Tetracaine Gel Research Articles

The Effect of Tetracaine Gel in Male Patients with Indwelling Catheterization on Agitation and Urethral Irritation During Recovery from General Anesthesia

The Effect of Tetracaine Gel in Male Patients with Indwelling Catheterization on Agitation and Urethral Irritation During Recovery from General Anesthesia

Cause analysis of gastric tube misplacement into the trachea using tetracaine gel as lubricant before gastrointestinal surgery: A case report and literature review

Cause analysis of gastric tube misplacement into the trachea using tetracaine gel as lubricant before gastrointestinal surgery: A case report and literature review

Dorsal penile nerve block alleviates pain in men undergoing rigid cystoscopy: A single-center, randomized, double-blind, and placebo-controlled trial.

ObjectiveTo assess the effectiveness and safety of dorsal penile nerve block (DPNB) compared with tetracaine gel in analgesia for men undergoing rigid cystoscopy.Patients and methodsThis study was conducted as a prospective, randomized, double‐blind, placebo‐controlled, and single‐center trial. Men undergoing diagnostic rigid cystoscopy were randomly allocated into one of three groups (n = 86 each): (1) tetracaine gel group (DPNB with saline), (2) DPNB group (DPNB with ropivacaine + plain lubricant), and (3) combination group (DPNB with ropivacaine + tetracaine gel). The primary outcome was visual analog scale (VAS) for pain at cystoscopic inspection of the external sphincter.ResultsVAS (median [interquartile]) at inspection of the external sphincter was significantly lower in both DPNB and combination groups than that in tetracaine gel group (4 [3–6] and 4 [3–5] vs 6 [5–7], P < .0001), with a 33% reduction of median VAS. Overall pain level during procedure was significantly alleviated in the DPNB and combination groups with more stabilized HR and MAP when compared with tetracaine gel group. No adverse events were observed during DPNB including penile hematoma, erection, local anesthetic toxicosis or incompletion of cystoscopy.ConclusionOur study suggests analgesia provided by DPNB with or without tetracaine gel instilled is superior to that provided by tetracaine gel alone in men undergoing diagnostic rigid cystoscopy.Clinical Trials RegistrationClinicalTrials.gov registration number: NCT02502487.

Efficacy and Safety of COX-2 Inhibitor Parecoxib for Rigid Cystoscopy-related Pain Management in Male Patients: A Prospective, Randomized and Controlled Study.

Using anesthetic gel may not sufficiently exclude pain perception during and after cystoscopy in male patients. To evaluate the analgesic efficacy and safety of intramuscular parecoxib (40 mg) for outpatient-based rigid cystoscopy, we performed a prospective, randomized and controlled study. Consecutive male patients requiring diagnostic cystoscopy in our hospital were divided into group A (1% tetracaine gel, n=50) and group B (parecoxib, n=51) at random. Patients received intramuscular injections of either 2 mL sterile saline in group A or 40 mg parecoxib in group B 30 min before the procedure. Tetracaine gel was injected into the urethra 3 min before the procedure in group A, with patients receiving plain lubricant gel in group B at the same time. Cystoscopy-associated pain levels were evaluated using the Visual Analog Score (VAS) during the procedure. Post-procedure urethral pain and complications were recorded and analyzed. The results showed that male patients experienced significantly less pain in group B than in group A (2.70±1.36 vs. 3.56±1.74, P=0.008). The percentage of patients with dysuria pain was not significantly different between the two groups. In addition, 24 h after cystoscopy, the patients with no previous experience of cystoscopy were more likely to declare urethral pain (59.2% vs. 33.3%, P=0.012, relative risk=1.78). No difference was observed in analgesic-related complications between the two groups. We conclude that intramuscular injection of 40 mg parecoxib may improve comfort for male patients undergoing rigid cystoscopy.

The use of Lidocaine, Adrenaline and Tetracaine (LAT) gel in the treatment of paediatric facial lacerations in a single Maxillofacial Unit

The use of Lidocaine, Adrenaline and Tetracaine (LAT) gel in the treatment of paediatric facial lacerations in a single Maxillofacial Unit

Abstract PR511

Background & Objectives: The use of intravitreal injection (IVI) has increased dramatically with the therapy for macular degeneration(1). Patients may experience pain during injection leading to sudden movements of the eye, wich can cause intraocular complications(2). The objective of this systematic review was to compare different local anesthetic techniques for IVI to determine the effectiveness of these methods to relieve pain of the patient undergoing intraocular injection. Materials & Methods: For this systematic review, we compared different techniques of local anesthesia with no sedation for intravitreal injection of antiangiogenic agents and steroids. Anesthetic and/or analgesic effect was evaluated by pain scale. Studies to be considered for inclusion were identified by searching the following electronic bibliographic databases: Cochrane, LILACS, PubMed, Scopus, and Web of Science. The methodology of the selected studies was evaluated using the Cochrane risk of bias tool. Results: After searching and comprehensive evaluation 13 randomized clinical trials were retained for the final selection. According to the Cochrane risk of bias tool (figure 1) only three studies presented a low risk of bias for random sequence generation. The reported anesthetic techniques included topical tetracaine, topical proparacaine, tetracaine gel, instilation of 5% lidocaine, 4% lidocaine pledget, 4% topical cocaine, peribulbar injection of lidocaine 2%, subconjunctival injection of lidocaine 2%, lidocaine gel in different concentrations 2,3.5,5,8 and 12%, topical levobupivacaine 0,75%. All techniques presented a low pain score reported by the patients during IVI. Rifkin showed that topical tetracaine has a better anesthetic effect than proparacaine or tetracaine gel(3). When considering subconjunctival injection (SCI) of lidocaine 2%, the interval between the placement of anestesia and IVI is importante. When waiting 5 minutes SCI of lidocaine 2% provides a better anesthetic effect when compared to other techniques(2).Conclusion: All techniques included in this review provides a good analgesia for IVI. The results should be evaluated carefully due to the risk of bias of the studies, specially regarding the random sequence generation.

Dorsal penile nerve block for rigid cystoscopy in men: study protocol for a randomized controlled trial.

BackgroundPain is common in men undergoing rigid cystoscopy. Even with the application of a lubricant containing 2 % lidocaine, about 76 % of men suffer from mild to severe pain when undergoing rigid cystoscopy. The most painful part of the procedure for men is when the cystoscope passes through the membranous urethra. Song et al. (Neurourol Urodyn 29:592–5, 2010) did autopsies on males and found that the dorsal nerve of the penis (DNP), the terminal branch of the pudendal nerve, innervates the membranous urethra in 53.3 % of specimens. In addition, the urethral mucosa has branches of innervated DNP. Dorsal penile nerve block (DPNB) is usually used for circumcision in children, and it has been shown to provide effective analgesia for penile surgeries. In this study, we hypothesized that DPNB could reduce the overall pain level in men during rigid cystoscopy.Methods/designThe trial is a prospective, randomized, double-blind, placebo-controlled, single-center trial to evaluate the effectiveness and safety of DPNB in analgesia for men undergoing rigid cystoscopy. Participants will be enrolled and randomly allocated into one of three groups according to the different analgesia regimens: 1) tetracaine gel group (DPNB with saline), 2) DPNB group (DPNB with ropivacaine plus plain lubricant), 3) combination group (DPNB with ropivacaine plus tetracaine gel). The primary outcome of this study is the visual analog scale (VAS, 0–10) for pain at cystoscopic inspection of the external sphincter. VAS scores evaluated at other time points serve as secondary outcomes. Vital signs are secondary outcomes that address the discomfort and pain during the procedure. Furthermore, the incidence of adverse events as secondary outcomes will also be recorded for evaluation of the safety of DPNB in rigid cystoscopy. Clinical assessments will be evaluated prior to DPNB, at administration of the lubricant gel, at cystoscopic inspection of the penile and bulbar urethra, external sphincter, prostate, and bladder, as well as at withdrawal of the cystoscope.DiscussionThis research will determine the effectiveness and safety of DPNB in men undergoing rigid cystoscopy. The results of this trial may have important implications for exploring the role of DPNB in analgesia for cystoscopy in men.Trial registrationClinicalTrials.gov identifier NCT02502487 (6 Jul 2015).

Paediatric vascular access

### Key points Obtaining reliable vascular access in small children is frequently made challenging by anatomical factors—in particular, small, mobile veins and an excess of subcutaneous fat which make visualization and palpation of veins difficult. Paediatric patients are often less co-operative, and the potential for psychological trauma, especially with repeated procedures in the conscious patient, further complicates matters. Short-term vascular access is frequently required in hospitalized children for the delivery of i.v. fluids, medication, and blood product administration. Longer-term vascular access devices are required for repeated medication delivery (e.g. enzyme replacement therapy in inherited metabolic diseases), chemotherapy, immunotherapy, total parenteral nutrition, and extracorporeal procedures such as plasmapheresis and haemodialysis. In addition, vascular access devices may be needed for repeated blood sampling and invasive haemodynamic monitoring. The choice of vascular access device depends upon the condition and preference of the patient or parent/guardian, the likely duration and frequency of treatment, and the properties of the infusate. Infusates with vesicant properties (drugs with the potential to cause blistering with tissue injury, e.g. calcium solutions and amphotericin B), hypertonic solutions, and those with pH 9 will necessitate central venous access. Vasopressors and inotropes are preferentially administered centrally as they require reliable access and extravasation may cause tissue necrosis. It is important to try to predict future needs for vascular access as poor prospective management …

G81(P) Safety of “single checker” patient group directives for selected medications during initial nurse assessment in the emergency department (ed)

Aims Innovative ways to optimise ED patient flow, without sacrificing quality of care, are at a premium.2 Within our own paediatric ED, it was observed that inefficiency occurred whenever a triage nurse had to leave the assessment room in order to find a colleague to check the dose of a Patient Group Directive (PGD), including those for simple, over-the-counter medications. Doubt has been cast on the efficacy of double checking in all but high risk medications.2 We aimed to evaluate the safety of a “single checker” PGD process at triage for paracetamol (pain and fever), ibuprofen (pain and fever), oral rehydration salts (ORS) and topical 4% tetracaine gel (Ametop) to improve patient flow. Methods Single-checker PGDs were devised for the medications and indications listed above, to be used exclusively within the triage/assessment area by nurses who had completed PGD competency training. The process change was approved by the Trust Drug and Therapeutics Committee, after assurance that robust safety nets were in place (including the production of weight/dose tables for paracetamol and ibuprofen which were displayed in the assessment room). At launch, a 3 month audit (August–October 2011) was conducted, in which all single checker PGDs were logged. Subsequently, the hospital incident reporting system was reviewed for any medication errors associated with PGDs from ED. Results During the first 3 months of the use of single-checker PGDs, no errors in dose were identified. To date, no medication errors associated with ED PGDs have been identified within the hospital incident reporting system. Benchmarking data regarding the prevalence of this practice within EDs in the PERUKI network will be identified. Conclusion There were no drug errors with single checking by protocol of simple emergency medications at triage, within one of the UK’s busiest paediatric EDs. Further research is required to quantify the time and resources saved on the patient journey. References Sinclair D. Emergency department overcrowding – implications for paediatric emergency medicine. Paediatrics Child Health 2007;12:491–494 David U. Double checking: does it work? Can J Hosp Pharm. 2003;53:167–169

Comparative Efficacy and Patient Preference of Topical Anaesthetics in Dermatological Laser Treatments and Skin Microneedling.

Background:Topical anaesthetics are effective for patients undergoing superficial dermatological and laser procedures. Our objective was to compare the efficacy and patient preference of three commonly used topical anaesthetics: (2.5% lidocaine/2.5% prilocaine cream (EMLA®), 4% tetracaine gel (Ametop™) and 4% liposomal lidocaine gel (LMX4®)) in patients undergoing laser procedures and skin microneedling.Settings and Design:This was a prospective, double-blind study of patients undergoing laser and skin microneedling procedures at a laser unit in a tertiary referral dermatology centre.Materials and Methods:All 29 patients had three topical anaesthetics applied under occlusion for 1 hour prior to the procedure, at different treatment sites within the same anatomical zone. A self-assessment numerical pain rating scale was given to each patient to rate the pain during the procedure and each patient was asked to specify their preferred choice of topical anaesthetic at the end of the procedure.Statistical Analysis:Parametric data (mean pain scores and frequency of topical anaesthetic agent of choice) were compared using the paired samples t-test. A P-value of ≤0.05 was considered as statistically significant.Results and Conclusions:Patients reported a mean (±SD; 95% confidence interval) pain score of 5 (±2.58; 3.66-6.46) with Ametop™, 4.38 (±2.53; 2.64-4.89) with EMLA® and 3.91 (±1.95; 2.65-4.76) with LMX4®. There was no statistically significant difference in pain scores between the different topical anaesthetics. The majority of patients preferred LMX4® as their choice of topical anaesthetic for dermatological laser and skin microneedling procedures.

Cross-over study of topical anaesthesia with tetracaine solution for transoral rigid laryngoscopy

Transoral rigid laryngoscopy with videostroboscopy is the most practical method to visualise the vocal folds. The optimal topical anaesthesia regimen for transoral rigid laryngoscopy has not yet been established. To compare patient comfort and compliance with various topical anaesthetics for transoral rigid laryngoscopy. Each of 10 patients received a random topical administration of either 2 per cent lidocaine gel, 1 per cent tetracaine gel or 1 per cent tetracaine solution, 10 minutes before undergoing rigid laryngoscopy with videostroboscopy. During follow-up laryngoscopies, the agent with the lowest mean visual analogue scale score for discomfort was then used to study the timing of topical anaesthetic application: the agent was given to the patient 5, 10 or 15 minutes before laryngoscopy (with the timing randomly selected). Compared with lidocaine gel or tetracaine gel, laryngoscopy with topical tetracaine solution was more comfortable. There was a statistically significant difference in discomfort score between the 5 and 10 minute application groups, but not between the 10 and 15 minute groups. Tetracaine solution, applied topically 10 minutes before transoral rigid laryngoscopy, significantly decreases patient discomfort.

Comparative efficacy of topical tetracaine solution versus lidocaine gel in cataract surgery

Comparative efficacy of topical tetracaine solution versus lidocaine gel in cataract surgery Roberto Bellucci1, Francesco Bellucci21Ophthalmic Unit, Department of Neurosciences, Hospital and University of Verona, Verona, Italy; 2Faculty of Psychology, University of Parma, Parma, ItalyBackground: Cataract surgery is mainly performed under topical anesthesia achieved either by tetracaine solution (0.5%&ndash;1.0%) or gel (0.5%), or by 2% lidocaine gel. This paper reviews the current knowledge about these two drugs, with special emphasis on a published prospective comparison between them.Methods: The main pharmacological aspects of topical anesthetic agents are summarized, explaining the difference between the ester (tetracaine) and the amide (lidocaine) compounds. Tetracaine is available as single-use eye drops, or as a multidose gel containing benzalkonium chloride, a preservative not contained in the multidose lidocaine gel. A literature search was performed, using &ldquo;tetracaine&rdquo;, &ldquo;tetracaine gel&rdquo;, &ldquo;lidocaine&rdquo;, &ldquo;lidocaine gel&rdquo;, &ldquo;lidocaine jelly&rdquo;, and &ldquo;cataract surgery&rdquo; as keywords, and compiling cross-references. A total of 25 studies were identified and included in this review. Of them, seven were uncontrolled studies describing different experiences with the drugs of interest, and 18 were controlled studies. Six studies directly compared tetracaine eye drops or gel with lidocaine gel before cataract surgery.Results: Both tetracaine solution and gel and lidocaine gel proved to be effective in providing analgesia before cataract surgery. Both drugs were comparable with needle injection anesthesia when intracameral lidocaine was added to topical treatment. Direct comparisons indicate better activity for tetracaine when used at the 1% concentration in single-dose units, or in the gel form at a 0.5% concentration. Patients showed a slight preference for the agent that caused the least discomfort when administered (lidocaine), while the surgical complication rate and the surgeon satisfaction were the same with either drug.Conclusion: Tetracaine solution and lidocaine gel were equally effective in providing topical anesthesia for cataract surgery in the published studies. Tetracaine was found to be better than lidocaine only if augmented by either increasing the concentration to 1% (solution) or by increasing the penetration by adding benzalkonium chloride (gel).Keywords: tetracaine, tetracaine gel, lidocaine, lidocaine gel, cataract surgery

Relief of palatal injection pain by liposome-encapsulated 2% lignocaine prepared by ultrasonic dental scaler

Injections into the palate are common in dental treatment and are unpleasant for the patient. A liposomal encapsulation technique was developed to improve the efficacy of 2% lignocaine dental injection so that it could be used as a topical anaesthetic. Liposome-encapsulated 2% lignocaine was prepared as needed by sonicating 2% lignocaine hydrochloride dental injection (with 1:100,000 adrenaline) with a lipid mixture using a dental ultrasonic scaler for 1min. The time to onset and time to take effect were calculated by a pinprick test in the palatal mucosa in 10 normal subjects. In another experiment, the preparation was tested in a further 22 subjects for its pain-relieving effect during a standard palatal injection, and compared with 18% benzocaine/2% tetracaine gel. The results showed that the mean (SD) time to onset and time to take effect of the liposome-encapsulated 2% lignocaine were 39.0 (21.4) and 157.5 (2.3)s, respectively, and the mean (SD) pain score measured on a visual analogue scale (VAS) during injection was 4.1 (2.3)cm. After the application of the gel the corresponding measurement was 4.8 (2.8)cm (p=0.045). The encapsulation of 2% lignocaine dental injection in liposomes by a dental ultrasonic scaler was effective in improving the efficacy of the anaesthetic for topical application.

Eyelid anaesthesia using tetracaine gel in the treatment of paediatric superglue tarsorrhaphy

Eyelid anaesthesia using tetracaine gel in the treatment of paediatric superglue tarsorrhaphy

A Comparison of Topical Application of 1% Tetracaine Gel Before and After the Procedure in Removal of Cutaneous Pigmentation with Q-Switched Neodymium-Doped Yttrium Aluminium Garnet Laser (1064/532 nm)

To evaluate the anesthetic efficacy of topical application of 1% tetracaine gel before and after a Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser procedure. A variety of topical anesthetics are available for painful cutaneous procedures, including laser treatments, which are applied before treatment. Seventy-nine adults were assigned to Q-switched laser treatment at a wavelength of 532 nm (freckle, chloasma, and seborrheic keratosis) and 1064 nm (nevus fusco-caeruleus zygomaticus, nevus of Ota). Based on application time of tetracaine, there were three groups receiving each wavelength: 5 minutes before treatment, and 10 minutes before treatment, and after the procedure. Patients' lesions were divided into tetracaine-treated area and margin, which were treated with the same laser dose and wavelength. The energy density was 2 J/cm(2) for 532 nm and 5 J/cm(2) for 1064 nm. The pain relief score (PRS) for all groups, the latency time, and the time to maximal anesthesia of tetracaine for the after-procedure group were recorded. The PRSs were rated on visual analog scales. The mean PRSs +/- standard deviation of the group receiving the tetracaine 10 minutes before the procedure (42.37 +/- 9.18) were higher than the scores of those receiving it 5 minutes before (26.32 +/- 5.49)with the 532-nm laser. Using the gel after the procedure and using the 1064-nm and 532-nm lasers, the latency time was 20 to 80 seconds, the duration to maximal anesthesia was 2 to 6 minutes, and the maximum PRSs were 70 to 100, higher than the scores of those receiving tetracaine 10 minutes before the procedure (P < 0.001). The gel was well tolerated. Topical application of 1% tetracaine gel provides better anesthesia used 10 minutes before Q-switched Nd:YAG laser treatment than 5 minutes before but provides superior anesthesia and shorter latency time when applied after the procedure.

Helping to alleviate pain for children having venepuncture

This article reviews the literature on venepuncture and children. The evidence on the use of topical agents namely tetracaine (amethocaine) gel and lidocaine/prilocaine cream is discussed, along with the use and benefits of distraction techniques and parental presence to make this an easier procedure for the child, their families and the nurse.

Local anaesthesia for manipulation of nasal fractures: systematic review

To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia. Systematic review and meta-analysis. Medline, Embase, Cochrane Library, National Research Register and metaRegister of Controlled Trials. We included randomised, controlled trials comparing general anaesthesia with local anaesthesia or comparing different local anaesthetic techniques. Non-randomised studies were also systematically reviewed and appraised. No language restrictions were applied. Five randomised, controlled trials were included, three comparing general anaesthesia versus local anaesthesia and two comparing different local anaesthetic methods. No significant differences were found between local anaesthesia and general anaesthesia as regards pain, cosmesis or nasal patency. The least painful local anaesthetic method was topical tetracaine gel applied to the nasal dorsum together with topical intranasal cocaine solution. Minimal adverse events were reported with local anaesthesia. Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel.

Synergistically enhanced transdermal permeation and topical analgesia of tetracaine gel containing menthol and ethanol in experimental and clinical studies

The aim of this study is to observe the synergistically enhanced percutaneous penetration and skin analgesia of tetracaine gel containing menthol and ethanol through experimental and clinical studies. Four anesthetic gels containing 4% tetracaine in carbomer vehicle named T-gel (containing no menthol or ethanol), 5%M/T-gel (containing 5% menthol), 70%E/T-gel (containing 70% ethanol, an optimal concentration for antiseptic), and 5%M+70%E/T-gel (containing both 5% menthol and 70% ethanol), respectively, were fabricated. The in vitro mouse skin permeation was investigated using a Franz diffusion cell. The mouse skin morphology was examined by a scanning electron microscope. The in vivo skin analgesic effect in mice was evaluated using the von Frey tests. To determine the efficacy of tetracaine gels for managing the pain in human volunteers, a paralleled, double-blinded, placebo-controlled, randomized controlled trial design combined with verbal pain scores (VPS) was performed. The combination of menthol and ethanol (5%M+70%E/T-gel) conferred significantly higher tetracaine diffusion across full-thickness mouse skin than 5%M/T-gel, 70%E/T-gel, and T-gel. The ultra structure changes of mouse skin stratum corneum treated with 5%M+70%E/T-gel were more marked compared with those of any other tetracaine gel. von Frey tests in mice showed a synergistically enhanced effect of menthol and ethanol on the analgesia of tetracaine gel. The mean VPS were significantly lower for volunteers treated with 5%M+70%E/T-gel than those receiving other gels or the EMLA cream. 5%M+70%E/T-gel possessed the shortest anesthesia onset time, the longest anesthesia duration and the strongest anesthesia efficacy. Seventy percent ethanol in 5%M+70%E/T-gel not only improved the analgesic efficacy of the tetracaine gel through synergistically enhanced percutaneous permeation with menthol but also served as an antiseptic agent keeping drug application site from infection. 5%M+70%E/T-gel is a potential topical anesthesia preparation for clinical use.

Contact Dermatitis and Bradycardia in a Preterm Infant Given Tetracaine 4% Gel

The use of analgesics for procedural pain management in the newborn infant has been steadily increasing during the past decade. With this trend of increased analgesic utilization, there is the potential for infants to suffer from drug-induced side effects. There also is the potential to wrongfully blame drugs for all adverse events that occur during analgesic use. Two adverse events that occurred in a neonate exposed to tetracaine gel and the probability that the adverse events were caused by the drug are presented. During administration of the topical local anesthetic tetracaine for analgesia during percutaneous central venous catheter placement, a preterm infant experienced bradycardia. Several hours later, a local cutaneous reaction that progressed to skin desquamation occurred at the site. The authors assessed the probability that tetracaine caused 2 adverse events using a validated adverse drug reaction probability scale by Naranjo et al. According to the algorithm developed by Naranjo et al, it was determined that bradycardia was unlikely caused by the drug; however, the dermal reaction was probably the result of the drug.The authors determined that tetracaine caused a serious local skin reaction, but not bradycardia, in a preterm infant. This is the first report of a serious skin reaction in a neonate treated with tetracaine. Based on these findings, tetracaine gel can continue to be used to treat pain in neonates with careful evaluation of the skin.

Tetracaine Gel Relieves Pain in Head and Neck Cancer

Tetracaine Gel Relieves Pain in Head and Neck Cancer