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AbstractUltrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols.

Peripheral venous cannulation is one of the most common procedures in medicine. It is associated with noticeable pain and apprehension, although in most cases it is performed without any anesthesia due to lack of a painless, cost-effective option, which would provide rapid local anesthesia with subsequent significant reduction in the experienced pain. We conducted an open-label placebo-controlled clinical trial to evaluate the efficacy and safety of a 2% lidocaine injection using the commercially available microneedle device MinronJet600 (NanoPass Technologies Ltd, Israel) to achieve rapid local anesthesia prior to peripheral venous cannulation. One hundred and two subjects were randomly allocated into two groups. In the first group, 100μL of lidocaine hydrochloride (2%) was injected intradermally to subjects using the MicronJet600 device in the left arm (MJ-Lido) and 100μL of saline was injected intradermally using the device in the right arm (MJ-Saline). In the second group, 100μL of lidocaine hydrochloride (2%) was injected using the MicronJet600 device into the left arm (MJ-Lido), with no injection into the right arm of subjects (No pretreatment). In both groups the intradermal injection was performed at the cannulation site prior to insertion of a 18G cannula into a median cubital vein in both arms. As a primary variable, a score of cannulation-induced pain was indicated by subjects using a 100-point visual analog scale immediately after cannulation. As a secondary variable, subjects in Group 2 also indicated their preference to receive the anaesthetic injection with MicronJet600 in the future by using the 5-point Likert scale. Also, as a secondary variable, the duration of skin numbness after lidocaine injection was indicated by performing a superficial pin-prick with a 27G needle at 15, 30 and 45 minutes, at distances of 1, 2 and 3 centimeters from the injection site. A significant pain reduction (11.0-fold) was achieved due to the lidocaine injection compared to the cannulation without any pretreatment (p< 0.005). After the lidocaine injection the anesthesia was effective up to 2 centimeters from the injection site and remained for up to 30 minutes. Eighty percent of subjects from the second group preferred cannulation after the lidocaine injection over cannulation without any pretreatment. No significant side effects were identified. Intradermal injection of anaesthetic with Micronjet600 was found to be a safe and effective option for providing rapid local anesthesia for peripheral intravenous cannulation. The clinical trial was registered, before the patient enrollment began, in the Research Registry publicly accessible database (registration identifier: researchregistry4662). Also, the trial was registered in ClinicalTrials.gov (registration identifier: NCT05108714) after its completion.

Aim: Pain is highly subjective and it is neurologically proven that stimulation of larger diameter fibers - e.g., using appropriate coldness, warmth, rubbing, pressure or vibration - can close the neural \"gate\" so that the central perception of itch and pain is reduced. This fact is based upon \"gate control\" theory of Melzack and Wall. The present study was carried out to investigate the effects of vibration stimuli on pain experienced during local anesthetic injections. Materials and Methods: Thirty patients aged 6-12 years old of both the genders with Frankel′s behavior rating scale as positive and definitely positive requiring bilateral local anesthesia injections for dental treatment were included in the split-mouth cross over design. Universal pain assessment tool was used to assess the pain with and without vibration during the administration of local anesthesia and the results obtained were tabulated and statistically analyzed. Results: Local anesthetic administration with vibration resulted in significantly less pain (P = 0.001) compared to the injections without the use of vibe. Conclusion: The results suggest that vibration can be used as an effective method to decrease pain during dental local anesthetic administration.

No consensus has yet been reached regarding the best anesthetic technique for inguinal hernia repair. This study aimed to compare postoperative clinical outcomes and inflammatory markers among patients who were anesthetized using local, spinal, or general anesthesia for inguinal hernia repair. This randomized controlled trial included patients scheduled to undergo elective unilateral inguinal hernioplasty at Siriraj Hospital during November 2014 to September 2015 study period. Patients were randomly assigned to the local (LA), spinal (SA), or general (GA) anesthesia groups. Primary outcomes were postoperative pain at rest and on mobilization at 8 and 24 hours after surgery. Fifty-four patients were included, with 18 patients randomly assigned to each group. Patient demographic and clinical characteristics were similar among groups. There were no significant differences among groups for postoperative pain at rest or on mobilization at 8 and 24 hours after surgery. No significant differences were observed for interleukin-1β, interleukin-6, and interleukin-10 at any time points in any groups. Patients with local anesthesia was associated with less time spent in anesthesia (p = 0.010) and surgery (p = 0.009), lower intraoperative cost (p = 0.003) and total cost in hospital (p = 0.036); however, patient satisfaction in the local anesthesia group (94/100) was statistically significantly lower than the spinal and general anesthesia groups (100/100) (p = 0.010). No statistically significant difference was observed among groups for postoperative pain scores, duration of hospital stays, complications, or change in inflammatory markers. However, time spent in anesthesia and surgery, the intraoperative cost and total cost for hernia repair, and patient satisfaction were significantly lower in the local anesthesia group than in the other two groups.

This randomized, prospective, blinded study compared pain in children following dental treatment under general anesthesia (GA) using 1 of 2 established analgesia methods. Patients age 4 to 7 years were randomly assigned to a control group (intravenous [IV] analgesics) or experimental group (IV analgesics and intrapapillary local anesthetic infiltrations) between July 2017 and February 2018. During recovery from surgery, Faces, Legs, Activity, Cry, and Consolability (FLACC) scores were recorded upon regaining consciousness and reassessed every 15 minutes until discharge. Overall pain occurrence (FLACC ≥1) and moderate/severe pain occurrence (FLACC ≥4) were analyzed using mixed effects logistic regression (N = 88). The experimental group had a 17% lower overall pain occurrence than the control group (16 vs 33%; p = .02). Moderate/severe pain occurrence between the groups was not significant (9 vs 22%; p = .23). The dental treatment subjects received (number of completed stainless steel crowns, extractions, and/or pulpotomies) did not significantly affect pain occurrence. Local anesthesia intrapapillary infiltrations around stainless steel crowns decrease overall pain occurrence but not moderate/severe pain occurrence following dental treatment under GA in pediatric patients.

In the emergency department patients experience high levels of anxiety during suturing because they are conscious, feel pain, are suffering owing to trauma, and believe they will experience pain during the suturing. This study aimed to evaluate the effect of virtual reality glasses on patients’ anxiety during the suturing under local anesthesia in the emergency department. This prospective, parallel 2-arm, randomized controlled clinical study involved 138 patients admitted to the emergency department of a public hospital in Mersin, Turkey. The virtual reality glasses group (n = 69) watched videos through virtual reality glasses during the suturing, and the control group (n = 69) received routine practice. Patients’ anxiety level was assessed using the State Anxiety Inventory and measured via physiological responses to anxiety, such as changes in systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation, before and after suturing. Watching videos through virtual reality glasses resulted in significantly lower State Anxiety Inventory scores and different systolic blood pressure, diastolic blood pressure, respiratory rate, and peripheral oxygen saturation, but not heart rate, in the virtual reality glasses group than the control group after suturing (P < 0.05). The study results suggest that virtual reality glasses attenuate psychological and physiological responses to anxiety in patients during emergency suturing under local anesthesia, positively affecting all examined physiological parameters except heart rate. Therefore, nurses can use virtual reality glasses to reduce anxiety in patients undergoing suturing in the emergency department.

Background Buzzy ® - a vibratory unit with ice wings -was introduced to reduce pain induced by needle prick. Objective of the study was to evaluate the effectiveness of “Buzzy ® ” in reducing pain perception during administration of maxillary infiltration local anaesthesia compared to the traditional topical anaesthetic gel in pediatric patients. In addition, it aimed to evaluate its effectiveness in intrapapillary anaesthesia in comparison to the conventional palatal injection following buccal infiltration anaesthesia. Methods Randomized controlled clinical trial with parallel arms. Forty-eight cooperative children aged 6–8 years indicated for maxillary first or second primary molar extractions were selected. They were randomly allocated into 2 main groups (I and II) then into 2 subgroups each (A and B). All groups received buccal infiltration anaesthesia. Group I received local anaesthesia following the use of Buzzy ® extra orally for 2 min. Group II received local anaesthesia following topical anaesthetic gel (benzocaine 20%) intraorally for 1 min. Subgroups A received routine palatal injection whereas subgroups B received intrapapillary anaesthesia. Each patient was videotaped during local anaesthesia injection to objectively assess the reaction using sound, eye, motor scale (SEM). After local anaesthesia administration, pain was subjectively assessed using the visual analogue scale (VAS). Normality was checked in age and VAS using Shaprio Wilk test. The Independent T test was used to compare age between groups. Differences in SEM and VAS between buzzy and infiltration groups were analyzed using the Mann Whitney U test while Wilcoxon sign Rank test was used to analyze the difference in SEM and VAS between intrapapillary and palatal injection within each group. All tests were two tailed and the significance level was set at p  value ≤ 0.05. Results No statistical significance was observed in pain perception between Buzzy and topical gel regarding buccal local anesthesia. Conversely, objective and subjective statistical significance in pain perception between (Group I) and (Group II) regarding both palatal and intrapapillary anesthesia was recorded. Conclusion Applying external cold and vibratory stimulant can reduce pain perception during maxillary buccal, intrapapillary and palatal local infiltration anesthesia. Clinical trial registration The clinical registration number in ClinicalTrials.gov holds the identifier: NCT05857033 retrospectively registered on 12/5/2023.

Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults. This is a retrospective review of 97,437 patients in the Veterans Affairs Surgical Quality Improvement Program who had open inguinal hernia surgery under local or general anesthesia. Outcomes included 30-day postoperative complications, operative time, and recovery time. Our cohort included 22,333 (23%) Veterans who received local and 75,104 (77%) who received general anesthesia. Mean age was 62 years. Local anesthesia was associated with a 37% decrease in the odds of postoperative complications (95% CI 0.54–0.73), a 13% decrease in operative time (95% CI 17.5–7.5), and a 27% shorter recovery room stay (95% CI 27.5–25.5), regardless of age. Using local rather than general anesthesia is associated with a profound decrease in complications (equivalent to “de-aging” patients by 30 years) and could significantly reduce costs for this common procedure. •Local anesthesia is associated with fewer complications for inguinal hernia repair.•Local anesthesia reduces operative and recovery time for inguinal hernia repair.•Using local instead of general anesthesia may reduce cost for hernia repair. We found that using local rather than general anesthesia for inguinal hernia surgery was associated with significantly fewer complications and less time in the operating room and post-anesthesia care units, regardless of patient age. The importance of this finding is the potential reduction in postoperative morbidity, mortality, and costs for the most common general surgery procedure performed in the US.

Background It is debatable whether opioid-free anaesthesia (OFA) is better suited than multimodal analgesia (MMA) to achieve the goals of enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic sleeve gastrectomy. Methods In all patients, anaesthesia was conducted with an i.v. induction with propofol (2 mg. kg-1), myorelaxation with cisatracurium (0.15 mg.kg-1), in addition to an ultrasound-guided bilateral oblique subcostal transverse abdominis plane block. In addition, patients in the OFA group ( n  = 51) received i.v. dexmedetomidine 0.1 μg.kg-1 and ketamine (0.5 mg. kg-1) at induction, then dexmedetomidine 0.5 μg. kg-1.h-1, ketamine 0.5 mg.kg-1.h-1, and lidocaine 1 mg. kg-1.h-1 for maintenance, while patients in the MMA group ( n  = 52) had only i.v. fentanyl (1 μg. kg-1) at induction. The primary outcome was the quality of recovery assessed by QoR-40, at the 6th and the 24th postoperative hour. Secondary outcomes were postoperative opioid consumption, time to ambulate, time to tolerate oral fluid, and time to readiness for discharge. Results At the 6th hour, the QoR-40 was higher in the OFA than in the MMA group (respective median [IQR] values: 180 [173–195] vs. 185 [173–191], p  < 0.0001), but no longer difference was found at the 24th hour (median values = 191 in both groups). OFA also significantly reduced postoperative pain and morphine consumption (20 mg [1–21] vs. 10 mg [1–11], p  = 0.005), as well as time to oral fluid tolerance (238 [151–346] vs. 175 min [98–275], p  = 0.022), and readiness for discharge (505 [439–626] vs. 444 min [356–529], p  = 0.001), but did not influence time to ambulate. Conclusion While regional anaesthesia achieved most of the intraoperative analgesia, avoiding intraoperative opioids with the help of this OFA protocol was able to improve several sensible parameters of postoperative functional recovery, thus improving our knowledge on the OFA effects. Clinical trial number Registration number NCT04285255.

Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998–2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38–0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13–21% with local. Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population. •Local anesthesia may mitigate the effect of frailty for inguinal hernia repair.•Surgeons should consider local rather than general anesthesia for frail Veterans.•Local anesthesia also is associated with reduced operative/recovery time.