Analgesia and anaesthesia

2012 ◽  
pp. 271-318
Author(s):  
Jonathan P. Wyatt ◽  
Robin N. Illingworth ◽  
Colin A. Graham ◽  
Kerstin Hogg ◽  
Michael J. Clancy ◽  
...  
Keyword(s):  
Pain Relief ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Topical Anaesthesia

Pain relief 272 Analgesics: aspirin and paracetamol 274 Analgesics: NSAIDs 275 Analgesics: opioids 276 Analgesics: Entonox® and ketamine 278 Analgesia for trauma 279 Analgesia in specific situations 280 Local anaesthesia 282 Local anaesthetic toxicity 284 General principles of local anaesthesia 286 Topical anaesthesia 288...

Transcricothyroid injection of local anaesthesia: a serious complication

2021 ◽  
Vol 14 (8) ◽  
pp. e244493
Author(s):  
Anna Li ◽  
Jason D'Costa
Keyword(s):  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Ultrasound Guidance ◽  
Rare Complication ◽  
Anatomical Landmarks ◽  
Topical Anaesthesia ◽  
Airway Compromise ◽  
Puncture Site ◽  
Clinician Satisfaction ◽  
The Right

Transcricothyroid membrane (CTM) injection of local anaesthesia is widely used during bronchoscopic procedures. It is an effective way of delivering topical anaesthesia, and has been shown to reduce patient discomfort, improve clinician satisfaction and reduce overall sedation requirements. Risks from this procedure are uncommon and usually minor. Localisation of the CTM is usually performed clinically by palpation of anatomical landmarks and can vary depending on clinician skillset and experience. Clinical identification may be less accurate compared with ultrasound guidance in identifying puncture site, however, ultrasound is not always readily available and seldom used for this purpose. This case describes a rare complication following attempted local anaesthetic infiltration into the cricothyroid space, after clinical identification of puncture site. An obstructive fluid-filled mass formed around the site of injection on the right vocal cord; resulting in airway compromise, abandonment of procedure and subsequent intubation.

scholarly journals Adolescents’ pain and distress during peripheral intravenous cannulation in a paediatric emergency setting

2021 ◽  
Author(s):  
Giorgio Cozzi ◽  
Marta Cognigni ◽  
Riccardo Busatto ◽  
Veronica Grigoletto ◽  
Manuela Giangreco ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Relief ◽  
Local Anaesthesia ◽  
Cross Sectional Study ◽  
Emergency Setting ◽  
Older Children ◽  
Cross Sectional ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Significant Difference

AbstractThe objective of the study is to investigate pain and distress experienced by a group of adolescents and children during peripheral intravenous cannulation in a paediatric emergency department. This cross-sectional study was performed between November 2019 and June 2020 at the paediatric emergency department of the Institute for Maternal and Child Health of Trieste, Italy. Eligible subjects were patients between 4 and 17 years old undergoing intravenous cannulation, split into three groups based on their age: adolescents (13–17 years), older children (8–12 years), and younger children (4–7 years). Procedural distress and pain scores were recorded through validated scales. Data on the use of topical anaesthesia, distraction techniques, and physical or verbal comfort during procedures were also collected. We recruited 136 patients: 63 adolescents, 48 older children, and 25 younger children. There was no statistically significant difference in the median self-reported procedural pain found in adolescents (4; IQR = 2–6) versus older and younger children (5; IQR = 2–8 and 6; IQR = 2–8, respectively). Furthermore, no significant difference was observed in the rate of distress between adolescents (79.4%), older (89.6%), and younger (92.0%) children. Adolescents received significantly fewer pain relief techniques.Conclusion: This study shows that adolescents experience similar pain and pre-procedural distress as younger children during peripheral intravenous cannulation. What is Known:• Topical and local anaesthesia, physical and verbal comfort, and distraction are useful interventions for pain and anxiety management during intravenous cannulation in paediatric settings. • No data is available on pain and distress experienced by adolescents in the specific setting of the emergency department. What is New:• Adolescents experienced high levels of pre-procedural distress in most cases and similar levels of pain and distress when compared to younger patients• The number of pain relief techniques employed during procedures was inversely proportional to patient’s age, topical or local anaesthesia were rarely used

scholarly journals Effect of Music on Blood Pressure and Heart Rate in Patients Undergoing Cataract Extraction Surgery

2021 ◽  
Vol 10 (20) ◽  
pp. 1474-1478
Author(s):  
Aditi Gadegone ◽  
Sachin Daigavane ◽  
Ruta Walavalkar
Keyword(s):  
Blood Pressure ◽  
Local Anaesthesia ◽  
Large Population ◽  
Cost Effective ◽  
Cataract Extraction ◽  
Topical Anaesthesia ◽  
Heart Rates ◽  
Prevalence Studies ◽  
Before And After ◽  
Anxiety Levels

BACKGROUND Music is an inexpensive, easily available anxiolytic known to mankind since ages. Cataract extraction surgery is one of the widely performed surgeries under local anaesthesia. India is a developing country where limited resources are spent over health infrastructure which has to cater to a large population. In our study we have tried to utilize the anxietolytic effect of music in combating the anxiety and stress patients suffer during surgery. METHODS In this prospective, interventional study, 300 patients diagnosed with senile cataract were selected. The sample size was decided taking into consideration various prevalence studies. The patients were consequently recruited for the study considering the inclusion and exclusion criteria. Patients were divided into three groups - one undergoing phacoemulsification surgery under topical anaesthesia and two groups undergoing phacoemulsification surgery under local anaesthesia by the same surgeon in a same operating room. Two groups including the one where topical anaesthesia was used were made to listen to ‘Classical Sitar Music’ whereas one group was not made to listen to music. Blood pressure and heart rates were measured before and after surgery and compared in all patients. RESULTS Blood pressure and heart rates were statistically significantly normalized (lowered) post-operatively when compared to their pre-operative values in groups which were made to listen to music. There was a marked decrease in the anxiety levels in patients who were operated under topical anaesthesia when compared to those operated under local anaesthesia. CONCLUSIONS Music can be widely used in decreasing anxiety levels in patients undergoing cataract extraction surgery thereby improving the post-operative prognosis in patients in a cost-effective way. KEY WORDS Phacoemulsification Surgery, Classical Sitar Music, Peri-Bulbar Block, Topical Anaesthesia, Anxiety, Blood Pressure, Pulse Rate

Analgesia and anaesthesia

2020 ◽  
pp. 281-327
Author(s):  
Jonathan P. Wyatt ◽  
Robert G. Taylor ◽  
Kerstin de Wit ◽  
Emily J. Hotton ◽  
Robin J. Illingworth ◽  
...  
Keyword(s):  
Emergency Department ◽  
Nerve Block ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Femoral Nerve Block ◽  
Rapid Sequence Induction ◽  
Femoral Nerve ◽  
General Anaesthetic ◽  
Intravenous Sedation ◽  
Nerve Blocks

This chapter in the Oxford Handbook of Emergency Medicine investigates analgesia and anaesthesia in the emergency department (ED). It looks at options for relieving pain, such as the analgesics aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), morphine and other opioids, Entonox®, and ketamine, and explores analgesia for trauma and other specific situations. It discusses local anaesthesia (LA) and local anaesthetic toxicity, including use of adrenaline (epinephrine) and general principles of local anaesthesia. It explores blocks such as Bier’s block, local anaesthetic nerve blocks, intercostal nerve block, digital nerve block, median and ulnar nerve blocks, radial nerve block at the wrist, dental anaesthesia, nerve blocks of the forehead and ear, fascia iliaca compartment block, femoral nerve block, and nerve blocks at the ankle. It examines sedation, including drugs for intravenous sedation and sedation in children, and discusses general anaesthesia in the emergency department, emergency anaesthesia and rapid sequence induction, difficult intubation, and general anaesthetic drugs.

Pain and outcomes of carpal tunnel release under local anaesthetic with or without a tourniquet: a randomized controlled trial

2018 ◽  
Vol 43 (8) ◽  
pp. 808-812 ◽  
Author(s):  
Hafiz J. Iqbal ◽  
Ashtin Doorgakant ◽  
Nader N. T. Rehmatullah ◽  
Ashok L. Ramavath ◽  
Prasad Pidikiti ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Carpal Tunnel ◽  
Local Anaesthetic ◽  
Local Anaesthesia ◽  
Controlled Trial ◽  
Carpal Tunnel Release ◽  
Similar Degree ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Anaesthetic Mixture

We conducted a prospective randomized controlled trial to investigate carpal tunnel decompression under local anaesthesia. Carpal tunnel decompression was performed in 37 wrists using local anaesthesia and an arm tourniquet and 36 without tourniquet but with a local anaesthetic mixture containing adrenaline. Patients who underwent carpal tunnel decompression using a tourniquet experienced a significantly greater degree of pain when compared with those who did not have a tourniquet. Pain and hand function improved to a similar degree in both groups. We conclude that carpal tunnel decompression performed with a tourniquet causes patients unnecessary pain with no additional benefit as compared with the wide-awake carpal tunnel decompression without use of a tourniquet. Level of evidence: I

scholarly journals Cryoneurolysis for cervicogenic headache – a double blinded randomized controlled study

2019 ◽  
Vol 20 (1) ◽  
pp. 39-50
Author(s):  
Gunnvald Kvarstein ◽  
Henrik Högström ◽  
Sara Maria Allen ◽  
Jan Henrik Rosland
Keyword(s):  
Pain Relief ◽  
Local Anaesthetic ◽  
Cervicogenic Headache ◽  
Pain Clinic ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Group Differences ◽  
Anatomical Landmarks ◽  
Randomized Controlled ◽  
Double Blinded

AbstractBackground and aimsCervicogenic headache (CEH) is a debilitating condition and analgesics have limited effect. Percutaneous cryoneurolysis is thus still in use although the clinical evidence is lacking. We present a randomized, controlled study to assess the clinical efficacy of cryoneurolysis compared with a corticosteroid combined with a local anaesthetic.MethodsIn a university-based outpatient pain clinic we performed a randomized, double blinded, comparative study with an 18-week follow-up. After positive diagnostic test blocks 52 eligible patients were randomly allocated in a ratio of 3:2, 31 participants to occipital cryoneurolysis and 21 participants to injections of 1 mL methylprednisolone 40 mg/mL (Depo-Medrol®) combined with 1 mL bupivacaine 5 mg/mL.ResultsWe observed a significant pain reduction of more than 50% in both treatment groups, slightly improved neck function and reduced number of opioid consumers. After 6–7-weeks, however, pain intensity increased gradually, but did not reach baseline within 18 weeks. Although cryoneurolysis provided a more prolonged effect, the group differences did not reach statistical significance. Health related quality of life and psychological distress improved minimally. A large number reported minor and transient side effects, but we found no significant group differences. After 18 weeks, 29% rated the headache as much improved, and 12 (24%) somewhat improved, but a large proportion (78%) reported need for further intervention/treatment.ConclusionsCryoneurolysis provided substantial, but temporary pain relief, and the effect was not significantly different from injections of a corticosteroid combined with a local anaesthetic. Participants were selected by a single test block, and the neurolytic procedure was guided by anatomical landmarks and nerve stimulation. A stricter patient selection and an ultrasound-guided technique might have improved the results. Cryoneurolysis provides temporary pain relief not significantly superior to corticosteroid injection, and the results question the value of occipital cryoneurolysis for a chronic pain condition like CEH.ImplicationsOccipital cryoneurolysis may be considered when non-invasive treatments appear insufficient, but only for patients who have responded substantially to test blocks. A risk of local scar and neuroma formation by repeated cryoneurolysis, leading to neuropathic pain has been discussed by other researchers.

scholarly journals Electroencephalography Can Distinguish between Pain and Anaesthetic Intervention in Conscious Lambs Undergoing Castration

Animals ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 428 ◽  
Author(s):  
Charissa Harris ◽  
Peter John White ◽  
Virginia L. Mohler ◽  
Sabrina Lomax
Keyword(s):  
Pain Relief ◽  
Local Anaesthesia ◽  
Pain Measurement ◽  
Conscious State ◽  
General Anaesthetic ◽  
Treatment Groups ◽  
Australian Sheep ◽  
Ram Lambs

Australian sheep routinely undergo painful surgical husbandry procedures without anaesthesia or analgesia. Electroencephalography (EEG) has been shown to be a successful measure of pain in livestock under a general anaesthetic. The aim of this study was to compare this EEG model to that of conscious lambs undergoing castration with and without local anaesthesia. Sixteen merino crossbred ram lambs 6 to 8 weeks of age (13.81kg ± 1.97) were used in the study. Lambs were randomly allocated to 1 of 4 treatment groups: (1) Conscious EEG and surgical castration with no anaesthetic intervention (CON; n = 4); (2) Conscious EEG and surgical castration with pre-operative applied intra-testicular lignocaine injection (CON + LIG; n = 4); (3) surgical castration under minimal anaesthesia (MAM; n = 4); (4) and surgical castration with pre-operative lignocaine injection (2 mL lignocaine hydrochloride 20 mg/mL, under minimal anaesthesia (MAM + LIG; n = 4). Distinct differences in the EEG parameters Ptot, F50 and F95 between pre-and post-castration in conscious lambs were demonstrated in this study (p < 0.01). Further, CON and CON + LIG treatments were distinguishable using F50 and F95 measures (p = 0.02, p = 0.04, respectively). Significant changes in the EEG output of MAM animals were identified pre- to post-castration (p < 0.01). The EEG output of MAM and MAM + LIG were similar. EEG was successful in differentiating lambs treated with pain relief in a conscious state after castration by examining F50 and F95, which may suggest the suitability of conscious EEG pain measurement.

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