Need For Additional Anesthesia Research Articles

Comparative evaluation of efficacy of 2% lidocaine containing adrenaline with and without hyaluronidase in inferior alveolar nerve blocks for patients requiring bilateral mandibular extractions

AbstractPurposeTo evaluate and compare the efficacy of 2% lidocaine containing adrenaline with and without hyaluronidase in inferior alveolar nerve blocks for patients requiring bilateral mandibular extractions.Patients and MethodsThis was the split‐mouth study conducted on 26 patients requiring bilateral mandibular teeth extraction. All the patients were assigned randomly to one of the two groups: (i) 2% lignocaine HCl + 1:2,00,000 adrenaline + hyaluronidase (75 IU) solution will be administered on one side which is the experimental side and (ii) 2% lignocaine HCl + 1:2,00,000 adrenaline solution on the other side is control side. In the first session, the patients randomly received the inferior alveolar nerve block with or without hyaluronidase in one side of the oral cavity. One week later, the same patient received the other technique which was not received in the first session. We also evaluated the onset, duration and need of any supplementary anaesthesia in both the groups.ResultsComparison of VAS score in the control group (2.73 ± 0.724) and experimental group (3 ± 0.693) showed statistically insignificant results (p = 0.177). Whereas the onset of local anaesthesia showed a statistically significant difference between the two groups (p < 0.001) mean of control group (2.73 ± 0.47) and experimental group (1.15 ± 0.23). Comparison of duration of anaesthesia showed a statistically significant difference (p < 0.001) with the mean duration of the experimental group being higher (106 ± 7.94) than the control group (86.27 ± 3.90). Comparison for the need for supplementary anaesthesia showed no statistically significant difference between the two groups.ConclusionWe conclude that if hyaluronidase is used, better blocks with smaller volumes are produced. LAs with hyaluronidase have been shown to improve the quality and effectiveness of anaesthetic blocks and shorten the time it takes for anaesthesia to begin, accelerate the onset of akinesia and lessen the need for additional anaesthesia. It also increases the duration of anaesthesia.

Effectiveness and safety of ultra-low-dose spinal anesthesia versus perineal blocks in hemorroidectomy and anal fistula surgery: a randomized controlled trial

BackgroundUltra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). MethodsA two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. ResultsFifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). ConclusionSA and PB are similarly effective in pain control during the first 48 h after hemorrhoidectomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.

MP23-19 LESSONS LEARNT FROM A MULTICENTER SERIES OF 400 CASES ON THE UTILITY OF PRE-STENTING FOR PEDIATRIC RETROGRADE INTRA RENAL SURGERY (RIRS)

You have accessJournal of UrologyCME1 Apr 2023MP23-19 LESSONS LEARNT FROM A MULTICENTER SERIES OF 400 CASES ON THE UTILITY OF PRE-STENTING FOR PEDIATRIC RETROGRADE INTRA RENAL SURGERY (RIRS) Ee Jean Lim, Stefania Ferreti, Anna Bujons, Olivier Traxer, Danielle Castellani, Yesica Quiroz, Deepak Ragoori, Tanuj Paul Bhatia, Chandra Mohan Vaddi, Claudia Gatti, Khi Yung Fong, Yiloren Tanidir, Bhaskar Kumar Somani, Anil Shrestha, and Vineet Gauhar Ee Jean LimEe Jean Lim More articles by this author , Stefania FerretiStefania Ferreti More articles by this author , Anna BujonsAnna Bujons More articles by this author , Olivier TraxerOlivier Traxer More articles by this author , Danielle CastellaniDanielle Castellani More articles by this author , Yesica QuirozYesica Quiroz More articles by this author , Deepak RagooriDeepak Ragoori More articles by this author , Tanuj Paul BhatiaTanuj Paul Bhatia More articles by this author , Chandra Mohan VaddiChandra Mohan Vaddi More articles by this author , Claudia GattiClaudia Gatti More articles by this author , Khi Yung FongKhi Yung Fong More articles by this author , Yiloren TanidirYiloren Tanidir More articles by this author , Bhaskar Kumar SomaniBhaskar Kumar Somani More articles by this author , Anil ShresthaAnil Shrestha More articles by this author , and Vineet GauharVineet Gauhar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Retrograde intrarenal surgery (RIRS) is an option for pediatric kidney stone upto 1 cm in EAU guidelines and many urologist do RIRS for >1 cm stones as well if they have sufficient experience. We aim to assess the outcomes of pre-stenting versus non-pre-stenting in a pediatric population undergoing RIRS for intrarenal stones in different age groups and locations. METHODS: Data collected on Children/adolescents with kidney stones undergoing RIRS in 9 centers between 2015-2020 were retrospectively reviewed. Exclusion criteria: ureteral lithotripsy, bilateral procedures. Stone-free status was evaluated at 3-month and deemed as a single residual fragment (RF) ≤2 mm/absence of multiple fragments. Patients were divided into two groups (Group 1 no pre-stenting , Group 2 pre-stented). Student’s, Chi-square and Fisher’s exact test was used to assess difference between groups. Univariable and multivariable logistic regression analysis were performed to predict RF. Statistical signicance: p-value <0.05. RESULTS: 389 children/adolescents were included (192 patients in Group 1). Pre-stented patients were younger compared with non-presented (mean age 8.30±4.93 vs 10.43±4.30 years, p<0.001). There were no differences in stone characteristics (number, size, locations). Lasing and total surgical time were similar. Urinary tract infections (Clavien grade 2) were more prevalent in Group 2 (10.7%) compared to Group 1 (3.7%, p=0.016). Sepsis (Clavien grade 4) occurred in 2.1% of patients in Group 2 and no patient in Group 1 (p=0.146). 30.7% patients in Group 1 and 26.4% in Group 2 had RF (p=0.322). Multivariate logistic regression analysis showed that stone size was associated with RF (OR 1.20 95% CI 1.08-1.36, p=0.001). CONCLUSIONS: RIRS showed similar stone-free rate in pre and non-pre-stented children/adolescents, In this multicenter study, we found that preoperative positioning of ureteral stent had no effect in clearing stones but a higher incidence of postoperative infections. Whilst routine pre-stenting cannot be recommended it becomes imperative that the child's guardian is counseled appropriately about pros and cons of prestenting including need for additional anaesthesia. Source of Funding: NIL © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e314 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ee Jean Lim More articles by this author Stefania Ferreti More articles by this author Anna Bujons More articles by this author Olivier Traxer More articles by this author Danielle Castellani More articles by this author Yesica Quiroz More articles by this author Deepak Ragoori More articles by this author Tanuj Paul Bhatia More articles by this author Chandra Mohan Vaddi More articles by this author Claudia Gatti More articles by this author Khi Yung Fong More articles by this author Yiloren Tanidir More articles by this author Bhaskar Kumar Somani More articles by this author Anil Shrestha More articles by this author Vineet Gauhar More articles by this author Expand All Advertisement PDF downloadLoading ...

A comparative analysis between atraumatic and conventional anesthetic techniques in surgical removal of upper third molars

Pain control is essential in dental practice, and can be accomplished through various techniques. This study seeks to compare atraumatic and conventional anesthetic techniques, applied during surgeries to remove upper third molars. The endpoints evaluated were pain indices, patient satisfaction and anesthetic efficacy. A random parallel split-mouth clinical trial was conducted with 14 patients. Group A received atraumatic anesthesia without a needle (Comfort-in®) and group B received conventional anesthesia by blocking the posterior superior alveolar nerve (PSAN) and Greater Palatine Nerve (GPN). A Visual Analogue Scale (VAS) was used to assess pain. A significantly (p&lt;0.001) lower perception of pain was observed among individuals who received the atraumatic technique. In 71% of cases, it was necessary to supplement the anesthesia during the procedure. Even considering the need for additional anesthesia, the Comfort-in® technique was more accepted by patients with regard to pain perception than the conventional manual technique.

Evaluation of single stage adjustable strabismus surgery (SSASS) under topical anesthesia in patients with symptomatic diplopia

ABSTRACT We wish to assess effectiveness of using topical anesthesia without sedation in single-stage adjustable strabismus surgery (SSASS). Sixteen consecutive adults with diplopia and those willing to undergo SSASS, participated in a prospective study between September 2018–August 2019. They underwent detailed ophthalmic evaluation, ocular alignment measurement by prism cover test (PCT), and sensory evaluation. Subsequently they underwent SSASS under topical anesthesia (2% lidocaine gel). Surgery was performed using conventional technique; ocular alignment was then reassessed in sitting position by alternate cover test using prisms, for which with Snellen’s chart was used as distance target and Lang’s fixation stick as near target. Absence of diplopia was considered the end point of measurement. Any adjustment, if required, was performed intraoperatively, after recleaning the operative area with povidone iodine and redraping the eye. Participants were reassessed 1 day, 1 month, and 3-month after procedure, ocular deviation, and presence or absence of diplopia was documented. Fifteen males and one female patient participated in the study. Mean age of the study population was 31.29 years (range 19–65 years). Of these, 62.5% of patients required intraoperative modification of planned surgical dose. Patients with esotropia, vertical deviations, and combined deviations obtained surgical success, which remained stable till 3-month review. Patients with exotropia had initial surgical success rates of 100% immediately following surgery (day 1 postoperative evaluation), but it decreased to 83.33% and 66.67% during one and 3-months follow-up visits. In this study all patients tolerated the procedure well, without systemic adverse occurrence, including vasovagal reflex and without the need for additional anesthesia. SSASS is a good option in patients with diplopia and variable ocular deviations. Topical anesthesia allows intraoperative adjustment of surgical dosing, with aim of orthophoria or relief from diplopia, leading to satisfactory results. Postoperative drift may occur in exotropia. Case selection and preoperative counseling are necessary for cooperation during surgery, under topical anesthesia.

Ostéosynthèse des fractures du radius distal en mini-open et en WALANT par plaque verrouillée antérieure

The aim of this comparative and prospective study was to evaluate the feasibility and benefits of a mini invasive pronator-sparing technique for radius distal fracture treated with volar locking plate performed with a WALANT anesthesia. Sixty patients (from June 2016–June 2017) with an extra articular fracture of the distal radius and a mean age of sixty two years were managed with a distal volar plate and an in situ catheter for continuous diffusion of Ropivacaine during 48 hours after surgery. There were two groups (30 patients per group). Patients of the first group receive a WALANT anesthesia (Lidocaine 1%, epinephrine 0.05/10 ml). In the second group patients have had an ultrasound guided axillary block and a tourniquet. The following points were monitored: duration of the procedure, need for additional anesthesia or sedation during the surgery, patient discomfort. Pain was evaluated with a visual analog scale at Day 0, Day 1, Day 2, Day 3, Day 7, and Day 45. A clinical and radiological evaluation was made at 6 weeks and 3 months after surgery (range of motion, anatomical alignment and screw placement). The study was approved by our local ethics committee. All the patients were available at the last follow up. In the group I (WALANT) VAS (D0/D1/D2) was significantly lower than in the group II (2.2/3.5/4.9 vs 4.1/4.8/6.2). The were no difference of the results of VAS after Day 2. In the group I no patients received a sedation, while in group II 4 patients required additional analgesia. During the procedure, and only in group II, 2 patients complained about pain at the wrist, 12 of discomfort at the tourniquet and 8 patients were anxious about not knowing where their arms were located. At the last follow up there was no significant difference between the two groups for the duration of the procedure, range of motion and for the anatomical alignment. A reflex sympathetic dystrophy syndrome occurred for 3 patients of the second group. The use of WALANT for open reduction and internal fixation of distal radius fractures allows clinical and anatomical results identical to those obtained with conventional techniques. Moreover, WALANT seems to be a powerful tool for risk management of reflex sympathetic dystrophy syndrome.

RANDOMIZED EVALUATION OF THE INFLUENCE OF INTRAVENOUS USE OF DEXAMETHASON ON POSTOPERATIVE ANALGESIA IN PATIENTS AFTER ARTHROSCOPIC OPERATIONS ON THE KNEE JOINT UNDER THE CONDITIONS OF THE PERIPHERAL REGIONARY BLOCKADE

Aim: to evaluate the effects of intravenous dexamethasone on postoperative analgesia in patients after arthroscopic knee joint surgery in conditions of peripheral regional blockade. Material and methods: 60 patients were included in the study, divided into 2 groups. In the first group, patients underwent peripheral regional blockade of the femoral and sciatic nerves with a 0.5% solution of levobupivacaine. In the second, the traditional peripheral regional blockade was supplemented by intravenous administration of 8 mg (0.4% - 2 ml) of dexamethasone immediately after catarrhization of the peripheral vein. Results: The duration of the sensory blockade in the group using dexamethasone was 25% greater than in the first group. In the postoperative period, patients who were intraoperatively injected with dexamethasone required 33% less additional anesthesia. The duration of motor blockade in the group with dexamethasone was 26.5% higher than in the patients of the first group. Conclusion: intravenous dexamethasone injection with levobupivacaine peripheral regional anesthesia with arthroscopic knee joint surgery, increases the duration of the sensory block and the duration of postoperative analgesia. The use of dexamethasone led to a decrease in the need for additional anesthesia in the early postoperative period.

Multimodal perioperative analgesia with minimally invasive interventions on the mammary gland

The article presents the study of the use of parenteral forms of drugs Infulgan and Nalbuphine on the base of the Regional Mammological Center and the Department of Anesthesiology N 1 of Clinical Oncology Dispensary (Dnipro). We have generalized the experience of using these agents as part of multimodal perioperative analgesia in 15 patients who underwent a vacuum aspiration biopsy of the mammary gland using the “Mammotome HH” device. We assessed the intensity of pain in the postoperative period and the need for additional anesthesia. The results of the study showed that the pre-emptive multimodal analgesia with the use of par cetamol in the form of an infusion of Nalbuphine was effective and safe for perioperative analgesia in outpatient minimally invasive diagnostic and therapeutic operations on breast tissue. Such anesthesia made it possible to reduce the doses of anaesthetics used in the postoperative period, facilitating the return of patients to a full life after breast vacuum aspiration biopsy. Our experience may be recommended for relief of the pain syndrome after minimally invasive surgery interventions.

Topical lidocaine-prilocaine cream versus lidocaine infiltration for pain relief during repair of perineal tears after vaginal delivery: randomized clinical trial

Objective: The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery.Materials and methods: A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 2016 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women, who delivered at gestational age >37 weeks with first- or second-degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants’ satisfaction, the need for additional anesthesia, the duration of perineal repair, and the rate of adverse effects of both medications.Results: The study included 144 participants randomized to both groups. The mean pain score during perineal repair was significantly lower in the LP cream group (3.86 ± 1.59) than the lidocaine infiltration group (5.99 ± 1.47) [p = .001]. The duration of repair was significantly shorter in the LP group than the lidocaine infiltration group (6.37 ± 3.68 versus 8.17 ± 2.75 min, respectively, p = .001). The need for additional anesthesia was quite similar in both groups (p = .371). More women in the LP cream group were satisfied than the other group with statistical significant difference (76.4 versus 30.6%, p = .000). No difference between side effects in both groups (p = .171)Conclusions: Topical application of lidocaine-prilocaine cream is an effective analgesic during repair of perineal tears with no harmful side effects.

The regional anesthesia for surgical correction of the malformation of upper extremities in pediatric

The article presents an analysis of the publications devoted to the problems of anesthesia to surgical procedures at the malformations of the upper extremity in children. The article reviews the questions of epidemiology, classification of upper extremity malformation, safety of anesthesia and the role of regional blockades in the structure of intraoperative and postoperative analgesia to surgical procedures at the malformations of the upper extremity in children. Children are more likely than adults to experience stress in the operating room and early postoperative period. Children are almost impossible to prepare psychologically for the upcoming anesthesia, surgical intervention, a sense of pain after it. Surgical correction of malformations of the upper limbs in children is characterized by multistage and high traumatism, which requires the search for adequate methods of anesthesia, capable of ensuring not only the absence of pain, but also the negative impact on the nervous system of little patients. The key to the application of regional anesthesia in young children is the need for sedation or general anesthesia. The use of ultrasound navigation and electrostimulation of peripheral nerves significantly increases the level of safety and success of their realization. At present, the questions about the duration of postoperative analgesia with the use of peripheral nerve blocks and the need for additional anesthesia in the early postoperative period have been little studied. The influence of the applied anesthesia technique on the state of young children in the postoperative period are requires further investigation.

LAT gel for laceration repair in the emergency department: not only for children?

LAT (lidocaine, adrenaline, and tetracaine) gel is a topical anesthetic that can be applied on lacerations before suturing. It is considered easy to use and less painful than infiltrative anesthesia. Its use in laceration management has been studied the most in younger children.We aimed to describe the potential value of the use of LAT gel in older children and adults with simple lacerations. As part of a quality audit project, we reviewed all emergency department records of patients who had LAT gel applied for laceration repair in a 3-month period following the initial protocol implementation. Patients younger than 8 years of age, under the influence of alcohol or drugs, or those who received additional sedation were excluded. The need for additional anesthesia after needle probing was used as the primary endpoint. Of the 89 patients included, 21 (23.6%) needed additional anesthesia. The length of the wound was significantly longer in the group who needed additional anesthesia (difference between medians 1 cm; 95% confidence interval 0.5-2; P<0.005). Lacerations located on the extremities/trunk/fingers/toes needed significantly more additional anesthesia compared with lacerations located on the head (19.1% difference between proportions; 95% confidence interval 1-34.8%; P<0.05). LAT gel is a valuable alternative to infiltrative anesthesia for laceration repair. Its use should not be limited to children. The application of LAT gel seems to be specifically suitable for short lacerations (<4 cm), lacerations located on the head, and simple finger lacerations.

Analiza efikasnosti ropivakaina sa deksametazonom u oralnoj hirurgiji

Introduction: Prolonged local anesthesia is achieved by using long-acting local anesthetics, as ropivacaine and bupivacaine. In different surgical branches, longer absence of pain is noted after surgical intervention when ropivacaine is used with dexamethasone than when it is used alone. The aim of the study was to determine the effect on the duration of local anesthesia with a combination of 0.75% ropivacaine with the addition of dexamethasone during oral surgery interventions. Material and methods: A total of 12 patients participated in the study which was conducted at the Department of Oral Surgery at The Dentistry Clinic in Niš, in 2017.Surgical interventions were performed on both upper and lower jaw. Patients were divided into 2 groups: the study group of 6 patients who received 4 ml of 0.75% ropivacaine solution with addition of 1 ml/4mg dexamethasone and the control group of 6 patients who received 4 ml of 0, 75% solution of ropivacaine without the addition of dexamethasone. Statistical data was processed by the SPSS 15.0 software. The results: The onset time of first signs of anesthesia, confirmed by testing sensibility of soft tissues (lip and gingiva), was 1,5 min in the study group and 2.66 in the control group. The time necessary for the full effect of anesthesia to set in, i.e. total insensitivity of soft tissues, was 3.5 min in the study group and 4.66 min in the control group. The duration of local anesthesia was 625,5 min in the study group which is considered statistically significant (p < 0.01) and 290 min in the control group. Conclusion: Small doses of dexamethasone added to local anesthetics may reduce the need for additional anesthesia and analgesic therapy within the first 24 hours after major oral surgery interventions.

The effectiveness of articaine in mandibular facial infiltrations.

Four percent articaine local anesthetic has been successfully used to attain local anesthesia for dental procedures. Mandibular block anesthesia may consume longer time to attain and have a higher failure of local anesthesia compared to infiltration. Mandibular facial infiltration has been reported to successfully attain effective local anesthesia for dental procedures. This study involved only several tooth sites and found that 1.8 cc of 4% articaine facial infiltration in the mandible may be effective when the facial mandibular cortex is <2.0–3.0 mm. A waiting time of 5–10 minutes may be required for effective anesthesia. An additional 1.8 cc of dose may be required to attain anesthesia if an initial 1.8 cc of dose fails. The need for additional anesthetic may be predicted by a measurement of the facial cortex using cone beam computerized tomography. A study of mandibular sites is needed to delineate the anatomical dimensions, density of cortical bone, and apical neural location for ensuring successful local anesthetic infiltration.

Split-mouth and parallel-arm trials to compare pain with intraosseous anaesthesia delivered by the computerised Quicksleeper system and conventional infiltration anaesthesia in paediatric oral healthcare: protocol for a randomised controlled trial

IntroductionLocal anaesthesia is commonly used in paediatric oral healthcare. Infiltration anaesthesia is the most frequently used, but recent developments in anaesthesia techniques have introduced an alternative: intraosseous anaesthesia. We propose...

The Effect of Early Warm Plastic Bag Application on Postoperative Pain after Hemorrhoidectomy: A Prospective Randomized Controlled Trial

Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.

Femoral Nerve Block in Anterior Cruciate Ligament Surgery: A Prospective Randomized Trial

Early painless rehabilitation is essential after anterior cruciate ligament surgery (ACL). Postoperative main management with femoral nerve block (FNB) is a frequently used method, but it is still unknown how to administer this procedure in order to achieve faster and better analgesia. Purpose: To compare effectiveness of pain management after single shot FNB vs. continuous infusion FNB during the first 48 hours after ACL surgery. Materials and Methods: Forty-three patients older than 18 years, ASA I-II, underwent ACL reconstruction with autograft. Patients are prospectively randomized into two separate groups: Group 1 (G1) received single shot FNB with bupivacaine diluted in 10mL saline solution. Group 2 (G2) received continuous infusion FNB with bupivacaine and epinephrine (1:300.000) for 48 hours. Pain was assessed at rest and with controlled passive motion of the knee. Thigh hypoesthesia and need for additional analgesia were evaluated at 6, 12, 24 and 48 hours. Statistical analysis was performed with Fisher´s exact test (%) and Mann-Whitney´s test (VAS). Statistical significance was considered with P value <0.05. Results: FNB was successful in all patients, and thigh hypoesthesia was present in 100% of G2 vs. 17% in G1 at 24 hours, declining to 74% vs. 0% at 48 hours, respectively. Postoperative pain scores were low and did not differ between both groups. Additional analgesia was required in 33% of patients in G1 vs. 0% in G2. Neither side effects nor complications were related to both methods of FNB. Conclusion: FNB is a safe and successful method for controlling pain after ACL reconstruction, allowing early rehabilitation in both methods of local anesthesic administration. No differences in pain control were found after 48 hours, but continuous infusion FNB descreses need for additional anesthesia at 24 hours of surgery.

Comparison of local infiltration anesthesia and peripheral nerve block:a randomized prospective study in hand lacerations

To compare local infiltration anesthesia (LIA) and peripheral nerve block (PNB) in repairing hand lacerations. This prospective study was designed as a randomized, controlled, unblinded trial. Fifty four patients with hand lacerations were included in the study. While 23 of these patients had LIA, PNB was performed in the remaining 31 patients. Lidocaine hydrochloride 2% and 27 gauge needles were used. Onset time of the anesthesia, response to the injection and suturing procedures, need for additional anesthetic, and patient satisfaction were compared. No significant differences were noted between the groups in terms of response to injection pain and suture pain (Mann-Whitney U; P = 0.220/P = 0.316). There were also no significant differences between the groups when patient satisfaction (chi-square; P = 0.785) and need for additional local anesthetics (Fisher's exact; P = 0.628) were evaluated. The time to loss of pinprick sensation in the local infiltration group was 1.3 min, whereas in the nerve block group it was 2.2 min. The difference was statistically significant (Mann-Whitney U; P < 0.001). Despite the fact that performing PNB in emergency departments requires some experience, it still counts as a convenient method comparable to LIA.

Effects of intratesticular and incisional local anesthetic administration for castration of alpacas anesthetized with intramuscular ketamine-xylazine-butorphanol.

To determine the effects of intratesticular and incisional injection of local anesthetics on response to castration, surgical ease, and recovery in alpacas. Prospective, blinded, randomized, and clinical trial. Intact male alpacas (n = 38). Alpacas were anesthetized with intramuscular butorphanol, ketamine, and xylazine (BKX). Once recumbent, alpacas were instrumented with electrocardiogram, pulse oximeter, oscillometric blood pressure, and capnography. Heart rate (HR), respiratory rate (RR), and blood pressure (BP) were recorded every minute. Treatment drug (lidocaine, bupivacaine, or saline) was infiltrated along the incision and into both testicles followed by a prescrotal closed castration. Timing of major events, presence of movement during the procedure, need for additional anesthesia, and ease of surgery were recorded. Alpacas were administered postoperative oral meloxicam and assessment was made 24 hours after recovery. Median RR and mean BP (MBP) were lower in the lidocaine compared with the saline treated group. Median RR, HR, and MBP were significantly lower in the bupivacaine group compared with the saline group. Fewer alpacas displayed physical response to surgical stimulus with bupivacaine. No significant differences were found between groups for timing of events, need for additional anesthesia, ease of surgery, or postoperative assessment. Intratesticular local anesthetic blunts autonomic response and facilitates castration in alpacas anesthetized with BKX with minimal negative effects. Bupivacaine may have some benefit for local anesthesia during castration compared with lidocaine.

Stentless pediatric robotic pyeloplasty

Open dismembered pyeloplasty remains the standard of care for the correction of ureteropelvic junction obstruction in children. We describe our experience with a tubeless, stentless pediatric robotic pyeloplasty technique. Between October 2008 and September 2009, 12 consecutive children underwent robotic dismembered pyeloplasty. Ureteral stents or nephrostomy tubes were not used. Operative time, hospital stay, days of Jackson-Pratt drainage, and complications were analyzed. Postoperative renal ultrasonography was obtained at 4-6 weeks after surgery. The mean patient age was 9.1 years (3.5-16). The mean operative and console times were 178 (122-250) and 129 (96-193) minutes, respectively. The Jackson-Pratt drain was removed after a mean of 1.8 days (1-4). The mean hospital stay was 2.4 days (1-4.5). There were no complications. Mean follow up was 16 months (12-24 months). All patients had complete resolution of symptoms. Hydronephrosis either completely resolved or significantly decreased in all cases. In cases without complete resolution of hydronephrosis, 99m Tc-MAG-3 diuretic renography showed preservation of renal function without obstruction. Robot-assisted laparoscopic pyeloplasty can be safely performed without internal indwelling stent drainage. In children, this avoids the need for additional anesthesia and stent-related morbidity.

Use of a mixture of lignocaine and bupivacaine vs lignocaine alone for male circumcision under local anaesthesia in Rakai, Uganda

To assess self-reported pain control during and after surgery with a mixture of lignocaine and bupivacaine compared with lignocaine alone among male circumcision (MC) service recipients in Rakai, Uganda. The two formulations of local anaesthesia for MC were used alternatively at weekly intervals in 360 patients; 179 received lignocaine alone and 181 received the lignocaine and bupivacaine mixture (LBmix). The proportions of men reporting pain during or after surgery, and the need for additional anaesthesia during surgery were determined for the LBmix vs lignocaine using Poisson adjusted rate ratios (RRs). Characteristics including age, weight, surgeon (medical officer vs clinical officer), surgical method and duration of surgery were compared between the arms using two-sample t-tests and chi-square tests. Patient and provider characteristics were comparable between the two anaesthetic groups. A higher proportion of patients reported pain during surgery in the lignocaine group (adjusted RR 11.6, 95% confidence interval [CI] 3.5-37.9, P < 0.001), required additional anaesthesia (adjusted RR 4.8, 95% CI 1.4-17.1, P = 0.015), and were more likely to report pain during the immediate postoperative period (adjusted RR 3.4, 95% CI 2.3-5.0, P < 0.001). These differences were particularly marked among patients with MC times longer than the median (adjusted RR 13.4, 95% CI 3.1-57.0, P < 0.001). The LBmix significantly reduced pain associated with MC and the need for additional anaesthesia during MC.