Local Anesthesia

Surgical treatment for Parkinson’s disease has evolved from permanent removal of parts of the brain to minimally invasive surgical techniques such as deep brain stimulation. Ample evidence supports the efficacy and safety of DBS giving rise to its use in other clinical settings such as benign tremors, dystonia, epilepsy and other neuropsychiatric disorders.

Background: Coagulation changes can complicate liver resection, particularly in patients with cirrhosis.

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Distraction is one of the most commonly used techniques for control of pain associated with injection procedures. This study's purpose was to evaluate the effect of a distraction technique using audiovisual (A/V) glasses on pain perception during administration of local anesthesia for children. Forty-eight healthy, cooperative 5- to 7-year-olds were selected on the basis of existence of bilateral carious primary mandibular molars, which necessitated an inferior alveolar nerve block anesthesia before treatment. Treatment was done on 2 visits 1 week apart. Children had been randomly assigned to receive the A/V glasses at one visit and no distraction during the other visit. Two different pain assessment scales were used: the pain faces scale (PFS) and the face, legs, activity, cry, and consolability scale (FLACC) scale. Kappa statistics were calculated for the reliability of the observer when using the FLACC scale. A comparison between the 2 study techniques was done using the Wilc...

Introduction: Computer modeling studies have shown that depolarization of the posterior and anterior root fibers can be achieved by surface tripolar electrical stimulation. This study investigated the soleus and gastrocnemius H-reflex recovery curve after applying tripolar electrical stimulation on the anesthetized skin of vertebral column. We emphasized on the early and secondary facilitation phases of the H-reflex recovery curve.

Although the use of injectable anesthesia prior to subgingival scaling and root planing (SRP) reduces pain, many patients report fear and prolonged numbness of adjacent tissues. The aim of the present study was to compare the effects of a eutectic mixture containing 25 mg/g of lidocaine and 25 mg/g of prilocaine, injectable 2% lidocaine, topical 2% benzocaine and a placebo substance on reducing pain during SRP. In this randomized, split-mouth, masked clinical trial, thirty-two patients presenting more than two teeth with probing depth and clinical attachment level ≥5 mm in at least 4 sextants were randomly allocated to four groups: EMLA(r); injectable 2% lidocaine; topical 2% benzocaine and placebo. Pain and discomfort were measured using a visual analogue scale (VAS) and verbal scale (VS). Repeated-measures analysis of variance and Poisson regression were used for analysis. Patient satisfaction with the anesthesia was determined at the end of each treatment session. VAS and VS scor...

The aim was to assess the anatomo-functional changes in the carpal tunnel lumen during standard and ergonomic methodology of holding the carpulo-injector in dentistry. Materials and methods. 100 dentists aged 30 to 45 years (average 38±6 years) without carpal tunnel pathology were examined. As part of the experiment, conduction (mandibular) anesthesia was carried out on a biological material (head) under conditions close to natural, using a disposable carpool syringe-injector. Comparative analysis of carpal tunnel lumen was carried out according to the ultrasound examination data. Results. Under the the standard technique of holding the syringe-injector, a significant change in all parameters of the carpal tunnel lumen were noted: while its width was considerably reduced, its maximum height was increased in parallel due to wrist flexor tendon strain, which may contribute to carpal tunnel syndrome. Under the ergonomic technique of holding the syringe-injector, the anatomo-functional parameters of the carpal tunnel lumen did not significantly change, which indicates less tension load on the median nerve from the tendons of flexor muscles. Conclusion. The results of the study showed that ergonomic methods of carpula syringe holding during perduction anaesthesia can reduce the influence of tension load on the median nerve from the flexor muscles’ tendons, which will help prevent the carpal tunnel syndrome in dentists.

Aim: In this study we aimed to administer sedoanalgesia with propofol and ketamine combination in patients undergoing planned minor urologic interventions with limited anesthesia. By combining these two medications, lower doses may be used, and we aimed to provide sufficient sedation, analgesia and amnesia without disrupting hemodynamic and respiratory stability and to increase patient and surgeon satisfaction.
Material-Method: The study included 53 patients with planned minor urologic interventions aged from 19 to 85 years and physical situation ASA I-III. After six hours starvation, patients were taken to the surgery. Patients were monitored for electrocardiography (ECG), oxygen saturation (SPO2) and non-invasive blood pressure. For use if necessary a nasal O2  cannula was inserted. A vein in the back of the left hand was opened and 5 ml/min isotonic sodium chloride infusion was begun. Patient heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and oxygen saturation
(SpO2) values were measured and a 5 point sedation scale (Table 1) was used to measure sedation scores. Basal values were recorded (0 min). Later patients were randomly divided into two groups with Group I administered intraurethral lidocaine gel for local anesthesia by the surgeon, while Group II were administered intravenous 0.015 mg/kg midazolam, 0.5 mg/kg 1% ketamine and 0.5 mg/kg 1% propofol by the authors for sedoanalgesia. At five minute intervals the HR, SAP, DAP, MAP, SpO2  values and sedation scores were measured and recorded.
Results: Statistical evaluation found a statistically significant increase in SAP, DAP and MAP values measured at the 5th minute in Group I patients compared to preoperative values. In Group I patients, when the heart rate measured in the 1st and 5th minutes are compared with preoperative values there was a statistically significant increase identified. In Group II patients, there was a statistically significant fall in SpO2  values in the 1st and 5th minutes compared with preoperative values. When patient and surgeon satisfaction are compared with Group I, Group II was found to be statistically significantly higher. Though the blood pressure and heart rate increases in Group I patients were statistically significant, they were not at levels that required clinical intervention and/or treatment. Similarly the SpO2  decrease observed in Group II patients did not fall below 90% in any patient in spite of being statistically significant and rose again without clinical intervention and/or treatment.
Conclusion: In this study we showed that sedoanalgesia administration with propofol and ketamine may be an alternative method for patients undergoing minor urology interventions that does not disrupt hemodynamic and respiratory stability, does not delay patient discharge, has low side effect incidence and has high patient and surgeon  satisfaction.

Les blocs des nerfs ulnaire, médian et radial sont des techniques de choix dans l’abord de la main traumatisée en urgence: fracture, luxation, plaie, douleur par exemple. L’anatomie fonctionnelle doit être connue et comprise. La réalisation de ces blocs permet dans la majorité des cas le traitement en urgence d’une main traumatisée, sans avoir recours nécessairement à la neurostimulation ou encore à l’échographie. Le principe est de déposer à proximité du nerf une quantité de xylocaïne suffisante permettant l’anesthésie de celui-ci par diffusion et en sécurité. En France et depuis 2002, la Société Française d’Anesthésie et de Réanimation (SFAR), le Service d’Aide Médicale Urgente (SAMU) ainsi que la Société Francophone de Médecine d’Urgence (SFMU) autorisent le médecin urgentiste à pratiquer les anesthésies locorégionales de la main : Pratique des anesthésies locales et locorégionales par des médecins non spécialisées en anesthésie-réanimation. Les recommandations actualisées de 201...

The aim was to assess the anatomo-functional changes in the carpal tunnel lumen during standard and ergonomic methodology of holding the carpulo-injector in dentistry. Materials and methods. 100 dentists aged 30 to 45 years (average 38±6 years) without carpal tunnel pathology were examined. As part of the experiment, conduction (mandibular) anesthesia was carried out on a biological material (head) under conditions close to natural, using a disposable carpool syringe-injector. Comparative analysis of carpal tunnel lumen was carried out according to the ultrasound examination data. Results. Under the the standard technique of holding the syringe-injector, a significant change in all parameters of the carpal tunnel lumen were noted: while its width was considerably reduced, its maximum height was increased in parallel due to wrist flexor tendon strain, which may contribute to carpal tunnel syndrome. Under the ergonomic technique of holding the syringe-injector, the anatomo-functional parameters of the carpal tunnel lumen did not significantly change, which indicates less tension load on the median nerve from the tendons of flexor muscles. Conclusion. The results of the study showed that ergonomic methods of carpula syringe holding during perduction anaesthesia can reduce the influence of tension load on the median nerve from the flexor muscles’ tendons, which will help prevent the carpal tunnel syndrome in dentists.

Purpose: To assess the pain experienced by patients at the time of suture adjustment using topical proparacaine hydrochloride 0.5% anesthesia, in adjustable suture strabismus surgery. Material and Methods: A prospective study was carried out to assess the pain experience of patients undergoing suture adjustment under topical proparacaine hydrochloride 0.5% anesthesia, during routine adjustable squint surgery. All surgeries were performed under general anesthesia with suture adjustment done 1 hour or more after surgery when the effects of general anesthesia had worn off. Horizontal and vertical muscle recessions and resections were included along with inferior oblique surgeries, and transposition procedures. The patients were given the 'Wong-Baker FACES ® Pain rating Scale'; along with a 'Numeric Pain Rating Scale' from 0 to 10 (0 signifying 'no pain' and 10 signifying 'worst possible pain') on a proforma. The response of the patients was noted. Results: Thirty three patients who underwent adjustable strabismus surgery were included in this study. The mean age was 19.1 ± 11.1 years. The average number of muscles operated upon for each patient were 2.87 ± 1.08. The patients' response to the 'Wong-Baker FACES ® Pain rating Scale' ranged from 0 to 8, with a mean of 2.03 ± 1.81 SD. On the 'Numeric Pain Rating Scale' a similar response was obtained with a mean of 2.0 ± 1.82 SD. Augmentation of anesthesia was not needed in any patient. Conclusion: Adjustment of sutures under topical proparacaine hydrochloride 0.5% anesthesia after strabismus surgery is a practical, comfortable and safe procedure.