Determination of the Effect of Two Different Methods of Dental Anaesthesia on Pain Level in Pediatric Patients: A Cross-Over, Randomised Trial

ObjectiveTo compare intraosseous (IOA) and needle-free dental anaesthesia (NFA) methods that painless anaesthesia.Materials and MethodsTwenty patients aged 8–10 years were included in this cross-over study. To determine the anxiety levels and pain experienced by the patients, Face, Legs, Activity, Cry, Consolability (FLACC) and Frankl Behavioural scales were used. The pulse rate (PR) and salivary opiorphin levels (SOL) determined. The Friedman and Wilcoxon signed-rank tests were used. p<0.01 was considered significant.ResultsAccording to FLACC scores, IOA and NFA exhibited significantly pain alteration patterns in during local and topical anaesthesia, respectively (p=0.004,0.001; p<0.01). Also, only NFA showed significantly decreased SOL values in 5- and 10- minutes after local anaesthesia periods compared to the before levels (p=0.004, p=0.001; p<0.01).ConclusionsPatients feel similar pain perceptions during local anaesthesia application in both injection systems. According to the SOL values, NFA may provide more higher anaesthetic efficiency than IOA.Clinical RelevanceThis study provides to compare two different new anaesthetic systems for pain reduction during local anesthesia for pediatric population.

Preliminary study on the potential of topical anaesthesia from betel leaf and clove leaf extract

Introduction: Betel leaf (Piper betle Linn.) and clove leaf (Syzygium aromaticum) are Indonesian herbs which are known to cause a numb sensation. The main ingredients of betel leaf, which act as an anesthetic, are caryophyllene, eugenol, methyl eugenol, eucalyptol (1.8-cineol), linalool, α-Pinene, estragole, while cloves have local anesthetic effects through their ingredients, namely eugenol, and β-Caryophyllene. Research on the benefits of these two ingredients as topical anesthetics in Indonesia is still rare. This study was aimed to describe the potential of betel leaf and clove leaf extract as a topical anesthetic in Wistar rats. Methods: This research was a laboratory experimental research with simple randomized controlled design. The sample consisted of 6 male Wistar rats, each of which was given four treatments, namely extract with a concentration of 50%, 75%, and 100%, and topical anaesthetic benzocaine 20% as a control. Each treatment was tested using an electric stimulator and observed onset, duration of action, and depth of topical anaesthesia. The data were processed using descriptive statistics with tables and graphs. Results: Betel leaf extract with a concentration of 100% had a better mean onset, duration of work, and depth of anesthesia than the 20% benzocaine control, whereas 75% clove leaf extract had the longest duration of action compared to 20% benzocaine and 100% concentration was the topical anesthetic agent with the highest anesthetic depth. Conclusion: Based on the onset, duration of action, and depth of anesthesia, betel leaf, and clove leaf have potential as topical anesthetic agents.

Phacoemulsification under Topical Anesthesia in a Tertiary Care Hospital

Introduction: The use of topical anaesthesia for cataract surgery dates back to 1884 when Knapp used 5% cocaine to anaesthetize cornea. The advancement in cataract surgery techniques like small stepped, self-sealing corneal incisions, phacoemulsification and advanced intraocular lenses has allowed the use of topical anaesthesia thus reducing surgical time and need of akinesia. Materials and Methods: Prospective non-comparative evaluation of patients’ and surgeon’s satisfaction under topical anaesthesia. All patients received topical anesthesia with proparacaine 0.5%. A 10-point visual analogue scale was given to patients to rate the level of pain felt during the operation. Also, the level of patient satisfaction, the need for supplemental anaesthesia, level of ocular motility, surgical complications and postoperative visual acuity were recorded. Results: Total number of cases were 156 out of which 86 (55.1%) were males and 70 (44.9%) were females. Nuclear sclerosis was most common type of cataract followed by mixed opacities. Majority of patients had no intraoperative movement and 30.8% of patients had some movement. Surgeon was dissatisfied in only 12.2% cases who had disturbing movements during surgery. Although majority of patients felt no pain (68%) or mild pain (23.7%) during surgery 8.3% cases had moderate to severe pain which required supplemental intracameral lidocaine. Conclusion: Topical anaesthesia is cost effective, provides high patient comfort during surgery, is less stressful for the patient, saves considerable time and complications compared to regional anaesthesia. Keywords: topical anaesthesia, phacoemulsification, pain assessment, surgeon`s satisfaction.

Topical Anaesthesia Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery – A Comparative Study from Hyderabad Karnataka Region

BACKGROUND Anaesthesia is an integral part of any successful surgery. Advances in cataract surgery have led to changes in delivery of anaesthesia as well. Patient and surgeons’ comfort during anaesthesia and surgery is the single most important factor. In developing countries, small incision cataract is preferred sometimes over phacoemulsification in high volume centers. This study was done to compare patient and surgeon satisfaction following topical anaesthesia (TA) versus peribulbar anaesthesia (PA) for small incision cataract surgery (SICS) with intraocular lens implantation (IOL). METHODS This comparative observational study was done at M.R. Medical College, Kalaburagi over a period of 15 months from November 2018 to April 2020. 400 patients undergoing manual small incision cataract surgery (MSICS) after obtaining consent were included in the study, out of which 200 patients were administered TA while 200 were given PA randomly. Patients were prospectively evaluated for pain during administration, during surgery and 4-hours postoperatively through a questionnaire. RESULTS In our study TA group complained no pain whereas 85 % had mild pain and 13 % had moderate pain in PA group during administration of anaesthesia (P < 0.05). During surgery, none of the patients in both the groups experienced severe pain. 17 % patients in TA group had mild pain at 4 hours while only 4 % patients in PA group had pain (P < 0.05). There was no statistically significant difference in surgeon’s satisfaction between 2 groups. CONCLUSIONS Although the administration of PA is painful compared to TA, the patient satisfaction was more post-operatively in PA group. Topical anaesthesia has gained popularity due to minimal discomfort, speed of onset and lack of PA related complications. It is a safe and effective alternative to PA in MSICS with proper selection and education of patient. KEYWORDS Small Incision Cataract Surgery, Topical Anaesthesia, Peribulbar Anaesthesia

Transcricothyroid injection of local anaesthesia: a serious complication

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.

GOLDENHAR SYNDROME-NO MORE A CHALLENGE TO ANAESTHESIOLOGIST

A patient K/C/O Goldenhar syndrome came for right external ear reconstruction. Patient had typical features of the syndrome with hypoplastic mandible and maxillae, malocclusion of teeth ,malaligned teeth ,retrognathia and hypoplastic hyoid bone . Anticipating a difcult intubation it was decided to go ahead with awake intubation in this patient . Blind nasal intubation was planned because of unavailability of breoptic in our institution and it was achieved with 7 mm ivory white north pole tube with dexmedetomidine infusion at rate of 0.5mcg/kg/hr and topical anaesthesia .

Labial adhesions in a pre-pubertal girl: The importance of awareness

Labial adhesion affects up to 0.6–5% of pre-pubertal girls. They may be congenital or acquired. Patients usually are asymptomatic, and thus, labial adhesions are found incidentally on routine examination. If the patient is indeed truly asymptomatic, there is no need for any treatment, and reassurance only is needed. When treatment is indicated, topical application of oestrogen cream is advised, but when this fails, surgical intervention is recommended. Recurrence is common regardless of the treatment. We present the case of a three-year-old girl managed by release of adhesions under topical anaesthesia and topical application of oestrogen cream.

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

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

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.