Injection Of Lidocaine Research Articles

Return of sensation after perineural injection of ropivacaine, bupivacaine or lidocaine to the femoral and sciatic nerves in dogs: a blinded randomised clinical trial

Return of sensation after perineural injection of ropivacaine, bupivacaine or lidocaine to the femoral and sciatic nerves in dogs: a blinded randomised clinical trial

Efficacy and safety of ultrasound guided stellate ganglion block: developing new clinical indications beyond electrical storm

Abstract Background Percutaneous stellate ganglion block (PSGB) is recommended by the latest European guidelines for patients with drug and ventricular tachycardia (VT) ablation refractory electrical storm (ES). Yet, due to the strong antiarrhythmic potential, combined with the good safety profile, we’ve recently used it for to the prophylaxis of ventricular arrhythmias (VAs) in high-risk patients and the prophylaxis/treatment of atrial arrhythmias in patients with acute heart failure (HF). Purpose To describe our single-center experience with PSGB usage outside the conventional indication of ES. Methods We hereby describe our single center experience with PSGB from 2/2021 to 2/2024. Results 56 patients (87% male, mean age 64 ± 12 years) received a total of 91 PSGB performed with the lateral, ultrasound (US) guided technique. Most of the procedures consisted of a single bolus anesthetic injection of lidocaine plus ropivacaine, 27% in an additional continuous infusion, mainly with ropivacaine. All procedures except for 3 in a single patient who had previously received left cardiac sympathetic denervation, were performed on the left side. Most of the patients (61%) suffered ischemic cardiomyopathy (CMP), including 11 with an acute coronary syndrome; the rest had non-ischemic CMP. 63 PSGB (69%) were performed in patients with impending or manifested cardiogenic shock (SCAI classification B or more). Mean LVEF was 24 ± 12%. Most of the procedures (n=80, 88%) were performed due to ongoing refractory VAs, yet 6 (6%) aimed to prevent major VAs in high-risk patients, mostly in the setting of recent ES (within 1 month) and need for Levosimendan to support cardiac output, in one case due to recent stereotactic VT ablation, to prevent early VAs in the phase of acute radiation induced microvascular damage. All 6 were effective in preventing clinically significant VAs. Additionally, 5 single bolus PSGBs (5%) were performed due to atrial arrhythmias with high ventricular rate despite intravenous drugs in the setting of acute HF. Specifically, 3 patients had atrial fibrillation (AF), 1 patient runs of ectopic atrial tachycardia (AT) and 1 patient 2:1 atrial flutter. Left-sided PSGB significantly reduced (≥25% reduction) ventricular rate during AF and AT but not during the single case of 2:1 atrial flutter, in 2/3 AF cases a cardioversion into sinus rhythm occurred within 40 minutes from PSGB. Only 1 (1%) major complication occurred (respiratory arrest), that was quickly and effectively treated with lipid emulsion, while minor complications were observed in 11% of PSGBs (mostly transient left arm weakness). Conclusions Our data suggest that US-guided PSGB usage, thanks to its feasibility at bed-side and good safety profile, may expand, beyond ES, to not only VAs prevention in high-risk settings, but also to prophylaxis/treatment of atrial arrhythmias in critically ill patients with acute heart failure requiring concomitant inotropic support.

Comparison of Trigger Point Lidocaine Injection and Stabilization Splint Use in Myofascial Orofacial Pain Treatment

Objective: This study aims to compare the short-, medium-, and long-term efficacy of trigger point local anesthetic injection and stabilization splint use for myofascial orofacial pain. Materials and methods: Group 1 comprised 15 patients who received trigger point local anesthetic injections (LAI), while Group 2 comprised 15 patients who were treated with a stabilization splint (SS). Analysis of pain-free maximum mouth opening (MMO) measurements, jaw disability checklists (JDC), short-form McGill pain questionnaires (SF-MPQ), and Visual analog scales (VAS) were used for comparison between the groups. Results: The LAI group showed a significantly greater increase in pain-free MMO in all terms (p < 0.001) and had significantly lower values on the JDC in both the medium (p = 0.026) and the long term (p = 0.006). The SF-MPQ was significantly lower in the medium term (p = 0.001) in the LAI group; the VAS showed a significantly greater decrease in the short (p = 0.016) and medium terms (p < 0.001) in the LAI group. Conclusion: The results indicate that a treatment choice can be made between TN lidocaine injection and occlusal splint based on patient tolerance.

PSLBI-14 Assessment of the effective tissue concentrations of injectable lidocaine and a lidocaine-impregnated latex band for castration in calves and lambs

Abstract Tail docking in lambs and castration in lambs and calves are common husbandry practices, both of which cause pain and discomfort, for which many industries recommend or require pain management. The purpose of this study was to assess the effective tissue concentrations of the current standard of care for pain mitigation in calves and lambs during castration or tail docking (injectable lidocaine) and to assess the ability of a lidocaine-loaded elastration band (LLB) to deliver effective concentrations into the scrotal or tail tissues over time. This work comprised four different field trials (n = 50/trial): 1) effective concentrations of injectable lidocaine in the scrotal tissue of dairy calves; 2) the in vivo delivery of effective concentrations of lidocaine from LLBs placed on the calf scrotums; 3) effective concentrations of injectable lidocaine in the scrotal and tail tissue of lambs; and 4) the in vivo delivery of effective concentrations of lidocaine from LLBs placed on the lamb scrotums and tails. Sensation in the tissue of interest was assessed by electrocutaneous stimulation. Sensation was correlated to tissue concentrations of lidocaine by analyzing sampled tissue for lidocaine content by High-Performance Liquid Chromatography (HPLC). Injectable lidocaine allowed for short-term anesthesia for up to 60 min calves, highlighting the importance of finding additional strategies to mitigate long-term pain. An effective concentration (EC) yielding 50% reduction in tissue sensation (EC50) of 0.635 (95% CI 0.462 to 0.829) mg/g was calculated for calf scrotal tissue. Based on HPLC data of processed biopsy samples taken over time, the LLBs yielded tissue concentartions of lidocaine that approached EC50 and exceeded EC95 at 2 and 72 h following application, respectively, and remained above those concentartions for at least 28 d after application. In lambs, injectable lidocaine allowed for short-term anesthesia for up to 180 min following injection. An EC50 of 0.174 (95% CI 0.125 to 0.248) mg/g was calculated for lamb scrotal tissue and an EC50 of 0.0765 (95% CI 0.0533 to 0.113) mg/g was calculated for lamb tail tissue. The use of the LLB provided tissue lidocaine concentrations that met or exceeded the EC50 for at least 21 to 28 d and, based on electrostimulation data, provided local anesthesia for at least 3 d when compared with a control band. The use of an LLB could provide a practical, long-duration alternative to injectable lidocaine for pain mitigation during castration and tail docking. Further studies are warranted to compare the use of LLBs to injectable local anesthetics.

Less Pain, but no changes in maximal inclination angles during an overhead reach task following local anesthetic in patients with ongoing shoulder pain

This multicenter observational study aimed to assess how pain reduction, induced by local anesthesia, affects the relative angular contributions of the shoulder girdle and trunk to the maximal angular performance during a semi-constrained overhead reach task in patients with ongoing shoulder pain. Twenty-nine individuals (age 59.0 SD 12.8 years;16-male) with symptomatic shoulders were administered corticosteroid and lidocaine injections by their attending orthopedic surgeon. Immediately before and after the injections, participants reached for a target on the ceiling ten times as high as possible while their pain levels, shoulder, and trunk movements were recorded. The analysis revealed that there was a significant reduction in pain following the injections. However, there were no significant differences in maximum shoulder and trunk inclination angles between the pre- and post-injection conditions. Notably, there were slight but statistically significant alterations in humeroscapular kinematics during the initial phase of arm elevation following the injections. In conclusion, acute pain relief following local anesthetics is not associated with immediate alterations in maximum shoulder girdle and trunk inclination angles during a semi-constrained overhead reach task in patients with ongoing shoulder pain. However, there are signs of small alterations in humeroscapular kinematics during the initial phase of arm elevation.

The perfusion index as a method of assessing epidural anaesthesia efficacy in healthy dogs

Abstract Introduction Perfusion index (PI) is used as assessment of epidural anaesthesia efficacy in human medicine, but its usefulness in dogs is unknown. The aim of this study was to evaluate the usefulness of PI in determining epidural anaesthesia effectiveness. Material and Methods This is prospective cross-over experimental study. Five healthy adult beagle dogs were anaesthetised and an epidural catheter was inserted in the lumbosacral area and adjusted so that the end of the catheter was placed at the fourth lumbar vertebra. Single-port catheters were used in the control group and multiple-port catheters were used in the treatment group. A PI probe was placed on a hind leg, and the catheter placement was confirmed via computed tomography. The treatment group received a bolus dose of lidocaine, and the control group received saline, via epidural catheter. The PI value was recorded every 5 min until 30 min after lidocaine injection. Results The PIs of the hind limbs were not significantly different over time, nor were they between the control and lidocaine-injected groups at any point in time. Conclusion The PI is not useful in determining the efficacy of epidural anaesthesia in dogs under general anaesthesia. In the future, finding a reliable method to evaluate the success of regional anaesthesia, even in patients under general anaesthesia, will be necessary.

Comparison of Analgesic Effect of Local Anesthetic Injection for Pain Relief During Peripheral Venous Insertion in Adult Surgical Patients: A Prospective Observational Study

PurposeIntradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients. DesignA prospective observational study. MethodsAfter institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure. FindingsThe patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001). ConclusionsWe found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

The effect of perioperative intravenous lidocaine infusion on postoperative sleep of elderly patients with colorectal cancer: A randomized controlled study

BackgroundPostoperative sleep disturbance (POSD) caused by postoperative pain can impede the enhanced rapid recovery of elderly patients with colorectal cancer. We propose that perioperative intravenous lidocaine infusion may enhance postoperative sleep quality by alleviating postoperative pain in elderly patients undergoing laparoscopic radical resection for colorectal cancer. MethodsSixty-three elderly patients were divided into two groups: the lidocaine group (group L) and the placebo group (group C). Patients in group L received intravenous injection of lidocaine 1.5 mg/kg during the induction of anesthesia, followed by lidocaine 1.0 mg kg−1 h−1 during surgery and for 24 h after surgery. Patients in group C received the same volume of normal saline. The primary outcome was postoperative sleep function, which was evaluated using the Athens Insomnia Scale (AIS). The secondary outcomes included the pain-at-rest and pain-on-movement of patients at 2, 4, 6, 12, 24, 48, and 72 h after surgery, opioid and propofol consumption, bowel function recovery time, postoperative complications, and lidocaine side effects. ResultsCompared to group C, AIS scores in group L were significantly lower on day 1 (12.9 ± 4.0 vs 10.6 ± 3.9, P < 0.05), day 3 (8.6 ± 4.2 vs 6.2 ± 3.9, P < 0.05), and 1 week (4.3 ± 3.1 vs 2.2 ± 2.5, P < 0.05) after surgery. There were no significant differences in VAS scores between the two groups. The intraoperative consumption of propofol and remifentanil was significantly reduced in group L. Lidocaine infusion significantly shortened the recovery time of bowel function. There were no statistical differences between the two groups regarding the incidences of PONV and postoperative pulmonary complications. No cases of local anesthetic toxicity occurred in either group. ConclusionsPerioperative intravenous administration of lidocaine can facilitate the restoration of postoperative sleep function in elderly patients undergoing laparoscopic radical resection of colorectal cancer.

Comparing the Efficacy of “Spray as You Go” Technique Versus Combined Airway Nerve Block and “Spray as You Go” as Topical Anesthesia During Flexible Bronchoscopy; a Double-Blinded Randomized Clinical Trial

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P&lt;0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications.

A Comprehensive Multi-drug Strategy for the Management of Foreign Body Granuloma Following Mesotherapy.

Mesotherapy is a medical technique that administers cosmetic nutrients directly to the dermis through microdrop injections for aesthetic purposes. Its application has become increasingly widespread. However, there have also been a growing number of reported cases of multiple foreign body granulomas following mesotherapy. It is crucial to find an effective and safe treatment. In this study, 31 patients with facial foreign body granuloma after mesotherapy were included. A mixture of 5-fluorouracil, lidocaine injection , and normal saline was prepared in a ratio of 1:1:4 and injected subcutaneously. Triamcinolone acetonide, 5-fluorouracil, lidocaine injection, and normal saline were prepared in a ratio of 2:5:3:10. Subcutaneous injections were administered to each papule using a 34G needle. The treatments were scheduled at intervals of 10-14 days. Color Doppler ultrasound was used to evaluate the condition before the initial treatment and after the final treatment. The preoperative ultrasonography revealed diffuse hypoechoic areas in the dermis of the facial skin. After an average of 2-4 treatment sessions, a significant improvement was observed in all patients' appearance, with reduced redness and swelling, softened nodules, absence of pain and itching symptoms, and no evident abnormal echo on ultrasound examination. During a follow-up period ranging from 1 to 8 months, no recurrence or adverse reactions were reported. This technique demonstrates clear efficacy. And this formulation effectively reduces the dosage of triamcinolone acetonide and minimizes the risk of adverse reactions such as skin atrophy. Therefore, it can be considered an effective treatment for multiple foreign body granulomas following mesotherapy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Non-Operating Room Anesthesia (NORA) for Ultrasound-Guided Liver Radiofrequency Ablation.

Percutaneous ultrasound-guided radiofrequency ablation (RFA) is a well-studied treatment option for locally non-advanced hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLMs). Sedation is of crucial interest as it enables safe and pain-free procedures. Whether the type of sedation has an impact on procedural outcome is still not well investigated. We retrospectively collected data on patients undergoing liver RFA for various oncological conditions. Procedures were conducted in a non-operating room anesthesia (NORA) setting. Procedural-related complications and short-term oncological outcomes were analyzed. Thirty-five patients (mean age 71.5 y, 80% male) were treated for HCC (26), CRLM (6) and gastric cancer metastases (3). Mean lesion size was 21 mm (SD ± 10.1 mm), and the most common tumor localization was the right hepatic lobe. RFA was performed in a step-up sedation approach, with subcutaneous lidocaine injection prior to needle placement and subsequent deep sedation during ablation. No anesthesia-related early or late complications occurred. One patient presented with pleural effusion due to a large ablation zone and was treated conservatively. Local tumor-free survival after 1 and 6 months was 100% in all cases where a curative RFA approach was intended. NORA for liver RFA comes with high patient acceptance and tolerance, and optimal postoperative outcomes and oncologic results.

Ultrasonography-guided corticosteroid injection in the coracohumeral ligament in patients with adhesive capsulitis of the shoulder: a double-blinded, sham-controlled randomized study

BackgroundContracture and thickening of the coracohumeral ligament (CHL) occur in patients with adhesive capsulitis. This adversely affects the movement and function of the shoulder joint. There is limited evidence that explores the effectiveness of an isolated steroid injection into CHL in combination with physical therapy. This prospective randomized control trial aimed to evaluate the clinical effects of ultrasound-guided corticosteroid injection compared to a sham injection into the CHL in subjects with adhesive capsulitis. MethodsForty patients (23 males, 52.2 ± 8 years of age) with unilateral adhesive capsulitis (with 5.4 ± 2 months mean duration of symptoms) were randomly assigned to either the experimental or control group. Both groups received ultrasound-guided injections into the CHL. The experimental group (n=20) received corticosteroids and the control group (n=20) received a sham lidocaine injection. All subjects underwent supervised conventional physical therapy three times a week for 3 months. Subjects were evaluated for improvements in pain, range of motion, and disability at 6 and 12 weeks as compared to pre-injection baseline measurements. Data were compared statistically across groups and times at p<0.05. The CHL thickness was compared at baseline across sides using paired t-tests. ResultsThe experimental group showed statistically greater improvements in pain, functional scores, flexion, abduction, internal and external rotation range of motion at 12 weeks compared to the control group. Pain reduction was observed in both groups at 6 and 12 weeks, but the experimental group exhibited significantly greater reductions. The CHL was significantly thicker on the affected side as compared to the unaffected side (p<0.001). Discussion and ConclusionThis study partially supported the hypothesis. Notably, significant improvements in pain, range of motion, and functional scores were observed at 12 weeks in the experimental group. The greater improvements in pain and external rotation may have resulted in lower disability scores in the experimental group. The results emphasize the importance of targeted intervention into the CHL.

Comparison of Pain With Ultrasound-Guided Intra-Articular Hip Injections With and Without Prior Subcutaneous Local Anesthesia.

To compare pain levels of intra-articular hip steroid injections performed with and without prior subcutaneous local anesthesia (LA) injection. Randomized prospective study. University-based musculoskeletal clinic. Forty-one adult patients undergoing a first-time ultrasound-guided unilateral intra-articular hip steroid injection. Subjects were randomized into 1 of 2 groups: intra-articular hip injection with prior subcutaneous LA with 2 mL of lidocaine 1% (With LA) or hip injection without prior subcutaneous LA (Without LA). Visual analog scale (VAS) pain scores (0-100) were collected before and after each injection. Visual analog scale pain score for the intra-articular hip injection. Of the 41 total subjects, 18 were randomized to the Without LA group and 23 to the With LA group. There was no significant difference in baseline (preprocedure) VAS scores between the Without LA (mean ± SD = 39.2 ± 27.2) and With LA (41.2 ± 24.0) groups (P = 0.864). The mean ± SD VAS score for the subcutaneous LA injection in the With LA group was 20.4 ± 16.1. There was no significant difference in VAS scores for the intra-articular hip injection between the Without LA (48.5 ± 27.7) and With LA (39.5 ± 25.7) groups (P = 0.232). Subcutaneous injection of lidocaine before an intra-articular hip injection did not significantly decrease pain from the intra-articular hip injection. Providers may perform intra-articular hip injections with a 22-gauge 3.5-inch spinal needle without the need for an extra subcutaneous LA injection.

Anesthetic recovery outcomes after 2 methods of nasal mucosal preparation for endoscopic sinus surgery

PurposeOur institution uses two approaches for nasal mucosal preparation during endoscopic sinus surgery (ESS) to improve surgical field visualization: topical epinephrine (TE) versus topical cocaine with injection of lidocaine containing epinephrine (TCLE). We aimed to compare anesthetic outcomes after ESS using these techniques. Methods and materialsWe retrospectively identified adult patients at our institution who underwent ESS from May 2018 through January 2023 under general anesthesia with propofol and remifentanil infusions. Postoperative anesthetic outcomes, including pain and recovery time, were compared between patients who had mucosal preparation with TE versus TCLE using inverse probability of treatment weighting (IPTW) to adjust for potential confounders. ResultsAmong 1449 patients who underwent ESS, 585 had TE, and 864 had TCLE. Compared with TE, during anesthetic recovery, the TCLE group had fewer episodes of severe pain (numeric pain score ≥ 7) (IPTW-adjusted odds ratio, 0.65; 95 % CI, 0.49–0.85; P = .002), less opioid analgesic administration (IPTW-adjusted odds ratio, 0.55; 95 % CI, 0.44–0.69; P < .001), and shorter recovery room stay (IPTW-adjusted ratio of the geometric mean, 0.90; 95 % CI, 0.85–0.96; P = .002). Postoperative nausea and vomiting and postoperative sedation were similar between groups. ConclusionsPatients who received preparation of the nasal mucosa with TCLE, compared with TE, were less likely to report severe pain or receive an opioid analgesic in the postanesthesia recovery room and had faster anesthetic recovery. This observation from our large clinical practice indicates that use topical and local anesthetic during endoscopic sinus surgery may have benefit for ambulatory ESS patients.

Recalcitrant Ulnar Sided Hand Pain in a Collegiate Golfer: A Case Report.

This case report details a diagnosis of myositis ossificans (MO) in a collegiate golfer with right ulnar-sided hand pain after striking the ground on a swing. Despite conservative treatment and a thorough workup, the patient's ulnar-sided hand pain did not improve. An ultrasound eventually revealed MO within the abductor digiti minimi muscle. The patient received an ultrasound-guided fenestration and injection of lidocaine and dexamethasone into the affected muscle, leading to complete symptom resolution. MO is often secondary to trauma, causing bone formation in soft tissue, leading to pain, limited range of motion (ROM), and disability. This case highlights the importance of considering MO in cases of persistent muscular pain and the diagnostic challenges related to ulnar-sided hand anatomy.

Comparison of subarachnoid administration of low-dose bupivacaine and lidocaine in healthy goats.

This study aimed to compare the effects of low-dose subarachnoid injections of 2% lidocaine (LIDO) and 0.5% bupivacaine (BUPI) in goats. 6 healthy, privately owned female goats. In this randomized blind crossover clinical trial, each goat received 0.05 mL/kg-1 of LIDO, BUPI, or sterile saline solution into the lumbosacral subarachnoid space, with a seven-day washout. Cardiorespiratory variables, rectal temperature, and somatosensory (pinprick) and motor (ataxia) functions were recorded at baseline (time 0) and 2, 5, 10, 15, and 30 minutes after injection, then every 20 minutes until the goat was standing and able to walk. Time to regain somatosensory and motor functions was compared between treatments using Kaplan-Meier survival curves and the Cox proportional hazards model. Linear mixed-effects models were used to compare cardiorespiratory variables between treatments and over time. A P value ≤ .05 was considered significant. Somatosensory recovery was longer with BUPI, though not statistically significant. The median time to stand was 50 (50, 67) minutes after LIDO injection and 104 (101, 156) minutes after BUPI injection (P = .031). The median time to walk was 72 (54, 85) minutes after LIDO versus 225 (220, 245) minutes after BUPI injection (P = .031). Cardiovascular and respiratory variables showed no significant differences between treatments. Despite prolonged ataxia with BUPI, pinprick sensation recovery did not differ. At reduced doses, both LIDO and BUPI are deemed acceptable for short procedures of the flank, pelvic limb, or tail in healthy goats.

Poster 186: The Utility of Preoperative Hip Injection Response as a Predictor of 2-Year Postoperative Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement

Objectives: The objective of this study is to determine whether response to preoperative lidocaine or corticosteroid intra-articular hip injections can predict 2-year postoperative outcomes in patients undergoing arthroscopic management of femoroacetabular impingement syndrome (FAIS). Methods: We performed a retrospective analysis of a prospective cohort consisting of patients who received a preoperative corticosteroid or lidocaine intra-articular hip injection and subsequently underwent hip arthroscopy for treatment of FAIS between 2014-2020. Patients were classified by injection received and labeled as “responders” if the injection provided pain relief. Lidocaine and corticosteroid cohorts were matched using 1:1 matching for age, BMI, and sex. Patient reported outcome (PRO) measurements including the Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12 MCS) and physical component survey (SF-12 PCS), and visual analog scale (VAS) Pain were completed both preoperatively and 2-years postoperatively. Mean differences in preoperative and 2-year postoperative scores were calculated as was the percentage of patients achieving a mean clinically important difference (MCID). Floor and ceiling effects of PROs were also evaluated with 15% of patients achieving a maximum or minimum survey score deemed as significant. Results: Our cohort included 110 patients (55 lidocaine, 55 corticosteroid) with no significant differences in preoperative demographic variables (Table 1). Both cohorts demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12 MCS, which was unchanged. Lidocaine non-responders demonstrated greater 2-year mean difference in all PROs, except for SF-12 MCS, when compared to lidocaine responders (Table 2). Lidocaine non-responders also achieved MCID at higher rates than responders in both HOOS Pain &amp; VAS Pain (Table 3). There was no difference in percentage of patients achieving MCID or mean difference in PROs between corticosteroid responders and non-responders. Ceiling and floor effects were seen in 2-year postoperative PROs of a combined lidocaine &amp; corticosteroid responder cohort. [Ceiling: HOOS ADL (34.6%) HOOS Pain (21.0%) HOOS Sport (28.4%); Floor: VAS Pain (34.6%)] Conclusions: Preoperative intra-articular hip injection response did not predict 2-year postoperative outcomes after hip arthroscopy for FAIS. Results from this study suggest that preoperative injection response should not be used in isolation to predict outcomes after arthroscopic treatment of FAIS.

What is the Effect of Lidocaine Compared to Lidocaine and Clove Oil on Episiotomy Site Anesthesia: Results from a Randomized Clinical Trial

Background: Episiotomy is a commonly performed obstetric procedure that often results in perineal pain for women. Objectives: This study aimed to compare the effects of lidocaine alone and lidocaine combined with clove oil on pain at the episiotomy site. Methods: This randomized clinical trial was conducted at Baharloo Hospital in Tehran, involving 65 nulliparous women who underwent episiotomy. Perineal pain was assessed using the Visual Pain Intensity Scale (VAS) and the McGill Questionnaire. The control group received a 2% lidocaine injection, while the intervention group received a combination of 0.8% clove oil and 2% lidocaine to alleviate pain before the episiotomy. The clove oil was applied topically to the episiotomy site 10 minutes prior to the lidocaine injection. During the episiotomy repair stage, both groups received a 2% lidocaine injection. Pain intensity was measured using the aforementioned tools at 1, 6, and 12 hours after episiotomy repair. Results: There was no statistically significant difference in average pain intensity between the two groups before and 12 hours after the intervention (P &gt; 0.05). However, at 1 and 6 hours after the intervention, the combination of clove oil and lidocaine resulted in significantly lower pain compared to the lidocaine-only group (P &lt; 0.05). Conclusions: Considering the greater effectiveness of lidocaine combined with clove oil in reducing episiotomy site pain intensity and the absence of side effects, this method can be recommended as an adjuvant therapy to reduce pain at the episiotomy site.

The Effect of Music Therapy on the Pain Level of 3 to 6-year-old Children Undergoing Wound Repair by Suturing and Their Parents' Anxiety in the Emergency Department: A Randomized Controlled Trial

Background: Music can serve as a passive distraction to reduce pain and anxiety. Due to the limited number of studies in this field, a study was designed and implemented to determine the effect of music therapy on the pain level of 3 - 6-year-old children undergoing wound repair by suturing and their parents' anxiety in the emergency department. Objectives: This study aimed to examine the effect of music therapy on the pain level of 3 to 6-year-old children undergoing wound repair by suturing and their parents' anxiety in the emergency department. Methods: The present study is a parallel, controlled, randomized clinical trial. Sixty children aged 3 to 6 years referred to the emergency room for sutures were included in the study. In the test group, music was played on a mobile phone from the time the child entered the outpatient operating room until the end of the procedure and discharge. In the control group, children were sutured as usual. The behavioral reactions of both groups were assessed using Wong-Baker's pain scale before washing the wound, immediately after the injection of lidocaine, and at the end of the suture. The abbreviated Spielberger Situational Anxiety Questionnaire was used to measure parents' anxiety before washing the wound and at the end of the suture. These measures were recorded by the researcher. Results: Comparing the mean (standard deviation) of pain before washing the wound in the test group (9.90 ± 0.44) and the control group (9.97 ± 0.258) showed no statistically significant difference (P = 0.311). Using the GEE model, the average pain score immediately after lidocaine injection and at the end of the suture decreased by 1.77 and 4.9 units, respectively, compared to the phase before washing the wound (P &lt; 0.001). The average anxiety of parents before washing the wound was 21.05 ± 2.59 in the test group and 21.05 ± 2.09 in the control group, showing no statistically significant difference (P = 0.801). Conclusions: Based on the results of this study, there was no statistically significant difference between the two groups in terms of children's pain and parents' anxiety. However, clinically, the average levels of children's pain and parents' anxiety in the intervention group decreased at all three times. Music therapy seems to be effective in the emergency department during painful procedures.

Treatment of chronic mini-thoracotomy wound pain and lung herniation with intercostal cryoablation and surgical mesh repair: a case report

BackgroundThe incidence of minimally invasive heart surgery via mini-thoracotomy (MT; right anterior thoracotomy) is on the rise, accompanied by an increase in post-MT intercostal nerve neuralgia and the risk of lung herniation through the incision site. While various methods have been proposed to address these issues, none have been commonly effective. In this case report, we attempted to simultaneously address these problems by performing intercostal cryoablation (IC) and mesh repair.Case presentationA 43-year-old male was referred to our hospital for chronic post-thoracotomy neuralgia following heart surgery via MT, involving patch closure of an atrial septal defect and tricuspid annuloplasty. He presented with intercostal nerve neuralgia and lung herniation accompanied by severe pain. Despite medication and lidocaine injections, there was no relief. Consequently, he underwent surgical treatment with IC for chronic MT wound pain and simultaneously underwent mesh repair for a lung hernia. He was discharged from hospital free of complications. Subsequently, he no longer required further pain medication and experienced a favorable recovery.ConclusionOur findings suggest that concurrent IC and mesh repair can effectively relieve chronic post-MT intercostal nerve neuralgia and severe lung herniation pain in patients who underwent MT surgery, leading to a decrease in opioid medication usage.