Anesthetic Injection Research Articles

The Effectiveness of Quadratus Lumborum and Fascia Iliaca Blocks on Patient Outcomes in Hip Arthroplasty.

Hip arthroplasty is a common procedure with high costs and difficult rehabilitation. It causes postoperative pain, and this can reduce mobility which extends in-patient time. An optimal analgesia regime is crucial to identify. Opioids produce effective pain relief but are associated with nausea, vomiting, and respiratory depression which can hinder physiotherapy and discharge. Finding alternatives has been of interest in recent years, particularly fascial blocks. These are anaesthetic injections beneath fascia which spread to nerves providing pain relief from surgery and are used with a general or spinal anaesthetic. Two of these blocks which are of interest to total hip arthroplasty are the quadratus lumborum block and fascia iliaca block. Studies have investigated the effectiveness of these blocks through patient factors, primarily pain scores, opioid consumption, and other secondary outcomes such as ambulation and length of stay. This review takes a narrative approach and investigates the literature around the topic. Pain and opioid consumption were the most widely reported outcomes, reported in 90% and 86% of studies. 83% of these studies reported positive effects on pain scores when FIB was utilised. 80% of these studies reported positive effects on opioid consumption when FIB was used. When QLB block was utilised, pain and opioid consumption were positively impacted in 82% of studies. This paper has been written with the intention of reviewing current literature to give an impression of the effectiveness of the blocks and propose potential areas for future work on the blocks.

Efficacy of Inferior Mandibular Nerve Block (IANB) with Articaine Infiltration Versus Lidocaine Infiltration Administered inTeeth with Irreversible Pulpitis

OBJECTIVES To compare the efficacy of (Inferior mandibular nerve block) IANB with Lidocaine infiltration versus with articaine infiltration in patients with irreversible pulpitis. METHODOLOGY An observational cross-sectional study was conducted in the Department of Operative Dentistry and Endodontics at Altamash Institute of Dental Medicine, Karachi. The study was initiated in January-April 2022. A total of 150 patients’ positive history of irreversible pulpitis, confirmed with cold pulp testing, were randomly allocated into two groups: 75 cases were treated with standard Inferior mandibular nerve block with Lidocaine buccal infiltration, and 75 were treated with buccal infiltration of 1.8 ml of 4% articaine. Before administering the anaesthetic injection, each subject was shown the visual analogue scale (VAS). After 15 minutes of administration, subjects were asked to rate the pain. The data was recorded on a designed proforma. RESULTSThe average age of the patients was 35.52±10.09 years. Efficacy of the inferior alveolar nerve block with buccal infiltration of 1.8 ml of 4% articaine was significantly high as compared to Inferior mandibular nerve block with Lidocaine buccal infiltration [73.3% vs 50.67% p=0.004]. CONCLUSION Buccal infiltration of 4% Articaine for mandibular teeth during IANB can have a high success rate and is considered a good alternative.

Facial Blanching As An Unusual Complication After The Injection of Local Anesthesia: A Clinical Report

Facial blanching is a complication related to local anesthesia in dentistry. Anatomical variation, intravascular injection, rapid local anesthetic injection, decreased blood flow with the vasopressor effect of epinephrine, ortho-retrograde movement of the solution, incorrect positioning of the needle, and neurological origin may cause this phenomenon, the etiology of which is not fully known. Most of the blanching cases reported in the literature are related to injection of the inferior alveolar nerve block. Also, intra-extraoral clinical photography is limited. Supraperiosteal infiltration anesthesia is a safe and easy technique that is frequently used in daily practice in dental clinics. This unique case report describes partial blanching of the face and gingiva after supraperiosteal infiltration of vasoconstrictor containing local anesthetic into the maxilla. In addition, the clinical-anatomical relationship of facial-mucosal blanching with the injection site, literature information, and clinical management with this complication are explained.

COMPARISON OF PAIN LEVELS BETWEEN THE CONVENTIONAL AND THE COMPUTERIZED ANESTHETIC INJECTION WITH MORPHEUS® FOR THE NASOPALATINE NERVE BLOCK: A DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL

Objective: To compare pain levels between the conventional injection and the Morpheus® device for the nasopalatine nerve block concerning the puncture, needle introduction, and local anesthetic (LA) deposition. Methods: A crossover, double-blind, randomized clinical trial was carried out involving 32 participants. Group I comprised the conventional syringe (control group), while Group II comprised the Morpheus® device (experimental group). The study was developed in two sessions, two weeks apart. The pain was assessed using a 100-mm Visual Analog Scale (VAS). The intragroup analyses were performed using Friedman’s test and Durbin-Conover's post hoc test. The Wilcoxon test was used for intergroup analyses. The significance level was set at p < 0.05. Results: Intragroup analyses showed statistical differences within both groups (Group I, p < 0.001; Group II, p = 0.003). All the evaluated moments of both injection techniques differed statistically, except between the needle introduction and LA deposition within Group II (p = 0.526). In the intergroup analyses, participants of Group I presented higher pain levels, experiencing the highest pain at the LA deposition moment (median 58; 46 - 62). Pain levels were statistically significant between all the corresponding moments of the groups (p < 0.001). Conclusion: Computerized injection with the Morpheus® can be effectively employed to increase comfort during anesthetic injections and patient compliance with dental treatments.

Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations

BackgroundIt is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments. MethodsA Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables. FindingsPain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations. InterpretationIndividuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.

Use of laser for uncovering a mandibular retained tooth: case report

This clinical study aimed to describe a case of lower impacted canine to demonstrate the advantages of diode laser for crown exposure during orthodontic treatment. The patient received a surgical intervention by an infra-red diode laser to uncover a retained lower canine. The intervention did not need anesthetic injection and suture apposition, the patient did not refer pain, and the healing process was completed after a week. The diode laser was safe, fast, and easy to use, and the avoidance of bleeding was reached due to its excellent absorption by hemoglobin: this is particularly important considering that, for obtaining a strong adhesion, a bracket must be bonded in a dry enamel surface. The use of an infrared diode laser is a proper approach in the surgery of retained teeth during orthodontic treatment.

The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis

Abstract Objectives Evidence for the comparative cost-effectiveness of intra-articular corticosteroid injection in people with hip osteoarthritis (OA) remains unclear. This study investigated the cost-effectiveness of best current treatment (BCT), comprising advice and education, with BCT plus a single ultrasound-guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 ml 1% lidocaine hydrochloride (BCT+US-T). Methods A trial-based cost–utility analysis of BCT+US-T compared with BCT was undertaken over 6 months. Patient-level cost data were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a UK National Health Service (NHS) perspective. Results BCT+US-T was associated with lower mean NHS costs (BCT+US-T minus BCT: −£161.6; 95% CI: −£583.95, £54.18) and small but significantly higher mean QALYs than BCT alone over 6 months (BCT+US-T minus BCT: 0.0487; 95% CI: 0.0091, 0.0886). In the base case, BCT+US-T was the most cost-effective and dominated BCT alone. Differences in total costs were driven by number of visits to NHS consultants, private physiotherapists and chiropractors, and hip surgery, which were more common with BCT alone than BCT+US-T. Conclusion Intra-articular corticosteroid injection plus BCT (BCT+US-T) for patients with hip OA results in lower costs and better outcomes, and is highly cost-effective, compared with BCT alone. Trial registration EudraCT: 2014-003412-37 (8 August 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (28 July 2015). Trial protocol Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0, doi: doi.org/10.1186/s12891-018-2153-0.

Task-Specific Lingual Dystonia During Japanese Religious Services.

Lingual dystonia is a subtype of oromandibular dystonia characterized by involuntary contractions of the tongue muscles, often provoked by speaking or eating. This study reports six Japanese cases (four female and two male, mean age at onset of 49.5 years) with task-specific lingual dystonia during praying. In the early phase, all patients experienced lingual protrusion exclusively during Japanese religious services. When the patients start speaking, the tongues protrude forward, making it difficult to pronounce words. The patients were treated with multimodal treatment, including muscle afferent block (MAB) therapy comprising local anesthetic injection, botulinum toxin (onabotulinumtoxinA) injection, and a sensory trick splint. MAB therapy was conducted in five patients (mean time: 5.8), and botulinum toxin injection was administered in four patients (mean time: 8). The injected muscles were the genioglossal muscles and, in one case, the lateral pterygoid muscle. Sensory trick splints were inserted in three patients. After the multimodal therapy, the patients were able to pronounce words smoothly and clearly. Oromandibular Dystonia Rating Scale scores improved significantly (P<0.005) from baseline (187 points) to endpoint (47 points) with a mean follow-up of 4.7 years. Although this entity is rare, medical and dental professionals should be aware of this peculiar symptom. Multimodal therapy is required to ensure effective treatment of praying-induced lingual dystonia.

Stroke and Translational Research – Review of Experimental Models with a Focus on Awake Ischaemic Induction and Anaesthesia

Animal models are an indispensable tool in the study of ischaemic stroke with hundreds of drugs emerging from the preclinical pipeline. However, all of these drugs have failed to translate into successful treatments in the clinic. This has brought into focus the need to enhance preclinical studies to improve translation. The confounding effects of anaesthesia on preclinical stroke modelling has been raised as an important consideration. Various volatile and injectable anaesthetics are used in preclinical models during stroke induction and for outcome measurements such as imaging or electrophysiology. However, anaesthetics modulate several pathways essential in the pathophysiology of stroke in a dose and drug dependent manner. Most notably, anaesthesia has significant modulatory effects on cerebral blood flow, metabolism, spreading depolarizations, and neurovascular coupling. To minimise anaesthetic complications and improve translational relevance, awake stroke induction has been attempted in limited models. This review outlines anaesthetic strategies employed in preclinical ischaemic rodent models and their reported cerebral effects. Stroke related complications are also addressed with a focus on infarct volume, neurological deficits, and thrombolysis efficacy. We also summarise routinely used focal ischaemic stroke rodent models and discuss the attempts to induce some of these models in awake rodents.

Midpoint Transverse Process to Pleura Block for Analgesia in Breast Surgeries: A Case Series

Among the various techniques described for analgesia in breast surgeries, thoracic epidural and thoracic paravertebral block is the gold standard but have potential complications of hypotension and pneumothorax. Midpoint transverse process to pleura (MTP) block is one of the newest techniques developed to reduce these complications by injection of local anesthetic between the midpoint of the posterior transverse process and pleura. Originally performed at multiple levels, the literature is scant regarding the placement of a catheter. We report MTP block with catheter placement providing continuous infusion in five patients posted for modified radical mastectomy and found it a safe and effective alternative.

Effect of pre-cooling injection site along with topical 20% Benzocaine on pain perception in pediatric dentistry: “A randomized clinical trial”.

Objective: To evaluate the effect of pre-cooling the soft tissue of injection sites along with topical 20 Benzocaine on the pain perception of pediatric patients. Study Design: Randomized Clinical Trial. Setting: Department of Pediatric, Ibn-e-Sina Hospital. Period: September 2021 to January 2022. Material &amp; Methods: The study participants were divided into two groups by using lottery method, each group consisting of 40 participants. The first group was given local anesthetic gel and ice applied at site for two minutes before infiltration at the site of injection and the second group was given plain 20% benzocaine at site of injection before giving injection (control group). Pain response assessed by SEM (sound, eye, motor). Results: The present study group (topical anesthesia gel with ice + infiltration) had 40 children 23 boys and 17 girls with mean age 6.3 years and control group (plain topical anesthesia + infiltration) 40 children 21 boys and 19 girls with mean age 6.6 years. No statistically significant difference was found between the two groups in univariate analysis and multivariate analysis showed significant difference between two groups. No adverse events were reported in both groups. Conclusion: Topical anesthetic gel along with ice is more effective in reducing pain experience during local anesthetic injection administration during dental procedures.

Clinical Efficacy and Safety of Lidocaine Tape for Topical Anesthesia of the Oral Mucosa: A Preliminary Controlled Trial.

Local anesthesia is administered to reduce pain-induced stress during dental treatment. However, local anesthetic injections are extremely painful; thus, methods to minimize this pain should be developed. Clinical studies on the pain-relieving effects of dental topical anesthetics have shown that few topical anesthetics provide fast and adequate pain relief without harming the oral mucosa. We examined the efficacy and safety of lidocaine tape, which has a potent topical anesthetic effect. Lidocaine tape was applied to the oral mucosa of 14 healthy participants, and its suppression effect was assessed by examining the pain intensity at the non-lidocaine tape-applied site using the visual analog evaluation scale and the verbal evaluation scale. Lidocaine tape application significantly reduced visual analog scale (VAS) scores during mucosal puncture compared to non-application (p < 0.01). Moreover, lidocaine tape application significantly reduced VAS scores during local anesthetic injection compared to non-application (p < 0.001). Adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 5.0. No adverse events attributed to the application of lidocaine tape were observed in any participant. The findings in this study suggest that the application of lidocaine tape before infiltration anesthesia can reduce patient distress.

A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial

BackgroundFrozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI.MethodsA parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors.DiscussionThis study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury.Trial registrationChictr.org.cn ChiCTR2200067122. Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.

Comparison of the Low Back Pain Relief and Spread Level After Upper and Lower Lumbar Erector Spinae Plane Block

BACKGROUND: The erector spinae plane block (ESPB), which was introduced to manage the thoracic pain, is an ultrasound-guided technique that is relatively easy, less invasive, and safer. In spite of its technical ease and safety of ESPB, few studies have explored the analgesic efficacy and the exact spread level of injected local anesthetics. OBJECTIVES: The purpose of this study is to compare the analgesic efficacy and spread level of the upper and lower lumbar ESPBs . STUDY DESIGN: Prospective, randomized design. SETTING: The pain clinic of a tertiary university hospital. METHODS: This study included 84 patients with low back pain with or without leg pain who received lumbar ESPB at L2 (L2 ESPB group) or L4 (L4 ESPB group) using 10 mL of 0.2% ropivacaine mixed with 10 mL of the contrast medium. After finishing 20 mL of the local anesthetic mixture injection, a fluoroscopic examination was performed to evaluate the spread level. Analgesic efficacy was assessed using an 11-point Numeric Rating Scale (NRS-11) and a Back Pain Functional Scale. RESULTS: The number of patients who showed excellent-to-moderate low back pain relief was 35 (83.3%) and 36 (78.5%) in the L2 and L4 ESPB groups, respectively. Significant reductions in pain on the NRS-11 and improvements in disability were found in both groups. The total number of vertebral segments to which the anesthetic drugs spread was significantly higher in the L2 ESPB group than in the L4 ESPB group (2.7 ± 0.5 vs 2.0 ± 0.2, P = 0.002). LIMITATIONS: The analgesic efficacy of lumbar ESPB was evaluated with only short-term outcomes. CONCLUSIONS: Both the L2 and L4 ESPB groups demonstrated a significant reduction in low back pain and improvement in disability. The L2 ESPB group demonstrated a significantly increased spread level compared to the L4 ESPB group. KEY WORDS: Erector spinae plane block, spread level, low back pain, analgesic efficacy

Surgical Outcomes of Synthetic Cartilage Implant Hemiarthroplasty for Metatarsophalangeal Arthropathy.

Introduction Metatarsophalangeal joint (MTPJ) arthropathy in the great toe causes considerable pain and debilitation, severely impacting quality of life. Traditional management options included conservative measures, steroid injections, and arthrodesis. New options include Cartiva, a synthetic cartilage hemiarthroplasty for the MTPJ. This prosthesis has evidence of improved pain and function without the sacrifice of joint movement seen with arthrodesis. However, the implant itself has mixed reviews. This study aims to identify the pre-, peri, and short-term post-surgical outcomes of Cartiva surgery and review the literature for existing reported outcomes. Methods We retrospectively reviewed a cohort of 22 consecutive Cartiva procedures between 2016 and 2022 in a single UK institution. Hospital records were analyzed for peri-operative complications, implant survival, additional operative interventions, patient-reported outcomes, and functional improvement. Results Twenty-one patients underwent Cartiva for the first MTPJ pathology and one for the third MTPJ pathology. Prior to surgery, 40.9% of patients had undergone alternative therapies, including MTPJ steroid injections (seven patients), cheilectomy (four patients), and bunionectomy (one patient). Total complication rates, inclusive of medical, surgical, and implant complications were 45.5% (10/22). Total reoperation rates were 18.2% (4/22) including two revisions to arthrodesis and two manipulations under anesthesia (MUA) with local anesthetic injection. At the final follow-up, 55% were still experiencing pain, 15% neurovascular symptoms, 10% swelling, and 50% stiffness or reduced range of movement. However, 85% of patients returned to usual activities of daily living within two years. Conclusion Cartiva surgery for metatarsophalangeal arthropathy has demonstrated outcomes of persistent pain, limited range of movement, and restricted function at short-term follow-up. Rates of reoperation and revision to arthrodesis were comparable with similar studies.

Cooling Comfort: Enhancing Pediatric Pain Management with Pre-cooling Techniques - A Case Study Review

Background: One of the primary causes of children's avoidance behaviour development is local anaesthetic injections. There has been an attempt to lessen the feeling of injection pain. Before local anaesthetics were injected, the impact of chilling the injection site on pain perception was assessed in this study. Methods and Material: In order to treat dental patients who need bilateral buccal injection of local anaesthetics, 50 healthy paediatric patients participated in a prospective single-blind crossover clinical experiment to examine their experience of pain. Before the injection, they were given a topical anaesthetic (Benzocaine) for one minute on the control side and a topical anaesthetic with an ice pack for one minute on the experimental side. An unbiased dentist evaluated each patient's response to the injection. For statistical analysis, the Mann-Whitney U test and the Wilcoxon test were employed. P &lt; 0.05 was used to determine statistical significance. Results: For the study and control groups, the means of the sound, eye, and motor scales (SEM) were 4.06 ± 1.32 and 5.44 ± 1.79, respectively. The study and control groups' respective averages on the visual analogue scale (VAS) were 42.20 ± 12.70 and 58.40 ± 16.83, respectively. These differences were statistically significant (P &lt; 0.05). Conclusion: Paediatric patients reported less discomfort when the injection site was cooled prior to a one-minute infiltration of local anaesthetics into the buccal mucosa.

Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

IntroductionThis study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency. MethodsAnonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h0. Residents whose curves reached h0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up. ResultsThirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27–78 [4–132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13–24 [13–24]). ConclusionsThe LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.

Screening for Microbial Contamination of Multi-dose Lignocaine Vials in a Dental Hospital: A Prospective Study.

Multidose vials (MDVs) for local anesthetic injections are routinely used in dental practice. MDVs contain multiple doses of a parenteral drug intended for administration to the same or multiple patients. Potentially harmful microbes have been shown to be able to live and occasionally multiply in MDVs if not handled aseptically. The goal of this study thus was to evaluate the bacterial and fungal contamination (FC) of lignocaine MDVs after use in a dental hospital. A total of 27 MDVs of lignocaine free of any microbial contamination were distributed to different departments of the dental hospital and they were asked to use them on patients routinely. The samples were recollected from the departments either at the end of the 28th day or as and when the contents in the MDVs reached a predetermined level marked on the bottle during its usage, whichever was earlier. These leftover samples were subjected to a microbiological investigation by inoculation into thioglycolate broth and subsequent subculturing onto agar plates. None of the inoculated broths showed turbidity. Subcultured agar plates, even on the 7th day of incubation, did not show any bacterial or fungal growth. The lignocaine MDVs tested after use were thus found to be sterile. There was no bacterial or FC detected in MDVs of lignocaine subjected to testing after use in the dental hospital. Multidose vials (MDVs) continue to be used in clinics for economic reasons. But the clinician opting for MDVs should be conscious of their potential for microbial contamination and should meticulously follow the protocol for their aseptic use. Renu SM, Rao AP, Biranthabail D, et al. Screening for Microbial Contamination of Multi-dose Lignocaine Vials in a Dental Hospital: A Prospective Study. Int J Clin Pediatr Dent 2023;16(5):678-680.

Variability in the distance between the suprascapular notch with the spine of the scapulae and the acromion.

The suprascapular notch lies in the superior border of the scapula and is a passageway for the suprascapular nerve that is sensory to the shoulder joint. Suprascapular nerve block involves injection of local anaesthetic into the suprascapular notch, either ultrasound guided or blind, using the spine of scapula and/or the medial border of the acromion as surface landmarks. To investigate the anatomic variations that exist between the distance of the notch from the spine of scapula and acromion. Ninety-two dry scapulae were measured with a digital calliper for their length of the spine, distance between the midpoint of the spine and base of the suprascapular notch and distance between the medial border of the acromion and the base of the suprascapular notch. These measurements were compared for variations in the scapular bony landmarks, the spine and the acromion to determine the site for the injection. Measurement reliability was assessed by intraclass correlation, Cronbach's alpha being 0.99, 0.97 and 0.91 for length of spine, distance from spine and distance from acromion respectively. The distance from the acromion had less variation in measurement (3.73 ± 0.42cm) but a flatter distribution when compared to distance from the spine of the scapula (3.32 ± 0.39cm). Length of the spine of the scapula appeared not to influence either distance from the acromion or distance from the spine of scapula. There is potential for greater variability in placement of nerve blocks that use acromion as the bony reference. Key Points • Dry scapular measurement using electronic Vernier callipers is accurate (0.91-0.97). • There is potential for greater variability in placement of blind nerve blocks that use acromion as the bony reference to locate the suprascapular notch.

172 Effects of Anesthetic and Analgesic Administration at Castration on the Dry Matter and Water Intake, Growth, Feed Efficiency, and Carcass Characteristics of Beef Steers

Abstract The objective of this study was to determine the effects of anesthetic and analgesic administration at castration on the dry matter and water intake, growth, feed efficiency, and carcass characteristics of beef steers. Angus (n = 14) and Simmental x Angus (n = 12) bulls (200 to 278 days of age) were randomly assigned to 2 treatments by breed. Control (CON) bulls were castrated by elastration with no pain management. Pain managed (PM) bulls were castrated by elastration, but also received an anesthetic (lidocaine + 10% sodium bicarbonate; 15 to 20 mL) injection and an oral analgesic (meloxicam; 0.992 mg per kg BW). Initial BW = 325.4 ± 36.9 kg and 299.3 ± 48.2 kg for CON and PM bulls, respectively. Steers were provided with ad libitum access to feed and water using an Insentec RIC system (Hokofarm, Marknesse, Netherlands). Beginning 2 weeks after castration, steers received 2 diets containing increasing energy concentrations at weekly intervals until reaching a finishing diet. Steers were implanted 28 d after castration. Dry matter intake (DMI), diet water intake (DWI), liquid water intake (LWI), and total water intake (TWI) were collected from d -7 to d 195. Depression scores were determined at 6, 18, and 30 h after castration. Body weights were collected on d -7, d 0, d 7, d 14, d 21, d 28, and d 195. Camera carcass data and USDA Yield and Quality Grades were collected at slaughter. Data were analyzed using the PROC MIXED procedure of SAS and significance was declared at P &amp;lt; 0.05. Dry matter intake, water intake, and BW were analyzed by periods beginning 1 week before castration (d -7 to d -1). Periods 2, 3, and 4 were the weeks following castration (d 0 to d 6, d 7 to d 13, and d 14 to d 20, respectively). Period 5 was from d 21 to d 195 and overall was from d 0 to d 195. Dry matter intake, DWI, LWI and TWI were unaffected by treatment. Average daily gain (P = 0.0178) and G:F (P = 0.0130) were influenced by treatment x period interactions. Pain managed steers gained faster (ADG: 1.26 vs 0.48 kg/d; P = 0.0069) and more efficiently (G:F: 0.148 vs 0.051; P = 0.0032) than CON cattle in the week following castration. Depression scores, carcass characteristics, overall ADG, and overall feed and water intake were not different. Pain management at time of castration improves ADG and G:F in the short term; however, the effects are not different over the duration of the feeding period. Further research is needed to determine the best method of castration pain management for beef cattle.