Reply Re: “A Systematic Review and Meta-analysis of Methods for Reducing Local Anesthetic Injection Pain Among Patients Undergoing Periocular Surgery”

2019 ◽  
Vol 35 (4) ◽  
pp. 413
Author(s):  
Ahsen Hussain ◽  
Mišo Gostimir
Keyword(s):  
Systematic Review ◽  
Local Anesthetic ◽  
Meta Analysis ◽  
Injection Pain ◽  
Local Anesthetic Injection

scholarly journals https://painphysicianjournal.com/current

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. 335-348
Author(s):  
Nicholas Van Halm-Lutterodt
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Neck Pain ◽  
Functional Status ◽  
Spinal Stenosis ◽  
Local Anesthetic ◽  
Meta Analysis ◽  
Chronic Neck Pain ◽  
Epidural Injections ◽  
Significant Difference

Background: Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin. Objectives: To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain. Study Design: Systematic review and meta-analysis. Methods: A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage. Results: Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], –0.006; 95% confidence interval (CI), –0.275 to 0.263; P = 0.963; I2 = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, –1.231 to 1.549; P = 0.823; I2 = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, –0.093; 95% CI, –5.952 to 5.766; P = 0.975; I2 = 0.0% at 12 months). Limitations: Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies. Conclusions: The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain. Key words: Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial

Intra-articular Alpha-2 Agonists as an Adjunct to Local Anesthetic in Knee Arthroscopy: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 32 (02) ◽  
pp. 138-145 ◽  
Author(s):  
Rhys Holyoak ◽  
Ruan Vlok ◽  
Thomas Melhuish ◽  
Anthony Hodge ◽  
Matthew Binks ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Postoperative Pain ◽  
Local Anesthetic ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Intervention Group ◽  
Control Group ◽  
Antiinflammatory Drugs ◽  
Level Of Evidence

AbstractThe infiltration of local anesthetic has been shown to reduce postoperative pain in knee arthroscopy. Several studies have shown that the addition of agents such as magnesium and nonsteroidal antiinflammatory drugs (NSAIDs) result in an increased time to first analgesia and overall reduction in pain. The aim of this systematic review and meta-analysis was to determine whether the addition of an α-2 agonist (A2A) to intra-articular local anesthetic, results in a reduction in postoperative pain. Four major databases were systematically searched for relevant randomized controlled trials (RCTs) up to July 2017. RCTs containing a control group receiving a local anesthetic and an intervention group receiving the same with the addition of an A2A were included in the review. The included studies were assessed for level of evidence and risk of bias. The data were then analyzed both qualitatively and where appropriate by meta-analysis. We reviewed 12 RCTs including 603 patients. We found that the addition of an A2A resulted in a significant reduction in postoperative pain up to 24 hours. The addition of the A2A increased time to first analgesia request by 258.85 minutes (p < 0.00001). Total 24-hour analgesia consumption was analyzed qualitatively with all included studies showing a significant reduction in total analgesia requirement. Interestingly, none of the studies found an increase in side effects associated with the A2A. This study provides strong evidence for the use of A2As as a means to reduce postoperative pain post arthroscopic knee surgery, without a corresponding increase in side effects.

scholarly journals High-Dose Daily Opioid Administration and Poor Functional Status Intensify Local Anesthetic Injection Pain in Cancer Patients

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. E247-E256
Author(s):  
Kyung Bong Yoon
Keyword(s):  
Functional Status ◽  
Cancer Patients ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Injection Pain ◽  
High Dose ◽  
Pain Scores ◽  
Clinical Pain ◽  
Local Anesthetic Injection ◽  
And Behavior

Background: Evidence for opioid-induced hyperalgesia (OIH) has been shown in animal and human studies, but the clinical implications of this phenomenon remain unclear. Objectives: We examined whether cancer patients taking opioids differ in their sensitivity to a clinical pain stimulus using a local anesthetic injection compared to those not taking opioids. We also evaluated the effect of the opioid dose, duration of opioid therapy, and patients’ pain severity and functional status on this clinical pain stimulus. Study Design: Prospective observational study. Setting: University outpatient department for interventional pain management, Republic of Korea. Methods: Eighty-two cancer patients including 20 patients not taking opioids (non-opioid group) and 62 taking opioids (opioid group) who were scheduled for an interventional procedure were enrolled in this study. Patients received a standardized subcutaneous injection of lidocaine prior to a full dose of local anesthetic (LA). Before the injection, patients completed the Brief Pain Inventory (BPI) questionnaire and were asked to rate their current pain using numeric rating scales. Immediately following the injection, LA injection-specific pain was evaluated using pain intensity, unpleasantness, and behavior pain scores. Results: LA injection-specific pain intensity, unpleasantness, and behavior pain score were significantly higher in the opioid group compared with the non-opioid group (P < 0.001). In the opioid group, these post-injection pain scores were higher in patients taking high-dose opioids than those taking low doses (P < 0.05). In addition, we observed a strong correlation between the baseline BPI pain interference score and the LA injection-specific pain score (r = 0.695, P < 0.001). Limitations: This study is limited by its sample size and observational design. Various opioid medications, which were not standardized, may have inadvertently biased our results. Finally, the pain assessed by a brief stimulus does not fully reflect disturbances in endogenous pain inhibitory processes. Conclusion: The results of this study suggest that opioid medication is an important contributing factor to pain perception accompanying LA injection, and cancer patients using high-dose opioids may be highly susceptible to hyperalgesic responses to this clinical stimulus. We also suggest that the possible presence of OIH may be intensified among cancer patients with poor physical and psychosocial functional status. Key words: Adverse effects; analgesics, opioid; anesthetics, local; cancer; hyperalgesia; injections, subcutaneous; nociceptive pain; pain measurement; pain perception; quality of life

scholarly journals Intravenous versus perineural dexmedetomidine in prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review

Pain medicine ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 10-28
Author(s):  
Yan Feng ◽  
Pan Chang ◽  
Xiao-Bo Chen ◽  
Xiao-Lin Yang ◽  
Yu-Jun Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Local Anesthetic ◽  
Motor Block ◽  
Meta Analysis ◽  
Onset Time ◽  
Sensory Block ◽  
Controlled Trials ◽  
Sedation Scale ◽  
Randomized Controlled ◽  
Ramsay Sedation Scale

Background and Objective. It is unclear whether perineural administration offers advantages when compared to intravenous dexmedetomidine in local anesthesia. To compare the efficacy of perineural versus intravenous dexmedetomidine as local anesthetic adjuvant, we conducted the meta analysis and systematic review. Materials and Methods. Two researchers searched MEDLINE, OVID, PubMed, Embase, Cochrane Central, Web of Science and Wanfang data for randomized controlled trials comparing the effect of intravenous versus perineural dexmedetomidine as local anesthetic adjuvant without any language restrictions. Results. We identified 14 randomized controlled trials (801 patients). The results revealed that the duration of analgesia (SMD: -1.76, 95 % CI, [-2.7, -0.83] P = 0.000, I2 = 96 %), the duration of sensory block (SMD:- 3.99, 95 % CI, [-5.88, -2.0], P = 0.000, I2 = 97.6 %), the duration of motor block (SMD: -1.6, 95 % CI, [-2.78, -0.41] P = 0.008, I 2 = 95.5 %) were significantly longer in the perineural group, when compared to systematic dexmedetomidine. The onset time of sensory block (SMD: 1.55, 95 % CI, [0.16, 2.94] P = 0.028, I2 = 96.7 %) and the onset time of motor block (SMD: 0.84, 95 % CI, [0.17, 1.5] P = 0.013, I2 = 88.3 %) were shorter in perineural group compared to intrave nous dexmedetomidine. Meanwhile, analgesic consumption in 24 hours (SMD: 0.37, 95 % CI, [0.05, 0.69] P = 0.023, I 2 = 55.6 %) and the incidence of patients of Ramsay Sedation Scale > 3 (RR: 3.8, 95 % CI, [1.45, 9.97] P = 0.000, I 2 = 26.9 %), hypotension (RR: 1.74, 95 % CI, [1.15, 2.65] P= 0.009, I2 = 32.7 %) and bradycardia (RR: 3.71, 95 % CI, [1.27, 10.86] P = 0.017, I2 = 0 %) were lower in perineural dexmedetomidine compared to the intravenous group. Conclusions. Our meta-analysis generates the evidence that perineural dexmedetomidine is a superior adminstration for prolonging the duration of analgesia. Perineural dexmedetomidine also shows the advantages in duration of sensory block and the onset time of sensory and motor block, when compared to the intravenous administration. Simultaneously, dexmedetomidine as a local anesthetic adjuvant for perineural injection may be much safer than intravenous application because of the lower incidence of patients of Ramsay Sedation Scale > 3 and lower incidence of hypotension and bradycardia.

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