scholarly journals A randomized controlled trial of three different local anesthetic methods for minor hand surgery

2022 ◽  
Vol 30 (1) ◽  
pp. 230949902110472
Author(s):  
Sang Ki Lee ◽  
Woo-suk Kim ◽  
Won Sik Choy
Keyword(s):  
Local Anesthesia ◽  
Local Anesthetic ◽  
Controlled Trial ◽  
Hand Surgery ◽  
Good Alternative ◽  
Anxiety Score ◽  
Injection Pain ◽  
Patient Anxiety ◽  
Lidocaine Injection ◽  
Local Anesthetic Injection

Purpose: Hemostasis and local anesthetic injection are essential for minor hand surgeries under local anesthesia (LA). Wide awake local anesthesia no tourniquet (WALANT) became popular for achieving hemostasis without a tourniquet. However, a recent study reported that injection is more painful than tourniquet use in minor hand surgery. Therefore, this study aimed to compare three LA methods that differ according to injection and hemostasis, namely, the combination of a tourniquet and buffered lidocaine solution (CTB), WALANT, and conventional LA. Methods: This randomized prospective single-center study included 169 patients who underwent minor hand surgery between 2017 and 2020. We randomly allocated the patients to each group and recorded the pain and anxiety score during the surgery, as well as satisfaction after the surgery. Results: Pure lidocaine injection was significantly more painful than buffered lidocaine and WALANT solution injection ( p < 0.001). Local anesthesia injection was significantly more painful than tourniquet use in all groups ( p < 0.001). The intraoperative anxiety score was significantly lower in the CTB group than in the conventional LA and WALANT groups ( p < 0.001). The satisfaction score was significantly higher in the CTB and WALANT groups than in the conventional LA group ( p < 0.001). Conclusion: CTB for minor hand surgery under LA is associated with less injection pain and patient anxiety. The tourniquet is tolerable without much pain and waiting time. Thus, CTB in minor hand surgery is a good alternative to WALANT and conventional LA.

Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients

2015 ◽  
Vol 39 (5) ◽  
pp. 470-474 ◽  
Author(s):  
M Mittal ◽  
A Kumar ◽  
D Srivastava ◽  
P Sharma ◽  
S Sharma
Keyword(s):  
Heart Rate ◽  
Local Anesthesia ◽  
Study Design ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Pediatric Patients ◽  
Computerized Method ◽  
Local Anesthetic Injection ◽  
Computerized System ◽  
Buccal Infiltration

Background: Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. Study design: The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. Study design: It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Results: Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. Conclusion: It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups

scholarly journals Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
M Cardell ◽  
F Jung ◽  
N Zechmann-Müller ◽  
M Greminger ◽  
L Kern ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Surgical Procedures ◽  
Flexor Tendon ◽  
Hand Surgery ◽  
Patient Comfort ◽  
Injection Pain ◽  
Tendon Transfers ◽  
Fracture Stabilization ◽  
Wide Awake ◽  
No Tourniquet

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial

Hand ◽  
2019 ◽  
pp. 155894471988466
Author(s):  
J. Randall Patrinely ◽  
Shepard P. Johnson ◽  
Brian C. Drolet
Keyword(s):  
Local Anesthetic ◽  
Corticosteroid Injection ◽  
Controlled Trial ◽  
Treatment Method ◽  
Trigger Finger ◽  
Injection Pain ◽  
Double Blind ◽  
Pain Scores ◽  
Injection Methods ◽  
To Receive

Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.

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 Assessment of computer-controlled local anesthetic delivery system for pain control during restorative procedures: A randomized controlled trial

2019 ◽  
Vol 13 (4) ◽  
pp. 298-304
Author(s):  
Hrishikesh Saoji ◽  
Mohan Thomas Nainan ◽  
Naveen Nanjappa ◽  
Mahesh Ravindra Khairnar ◽  
Meeta Hishikar ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Delivery System ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Controlled Trial ◽  
Conventional Group ◽  
Lower Pain ◽  
Computer Controlled ◽  
Recovery From Anesthesia ◽  
Time Required

Background. Local anesthesia is given to decrease pain perception during dental treatments, but it may itself be a reason for pain and aggravate the dental fear. Computer-controlled local anesthetic delivery system (CCLADS) is one of the alternatives for decreasing the patients’ pain during local anesthesia. This study compared the time required for the recovery from anesthesia, pain/discomfort during injection and pain/discomfort 24 hours after administering local anesthesia with CCLADS, a standard self-aspirating syringe and a conventional disposable 2-mL syringe. Methods. The study was conducted on 90 subjects (an age group of 20-40 years), who suffered from sensitivity during cavity preparation. They were randomly divided into three groups of 30 individuals each to receive intraligamentary anesthesia (2% lignocaine with 1:80,000 adrenaline) using either of the three techniques: CCLADS, a standard self-aspirating syringe, or a conventional disposable 2-mL syringe. The onset of anesthesia, time required for recovery from anesthesia (in minutes), pain/discomfort during injection and pain/discomfort 24 hours after administering local anesthesia were recorded. Results. The time required for the onset of anesthesia and recovery from anesthesia was shorter with CCLADS (4.83±2.31 and 34.2±1.895, respectively) as compared to the standard self-aspirating group (10.83±1.90 and 43.5±7.581, respectively) and the conventional group (11.00±2.03 and 43.5±6.453, respectively) (P<0.001). The patients in the CCLADS group experienced no pain during local anesthesia administration as compared to the patients in the self-aspirating and conventional groups. The CCLADS and self-aspirating groups showed lower pain response as compared to the conventional group for pain after 24 hours. Conclusion. CCLADS can be an effective and pain-free alternative to conventional local anesthetic procedures.

scholarly journals Comparative Evaluation of the Efficacy of Topical Anesthetics in Reducing Pain during Administration of Injectable Local Anesthesia in Children

2014 ◽  
Vol 5 (2) ◽  
pp. 129-133
Author(s):  
Vikas Bendgude ◽  
Hrishikesh Walimbe ◽  
Mohammed Nadeem Ahmed Bijle ◽  
Sneha Muchandi ◽  
Rahul Deshpande ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Local Anesthetic ◽  
Pain Control ◽  
Comparative Evaluation ◽  
Rating Scale ◽  
Eutectic Mixture ◽  
Pain Reduction ◽  
Mixed Dentition ◽  
Topical Anesthetics ◽  
Local Anesthetic Injection

ABSTRACT Introduction Pain control is an integral part of modern dentistry. Needle injection of local anesthetic which is the commonest modality of pain control itself proves to be painful for the child. Hence, it is important for the pediatric dentists to resort to a pain free method of administering local anesthesia for a patient. Topical anesthetics have proven to reduce the pain experience during administration of local anesthetic injection. The aim of this study is to evaluate and compare the efficacy of two topical anesthetic agents—EMLA 5% cream (Eutectic mixture of local anesthetics—Lignocaine 2.5% and prilocaine 2.5%) and Benzocaine 20% gel in reducing the pain during administration of local anesthetic injection in children. Materials and methods EMLA 5% cream and Benzocaine 20% gel were used in the study. Children from mixed dentition age group between 6 and 9 years of age were selected. The two selected topical anesthetics were applied on buccal mucosa at two different appointments in a given child, following which the local anesthetic was administered on the test site. The pain responses of the child were evaluated using the Wong Baker Faces Pain Rating Scale. The results were then statistically analyzed using Mann-Whitney U-test. Results EMLA 5% cream was three times highly effective in pain reduction than Benzocaine 20% gel. Conclusion EMLA 5% cream is comparatively better than benzocaine 20% gel with regards to pain reduction during the administration of local anesthetic injection in children. How to cite this article Walimbe H, Muchandi S, Bijle MNA, Bendgude V, Deshpande R, Dolas A, Chaturvedi S. Comparative Evaluation of the Efficacy of Topical Anesthetics in Reducing Pain during Administration of Injectable Local Anesthesia in Children. World J Dent 2014;5(2):129-133.

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