around the world, no such studies have been conducted in Zawia, Libya. Therefore, this study aimed to determine the prevalence of dental fear and anxiety (DFA) among pupils aged 5 to 12- years in public and private schools in Zawia City. A cross-sectional survey was conducted in Zawia City over three months. In the survey, 205 students were randomly selected from several private and public schools. All participants were given a self-reported questionnaire containing ten closed-ended questions about DFA. After collecting the data, the results were analyzed based on gender and school type and entered into a Microsoft Excel sheet for further analysis. Results of the study showed that 31.71% of all pupils experienced dental fear and anxiety (DFA). Furthermore, the slight variations in fear levels based on school type indicate that the school environment may influence a pupil's perception of dental visits. Most private school students experienced DFA during physical contact with their dentists and upon seeing dental anesthesia injections. Whereas pupils attending government schools experienced DFA when hearing voices during treatment. Across all areas studied, female students reported slightly higher levels of anxiety than male students. Based on the survey results, it is evident that many pupils experience high levels of dental fear and anxiety (DFA). This highlights the need for intervention and attention in such situations, as DFA can significantly affect a pupil's dental experience and oral health outcomes. Therefore, it is essential to address these fears and anxieties to improve the overall dental experience of pupils and promote better oral health

Identification of hypothermia-inducing neurons in the preoptic area and activation of them by isoflurane anesthesia and central injection of adenosine

Hibernation and torpor are not passive responses caused by external temperature drops and fasting but are active brain functions that lower body temperature. A population of neurons in the preoptic area was recently identified as such active torpor-regulating neurons. We hypothesized that the other hypothermia-inducing maneuvers would also activate these neurons. To test our hypothesis, we first refined the previous observations, examined the brain regions explicitly activated during the falling phase of body temperature using c-Fos expression, and confirmed the preoptic area. Next, we observed long-lasting hypothermia by reactivating torpor-tagged Gq-expressing neurons using the activity tagging and DREADD systems. Finally, we found that about 40–60% of torpor-tagged neurons were activated by succeeding isoflurane anesthesia and by icv administration of an adenosine A1 agonist. Isoflurane-induced and central adenosine-induced hypothermia is, at least in part, an active process mediated by the torpor-regulating neurons in the preoptic area.Graphical abstract

Anesthesia Applications In Experimental Neurological Disease Modeling

Neuroscience, which covers the molecular mechanisms employed by the brain to cause neurological diseases and how they can be treated, remains current as the subject of high-budget investigations to develop early diagnosis and new treatment modalities with multidisciplinary approaches. For this purpose, creating the appropriate model with the correct modality and anesthesia in neurological in vivo experimental models is the most important phase to obtain accurate results and ensure animal welfare. To manage anesthesia in rodents, knowing the physiological characteristics of anesthetics and their risks will strengthen experimental procedures. Among the injectable anesthetics, ketamine, xylazine, and pentobarbital are the most frequently preferred agents for general anesthesia in short surgical procedures. Isoflurane and sevoflurane are inhaler anesthetics that are administered through a vaporizer because they are liquids. Important advantages of inhaled anesthetics, such as rapid induction and rapid withdrawal, make inhaled anesthetics stand out in neuroscience studies. In this review, the properties of frequently used anesthetic agents in rodents, their usage methods, and which model they are preferred will be discussed. For this purpose, the selection of appropriate anesthetics in animal models such as epilepsy, Alzheimer's disease, ischemia-reperfusion injury, traumatic brain injury, ischemic stroke, experimental autoimmune encephalomyelitis, and ophthalmic surgical procedures and their side effects will be reviewed.

Efficacy of photobiomodulation therapy on pain perception reduction associated with dental anesthetic infiltration injection: A systematic review and meta‐analysis

AbstractDental anesthetic injections, a common source of patient discomfort, often deter individuals from seeking dental care. Recently, there has been a growing focus on photobiomodulation therapy (PBMT) and its potential role in pain reduction. This systematic review explored the efficacy of PBMT in alleviating pain associated with dental anesthetic infiltration injections. A systematic literature search of different databases was performed up to December, 2023 using specific search strategy to find eligible studies that assessed the impact of PBMT on pain during local anesthesia injections. Data extraction was done based on the inclusion/exclusion criteria. A total of 13 studies, involving 972 patients were included. The studies employed various PBMT parameters, including wavelengths, and energy densities. Meta‐analyses revealed a significant reduction in pain with PBMT compared to controls (MD = −0.90, 95% CI: −1.36 to −0.44, and p = 0.0001), with notable heterogeneity (I2 = 91.79%). Stratified analyses by age demonstrated consistent pain reduction in both adults (MD = −0.59, 95% CI: −1.11 to −0.08, and p &lt; 0.0001) and children (MD = −0.59, 95% CI: −1.11 to −0.08, and p = 0.025). In conclusion, it seems that PBMT using infrared diode lasers can effectively reduce injection pain in both pediatric and adult populations. Further research should focus on optimizing PBMT parameters for enhanced pain management during dental procedures.

Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block.

Background and objective: variations in mylohyoid could lead to failure of an inferior alveolar nerve blockade. This study aimed to evaluate the impact of mylohyoid nerve variation on the persistence of pain following a successful inferior alveolar nerve block. Method: This clinical study was performed at the oral and maxillofacial department/college of Dentistry, Hawler Medical University. All patients with pain following a successful inferior alveolar nerve block were enrolled in this study. An additional submucosal injection (infiltration technique) as few drops in the lingual mucosa of the offending tooth is given by the same surgeon Results: A total of fifty patients were enrolled in this study,30 males and 20 females. age range was (16-56). Among the total only 20 patients (60%females,40% males) experienced pain on the lingual side during the attempt of dental extraction. Following lingual infiltration, all the cases were treated successfully in a pain free environment. Descriptive statistics was used to analyze the data. Conclusion: Lingual submucosal injection of 1/3 of 1.8 ml of local anesthesia might be an effective way to block all possible nerve variation on the lingual side. Keywords: Inferior alveolar nerve block (IANB), mylohyoid nerve variation, lingual mucosal infiltration, pain.

Clinical efficacy of multiple intra-articular injection for hip osteoarthritis.

Intra-articular (IA) injection may be used when treating hip osteoarthritis (OA). Common injections include steroids, hyaluronic acid (HA), local anaesthetic, and platelet-rich plasma (PRP). Network meta-analysis allows for comparisons between two or more treatment groups and uses direct and indirect comparisons between interventions. This network meta-analysis aims to compare the efficacy of various IA injections used in the management of hip OA with a follow-up of up to six months. This systematic review and network meta-analysis used a Bayesian random-effects model to evaluate the direct and indirect comparisons among all treatment options. PubMed, Web of Science, Clinicaltrial.gov, EMBASE, MEDLINE, and the Cochrane Library were searched from inception to February 2023. Randomized controlled trials (RCTs) which evaluate the efficacy of HA, PRP, local anaesthetic, steroid, steroid+anaesthetic, HA+PRP, and physiological saline injection as a placebo, for patients with hip OA were included. In this meta-analysis of 16 RCTs with a total of 1,735 participants, steroid injection was found to be significantly more effective than placebo injection on reported pain at three months, but no significant difference was observed at six months. Furthermore, steroid injection was considerably more effective than placebo injection for functional outcomes at three months, while the combination of HA+PRP injection was substantially more effective at six months. Evidence suggests that steroid injection is more effective than saline injection for the treatment of hip joint pain, and restoration of functional outcomes.

Effectiveness of Two Types of Distraction Techniques in the Management of Pain and Anxiety during Dental Treatment in 6-9-year-old Children.

To determine the effectiveness of distraction with virtual reality (VR) distraction devices in comparison with mobile phone video games in the management of pain and anxiety during dental treatment in 6-9-year-old children. It was a comparative observational study. A total of 33 children aged 6-9 years who reported to the department for their first dental visit were selected and the subjects were divided into three groups. Group I patients were in a normal clinical environment without any distractions. Group II patients were given mobile phone video games. Group III patients were given a VR distraction device as a means of distraction.The anxiety levels of patients before treatment, after using a distraction device preoperatively, during local anesthesia injection, and after dental treatment were assessed. Pain after local anesthesia injection in each group was assessed. The easability of handling the patient and carrying out the procedure was assessed using a questionnaire. All data were collected and analyzed. The results showed when compared to the children in groups I and II, children in group III obtained significantly lower anxiety scores after treatment, and they also reported significantly decreased pain perception during dental treatment (p < 0.001). The pain while administering local anesthesia was greater for the control group and lowest for the VR group. It was observed that VR group patients were easier to handle and easier to carry out procedures than those in the mobile phone group. Virtual reality distraction is an effective distraction technique for reducing pain and anxiety in children during various treatment procedures. Virtual reality distraction can be used effectively in clinics.It is a patient-friendly technique and is more comfortable for both patients and dentists during treatment.It does not require any previous education and training and has a positive impact on memories of the treatment, leading to behavior modification. Chandran LS, Issac JS, Girija P, et al. Effectiveness of Two Types of Distraction Techniques in the Management of Pain and Anxiety during Dental Treatment in 6-9-year-old Children. Int J Clin Pediatr Dent 2024;17(3):291-296.

The efficacy of primary progesterone on survival in early breast cancer: A real world scenario.

e12522 Background: Surgery performed during progestogenic milieu improves survival in breast cancer patients. We previously proved efficacy of pre-operative progesterone in high-risk, operable breast cancer. In another multicenter randomized trial, intra-operative peri-tumoral local anesthetic injection showed 29% reduction in mortality. In this study, several patients had also received progesterone injection since this is adopted as standard of care across some centers including ours. We assessed the effectiveness of pre-operative progesterone in patients who were randomized in the local anesthetic study. Methods: We analyzed 1583 patients randomized on the local anesthetic study during December 2011-October 2018 with respect to receipt of progesterone. All patient who had breast lump of ≥2cm and/or node positive were eligible to receive progesterone injection before surgery. Kaplan Meier curves were plotted along with Cox regression analysis to study factors affecting disease-free and overall survival. Results: Of 1583, 454 patients did not receive, and 1129 patients received progesterone before surgery. The median age of whole cohort was 51 years, median pT size was 3 cm, 45% were node positive, 60% ER/PR+ and 24%TNBC. At median follow-up of 68 (0·5-72) months in surviving patients, there were a total of 292 DFS events (progesterone arm-193, no-progesterone arm-99). The 5-year disease-free survival (DFS) was 86.5% in the progesterone arm and 79.2% in the no-progesterone arm (HR-0.57,0.45-0.73, P&lt;0.001). The 5-year overall survival (OS) was 90.5% in the progesterone arm and 82.8% in the no-progesterone arm (HR-0.47,0.36-0.63,P&lt;0.001). On Cox Regression analysis (Table), administration of progesterone injection was an independent prognostic factor for DFS (HR-0.53,0-41-0.70, p&lt;0.001) and OS (HR-0.44,0-32-0.60, p&lt;0.001) both. Conclusions: The receipt of pre-operative progesterone improved outcomes in the setting of another randomized trial. It should be administered to all high risk (T2/N1) breast cancer patients who are planned for surgery first. [Table: see text]

Axillary Brachial Plexus Block Compared with Other Regional Anesthesia Techniques in Distal Upper Limb Surgery: A Systematic Review and Meta-Analysis.

Background: Several regional anesthesia (RA) techniques have been described for distal upper limb surgery. However, the best approach in terms of RA block success rate and safety is not well recognized. Objective: To assess and compare the surgical anesthesia and efficacy of axillary brachial plexus block with other RA techniques for hand and wrist surgery. The attainment of adequate surgical anesthesia 30 min after block placement was considered a primary outcome measure. Additionally, successful block outcomes were required without the use of supplemental local anesthetic injection, systemic opioid analgesia, or the need to convert to general anesthesia. Methods: We performed a systematic search in the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and CENTRAL. RCTs comparing axillary blocks with other brachial plexus block techniques, distal peripheral forearm nerve block, intravenous RA, and the wide-awake local anesthesia no tourniquet (WALANT) technique were included. Results: In total, 3070 records were reviewed, of which 28 met the inclusion criteria. The meta-analysis of adequate surgical anesthesia showed no significant difference between ultrasound-guided axillary block and supraclavicular block (RR: 0.94 [0.89, 1.00]; p = 0.06; I2 = 60.00%), but a statistically significant difference between ultrasound-guided axillary block and infraclavicular block (RR: 0.92 [0.88, 0.97]; p < 0.01; I2 = 53.00%). Ultrasound-guided infraclavicular blocks were performed faster than ultrasound-guided axillary blocks (SMD: 0.74 [0.30, 1.17]; p < 0.001; I2 = 85.00%). No differences in performance time between ultrasound-guided axillary and supraclavicular blocks were demonstrated. Additionally, adequate surgical anesthesia onset time was not significantly different between ultrasound-guided block approaches: ultrasound-guided axillary blocks versus ultrasound-guided supraclavicular blocks (SMD: 0.52 [-0.14, 1.17]; p = 0.12; I2 = 86.00%); ultrasound-guided axillary blocks versus ultrasound-guided infraclavicular blocks (SMD: 0.21 [-0.49, 0.91]; p = 0.55; I2 = 92.00%). Conclusions: The RA choice should be individualized depending on the patient, procedure, and operator-specific parameters. Compared to ultrasound-guided supraclavicular and infraclavicular block, ultrasound-guided axillary block may be preferred for patients with significant concerns of block-related side effects/complications. High heterogeneity between studies shows the need for more robust RCTs.