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

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

Nitrous Oxide Reduces Pain Associated With Local Anesthetic Injections

2019 ◽  
Vol 23 (6) ◽  
pp. 602-607 ◽  
Author(s):  
Matthew J. Lin ◽  
Danielle P. Dubin ◽  
Hooman Khorasani
Keyword(s):  
Nitrous Oxide ◽  
Local Anesthetic ◽  
Rating Scale ◽  
Injection Pain ◽  
Mohs Micrographic Surgery ◽  
Micrographic Surgery ◽  
Topical Anesthetic ◽  
Pain Scores ◽  
Male Sex ◽  
Pain Rating Scale

Background Local anesthetic injections can be painful and distressing. Objective The aim of this study was to determine whether nitrous oxide, ice, vibration, or topical anesthetic improves analgesia for local anesthetic injections. Method A cohort study of 400 patients undergoing Mohs micrographic surgery with local anesthetic was conducted. Patients received no intervention ( n = 200), ice ( n = 50), topical anesthetic cream ( n = 50), vibration device ( n = 50), or nitrous oxide ( n = 50). Pain was rated using the Visual Analogue Scale (VAS) and Wong-Baker FACES Pain Rating Scale. Results Without intervention, mean VAS was 4.2 and FACES was 4.6. Nitrous oxide was the most successful in reducing pain (mean VAS 1.6 vs. 4.2, P < .01, FACES 1.2 vs. 4.6, P < .01). Topical ice reduced pain (mean VAS 3.0 vs. 4.2, P < .01, FACES 3.0 vs. 4.6, P < .01). Vibration reduced pain (mean VAS 3.5 vs. 4.2, P < .01, FACES 3.6 vs. 4.6, P < .01). Higher pain scores were associated with age <50 ( P = .02), male sex ( P = .05), and surgery on the nose, lip, ear, or eyelid ( P = .02). Conclusion Nitrous oxide, ice, and vibration reduce injection pain. These interventions are especially useful for younger males undergoing surgery on the nose, lip, ear, or eyelid.

Comparison of the Effectiveness between 5% Eutectic Mixture of Local Anesthetic Cream and Ethyl Chloride Spray Applied on the Skin Prior to Intravenous Cannulation

2021 ◽  
Vol 104 (1) ◽  
pp. 73-78
Keyword(s):  
Local Anesthetic ◽  
Pain Perception ◽  
Rating Scale ◽  
Eutectic Mixture ◽  
Numeric Rating Scale ◽  
Ethyl Chloride ◽  
Endoscopic Procedure ◽  
Pain Scores ◽  
Study Participants ◽  
Numeric Rating

Background: Since the patients scheduled for an endoscopic procedure had been unhappy with pain during intravenous cannulation. Objective: To compare the effectiveness between 5% eutectic mixture of local anesthetic cream and ethyl chloride spray applied on the skin prior to the procedure. Materials and Methods: One hundred eighty-six patients were randomized equally into three groups, A: 5% eutectic mixture of local anesthetic cream, B: ethyl chloride spray, and C: placebo. Then a nurse used a 22-gauge (22G) needle catheter to administer a cannula. Five minutes after the intravenous cannulation, a co-researcher assessed the patient’s pain perception and satisfaction as well as the nurse’s difficulty in performance by means of a numeric rating scale. Results: One hundred seventy-six patients completed the present study. Participants having the anesthetic cream and spray application as well as the placebo expressed their pain scores as 1.7±1.3, 1.6±1.2, and 2.2±1.3, respectively. Therefore, patients applied with local anesthetics had significantly less pain perception than those with the placebo (p=0.039); however, scores were not different between the anesthetic cream and the spray groups. Conclusion: Patients scheduled for an endoscopic procedure did not showed significant pain relief with either the 5% eutectic mixture of local anesthetic cream or the ethyl chloride spray. Keywords: 5% eutectic mixture of local anesthetic cream, Ethyl chloride spray, Endoscopic surgery, Intravenous cannulation, Pain

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 Comparison of Two Standard Scales for Pain Perception during Local Anesthetic Injection in Children

2020 ◽  
Vol 32 (1) ◽  
pp. 37-42
Author(s):  
Farzaneh Jalali ◽  
Saeedeh Shojaeepour ◽  
Raziyeh Shojaiepour ◽  
◽  
◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Pain Perception ◽  
Local Anesthetic Injection

A Comparative Study of Children's Pain Reactions and Perceptions to AMSA Injection using CCLAD versus Traditional Injections

2010 ◽  
Vol 34 (3) ◽  
pp. 217-222 ◽  
Author(s):  
May Feda ◽  
Najlaa Al Amoudi ◽  
Aly Sharaf ◽  
Azza Hanno ◽  
Najat Farsi ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Pain Perception ◽  
Negative Impact ◽  
Scientific Evidence ◽  
Pediatric Dentistry ◽  
Anesthetic Techniques ◽  
Pain Reaction ◽  
Time Required ◽  
Local Anesthetic Injection ◽  
Children's Pain

Pain control is an important part of dentistry, particularly in pediatric dentistry. Recently, a computer-controlled local anesthetic delivery system (CCLAD) has been developed to reduce pain related to the local anesthetic injection. In conjunction with this technology, a new approach to the anterior and middle superior alveolar nerves (AMSA) has been induced. Studies evaluating the CCLAD in pediatric dentistry showed variable results regarding its use in pediatric dentistry. Further evaluation of this technique is needed to provide sound scientific evidence on the use of the CCLAD at this specific injection site in children. Aim:To assess children's pain reactions and pain perceptions of the AMSA injection using the CCLAD compared to the traditional buccal/palatal injections. Materials and methods: Children's pain reactions and perceptions to both techniques were measured in a group of 40 children who received both anesthetic techniques alternatively on two visits. The pain reactions were scored using the SEM scale, whereas the pain perception was evaluated by the Eland color scale. Statistical analysis was carried out using SPSS version 10.0.Results: The AMSA injection delivered with the CCLAD had significantly lower mean pain reaction scores compared to traditional buccal and palatal injections. The prolonged injection time required for delivering the CCLAD injection had no negative impact on the children. The children's pain perception scores when using the CCLAD were also significantly lower compared to the traditional injection. Conclusion: The AMSA injection delivered with the CCLAD was found to be a promising device, and had significantly lower pain reaction and perception scores compared to the traditional buccal and palatal injections.

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