Mixture Of Lidocaine Research Articles

Bupivacaine-lidocaine versus Ropivacaine-lidocaine Retrobulbar Anesthesia in Vitreoretinal Surgery

Purpose: To compare efficacies of bupivacaine-lidocaine and ropivacaine-lidocaine mixtures in terms of inducing retrobulbar anesthesia during vitrectomy.Methods: Sixty patients who underwent retrobulbar anesthesia during vitrectomy were divided into two groups. Patients in group 1 received a mixture of bupivacaine and lidocaine (n = 30); patients in group 2 received a mixture of ropivacaine and lidocaine (n = 30). The effects of the two combinations were retrospectively compared and analyzed. The onset times of analgesia and akinesia were measured. Two hours after surgery, sensory blockade was assessed by touching the corneas with cotton swabs and by communicating with patients. Ocular movement was evaluated in four gaze direction quadrants. A 10-point visual analog pain scale was used to assess pain during and 2 hours after surgery. Intra- and postoperative complications were recorded.Results: The mean analgesia onset times in groups 1 and 2 were 94.62 ± 28.87 and 92.32 ± 35.53 seconds, respectively (p = 0.071); the mean akinesia onset times were 147.89 ± 59.35 and 132.57 ± 76.38 seconds (p = 0.223), respectively. Patients in group 2 reported significantly less postoperative pain and exhibited less postoperative ocular movement, compared with patients in group 1 (both p = 0.002). One patient in group 1 experienced respiratory depression after retrobulbar blockade.Conclusions: When retrobulbar anesthesia is required during vitrectomy, a ropivacaine-lidocaine mixture and a bupivacaine-lidocaine mixture induce anesthesia with similar rapidity. However, the ropivacaine-lidocaine mixture is safer and affords better-quality intra- and postoperative anesthesia.

The Efficacy of Skin Cooling for Pain Relief during Intralesional Steroid Injection for Keloid Treatment: A Randomized Cross-Over Study

Objective: To evaluate if pre-treatment skin cooling can reduce the pain during steroid injection. Materials and Methods: A randomized cross-over study was conducted between September 2015 and October 2016. This study received ethical approval ID035904 No. MURA2016/152. Forty-four subjects with keloid that needed intralesional steroid injection were divided into three pretreatment groups, no treatment, skin cooling with ice pack, and skin applying with a mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA®), in random order. Pain intensity was measured by using 100-mm visual analogue scale (VAS). The satisfaction levels were assessed with orderly interval rating scale from 1 to 5. Repeated-measure analysis of variance (ANOVA) and Bonferroni pairwise comparison were used for data analyses. Results: The mean VAS score at the time of needle puncturing into the skin and during steroid infiltration was statistically significant lower in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.05). The satisfaction level was also statistically significant higher in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.001). Thirty-seven patients (84%) selected skin cooling method as the most favorable pre-anesthetic method for intralesional steroid injection. Conclusion: Skin cooling with ice before intralesional steroid injection of keloid effectively reduces pain and patients are also satisfied. Keyword: Keloid, Corticosteroid, Pre-treatment, pain, skin cooling

Could a Simple Nerve Block be Considered as a Treatment Option for Occipital Neuralgia with Both Short-Term and Long-Term Effects?

Objective: The study aims to show both the short- and long-term treatment outcome of occipital nerve block (ONB) patients with occipital neuralgia (ON).Methods: Patients who visited our hospital between 2013 and 2020 were reviewed retrospectively. Patients were excluded if the medical records were incomplete, if they had received a cervical operation, if they had a traumatic event prior to the symptom onset, or if the follow-up period was less than 3 months. ONB targeted the greater occipital nerve, the lesser occipital nerve or both. Short term follow-up period was defined as 3 months and long term was defined as 12 months. Injection consisted of a mixture of triamcinolone acetonide, lidocaine, and normal saline. Visual analogue scale (VAS) was recorded and compared before and during the follow-up to period to assess treatment outcome.Results: Clinical charts of 309 candidates were reviewed and 72 patients were excluded, making it 237 patients. VAS scores significantly decreased in both 3-month follow-up (from 7.20±0.94 to 3.48 ±1.66, p<0.05) and after 1 year follow-up (from 7.20±0.94 to 2.71±1.07, p<0.05). Only 8 patients (3.3%) were refractory to ONB and the procedure was found to be relatively safe since only 2 patients (0.8%) showed transient side effects.Conclusion: There are many treatment options for ON. However, from the results of our study, conservative treatment via ONB may have sufficient effect in controlling symptoms of ON in both short and long term.

Neuro-Ophthalmological Emergencies. Are They Always Innocent? A Case Report and a Literature Review

Neuro-ophthalmogical complications are rare but can be serious after regional block. We present a case of a 54-year-old diabetic patient who was scheduled for pars plana vitrectomy of his right eye due to tractional retinal detachment, under a peribulbar block with a mixture of lidocaine and ropivacaine. He presented with tachycardia, hypertension, seizures, respiratory distress and apnea. He was intubated for less than 24 hours. He was discharged with no neurological deficit. A review regarding these rare but serious neurological complications of ophthalmic surgery is presented, to raise awareness of neurologists, who are called to evaluate and treat these patients

Use of a topical mix of lidocaine and prilocaine during split-thickness skin graft harvest improves postoperative recovery—A prospective randomized controlled trial

PurposeTo provide evidence of efficacy and postoperative benefit of topical anesthesia (TA) for harvesting split-thickness skin graft (STSG) in an Asian population. Materials and methodsPatients with well-granulating wounds with skin grafting were randomized into TA or general anesthesia (GA) groups. In the TA group, an eutectic mixture of lidocaine and prilocaine (EMLA) was applied. Perioperative heart rate, postoperative donor site pain, adverse effects, patients’ satisfaction, duration of surgery, and operation room (OR) stay duration were recorded. ResultsThirty-nine patients (19 males, 20 females; mean age 54.9 ± 17.8) were included. Twenty underwent TA and 19 underwent GA for STSG. The TA group patients had tolerable pain during skin graft harvesting (VAS, 0.85 ± 1.5). Average EMLA exposure duration was 180.3 ± 65.8 min, and the amount applied was 1.72 ± 0.43 g/10 cm2. The TA group had lower donor site pain score at one hour postoperatively (1.34 ± 1.49 vs 3.08 ± 1.90, p = 0.005), lower OR stay duration (36.5 ± 6.5 min vs 65.1 ± 17.2 min, p < 0.001) and less adverse effects than the GA group. ConclusionHarvesting STSG under TA with EMLA is an effective and efficient approach for most Asian patients with less early postoperative donor site pain and fewer adverse effects.

Recovery of motor function in ambulatory hand trauma using chloroprocaine 2%

Chloroprocaine 2% is an ester local anaesthetic offering a shorter onset, duration of action, and offset than other commonly used agents, making it particularly suitable for ambulatory surgery.1 Although established for short-acting spinal anaesthesia, it has only recently launched on the UK market for peripheral nerve block.2 We evaluated recovery of motor function in patients undergoing awake surgery using chloroprocaine 2% for ambulatory hand trauma procedures. Thirteen patients received an ultrasound-guided axillary brachial plexus block with 30 ml chloroprocaine 2%, of which 5 ml (100 mg) were specifically deposited around the musculocutaneous nerve. We established baseline biceps muscle strength (peak force over a 3-s period) with a handheld dynamometer (Lafayette). Patients also received supplemental distal blocks of the median, ulnar and superficial radial nerves as appropriate with levobupivacaine for postoperative analgesia. Biceps strength was assessed at fixed time points after block until >75% return of baseline function. Mean block performance time was 11 min (7–14 min). Surgery started 5–22 min (mean 12 min) thereafter with an operative time between 13 and 50 min (mean, 34 min). Median peak force immediately after block was 0% (0–25%) of pre-block strength. Six of 13 patients had >50% recovery of biceps strength by 70 min after block (Fig. 3). All had ≥75% recovery by 120 min (Table 1). Surgical conditions were excellent for all patients, and none received supplemental analgesia or reported tourniquet discomfort. Chloroprocaine 2% provided rapid onset block, good surgical conditions, and rapid recovery of motor function. In terms of offset and readiness for discharge, chloroprocaine 2% was a marked improvement on our previous awake surgery local anaesthetic mixture of lidocaine 1.5% with epinephrine. This has benefits for theatre efficiency, and patient safety and satisfaction. Of note patients were able to dress themselves in the PACU without aid. Five patients recorded higher peak force postoperatively compared with baseline, which may have been attributable to pain inhibition. We plan to recommend wider use of chloroprocaine 2% for procedures where operative duration is anticipated to be ≤1 h. Supplemental distal blocks can limit any concerns about postoperative analgesia.Table 1Biceps muscle strength post block.Duration since block finish (min)Median biceps muscle strength (% of baseline)00%7057%8085%12098% Open table in a new tab 1.Saporito A, Anselmi L, Borgeat A, Aguirre J. J Clinical Anesth 2016; 32: 119–262.Jafari S, Kalstein A, Nasrullah H, et al. Anesth Analg 2008; 107: 1746–50

Effectiveness Of Eutectic Mixture Of Local Anaesthetics Vs Lidocaine As A Topical Anaesthetic Agent In Dentistry

Effectiveness Of Eutectic Mixture Of Local Anaesthetics Vs Lidocaine As A Topical Anaesthetic Agent In Dentistry

Intra-articular corticosteroid injection and genicular nerve block under ultrasound guidance in pain control of knee osteoarthritis

BackgroundChronic knee osteoarthritis (OA) is a frequent disease among the elderly. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate knee OA-related pains. Recently, Genicular nerve block (GNB) has emerged as a new alternative technique. The current study aimed to investigate the efficacy of those two approaches when guided with ultrasound and to determine which one offers better results. This study included 40 patients with painful chronic knee OA (Nine males and 31 females, age ranged from 44 to 65 years) and were randomly assigned to two equal groups. Groups 1 was managed with ultrasound-guided IACSI and group 2 with ultrasound-guided GNB using a mixture of lidocaine and Triamcinolone Acetonide. The baseline mean visual analogue scale (VAS) and Oxford knee score (OKS) for the group 1 were 87.10 and 51.3, while for group 2 were 87.75 and 53.25 respectively. Follow up values were obtained at 2, 4 and 8 weeks using VAS and OKS.ResultsThe VAS score and OKS score were significantly lower in the GNB group and IACSI group at 2, and 4 weeks after the procedure (p < 0.001 for all), then returned near baseline values at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (mean reduction of 58.5, 53.3, and 9.25 points at 2, 4, and 8 weeks versus 44.9, 39.4, and 5.6 points at the IACSI groups, p < 0.001 at 2 and 4 weeks, p < 0.006 at 8 weeks). Similarly at the OKS, the GNB group showed significantly better results (33.50, 28.60, and 8.5 at GNB and 26.45, 20.10, 5.25 at IACSI. p < 0.001 at all periods).ConclusionsBoth GNB and IACSI are effective methods to relieve chronic knee osteoarthritis-related pains. When compared to each other, GNB showed more significant pain relief and functional improvement than IACSI.

Tumescent anaesthesia for liposuction surgery—A review

AbstractLiposuction surgery has traditionally been performed under systemic anaesthesia since its invention in mid 1970s. The concept of liposuction under tumescent local anaesthesia by Jeffrey Klein MD, USA, using a dilute mixture of lidocaine, adrenaline and sodium bicarbonate in normal saline has radically modified the outcomes of the procedure making it very safe and at the same time effective to conduct the procedure. Tumescent anaesthesia is very well accepted by dermatologists performing liposuction around the world. Not a single death has been recorded when the principles of tumescent anaesthesia have been followed strictly during liposuction. The article is a review of different types of anaesthesia and issues specific to their use in liposuction surgery. It is the end result of an extensive search and compilation of facts from scientific publications (articles and chapters form textbooks) in the dermatologic, plastic surgery, pharmacology and anaesthesia fields.

Ultrasound-guided local injection of dexamethasone and lidocaine into subcapsule for subacute thyroiditis

Objective:To compare the efficacy and safety of ultrasound-guided local injection of the mixture of dexamethasone（DEX） with lidocaine and oral prednisolone（PSL） in treating patients with subacute thyroiditis. Methods:Ninety-three patients with subacute thyroiditis were divided into group A（n=48） and Group B（n=45）. Group A was treated with ultrasound-guided subcapsular injection in thyroid lesion area, while group B was treated with oral medication. The pain relief time, the duration of treatment, thyroid function recovery, recurrence rate, concurrent hypothyroidism, and drug side effects were compared between the two groups. Results:After 6 months of follow-up, the pain relief time, the duration of treatment and thyroid function recovery in group A were significantly shorter than those in group B （P<0.05）, but not the recurrence rate and hypothyroidism（P>0.05）. Conclusion:Compared with oral PSL treatment, ultrasound-guided local injection of DEX and lidocaine mixture can quickly relieve pain, shorter the duration of treatment and lower adverse reactions.

Phase separation property of a hydrophobic deep eutectic solvent-water binary mixture: A molecular dynamics simulation study.

Over the past decade, deep eutectic solvents (DESs) have earned applicability in numerous fields as non-flammable, non-volatile, and greener alternatives to conventional organic solvents. In a first of its kind, a hydrophobic DES composed of a 1:1 mixture of oleic acid and lidocaine was recently reported, possessing a lower critical solution temperature in water. The thermoreversible phase property of this DES-water system was utilized to sequester out dye molecules from their aqueous solutions. In this article, we explore the phase separation phenomena for this particular DES in its aqueous solution using an all-atom molecular dynamics simulation. A 50 wt.% solution of the DES in water was studied at three different temperatures (253, 293, and 313K) to understand the various molecular interactions that dictate the phase segregation property of these systems. In this work, we have elaborated on the importance of hydrogen bonding interactions and the non-bonding interactions between the components and the competition between the two that leads to phase separation. Overall, we observe that the increase in unfavorable interaction between the DES components and water with increasing temperature determines the phase separation behavior. We have also studied the modification in the dynamical properties of water molecules close to the phase boundary. Such molecular insights would be beneficial for designing novel solvent systems that can be used as extraction-based media in industries.

Patient and surgeon comfort in vitreoretinal surgery performed with Sub-Tenon's Anaesthesia.

Background.Since Stevens first introduced Sub-Tenon’s anaesthesia into cataract surgery it has shown itself to be a safe, simple, and efficient technique. The advantages of this type of block are comparable to those of sharp needle anaesthesia and complications are minimal. Several studies have found that the anaesthesia provided by Sub-Tenon’s capsule injection is as good as or better for cataract surgery than that achieved by retrobulbar injection, but the efficacy of Sub-Tenon’s block in vitreoretinal surgery is less well established.Methods.We performed 50 vitreoretinal procedures; 50 eyes received a Sub-Tenon’s injection of a 5 ml mixture (50:50) of lidocaine and ropivacaine, plus 15 IU mL-1 of Hyaluronidase.Results.In 45 cases, only one injection was needed to achieve sufficient anaesthesia and akinesia; in 5 cases a second injection was performed five minutes after the first. Mean surgical time was 45.7 minutes. After surgery, each patient was asked to indicate his value on the VAS pain scale. Mean VAS degree was 2.4. In 7 cases, VAS was > 3 and the pain was successfully managed with the administration of paracetamol in the postoperative period. No light perception was detected at the end of surgery in 33 patients. All cases with 2 injections had no light perception at the end of surgery. Anaesthesia lasted throughout the surgery in all cases. The surgeon performed all surgery comfortably and with no difficulty.Conclusions.According to our experience and to a growing body of evidence, Sub-Tenon’s anaesthesia appears to be a safe, simple, versatile, and effective technique and should be considered as a real alternative method of anaesthesia in vitreoretinal surgery.

Comparison of three regional anaesthetic techniques for infraorbital or maxillary nerve block in cats: a cadaveric study.

ObjectivesThe maxillary nerve courses very close to the globe, rendering cats – with their large eyes – at risk of globe penetration during infraorbital or maxillary nerve blocks. Therefore, the goals of the study were to compare the distribution and potential complications of three infraorbital or maxillary regional injection techniques.MethodsTwenty-three bilateral maxillae of cat cadavers were used in a randomised blinded trial. Each maxilla was injected with a 0.2 ml 1:1 mixture of lidocaine 2% and a contrast medium by one of three injection techniques: infraorbital foramen (IOF; n = 14); infraorbital canal (IOC; n = 16); or maxillary foramen (MF; transpalpebral approach; n = 16) using a 25 G 1.6 cm needle. CT imaging of each cadaver head was performed before and after injections. A radiologist scored injectate distribution (none [0], mild [1], moderate [2], large [3]) in four locations: rostral, central and caudal IOC, and at the MF, for which the distribution side was also determined. Comparisons were performed with ordinal logistic mixed effects (P <0.05).ResultsThe median (range) total distribution score of the IOC and MF technique were significantly higher compared with the IOF technique (6.5 [4–12], 4 [2–8] and 0 [0–10], respectively). The total IOC score was also significantly higher compared with the MF technique. Injectate distribution at the MF was significantly more central following IOC injection compared with MF injection, which distributed centrolaterally. None of the techniques resulted in intraocular injection.Conclusions and relevanceThe IOC and MF techniques produced a satisfactory spread of the mixture that could result in effective maxillary anaesthesia in cats. Further studies are required to determine the effectiveness and safety of these techniques.

Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology

Objectives: Opioid-free anesthesia is used increasingly often in hospitals around the world. In this type of anesthesia, opioids are replaced by other analgesics, such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate. Many clinicians prepare these agents as dual, triple, or quadruple admixtures within a single syringe. However, data on the stability of the individual substances within these preparations over time and in different storage conditions is very limited. Here, we aim to investigate various admixture of dexmedetomidine, ketamine, lidocaine, and magnesium sulfate with respect to the stability of the individual agents over time at different storage conditions. Methods: An ultra-high performance liquid chromatography method coupled to mass spectrometric detection was developed and validated to determine the stability of lidocaine, ketamine, and dexmedetomidine. Quantification of magnesium was carried out in parallel by potentiometric titration. Results: Our results demonstrate the stability of dual, triple or quadruple mixtures of selected substances in 0.9% saline under different storage conditions. Under all conditions, analyzed admixtures remain stable for at least 8 weeks. The quadruple mixture of lidocaine, ketamine, dexmedetomidine, and magnesium sulfate was storable for as long as 148 days without a significant loss of analyte. Conclusion: A new chromatographic method was successfully developed to analyze the stability of various pharmacological agents commonly used by clinicians in opioid-free anesthesia. The data we obtained indicate that mixing these agents together in a single syringe is safe and reliable and suggest that hospital pharmacies may prepare these solutions in advance of planned surgeries.

Additive Effect of Sulfantil to Lidocain and Bupivacain for Supraclavicular Brachial Plexus Block

Purpose: We evaluated the effect of adding Sufentanil to the mixture of Lidocaine and Bupivacaine used for supraclavicular brachial plexus block in reducing postoperative pain.&#x0D; Method: This double-blind clinical intervention trial was conducted in 2007. Patients scheduled to undergo upper limb orthopedic surgeries under supraclavicular brachial plexus block were recruited. Participants of one arm were given the mixture of Sufentanil, lidocaine, and bupivacaine (Group S) while those of the other arm were given the mixture of later two drugs (Group C). Postoperative pain assessment was done every hour postoperatively till the first administration of systemic analgesic. We used a subjective pain score and duration of lack of muscle movement as a parameter to judge outcomes. The mean and standard deviation were compared of both arms.&#x0D; Result: We included 50 patients in both arms. The mean duration of the motor blockade in group S and C were 342.8 (± 145.4) and 171.1 (±50.2) minutes respectively. The additive effect of Sufentanil in motor blockage was 171.7 (95% CI 128.5–214.9) (p = 0.1×10-6). The mean duration of analgesia in group S and C were 892 (±34.7) and 350 (±72.1) minutes respectively. The additive effect of Sufentanil in analgesia was 542 (95% CI 524–559) (p = 0.1×10-6). In group S, one patient developed cardiac pain following pneumothorax and two had temporary Horner syndrome.&#x0D; Conclusion: Analgesia in the postoperative period can be enhanced with the addition of Sufentanil (an opioid) to local anesthetics in supraclavicular brachial plexus block.

Eutectic Mixture of Lidocaine and Prilocaine Decreases Movement and Propofol Requirements for Pediatric Lumbar Puncture During Deep Sedation: A Randomized, Placebo-Controlled, Double Blind Trial.

Deep sedation/general anesthesia is commonly used in pediatric oncology patients undergoing lumbar puncture (LP). Propofol is often used for sedation, with or without a narcotic. We hypothesized that eutectic mixture of lidocaine and prilocaine (EMLA) would allow for lower cumulative doses of propofol and less movement. We performed a prospective, randomized, double blind, placebo-controlled trial in children undergoing sedation for LP. Standard initial weight-based doses of propofol and fentanyl were administered, with either EMLA cream or a placebo cream applied topically. The primary outcome was the total dose of propofol administered to each patient. We also tracked patient movement and complications. Twenty-seven patients underwent 152 LPs. Patients randomized to EMLA cream (n=75) were significantly more likely to receive a lower dose of propofol (2.94 mg/kg, SE=0.25, vs. 3.22 mg/kg, SE=0.19; P=0.036) and to not require additional propofol doses (probability 0.49, SE=0.08 vs. 0.69, SE=0.06; P=0.001) compared with patients randomized to placebo cream (n=77). In addition, patients with EMLA cream were significantly less likely to demonstrate minor or major movement. EMLA cream results in less movement and less propofol administration in pediatric oncology patients undergoing sedation for LP.

Combined femoral and sciatic nerve blocks for lower limb surgeries

The peripheral nerve blocks can be used to interrupt the nerve pathways at multiple locations without undue sedation or loss of consciousness. Low incidence of pre and postoperative complications, good postoperative analgesia and increased operating room efficiency, all have accounted for the resurgence of interest in these techniques. The main aim of this study was to assess the suitability of this simple and safe technique for various unilateral lower limb surgeries and to assess the hemodynamic stability of the patients after this procedure.This prospective randomized study involved 50 patients, in the age group of 20-80 years, scheduled to undergo elective and emergency lower limb surgeries under combined femoral and sciatic nerve blocks. A sciatic nerve block was given by the posterior approach of Labat, and a femoral (3 in 1) block was given by Winnie's inguinal perivascular approach using a mixture of lidocaine, ropivicaine, and saline. Complete block was achieved in 92% of the patients. None of the patients had any complications and there was no significant difference between the pre-operative and post- operative vitals (pulse and blood pressure). 84% of the patients preferred to undergo the same anesthetic technique, if required in the future. Combined femoral(3-in-1) and sciatic nerve block is a simple, safe, and efficient technique with very low incidence of sideeffects and a negligible failure rate.

Application of WALANT technique for repairing finger skin defect with a random skin flap

BackgroundWide-awake local anesthesia no tourniquet (WALANT) technique has emerged among hand surgeons with other indications. Surgeries involving pedicled flap and revascularization are no longer used as contraindications. The present study aimed to evaluate the feasibility and merits of the WALANT technique in random skin flap surgery.MethodsFrom May 2018 to March 2019, 12 patients with finger skin defects repaired with random skin flaps were reviewed. Abdominal skin flaps or thoracic skin flaps were used to cover the wound. Both the fingers and the donor sites were anesthetized by the WALANT technique. A 40-mL conventional volume consisted of a mixture of epinephrine and lidocaine. A volume of 5 mL was injected at the distal palmar for nerve block, the other 5 mL was injected around the wound for hemostasis, and the remaining was injected at the donor site of flaps for both analgesia and hemostasis. Baseline data with respect to sex, age, side, type of finger, donor sites, flap size, dosage of anesthetics, usage of finger tourniquet, intraoperative and postoperative pain, hemostasis effect, operation time, Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) score, and hospitalization expense, were collected.ResultsAll patients tolerated the procedure, and none of them needed sedation. Single finger skin defect in 8 patients and double finger skin defect occurred in 4 patients; 5 patients were repaired by abdominal skin flaps, and 7 patients were repaired by thoracic skin flaps. The good surgical field visibility was 91.7%. All flaps survived adequately, without necrosis, pulling fingers out, and other complications. The average visual analog scale (VAS) score of the maximal pain was 1.1 in fingers vs. 2.1 in donor sites during the operation. On postoperative day one, the average VAS score of the maximal pain in fingers and donor sites was 1.3 and 1.1, respectively. The average hospitalization expense before reimbursement of the whole treatment was 11% less expensive compared to the traditional method. The average QuickDASH score was 9.1.ConclusionsUnder wide-awake anesthesia, patients have the ability to control their injured upper extremities consciously, avoiding the complications due to pulling flap pedicles. With the merits of safety, painlessness, less bleeding, and effectivity, the WALANT technique in random skin flaps is feasible and a reliable alternative to deal with finger skin defect.

Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia.

Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA. 32% of the patients reported post-operative pain within the first 48h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3% of the patients. 98.7% of the patients were satisfied with SLNB under TLA. SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.